I’m sorry. That sounds like a difficult road of anxiety and grief.
I wouldn’t actually guess that? You could ask your audiologist to run a TENS test to check, although the gross nature of the test wouldn’t necessarily rule out more isolated dead regions. Usually when we are referring to dead regions we are talking about large regions where the inner hair cells are damaged beyond function, and loss is typically more severe than what’s on your audiogram. I think it would be interesting to test your frequency acuity across frequencies, but while this is something done regularly in research settings it is not done clinically. Certainly if you are hearing noise instead of tones, volunteer that information to your clinician. It might be useful information for them to have, although research has not progressed enough that there is a standard approach to that. There is some minor research suggesting that fitting to prescriptive targets when cochlear dead regions are present is not detrimental (to speech perception), although also not necessarily beneficial the way it would be in someone with similar loss and no dead regions. Additionally, we often talk about damage to inner and outter hair cells, but there are a pile of other supporting cells that can be damaged, too. People with much more severe hearing losses than yours regularly still perceive tones as tones, so you perceiving tones as noise is definitely suggestive of more damage.
This should not be the case. You don’t have your bone line marked on your audiogram, but judging just by the air conduction thresholds you don’t have asymmetries that would be expected to overcome inter-aural attenuation.
How long have you had the hearing loss? One of the things that is difficult is that the brain can adapt to impoverised input and re-adjust perception to be more “normal”, but we don’t know to what degree and how long it will take. So there’s a sense that if you amplify everything to target, even if it sounds like crap the brain may re-adjust given some time. The benefit of putting up with the crap sound in the first place is that once the brain adapts you have more overall audibility. BUT, we don’t know how long to try that before giving up and it can be hard to put up with crap sound when you have no idea how long you will have to do so. It’s easier to counsel people with more common sloping losses on this because even though there is no objective answer about “how long” and “to what degree”, clinicians have seen that adaptation happen often enough over time in that population to generalize their experience. Your type of sudden reverse slope is rarer and therefore harder to make a generalization about. I have had two patients with sudden reverse-slope loss kind of like your right ear who were able to accept full gain right away and just powered through with the crap sound and DID adapt over ~6-8 months after which they reported that things sounded pretty normal. Their word recognition also increased. However, I have also had a few others who have not been able to do this–at least one who TRIED without luck, but others who simply couldn’t tolerate the sound quality enough to live with it day-to-day. I have recently had one more who couldn’t tolerate much low frequency gain immediately after the hearing loss occurred, but three years later was able to do so and we have seen improvements in sound perception and general hearing function. I don’t know to what extent there may have been some cochlear recovery after the sudden loss or resolution of loundess tolerance issues (which seem to be common after a sudden or traumatic loss), and to what degree the patient’s evolving understanding of hearing loss made him more willing to try it. There’s some minor research evidence that early amplification after a sudden loss leads to increased word recognition later on.
I would also observe that it’s harder to get musicans and engineers to put up with crappy sound to see if we can get that recovery. Musicians because they are so tuned-in to how things should sound, and engineers because they tend to focus on the function of the device, or even the function of the ear, and overlook the flexibility of the brain.
So, I’m sorry to perhaps complicate things even further for you, but especially if your loss is new it might be worth thinking about things from a perspective of neural plasticity. Consider, for example, all the people on these forums who have gotten cochlear implants; that is a device which provides dramatically impoverished input relative to a normally functioning cochlea, and yet individuals with good outcomes often report that their perception is relatively normal. It is also very common for cochlear implant users to engage in some quite focussed auditory training to help support that return to normal perception. Perhaps a perspective of neural plasticity will also provide you with a bit more hope–if this hearing loss is new, your current experience may not be your future experience, even if change is slower than you might prefer.