Anyone ever dealt with this? I believe that's what I've going on. I've had it before a few years ago, lasting 2-3 months, sounds like a static/white noise/unplugged analog speaker in my right ear.

This current episode, however, is causing my to have equilibrium issues when the sound is present. Certain sounds (like water from the shower/faucet), loud noises, or sometimes just the quiet of trying to go to sleep, will trigger that sound in my ear, and it'll be accompanied by an almost lightheaded dizziness.

The noise isn't a big issue for me. It's the accompanying vestibular symptoms. If I'm walking and it hits me I have to really focus on where I'm walking or I start drifting. So if I'm reading or on my phone while walking it can cause me to drift left. When I wash my hands in the sink, I'm bent forward, and I almost fall forward.

My understanding is there's not really a whole lot than can be done, other than adapting to it. Curious if anyone has had it, how they adapted, and how long it took. Or maybe if it went away at all? Anyone see an audiologist? Hoping it resolves on its own in a few weeks.

Meniere's disease or vestibular migraines are possibilities. Definitely need audiometry if not further testing.

Kool said:

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Meniere's disease or vestibular migraines are possibilities. Definitely need audiometry if not further testing.

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Got into see audiology, nothing stood out as abnormal on audiometry/tympanometry. Also did the combination audiometry with bone conduction on one side and ear on the other, not sure what it's called.

She wants to do OVEMP/CVEMP and ABR. Said it probably won't change any management, and she'd probably recommend vestibular therapy regardless. Though I don't think it's really bad enough to need vestibular therapy. So long as my eyes are open I can use visual cues to keep from drifting left/right while walking.

Is it a fair comparison to say that audiology is to ENT as optometry is to ophthalmology - essentially a non-surgical special organ specialist? Like when determining if you're going to refer to ENT vs audiology, should you first ask yourself "does this person potentially need surgery," and if so send to ENT, otherwise audiolgoy?

I would go see an ENT. I wouldn't make that comparison.

bigtruckguy3500 said:

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Kool said:

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Meniere's disease or vestibular migraines are possibilities. Definitely need audiometry if not further testing.

---

Got into see audiology, nothing stood out as abnormal on audiometry/tympanometry. Also did the combination audiometry with bone conduction on one side and ear on the other, not sure what it's called.

She wants to do OVEMP/CVEMP and ABR. Said it probably won't change any management, and she'd probably recommend vestibular therapy regardless. Though I don't think it's really bad enough to need vestibular therapy. So long as my eyes are open I can use visual cues to keep from drifting left/right while walking.

Is it a fair comparison to say that audiology is to ENT as optometry is to ophthalmology - essentially a non-surgical special organ specialist? Like when determining if you're going to refer to ENT vs audiology, should you first ask yourself "does this person potentially need surgery," and if so send to ENT, otherwise audiolgoy?

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Some of your symptoms sound consistent with Tullio phenomenon, which is a "third window" phenomenon. Any history of head or ear trauma before this began? If it is consistent every time you hear a loud noise, this should be looked into, might need a high resolution CT temporal bone to rule out an inner ear anomaly such as superior semicircular canal dehiscence syndrome. A perilymph fistula is also a possibility, which can occur with a strong Valsalva, strong insufflation of the middle ear, etc. As I said, though, vestibular Meniere's and migraine (which, in my opinion, is vastly underdiagnosed) is also possible. If things persist you might want to see a neurotologist and bring along your previous audiometry to the visit.

The ABR the audiologist recommended, in my opinion, won't really offer a lot. VEMPs might, but again you are just looking at doing vestibular therapy if they are abnormal, for the most part.

With regards to the relationship between audiologists and ENTs, I wouldn't make a comparison of ophthalmologists and optometrists in a strict sense. Audiologists are absolutely critical to ENT practice, but the aren't going to really be great for working up some of the things I mentioned. Keep us posted.

Ag9701 said:

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I would go see an ENT. I wouldn't make that comparison.

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I did. He didn't seem particularly interested, told me to go see audiology.

Kool said:

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bigtruckguy3500 said:

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Kool said:

---

Meniere's disease or vestibular migraines are possibilities. Definitely need audiometry if not further testing.

---

Got into see audiology, nothing stood out as abnormal on audiometry/tympanometry. Also did the combination audiometry with bone conduction on one side and ear on the other, not sure what it's called.

She wants to do OVEMP/CVEMP and ABR. Said it probably won't change any management, and she'd probably recommend vestibular therapy regardless. Though I don't think it's really bad enough to need vestibular therapy. So long as my eyes are open I can use visual cues to keep from drifting left/right while walking.

Is it a fair comparison to say that audiology is to ENT as optometry is to ophthalmology - essentially a non-surgical special organ specialist? Like when determining if you're going to refer to ENT vs audiology, should you first ask yourself "does this person potentially need surgery," and if so send to ENT, otherwise audiolgoy?

---

Some of your symptoms sound consistent with Tullio phenomenon, which is a "third window" phenomenon. Any history of head or ear trauma before this began? If it is consistent every time you hear a loud noise, this should be looked into, might need a high resolution CT temporal bone to rule out an inner ear anomaly such as superior semicircular canal dehiscence syndrome. A perilymph fistula is also a possibility, which can occur with a strong Valsalva, strong insufflation of the middle ear, etc. As I said, though, vestibular Meniere's and migraine (which, in my opinion, is vastly underdiagnosed) is also possible. If things persist you might want to see a neurotologist and bring along your previous audiometry to the visit.

The ABR the audiologist recommended, in my opinion, won't really offer a lot. VEMPs might, but again you are just looking at doing vestibular therapy if they are abnormal, for the most part.

With regards to the relationship between audiologists and ENTs, I wouldn't make a comparison of ophthalmologists and optometrists in a strict sense. Audiologists are absolutely critical to ENT practice, but the aren't going to really be great for working up some of the things I mentioned. Keep us posted.

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Yeah, like I said, ENT wasn't particularly concerned when I talked with them. Pretty much just used a regular otoscope to peak in my ears, talked to me about vestibular migraine vs bppv, and how I probably don't have labrynthitis or meniere's.

I haven't done any vigorous valsalva recently. I'm actually really good at valsalva, and I can pretty much pulsate my TMs at will. In fact if I do it frequently on the right (affected ear), I do get a warm, tinlging sensation deep in my inner ear. First time I felt that was about 2 years ago when I was in a dive chamber. Only went down to about 1.5 atm, but at around 1 atm it felt like someone poured some warm fluid in my inner ear. No evidence of barotrauma upon exiting, no pain, nothing. Never felt like I couldn't clear my ears during that "dive."

Is there any urgency to getting a more comprehensive eval?

bigtruckguy3500 said:

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Ag9701 said:

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I would go see an ENT. I wouldn't make that comparison.

---

I did. He didn't seem particularly interested, told me to go see audiology.

Kool said:

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bigtruckguy3500 said:

---

Kool said:

---

Meniere's disease or vestibular migraines are possibilities. Definitely need audiometry if not further testing.

---

Got into see audiology, nothing stood out as abnormal on audiometry/tympanometry. Also did the combination audiometry with bone conduction on one side and ear on the other, not sure what it's called.

She wants to do OVEMP/CVEMP and ABR. Said it probably won't change any management, and she'd probably recommend vestibular therapy regardless. Though I don't think it's really bad enough to need vestibular therapy. So long as my eyes are open I can use visual cues to keep from drifting left/right while walking.

Is it a fair comparison to say that audiology is to ENT as optometry is to ophthalmology - essentially a non-surgical special organ specialist? Like when determining if you're going to refer to ENT vs audiology, should you first ask yourself "does this person potentially need surgery," and if so send to ENT, otherwise audiolgoy?

---

Some of your symptoms sound consistent with Tullio phenomenon, which is a "third window" phenomenon. Any history of head or ear trauma before this began? If it is consistent every time you hear a loud noise, this should be looked into, might need a high resolution CT temporal bone to rule out an inner ear anomaly such as superior semicircular canal dehiscence syndrome. A perilymph fistula is also a possibility, which can occur with a strong Valsalva, strong insufflation of the middle ear, etc. As I said, though, vestibular Meniere's and migraine (which, in my opinion, is vastly underdiagnosed) is also possible. If things persist you might want to see a neurotologist and bring along your previous audiometry to the visit.

The ABR the audiologist recommended, in my opinion, won't really offer a lot. VEMPs might, but again you are just looking at doing vestibular therapy if they are abnormal, for the most part.

With regards to the relationship between audiologists and ENTs, I wouldn't make a comparison of ophthalmologists and optometrists in a strict sense. Audiologists are absolutely critical to ENT practice, but the aren't going to really be great for working up some of the things I mentioned. Keep us posted.

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Yeah, like I said, ENT wasn't particularly concerned when I talked with them. Pretty much just used a regular otoscope to peak in my ears, talked to me about vestibular migraine vs bppv, and how I probably don't have labrynthitis or meniere's.

I haven't done any vigorous valsalva recently. I'm actually really good at valsalva, and I can pretty much pulsate my TMs at will. In fact if I do it frequently on the right (affected ear), I do get a warm, tinlging sensation deep in my inner ear. First time I felt that was about 2 years ago when I was in a dive chamber. Only went down to about 1.5 atm, but at around 1 atm it felt like someone poured some warm fluid in my inner ear. No evidence of barotrauma upon exiting, no pain, nothing. Never felt like I couldn't clear my ears during that "dive."

Is there any urgency to getting a more comprehensive eval?

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BPPV is easily diagnosed by performing a Dix-Hallpike maneuver and looking for or feeling nystagmus, something you can do on your own on the edge of your bed. Your symptoms don't sound very consistent with that. There can be some benefit to getting a VNG performed, which the audiologist would do. IF the VNG showed "central" findings, or if you are particularly worried or bothered by the symptoms, that would move you towards a neurology eval in the former case and imaging in the latter case. Imaging would be an MRI with gadolinium, IAC protocol. Unless, of course, you were trying to diagnose Superior Semicircular Canal Dehiscence Syndrome, in which case a thin cut temporal bone CT would be the imaging of choice.
If the VNG showed peripheral findings, it could indicate vestibular Meniere's disease, or a weak vestibular system that might respond to therapy. Your symptoms may be self-limited, but if they persist I would see a neurotologist (different than a regular ENT, who you've already seen) and press further. Hope that helps.

Yeah, I was pretty sure it wasn't BPPV when it started. I was trying to Dix-Hallpike myself and shaking my head random directions to see if I could reproduce it. I was originally thinking a labrynthitis/vestibular neuritis/Meniere's. But ENT said it's definitely not any of those.

But, symptoms have largely resolved. At least the vestibular component is resolved. The auditory component is still there, but substantially diminished - both in frequency and loudness. Went from something that happened virtually all day to several times a day with certain stimuli, to now rarely during the day. And it is much softer when it happens.

I was going to touch base with audiology and see what they thought, but do you think there's any utility in still getting the OVEMP/CVEMP and ABR? It's 100% free, so not worried about money, but I'm a big fan of getting tests if there's no clinical utility.

Thanks

Short answer -no. ABR offers little to nothing if audiometry is normal, and the EMPs would largely only help target treatment of the vestibular symptoms. If it's getting better, wait it out.

Thanks.