Two Audiograms with Different Results

[Kriszti]

Today I went to audiology the second time after having one test done in October. I dont think, or I just don't realize that my hearing has changed, but I got completely different results. My tinnitus did change from a unilateral low buzzing to a bilateral, very high frequency grinding sound. At some frequencies there is like a 25 db drop from the previous results.

Can it be caused by that the first audiogram was done in a silent room, and the second, most recent one in a normal room, just with the headphones on?

Bone conduction hearing seems to be alright, but the air conduction one is not good. I'm not aware that I have a cold or allergy. I'm pretty tired and anxious because I've been sleeping 2-3 hours for 4 months, but I'm not sure whether it would have an impact on the audiogram. I've been protecting my ears vigorously, but of course I bumped into some loud noises and a very noisy MRI, but those did not make my tinnitus permanently worse.

I also have some earwax on my eardrum on my worse ear, but ENT said nothing to be worried about. ENT also was not too concerned about my audiogram.

 

[GregCA]

Bone conduction hearing seems to be alright, but the air conduction one is not good.

Are you comfortable posting your audiograms? (blank out any personal info)

 

[Kriszti]

Are you comfortable posting your audiograms? (blank out any personal info)

Yes, thank you if you take a look at it. I hope I don't screw up the uploading, I'm technically challenged.

 

[GregCA]

Yes, thank you if you take a look at it. I hope I don't screw up the uploading, I'm technically challenged.

Your latest audiogram does seem to show an air-bone gap.

If I were in your shoes, I would have another hearing test at another facility (different equipment, different people). If the results match your latest audiogram and the air-bone gap shows as well, I'd have a conversation with the ear doctor about it.

S/he may mention otosclerosis. Have you ever heard of it? (in your family, for example?)

 

[Kriszti]

Your latest audiogram does seem to show an air-bone gap.

If I were in your shoes, I would have another hearing test at another facility (different equipment, different people). If the results match your latest audiogram and the air-bone gap shows as well, I'd have a conversation with the ear doctor about it.

S/he may mention otosclerosis. Have you ever heard of it? (in your family, for example?)

Thank you, Greg.

I'm not aware that anyone in my family has otosclerosis. My parents' hearing is quite bad, and my grandma had a hearing aid, but they never mentioned otosclerosis. All I know about it that you have it. And it has something to do with the bones in the ears.
But, shouldn't the audiologist and the ENT have noticed this? In the last 3 months I visited 3 different ENTs and 2 audiologists. Also, is it possible to develop it in 3 months? I tend to have more faith in the previous audiogram, because the circumstances were better. Also, I had an MRI in November.

 

[Kriszti]

@GregCA

Can I have some other questions, if you don't mind? I'm starting to freak out.

So today's test was in a normal room, not a silent chamber. Even computers were in use. Can it affect the results? Also the headphones were not very tight-fitted.

Back in October I had low buzzing tinnitus, only in my left ear at 125 Hz. Prior to this, I had this for 1-2 weeks in 2016, and 2017. Now this buzzing is absolutely gone. Coincidentally (?) in my left ear, the biggest ABG is at 125 Hz. Now I have ultra high frequency, bilateral tinnitus around 10-12000 Hz. The audiologist was not able to determine the exact frequency. Also, I have earwax on my eardrum in my left ear. ENT tried to get rid of it today, but it's too dry, so I have an appointment for next Tuesday and she ordered me to put oil in my ear to soften the wax. So, I'm going back next week. Do you think it's soon enough to ask her about the possibility of otosclerosis? (She did see my audiograms from today and from October as well.)

I'm extremely anxious, haven't slept for 4 months, I'm already suicidal, I don't know if I could handle a potential stapedoctomy.

 

[GregCA]

But, shouldn't the audiologist and the ENT have noticed this? In the last 3 months I visited 3 different ENTs and 2 audiologists.

They should, but, well... what can I say...

Also, is it possible to develop it in 3 months?

It took 2 months for me. It is uncommon though: generally otosclerosis is a slow-progressing disease.
You could have another ossicle problem, too. You should ask your family members who have this problem: that is a big lead in my opinion.

I tend to have more faith in the previous audiogram, because the circumstances were better.

I'm not sure that the circumstances would affect the air-bone gap that much, but to be sure, like I suggested, I'd do another hearing test at a completely different facility.

Also, I had an MRI in November.

The MRI is typically used to rule out an acoustic neuroma. For otosclerosis, the imaging technology used is high resolution CT, as the doctors are looking for radiolucencies in the resulting images. Even then, it's quite difficult to spot otosclerosis in the images.

Like I mentioned, if the doctors suspect otosclerosis, they will run a couple of fork tests too (looking for lateralization). I don't know if you measured stapedial reflexes, checked for Schwartz sign, and if your doc looked for other symptoms or signs of otosclerosis.

I'm not a doctor, and this is not medical advice. I'm just giving you a few pieces of data that you can bring to your doctor's attention. Having gone through this myself, I know it's not easy to piece the otosclerosis puzzle together (it took over half a dozen doctors to see it in my case - I was misdiagnosed as SSNHL).

Good luck!

 

[Kriszti]

They should, but, well... what can I say...

It took 2 months for me. It is uncommon though: generally otosclerosis is a slow-progressing disease.
You could have another ossicle problem, too. You should ask your family members who have this problem: that is a big lead in my opinion.

I'm not sure that the circumstances would affect the air-bone gap that much, but to be sure, like I suggested, I'd do another hearing test at a completely different facility.

The MRI is typically used to rule out an acoustic neuroma. For otosclerosis, the imaging technology used is high resolution CT, as the doctors are looking for radiolucencies in the resulting images. Even then, it's quite difficult to spot otosclerosis in the images.

Like I mentioned, if the doctors suspect otosclerosis, they will run a couple of fork tests too (looking for lateralization). I don't know if you measured stapedial reflexes, checked for Schwartz sign, and if your doc looked for other symptoms or signs of otosclerosis.

I'm not a doctor, and this is not medical advice. I'm just giving you a few pieces of data that you can bring to your doctor's attention. Having gone through this myself, I know it's not easy to piece the otosclerosis puzzle together (it took over half a dozen doctors to see it in my case - I was misdiagnosed as SSNHL).

Good luck!

Thank you. I will ask about it and try not to freak out more than necessary.
Nothing else was done besides audiometry. I told the ENT that I didn't want tympanometry, because it was quite unpleasant the last time they did it, and I'm not sure if it contributed to my high frequency tinnitus, because ringing started a few day after that. (I have a bunch of other possible cause though. )
My grandma passed away, so I won't get much info about her, and I'm pretty sure that my parents never had a hearing test in spite of their hearing is quite abysmal. They don't have tinnitus (well, my mom has a very mild case which she was totally unaware of before I started complaining about my own problems), so they just don't care about their hearing loss.

 

[Tybs]

Keep in mind that audiogram results are easily "manipulated" by T. I've had three of them: the first and last one indicated no hearing loss at all. However, I had a bad T day when the second one took place, and with twelve fluctuating sounds dancing around all the time, it was really hard to distinguish the small beeps from the headset. This audiogram indicated multiple small gaps and one big one. As said, the one I took about two months later showed no issues at all, so at least one of these three results is incorrect (I know which I believe).

An audiogram is still subjective by nature, especially when it comes to T.

 

[Juan]

Yes, thank you if you take a look at it. I hope I don't screw up the uploading, I'm technically challenged.

If your air bone gap developed recently you may try prednisone for it. Some doctors prescribe it and, if you are lucky and respond to medication, it can push the lower frequencies up back to where they were before.

Another theory is that on the first audiogram there was more hearing loss than shown there, and the new audiogram is revealing your real hearing. My own audiograms show certain similarities with yours in the low frequencies, but the gap opened up in a period of many years, but appeared suddenly after an stapedial reflex test. Then the gap closed for maybe 1.5 years, and suddenly there was a bit of hearing loss in low frequencies, and no airbone gap. That's why I think tests like MRI or stapedial reflex can have a major long term impact on hearing, that may flash immediately in an audiogram (I had one right after the stapedial reflex test) and be confirmed in audiograms years later.

 

[Kriszti]

Keep in mind that audiogram results are easily "manipulated" by T. I've had three of them: the first and last one indicated no hearing loss at all. However, I had a bad T day when the second one took place, and with twelve fluctuating sounds dancing around all the time, it was really hard to distinguish the small beeps from the headset. This audiogram indicated multiple small gaps and one big one. As said, the one I took about two months later showed no issues at all, so at least one of these three results is incorrect (I know which I believe).

An audiogram is still subjective by nature, especially when it comes to T.

Thank you, Tybs.

I will make an other appointment and retest. But the strange thing is that the last time I had horrible, low buzzing T at 125 Hz-ish and very loud. Yet, the audiogram was ok. Now, I have ultra high frequency T, and the results are better in the higher frequencies. And my makeshift hearing test (aka YouTube) shows, that I do hear worse in the lower frequencies. But in normal, average setting I haven't noticed any worsening in my hearing, I feel that my hearing is actually better. And even though, my T fluctuates like crazy, I did feel a very slight improvement, which is of course worse now, because I've been panicking these last days. I really should change my mindset and calm down and not think about worst case scenarios. The fast change has me worried more than anything.

The ENT examined my ears, saw a little wax on my eardrum, tried to take it out, failed, so I need to go back after putting oil into them to soften the wax. Other than this I was referred to go to a psychiatrist because of my horrible sleep issues.

@GregCA
May I ask you how much time it took for you to get a diagnosis? You said that you were misdiagnosed and took many doctor to get a correct one.

 

[Kriszti]

If your air bone gap developed recently you may try prednisone for it. Some doctors prescribe it and, if you are lucky and respond to medication, it can push the lower frequencies up back to where they were before.

Another theory is that on the first audiogram there was more hearing loss than shown there, and the new audiogram is revealing your real hearing. My own audiograms show certain similarities with yours in the low frequencies, but the gap opened up in a period of many years, but appeared suddenly after an stapedial reflex test. Then the gap closed for maybe 1.5 years, and suddenly there was a bit of hearing loss in low frequencies, and no airbone gap. That's why I think tests like MRI or stapedial reflex can have a major long term impact on hearing, that may flash immediately in an audiogram (I had one right after the stapedial reflex test) and be confirmed in audiograms years later.

I don't think, I can get prednisone. Also, I don't know since when exactly my low freqs are bad.

What do you mean by the ABG closing? Was it a result of prednisone? Or your bone conduction hearing got worse and matched the air conduction one? Or the other way around?

I know, we all feel like this, but I'm so effing exhausted from this. I don't know what to do. I will get an other audiogram, but what to do with stapedial reflex test and tympanometry? If I'm not mistaken, they are needed to diagnose the otosclerosis, but they can affect the Tinnitus horribly. Which finger to bite?

 

[Juan]

What do you mean by the ABG closing? Was it a result of prednisone? Or your bone conduction hearing got worse and matched the air conduction one? Or the other way around?

I think at that time I had deflazacort, which in theory is softer than prednisone, but seems to work better for me. And eventually (maybe in 2 weeks - one month) the airbone gap obviously caused by the stapedial reflex disappeared.

But down the road.. like 2 years later my hearing dropped to the level of the airbone gap showed on that previous audiogram. With this I mean that I recovered my hearing for just like 2 years.. and then I have some minor hearing loss in low frequencies.

So lets say you have airbone gap and have some meds and get your hearing up to baseline, from 30 dbs to 15 dbs or whatever.. it may remain like that or go back down to -30 dbs after some time, depending on noise exposure, stress, and stuff like that.

If I were you I would not have the stapedial reflex test, and it wont show really anything. Some ENTS start to admit that most of the tests they perform are good for nothing, and that just talking to the patient and finding out how and in which circumstances hearing problems occurred and evolved is key, and tests can add very little, in practical terms, to the patient's narrative. Summing up: many tests, for many patients, do damage and do not offer any answer in terms of diagnosis or treatment.

 

[Kriszti]

@Juan
Thank you.

The thing that I don't understand and gets me kind of frustrated is why the two audiologists (one of them is an ENT as well) didn't say a thing about the visible quite big and rapid changes in the audiograms. The question is a rhetorical one, as Greg also implied.
I'm just so disappointed. I didn't have a good look on it and I'm not a professional, so I didn't ask. Why do patients have to get info in support groups and on the net, when I'm pretty sure doctors must have seen ABG in their practice lots of time.
Sorry for venting, I know it's rather futile.

 

[Tybs]

The thing that I don't understand and gets me kind of frustrated is why the two audiologists (one of them is an ENT as well) didn't say a thing about the visible quite big and rapid changes in the audiograms.

The frustration is understandable, I've been there as well (and still am, for a bit). Yet, I don't think we can really blame the ENT's... the hearing field is still largely unexplored and unknown. Doctors are no researchers, they can only work by most-known protocols. More research is needed to figure out how the human auditory system truly works.

 

[GregCA]

@GregCA
May I ask you how much time it took for you to get a diagnosis? You said that you were misdiagnosed and took many doctor to get a correct one.

About 2 months.

 

[Juan]

@Juan
Thank you.

The thing that I don't understand and gets me kind of frustrated is why the two audiologists (one of them is an ENT as well) didn't say a thing about the visible quite big and rapid changes in the audiograms. The question is a rhetorical one, as Greg also implied.
I'm just so disappointed. I didn't have a good look on it and I'm not a professional, so I didn't ask. Why do patients have to get info in support groups and on the net, when I'm pretty sure doctors must have seen ABG in their practice lots of time.
Sorry for venting, I know it's rather futile.

I think the way hearing changes and how fast it changes is quite unpredictable, based on my own case. It can be stable for years and then an audiogram can change a lot, or maybe we subjectively hear sound different, I don't know. But it can get worse very fast for apparently no significant reason.

After so many years with hearing problems there are still things that baffle me and I don't understand how sounds that I could bear with no problem can produce damage, or why a certain sound makes more damage some times than others. My feeling is that there are other things involved, like brain processing of sound, synapses, mechanical elements in throat or middle ear etc that may play a larger role sometimes for enhancing or inhibiting sound. That could be a reason for audiometric results changing so much.

 

[Juan]

@Juan
Thank you.

The thing that I don't understand and gets me kind of frustrated is why the two audiologists (one of them is an ENT as well) didn't say a thing about the visible quite big and rapid changes in the audiograms. The question is a rhetorical one, as Greg also implied.
I'm just so disappointed. I didn't have a good look on it and I'm not a professional, so I didn't ask. Why do patients have to get info in support groups and on the net, when I'm pretty sure doctors must have seen ABG in their practice lots of time.
Sorry for venting, I know it's rather futile.

What are the changes you notice in your hearing in practical terms? I mean, forget about the audiogram... what is the impact on your daily live? Is it harder to understand others, to hear TV, to work? That's what really matters, to put things in perspective.

 

[Kriszti]

What are the changes you notice in your hearing in practical terms? I mean, forget about the audiogram... what is the impact on your daily live? Is it harder to understand others, to hear TV, to work? That's what really matters, to put things in perspective.

Not much. I don't think that my hearing changed at all. It's more sensitive, but
I think it's due to the fact that I lowered the volume on everything that I listen to. Instruments in music seemed distorted in December, never had problems with singing voice, but I think it has improved a bit. When the ringing, grinding is louder (tend to be worse in the afternoon and evening), it's harder to pay attention to anything, but I guess, it's normal. It can be tricky though, because I have been quite reclusive and isolated lately, so I don't spend much time with other people, but I haven't really noticed worsening. But I guess, normally 125-250 Hz where I have the big drop, is not that common everyday frequency.

 

[Juan]

Not much. I don't think that my hearing changed at all. It's more sensitive, but
I think it's due to the fact that I lowered the volume on everything that I listen to. Instruments in music seemed distorted in December, never had problems with singing voice, but I think it has improved a bit. When the ringing, grinding is louder (tend to be worse in the afternoon and evening), it's harder to pay attention to anything, but I guess, it's normal. It can be tricky though, because I have been quite reclusive and isolated lately, so I don't spend much time with other people, but I haven't really noticed worsening. But I guess, normally 125-250 Hz where I have the big drop, is not that common everyday frequency.

Then you're fine! Don't worry too much. If you had some hearing loss that mattered you would be having trouble hearing speech in noise, or just holding a conversation with anyone at a cafe or a place like that. Just having aircon on the background or some sound resembling white noise and having to listen to speech on top of that layer of background sound would be very tricky.

 

[Kriszti]

Your latest audiogram does seem to show an air-bone gap.

If I were in your shoes, I would have another hearing test at another facility (different equipment, different people). If the results match your latest audiogram and the air-bone gap shows as well, I'd have a conversation with the ear doctor about it.

S/he may mention otosclerosis. Have you ever heard of it? (in your family, for example?)

Went back to the ENT. She said that she doesn't think that I have OS, because I don't have significant hearing loss. She didn't rule it out though, told me to monitor it, if in some months my hearing deteriorates further. I didn't want to take a tympanometry, because the first one done 3 months ago may have contributed to developing the high pitch grinding sound. I'm starting to feel stuffy in my nose, so maybe I'm getting sick, so I don't know whether to go to an audiology the next week.

 

[Kriszti]

Then you're fine! Don't worry too much. If you had some hearing loss that mattered you would be having trouble hearing speech in noise, or just holding a conversation with anyone at a cafe or a place like that. Just having aircon on the background or some sound resembling white noise and having to listen to speech on top of that layer of background sound would be very tricky.

I went to have a hearing test again, and surprise, surprise it's different than the other two. Maybe I should take yet another one and chose the two which are the most similar to each other.

 

[Juan]

I went to have a hearing test again, and surprise, surprise it's different than the other two. Maybe I should take yet another one and chose the two which are the most similar to each other.

Hearing tests are irrelevant. The only important test is an speech in noise recognition test, and it is also possible to have an idea of how you will perform in such a test without taking it. Basically that tests measures the words one misses in conversation with background noise reading words out of context over a layer of white noise. If you can repeat the words accurately, you are fine, no matter what your audiogram says. If you cannot repeat the words then hearing is getting worse... actually the results of a speech in noise recognition test can change with the same audiogram, or a very similar audiogram, and that's why the audiogram is not so important.

By the way, I think you said you're from Budapest... I might drop you a PM (if I figure out how to do it) to ask you about real estate there ;-) Maybe you can give me some good advice...

 

[Kriszti]

Hearing tests are irrelevant. The only important test is an speech in noise recognition test, and it is also possible to have an idea of how you will perform in such a test without taking it. Basically that tests measures the words one misses in conversation with background noise reading words out of context over a layer of white noise. If you can repeat the words accurately, you are fine, no matter what your audiogram says. If you cannot repeat the words then hearing is getting worse... actually the results of a speech in noise recognition test can change with the same audiogram, or a very similar audiogram, and that's why the audiogram is not so important.

By the way, I think you said you're from Budapest... I might drop you a PM (if I figure out how to do it) to ask you about real estate there ;-) Maybe you can give me some good advice...

I'm not really familiar with real estate, but I can look and ask around.

 

[Juan]

I'm not really familiar with real estate, but I can look and ask around.

I just wanted to know what are the main real estate portals or websites for Budapest, where realtors but also owners on their own post apartments for sale?

And if you could recommend a real estate agency there...