Expert: Harriet B Jacobster, Au.D. - 3/7/2009

Question
Hi!!  I had a bad sinus cold about a month ago and a few days later my ears felt stopped up. I then went to a family medicine doctor who prescribed a strong antibiotic in a blister pak for the head cold symptoms and also some ear drops (4 drops in affected ears 3 or 4 times a day for 7 to 10 days) Soon my head cold cleared up.  But I continued taking the ear drops for 12 days or more (I was allowed to "refill" once.) This was because, although my right ear cleared up, my left ear did not.  This past Wednesday 3/4/09, I went to see an ENT.  After looking into my ears, he said I did not have an outer ear infection and the ear drops were of no value. He agreed that, from the battery of hearing tests I took in his office, the right ear seemed "ok".  However, he said my left ear had sustained nerve damage in the inner ear and that was why I was continuing to have the "ringing" or other symptoms like "swimmer's ear", etc.  The hearing tests revealed an approximate 60% hearing loss in my left ear.  He started me on Valtrex that same day for inner ear viral infection.  He also wanted to put me on a "steroid" (didn't say name) but declined to prescribe it because my blood pressure is a little high and I'm taking Lisinopril-40 mg one tablet daily.  He said the prognosis often given in these situations is the "Rule of Thirds"----1] might clear up completely     2] might have some improvement     3] present nerve damage with hearing loss and "ringing" will be permanent.  He said he wished I could have come to see him sooner because he said the best results are forthcoming when treatment is within a couple of weeks.  He noted that I said the blockage and deafness in my ear had been going on for 3 weeks and possibly close to a month.  He said that, frankly, there is not a high degree of success after two weeks or so and that this hearing loss in my left ear could very well be permanent. He scheduled another appointment for me in two weeks for another battery of tests and evaluation.

I guess my questions are:

1]  Is there any type of "steroid" available to supplement the Valtrex that I could take that would be suitable given the fact that I am taking blood pressure medicine??????

2]  Would the "ear drops" I was mistakenly taking [Sorry, don't remember the name of the medication] likely have contributed to the nerve damage in my inner ear????????

3] What about what ENT said about the need for treatment to start within two-weeks of first symptoms?  How important, in your judgment, is that????????????  My treatment with Valtrex has started 3 weeks or more after first symptoms.

3] In your judgment, are the prospects really that dismal for recovery of some hearing and disappearance of symptoms described above???????????    

It seemed to me that ENT was basing most of his bleak prognosis on the fact that I had delayed too long in arriving at ENT for diagnosis and treatment.]  

I know this has been "wordy".  I just hope I have described things in a way that you can understand my present condition and concerns.  I will look forward to receiving your comments and observations.

Eric

Answer
Hi Eric,
This may not be what you want to hear, but I agree totally with the ENT's assessment.  The greatest prognosis for inner ear damage due to viral inflammation is when treatment is initiated within the first 24-48 hours, maybe a week.  The longer you wait, the less the chance of recovery, either full or even partial.  

As for a steroid for you to take, that is not my area of expertise and you would have to go with your ENT's recommendation on that.

There are some ear drops that when taken for too long a time can have some ototoxic effects, mainly those that contain a myacin-type drug.  However, this is a remote possibility and, based on your symptoms and history, your inner ear damage is more likely due to the virus from your sinus cold traveling to the inner ear. This is not uncommon.

So, in short, I do agree with your ENT's assessment all around.  I will tell you tho, that in my experience I have seen a few patients recover a considerable amount of hearing even after a year...HOWEVER, these are exceptions.  So, although it does seem bleak, do not totally give up hope.  The best thing to do is try to keep yourself as healthy as possible now and build up your immune system if you can and that may help a bit.

Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology