Expert: Harriet B Jacobster, Au.D. - 7/25/2008

Question
QUESTION: Since October 2006 I have been suffering from tinnitus and hearing distortion.The distortion is unbearable, particularly in my right ear. I am aware of an extra "clash" of sound accompanying almost all notes on the piano apart from the top octave and a half. My own speaking and singing voice "booms" in my head. The only way I can hear the piano's normal sound is by wearing foam barrel earplugs. Another way is by using valsalva technique. When air is entering the ear in this way I can hear the notes perfectly. However, teaching ( I teach voice and piano )is very difficult and accompanying has obviously become impossible. I have had FESS surgery and insertion of grommets in May 2007. My hearing was clearer after this, although I had not realised it was impaired. An audiogram has revealed that I have some hearing loss over 6 khz .This is the only kind of test I have had. I am 57. Specialists are giving varying opinions. One says my problems are catarrhal in origin; another that the problem lies in the inner ear and nothing can be done.This opinion came as devastating news to me as music is my life. I value your expert opinion and hope that I have included sufficient information for you to come to a conclusion. Thank you. Brenda

ANSWER: Hi Brenda,
Yes, I understand how unsettling it can be for a musician to have hearing problems.  From the information you ahve provided me, it seems as if you have two separate problems. One appears to be a Eustachian Tube Dysfunction (ETD) which causes the booming.  Especially since you claim that the valsalva helps, it points to ETD. ETD is usually caused by allergies or repeated inflammation of the mucous membranes and the standard treatment is grommets, or tubes. Next, the high frequency loss is most likely from the inner ear or beyond.  Unfortunately, musicians are at high risk for hearing loss because of their constant exposure to louder than average sounds.  At this point, my suggestion is that you seek an experience audiologist who can look over your audiogram and make recommendations for possible amplification.  I am also providing you with a great website where you will be able to connect with other musicians with hearing problems who can offer both great insight and support: Association of Adult Musicians with Hearing Loss:  http://www.aamhl.org/joomla10/
Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology

---------- FOLLOW-UP ----------

QUESTION: Is there a possibility that the slight hearing loss which has shown up on my audiogram could cause distortion and booming ? It is not enough to warrant amplification at this stage. I have no problems with actual hearing in my work or any other part of my life: it's just the distortion. I would just like to know, if possible, if I can solve the ETD , will the distortion disappear ? What are the tests for eustachian tubes so that I can ask for them ? So far I have only had audiograms.f

Answer
Hi Brenda,
Although even a slight hearing loss can cause some distortion, from your description it sounds as though your problem stems from ETD. There is a very simple test for ETD that any audiologist should be able to perform.  It consists of measuring middle ear pressure both before and after swallowing and comparing the pressure peaks.  Negative pressure should change to less negative after the swallow.  If there is no change, then the ET is not functioning properly.
Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology