Hearing Loss - Air/Bone Gap

Hello,

at first sry for my English, I am from Austria so I might not 100% translate all ENT-specific words correctly and thank you for your time reading this! I really walk in circles since last year after my hearing loss and get no 100% answer on my strange looking audiograms.

So I will let my photo speak for itself. I have a high frequency hearing loss at around 4-5khz with a drop to 90 decibel but a gap from over 30 decibel between my air and bone. The tymp was normal. By testing the bone conduction I clicked in the hearing test when I was able to hear any sound. The tone wasnt completly clear it was some kind of distorted but it was as you can see in the audiograms repeatable at different ENTs or in the hospital.

I am not sure if it was a hearing loss and/or a virus infection that caused my current situation as I had a swollen outter ear canal at the same time. I took “ear-friendly” antibiotics that should not cause any hearing loss. In my opinion I had a hearing loss at first and short after that the swollen outter ear canal. I had crusts/scabs on my eardrum for over 3 months no ENT was understanding where they came from.

I hope someone has an idea how this could happen. Thank you so much!

Due to having a normal tympanogram, it seems as though the middle ear is functioning alright. The difference could be due to your outer ear being swollen during testing. This will affect the conduction of sound into the ear canal which can affect how you hear sounds. Also, if the eardrum was scabbed, the sound will not be transmitted well through headphones/inserts like it would through bone conduction.

Thank you so much Dr. Barnes for your reply!

I had at the beginning of this hearing loss or at the same time a very very swollen outer ear canal on my left ear and a not that much swollen outer ear canal on my right eare but got Antibiotics and it was gone within 3 days. What was left was this audiogram and scabs over months also after removing them and also after 3 cortison therapies!

The Tympanogram was always OK. My eardrum was scabbed over a long period of time also after I took the Antibiotics. So I think about a Virus. The ENTs cleaned my eardrum like 3 times and after 3 weeks again a scab. All ENTs didnt know where that scabs came frome. But the audiogram was the same with and without scabs on the eardrum. I had MRT/CT from the brain/complete ear - also no result.

I also have to mention that I hear on the air conduction not a nice “Beep” tone its more like a “zzzz” for everything above 4khz. Some ENTs say the gap comes from the problem that I have recruitment with my hair cells but wouldnt a recruitment also mean that both the air and the bone should be in one line without any gap.

I also have looked around for so many hearing loss audiograms and also mixed loss etc and I was not able to find anything that matches my condition. Also that the gap is only in my hearing loss areas is very strange to me…

The audiograms were from different times with and without scabs over months show all the same result. I had on friday again an audiogram where i was not able to hear 8khz anymore with my inner ear…but can hear the 8khz on the air conduction. Gap still there still no clear “Beep” sounds in the hearing test for 8khz. So that puts again more pressure on my to find a reason for the gap.

I also have troubles in my left face so everything could also be a neuronal too, it feels like a mask over my left face and I feel my left top teeth like after a surgery. Maybe a virus infection…but again that would not be the answer to the gap itself. I take physical therapy every week 2 times since 2 months and no result on the face. Also neurological problems in my left fingers, feet (Ischias?) also doesnt get better from the physical therapy. since 6months now.

I just have no idea where I can search anymore for help what things are missing due to my lack of knowledge about such things I really run out of ideas and also my ENTs have no idea anymore. My personal opinion is that gap of 30db doesnt seem normal.

Dr. Barnes I know its hard to say anything because of the distance but maybe you have an other idea that I should keep in mind I would be really thankful!

Thank you so much!

Good afternoon. I agree that change in hearing (through air conduction) was likely due to a virus. Change in perception of sound (beep to buzz) seems to indicate viral origin as well. Also, weakness in face and on left side of the body seems to correlate with a virus. Did the ENTs rule out Bell’s Palsy? The difference in air/bone is not normal but could be a function of thickening of the ear drum after scabbing. I’m definitely glad to hear that imaging was normal. Is communication greatly affected by the condition of your hearing? If so, please see an audiologist for treatment options. If not, please try not to worry and stress over it as we know that stress can bring out dormant viruses in the body. I wish you well!

Hello Dr. Barnes. Thank you again so much for your fast reply.

Well, I made a complete blood count on my own with my doctor and also wanted to check for lyme disease - in connection with Bells Pasy as possible result of it. No other checks and the lyme disease based on blood was negative so my ENTs didnt go that way anymore…but in my opinion a negative blood test on lyme disease says nothing. I had troubles with my left side since one year and did so many sport activities to get things better without any result until I reached a training level of 4 hours a day I still felt I had no power at all.

So my next steps are getting in touch with someone for TMJ Treatment and someone for Lyme disease and testing for virus and/or other infections. I just have to make a research for possible infections I think. I took out my wisdom tooth left top side and bottom top nearly 2 months ago…bottom last year…no change on the face. Face issues started with the hearing loss or short time before it.

But yes I overall think its a virus maybe in connection with that lyme disease. Weak one body side, hearing loss, swollen outer ear canal, difficulties swallowing left sided, shoulder-arm syndrom without any result after 3 months physical therapy and 1 year training and sciatica pain left sided…still here…the symptoms get more and more and they reached my ear and reached my face.

I didnt know the beep to buzz is an indicator for viral diseases. Is it reversible? Is it part of a virus infection of the inner ear hair cells or just the ear drum? Does the thickening of the eardrum can go away also after 5 months when everything started when I can detect the virus? I know its hard to say but I never had that feedback yet and that caught my attention. Thank you so much!

The ENTs also said my eardrum is soft and the last ENT said I had some white “veil” on it and was cleaning it. But really not much he said! Calcium? As the tympanogram is normal the only point where the sound could be destroyed is my eardrum? Or could also an other position in the middle ear (still infected and maybe swollen) destroy only higher frequencies? What else could make that high frequency gap in my condition and why could my inner ear has in the same frequencies problems as my outer ear air/bone?

I have a lot of troubles as i suffer from a Tinnitus that actually sounds like the “buzz” sounds and I also cant follow conversations as good as before my hearing loss in loud areas like restaurants so I try to avoid those places right now. I have started to get in contact with an audiologist last year and they also said something is wrong that gap is completly unusual. After 4 ENTs the audiologists throwed me back to the ENTs checking all again. Now after the ENTs said again its normal to have that gap (like recruitment or physical phenomenon of sounds) and 5 cortison therapies one of them in the middle ear by a needle I went back to the audiologist and we try right now to get in touch with hearing aids…maybe for music…better understanding or just to train the nerve with sounds. I dont know I will give it a try of course. The problem is the buzz-sound when I get the hearing aid I am afraid I cant use it if I hear them…so i have to solve some issues first I dont want to flip frequencies with the hearing aid that doesnt make sense to me in my condition.

My biggest concern is that I might have a virus and noone is actually doing something and when a new hearing loss hits my left ear also my speech area gets damaged and my hearing loss was already August 2017.

Thank you so much you give me so important advises and information!

Please see my answers to your quotes below:

I’ve heard that people perceive sounds differently after having a virus that attacks the ear. This is why I tend to think that this is the result of a virus. Viruses typically do not attack both ears, how is the hearing in your right ear? To my knowledge, due to how much time has passed, it may not reverse. The virus tends to attack the 8th nerve (the auditory nerve).

The veil or white could have been from the virus that was occurring or scarring from the repeated scabs. If the tympanogram is normal, the part of the ear that the virus attacked is likely the 8th nerve (after sound is collected and funneled through the outer, middle and inner ear it travels to the brain via the 8th nerve). Frequency gap is likely due to scarring seen on eardrum (causing bone scores to not be normal) and then a virus attacking the 8th nerve (causing the air scores to not be normal). It is a mixed hearing loss.

Talk to your audiologist about hearing aids that have frequency lowering or transposition or possibly the option of a bone anchored hearing aid.

I hope that helps :sunny:

Thank you for your time!

You are right! I only have hearing loss on my left ear. Also on my left ear the Tinnitus - i can hear it clear there. Right ear is perfect. But I still have the feeling of a tooth surgery on my left side in the face sometimes I even get that feeling on the right side too but not as strong and not over a long period of time. Its like a feeling its swapping over to me right side…maybe thats also from the stress right now again with all the researching.

On Friday I lost the ability to hear the 8khz in my inner ear and again I got cortision therapy over the weekend - high doses. I went to the hospital Neuro and ENT and they said its not acute…Neuro said everything is fine and I got an appointment for a “special” ENT in June… I asked for testing for a virus they said I have none - just by looking at me. But they gave me something to read about for taking out spinal fluid for testing. So I think I will do that but they said its useless…strange…I dont know for me the symptoms and the loss of 8khz seem to be acute!

The ENTs said there is no scarring on the eardrum - everything looks fine. So I have a plan for the buzz-sounds but not for the gap…eardrum is ok, tymp is ok.

Anything else I should check? I try to focus on a virus infection that is maybe still in my body…cant do more now I think?

Thank you!

Hi there,

I think all that you have done is great. You’ve had hearing testing and imaging. I agree with you that continuing to search and stress is not good. I would follow-up with an audiologist and the ENT that you were referring to and just try and stay healthy and happy. :slightly_smiling_face: I know it is hard not to worry and continue to search, but trust in the medical professionals guidance and always feel free to reach out on here if you have further questions or comments.

Best,