Chance of permanent hearing damage? Should I see a doctor?

[Wathdoc]

Very hard to say much without an exam and an audiogram, or knowing much about the dive profiles. Tinnitus is poorly understood in general, but if it suddenly started while diving, that suggests some connection. Is there any hearing loss? It sounds like there might be, so an audiogram can distinguish between a conductive hearing loss and a sensorineural hearing loss, which have different implications. Here is some background reading on these issues.

Inner ear DCS is certainly treatable, but you may be beyond the time frame for that. Barotrauma of the middle ear can result in an inner ear injury, especially in cases of a perilymph fistula. In such cases, surgical exploration can help, but this is a complex decision tree. Middle ear effusion from barotrauma alone would rarely cause tinnitus. If there is a sensorineural hearing loss that is not related to diving, then steroids are occasionally helpful (although not a lot of support in the literature when you look at meta-analyses).

I think that it might be a good idea to call DAN and describe the details.

Good luck!

Or even use a good old fashioned tuning fork

 

[RedyTedy]

Thanks for posting the update! Fortunately, your hearing loss is only on one side and limited to the very high frequencies, and that's a good thing. I'm assuming that your tympanogram was normal also (Type A? Not on the posted image), which means no residual middle ear ventilation issues. You can have inner ear barotrauma due to poor equalization during a dive when that pressure wave is transmitted to the inner ear without any residual middle ear fluid or blood.

I can't really give you specific advice over the Internet, but I guess the main question for your docs to figure out is - is this a typical sudden sensorineural hearing loss (SSNHL) or related to diving (e.g. inner ear barotrauma or IEDCS)?

SSNHL is a real thing that most people haven't heard of, but it does happen and it is not clear why. The current thinking is that it is an autoimmune phenomenon, which is why there are reports of steroids helping (oral and injected). The large combined studies (meta-analyses) hasn't shown steroids to be overall effective, but there are plenty of cases where it seems to have worked anecdotally or in small series. Of course, without doing a rigorous study, you don't know if those people would have recovered without steroids, of if those who received steroids and did not recover would have gotten worse without them. It's hard (both ethically and from a study design point of view) to do the most statistically sound investigation, which is a double blinded prospective randomized trial. If it was me, I would probably take the steroids. SSNHL can absolutely happen in young people - I have seen it in kids. Acoustic neuroma is less common in younger patients.

If it was related to diving, the question is do you have an anatomic abnormality of the ear that predisposed you to that, which might mean worsening hearing in the future. That's a hard question to answer, and imaging might help. At this point, if it was IEDCS it is probably too late for recompression to be helpful - what was your profile?

The bottom line is that you might want to see an otologist (ear specialist) as opposed to a general ENT doc. If you PM me with where you are now, I may be able to give you a local referral.

Thanks doctormike. I believe they did a tympanogram (stuck an earplug in and a machine varied the pressure). The curves looked identical and healthy for both ears; does that help determine if it's normal SSHNL, baurotrauma, or IEDCS? Also PMing you about that referral.

 

[doctormike]

Thanks doctormike. I believe they did a tympanogram (stuck an earplug in and a machine varied the pressure). The curves looked identical and healthy for both ears; does that help determine if it's normal SSHNL, baurotrauma, or IEDCS? Also PMing you about that referral.

RIght, with normal (type A) tympanograms, that means that your middle ears are currently well ventilated. Now it's possible that a person with type A tymps had middle ear barotrauma in the past. But the main thing to look for in distinguishing between middle ear barotrauma and SSHNL / IEDCS / IEBT would be a conductive vs. sensorineural hearing loss.

 

[RedyTedy]

RIght, with normal (type A) tympanograms, that means that your middle ears are currently well ventilated. Now it's possible that a person with type A tymps had middle ear barotrauma in the past. But the main thing to look for in distinguishing between middle ear barotrauma and SSHNL / IEDCS / IEBT would be a conductive vs. sensorineural hearing loss.

They put something behind my ear that vibrated the bone and determined it was sensoineural hearing loss. Not sure how one would determine between SSHNL, IEDCS, and IEBT at this point though?

 

[doctormike]

Yup, that's on the audiogram. They test air conduction (headphones, sound sound going through eardrums, middle ear bones and then into cochlea) and bone conduction (bone oscillator, sound going directly to cochlea). If there is no "gap" (i.e. better hearing with the second test than with the first) that means that it is a SNHL. If there is an air-bone gap, that implies a conductive hearing loss (or mixed, if there is hearing loss on both tests but worse on air conduction). Conductive hearing losses in this context are almost always middle ear fluid and/or blood related to barotrauma, and much less commonly a large eardrum perforation or an ossicular injury.

Distinguishing between those three types of SNHL is mainly done by the clinical history, dive history, associated findings (vertigo is more common with IEDC or SSNHL), imaging findings (e.g. a congenital ear malformation predisposing to a perilymph fistula), etc...

Here is a good summary of SSNHL from the NIH.

 

[Trivan]

Just read this it’s very similar to my experience but it didn’t happen due to diving, Sudden hearing loss, fullness in the ear, ringing in the ears. If you get a episode of vertigo, drs may diagnoses Meniere's disease. I went through the steriod injections to the ear drum, oral steroids and nothing helped. If this is the case, you will be told to go on a low sodium diet. This works for me, if I’m really good about keeping salt out of my diet, the ringing, fullness and hearing loss decreases. I’m trying daily supplements of pycnogenol as well as there are a few studies showing improvement to the ear with it. There is no medical treatment for this disease.
Good luck,