The Natural Improvement Between My Two Audiograms

[Ed209]

What i find interesting is although my left ear compares very similar to yours, my right ear ear has a couplennof 30db drops at 3 and 4kz. Yet from how you have previously described your t i would say mine is a bit milder than yours. Weird??

I believe it's because my hearing declines quite considerably after 8khz, but that's just an educated guess. My T also reflects this.

My hearing is considered perfect for my age (up to 8khz), yet my tinnitus is far from mild.

I agree Sam, tinnitus is beyond weird.

 

[SilverSpiral]

@SilverSpiral

Tell me about it. Having an audiogram is like stepping back into the 70's.

It probably seems ironically high-tec to an audiologists most common client base like stepping into a space shuttle chamber and communicating with HAL-9000.
"Dish-washEr"
"Fire-truck"
"Raquet-Ball"

 

[GregCA]

Surely a 10+ db margin of error should be unacceptable as a measuring standard?

What I've been told is to expect a 5 dB variation. 10 dB may be a bit much, but when you think about it, it's not an objective measurement: it relies on the subject to report hearing something. And you know how it is, sometimes we think we hear something and we hit the button. Maybe there was something, maybe not. We are the ones creating the uncertainty I think, much more than the hardware/environment involved. It's possible that our mindset, and other physiological state also affects our reading.
At any rate, it's certainly not a very precise sampling method, but it is good enough to provide a high order diagnosis of hearing loss, and provide a reasonable input to a hearing aid if needed.

 

[bill 112]

Just request OAES/DPOAES like I did and make them repeat it three times.

There's no human involvement or at least it's minimal,they place earpieces into your ear canals that click and pick up the sound of your haircells moving in response to the stimulus,it then sends this information to a screen and that's it.If there's any gaps or a weak response then you know there's something wrong i.e haircells missing or lesions.Make them repeat it three times and make sure the results are the same everytime,much more informing than any audiogram.

As for the audiogram I don't bother anymore,the main problem I have with it is its overwhelming inaccuracy and how rudimentary it is.

They test 250hz,500hz,1000hz,2000hz,4000hz,6000hz and 8000hz.

What about the frequencies in between?Like 1100hz or 1200hz not to mention the upper frequencies?
Pointless test when you think about it,and to think all this time I thought my ears were perfect when they only knew 10% of what was going on in there.

 

[Ed209]

What I've been told is to expect a 5 dB variation. 10 dB may be a bit much, but when you think about it, it's not an objective measurement: it relies on the subject to report hearing something. And you know how it is, sometimes we think we hear something and we hit the button. Maybe there was something, maybe not. We are the ones creating the uncertainty I think, much more than the hardware/environment involved. It's possible that our mindset, and other physiological state also affects our reading.
At any rate, it's certainly not a very precise sampling method, but it is good enough to provide a high order diagnosis of hearing loss, and provide a reasonable input to a hearing aid if needed.

I get that it's sufficient for supplying hearing aids, but when it comes to tinnitus I find it all a bit archaic.

Usually, they repeat the same frequency several times at different points to rule out guesses and/or false presses. If you don't reliably press at the given threshold then they will mark the point at which you do.

 

[Ed209]

Just request OAES/DPOAES like I did and make them repeat it three times.

There's no human involvement or at least it's minimal,they place earpieces into your ear canals that click and pick up the sound of your haircells moving in response to the stimulus,it then sends this information to a screen and that's it.If there's any gaps or a weak response then you know there's something wrong i.e haircells missing or lesions.Make them repeat it three times and make sure the results are the same everytime,much more informing than any audiogram.

As for the audiogram I don't bother anymore,the main problem I have with it is its overwhelming inaccuracy and how rudimentary it is.

They test 250hz,500hz,1000hz,2000hz,4000hz,6000hz and 8000hz.

What about the frequencies in between?Like 1100hz or 1200hz not to mention the upper frequencies?
Pointless test when you think about it,and to think all this time I thought my ears were perfect when they only knew 10% of what was going on in there.

I've had an OAE and tymp.

 

[GregCA]

I get that it's sufficient for supplying hearing aids, but when it comes to tinnitus I find it all a bit archaic.

Agreed, it wasn't designed to deal with tinnitus. We're just piggybacking on an existing infrastructure because, well, there isn't much of anything else is there?

Usually, they repeat the same frequency several times at different points to rule out guesses and/or false presses. If you don't reliably press at the given threshold then they will mark the point at which you do.

OK, maybe the procedure is different in my neck of the woods. Somehow they've never done that with me: when I press the button, it switches to another tone (and never goes back to the one I acknowledged, whether I was confident about it or not).

 

[SilverSpiral]

@Ed209 What was the people you saw's approach to T in general aside from the audiograms?

 

[Ed209]

They were both caring, but I felt they lacked something. I was offered TRT, but I turned it down because I was coping and didn't feel it would have been worth the cost.

I especially felt that the second audiologist (first was a top ENT consultant) didn't understand tinnitus like a sufferer does. She came across like she had read a lot of books on the subject, but didn't quite understand the reality of what tinnitus is actually like.

 

[Alue]

I actually quite frequently exchange emails with Liberman(extremely nice guy)and haircells can and do recover after noise trauma usually a month after such trauma has occurred and has been seen to happen up to two months post trauma.

But this is exactly what Liberman is pointing out,just because your thresholds have recovered doesn't mean your hearing has recovered as these synapses almost certainly didn't survive the trauma as they're much more vulnerable to damage than haircells.He told me that synaptic damage isn't immediate but usually occurs slowly after the trauma has passed,@Reinier is proof of that judging from his experience that I read about in another thread.

Reiner suffered an acoustic trauma,muffled hearing that recovered to a certain degree then followed by tinnitus/distortion and Hyperacusis a month post trauma,this matches up with Libermans claims that synaptic damage or retraction happens slowly after the trauma has long passed,in some cases it can be immediate but according to him it can happen up to months post trauma.

Makes a lot of sense especially when you read a lot of stories here,people saying they got T suddenly but then go on to say that they were at a concert two months prior,maybe they did damage these synapses but simply didn't notice only now that T has arrived do they begin to notice.

The good news is,according to Liberman these nerve fibres survive for decades after they have detached from their membrane as seen in many patients who receive cochlear implants.There have been patients who were deaf since the age of 15 who received a cochlear implant when they were 35 years old and the nerve fibres were still there he told me.Also,he noted findings in these patients that their T went away once these nerve fibres were stimulated hence why he believes these fibres cause T and H in the cases of noise induced hearing loss.

I have the emails if you'd like to see them,makes for some interesting reading.

This mirrors my experience as well. I had a acoustic trauma and immediately knew something was off, but the loud tinnitus didn't start until about three or four days later.

I would very much like to see the emails. You can PM me or I can give you my e-mail address.

 

[Ed209]

This mirrors my experience as well. I had a acoustic trauma and immediately knew something was off, but the loud tinnitus didn't start until about three or four days later.

I would very much like to see the emails. You can PM me or I can give you my e-mail address.

Mine started around 3 days after a loud concert. I already had mild T that I had completely habituated to. I never thought about T at all, then that morning I woke up to the sound of a piercing dentist drill like sound. To say I freaked out is an understatement.

 

[PaulBe]

Its not that the hearing test hasn't advanced in however many years, its that the understanding of, and (mainstream) therapeutic options for disorders of hearing haven't changed fundamentally in that time, so the test still has application as it is within the existing paradigm of understanding and treatment. As such, its a useful baseline and starting point. The trouble with it is like any test, its all about the skill and will of the practitioner put it into the whole perspective and not think that the test is where it all starts and ends.

 

[Ed209]

Its not that the hearing test hasn't advanced in however many years, its that the understanding of, and (mainstream) therapeutic options for disorders of hearing haven't changed fundamentally in that time, so the test still has application as it is within the existing paradigm of understanding and treatment. As such, its a useful baseline and starting point. The trouble with it is like any test, its all about the skill and will of the practitioner put it into the whole perspective and not think that the test is where it all starts and ends.

I think they could at least put more effort into it. The equipment is straight from the 70s and they only test set frequencies. There is no option for a more thorough examination even if you wanted it and paid for it. Basic is an understatement.

They are primarily concerned with supplying us hearing aids. It's time they start providing better diagnostic tests for conditions like ours. Even though there isn't a treatment, it could provide a better understanding of what's going on.

 

[VRZ78]

I think it's important to make your audiograms at the same place.
I had two audiograms two weeks apart at to different places and one shows a straight line at 0 dB hearing loss with 3 frequencies at 5 db hearing loss and the other a straight line at 10 dB hearing loss with 2 frequencies at 5 db hearing loss...

It's quite a big difference...

Of course they only go up to 8 khz

 

[Ed209]

I think it's important to make your audiograms at the same place.
I had two audiograms two weeks apart at to different places and one shows a straight line at 0 dB hearing loss with 3 frequencies at 5 db hearing loss and the other a straight line at 10 dB hearing loss with 2 frequencies at 5 db hearing loss...

It's quite a big difference...

Of course they only go up to 8 khz

Should be irrelevant really in a controlled environment. It's like saying you should always have an eye exam in the same place. If the test has controls, calibrations and standards to follow then the result should be the same (or within a very small set of parameters). If not, the conclusion of most audiograms is surely suspect? But I know what you mean, background noise and such should be the same and this should be controlled with a soundproof booth in every case.

You can tell if someone is severely impaired without any test at all. And with the technology we have today, rudimentary results can be achieved on almost all household devices. So, the question has got to be asked: if the audiograms are not a highly accurate reflection of our hearing, and can change quite dramatically from clinic to clinic, then why bother trying to be so precise?

 

[bill 112]

Should be irrelevant really in a controlled environment. It's like saying you should always have an eye exam in the same place. If the test has controls, calibrations and standards to follow then the result should be the same (or within a very small set of parameters). If not, the conclusion of most audiograms is surely suspect?

You can tell if someone is severely impaired without any test at all. And with the technology we have today, rudimentary results can be achieved on almost all household devices. So, the question has got to be asked: if the audiograms are not a highly accurate reflection of our hearing, and can change dramatically from clinic to clinic, then why bother trying to be so precise?

I get the same results on a hearing test app I have that I do at my audiologists,so if I can administer this test to myself with similar results then why even bother with it in the first place.

As you said above,it's simply a quick tool to help in fitting a hearing aid,other than that it has no real meaning in my opinion,simply because it fails to even test our full hearing spectrum and just leaves a huge question mark over 50% of our hearing threshold.

 

[RaZaH]

With high frequencies the wavelength gets very small , so even placement of headphones can matter.
Making testing pretty hard , I am not sure where at what point exactly this starts to matter.

 

[Vinnitus]

They test 250hz,500hz,1000hz,2000hz,4000hz,6000hz and 8000hz.

What about the frequencies in between?Like 1100hz or 1200hz not to mention the upper frequencies?
Pointless test when you think about it,and to think all this time I thought my ears were perfect when they only knew 10% of what was going on in there.

I recently discussed this with @HomeoHebbian as well. His answer to this was as follows.

As for your last point about not measuring responses at cochlear frequencies positioned between the test frequencies (at least I think that is what you were driving at), that's not the case. A tone will cause a region of the basilar membrane to vibrate, not a point. The size of this region depends on the sound level (and other factors). At high sound levels, a tone will activate the corresponding region of the basilar membrane but also regions around it, which would include frequencies between those used during the audiogram. So, it does test the health of intervening regions of the cochlea even though it samples at discrete points. Hope that makes sense.

 

[bill 112]

I recently discussed this with @HomeoHebbian as well. His answer to this was as follows.

Thanks for clarifying that for me,it always bothered me that they didn't test the regions in between each frequency but if what Homeo says is right then it doesn't matter as if it was damaged it would show up.

Still bothers me that they don't test past 8,000hz,I'm currently here trying to find a place that does with no luck so far.

 

[Sam Bridge]

Thanks for clarifying that for me,it always bothered me that they didn't test the regions in between each frequency but if what Homeo says is right then it doesn't matter as if it was damaged it would show up.

Still bothers me that they don't test past 8,000hz,I'm currently here trying to find a place that does with no luck so far.

A hearing place shop tested me up to 20khz here in South London. Maybe worth trying somehwhere like that?

 

[bill 112]

A hearing place shop tested me up to 20khz here in South London. Maybe worth trying somehwhere like that?

That's what I'm thinking,there's a place near me that make specialised ear pieces for musicians,apparently they do high frequency hearing tests there so I'm just about to call them now

 

[linearb]

you have to look at 20-30-40+ dB differences to draw meaningful conclusions, because even if everything is perfectly calibrated there is some normal variation between what different people can hear, even without them having had some kind of damage.

 

[Sam Bridge]

That's what I'm thinking,there's a place near me that make specialised ear pieces for musicians,apparently they do high frequency hearing tests there so I'm just about to call them now

How did it go?

 

[GregCA]

When I first got in to see an ENT because my hearing felt muffled, I was still above the "normal" threshold, so my ENT doctor told me "no, your hearing is considered normal", even though it was clearly obvious that my ear felt plugged.
I think they draw the line at 30 dB, which makes me shake my head: I need the doctor to put a foam plug into one of his/her ears and go about his/her day and tell me if s/he thinks his/her hearing is "normal", because I'll be telling him/her that s/he is experiencing "only about 20 dB loss in that ear", so it's considered "normal hearing".

I suspect some thresholds' definitions are linked to disability/insurance claims and so it needs to be "quite bad" before some benefit will kick in. Below that threshold you are considered "normal".

 

[Reinier]

My conclusion, going by my results, is that the audiograms naturally fluctuate anyway.

My audiologist told me that it is not unlikely you will have a different audiogram in the morning compared to an audiogram taken late afternoon. I asked because this is what I noticed when doing this neuromodulator therapy. I needed to change level of neuromodulator in the morning to adjust it a couple of hours later.

 

[Ed209]

you have to look at 20-30-40+ dB differences to draw meaningful conclusions, because even if everything is perfectly calibrated there is some normal variation between what different people can hear, even without them having had some kind of damage.

I agree that on a meaningful level, regarding hearing loss, it only really matters when the difference is big enough to make a real world difference.

I'm interested in knowing if there is a quantifiable difference in any two audiograms that show improvement over time. Is this a 'real' value or does it prove nothing whatsoever.

My interest was spurred from the many posts in one of the LLLT threads I read about a year ago. I distinctly remember people talking about the improvements they had made to their hearing thresholds using audiograms as proof. Dr Wilden featured heavily in this. At the time I really didn't see much in the research to suggest the laser could make a meaningful difference, with the ear drum being a significant barrier.

When my second audiogram also showed a measurable difference (improvement) I immediately remembered the LLLT threads and thought: either I've improved with the help of nothing, or those other examples were flawed, because they relied on the accuracy of an audiogram to prove the LLLT had made a difference.

 

[Ed209]

My audiologist told me that it is not unlikely you will have a different audiogram in the morning compared to an audiogram taken late afternoon. I asked because this is what I noticed when doing this neuromodulator therapy. I needed to change level of neuromodulator in the morning to adjust it a couple of hours later.

That's interesting, I've never heard that before.

 

[PaulBe]

They are primarily concerned with supplying us hearing aids.

True enough. Its a bit like taking someones blood pressure and saying "you have high blood pressure so you need a pill to bring it down" but you don't look in any depth at addressing the body systems that contribute to that BP being high. Medicine is increasingly a time-limited commodity and simple solutions free up space for more consultations.

 

[GregCA]

I'm interested in knowing if there is a quantifiable difference in any two audiograms that show improvement over time. Is this a 'real' value or does it prove nothing whatsoever.

The way I do it is to do frequent audiograms with my iPhone app. I get screenshots and combine them into a quicktime movie. When I play the movie I can visually "see" that the graph moves around and our brains are very good at spotting trends (taking out the "sampling noise" automatically). If you don't see any trend, then all you have is noise and your hearing isn't changing. You need more than 2 samples, basically.

 

[Reinier]

That's interesting, I've never heard that before.

With this therapy I used to set the volume such that I was just able to detect the sound. So that was my hearing threshold for these frequencies (approximately 9 kHz).
This neuromodulator was able to change output levels 10 dB maximum. (-5dB to + 5 dB).
There was only a 5 dB (on average) difference between start in the morning and 3-4 hours later.
That is a small amount (dB wise). You will not notice a 5 dB difference in everyday life. I only noticed it because of this therapy. And it was confirmed by my audiologist when I asked about it.