What's wrong with my ear?

Factual Questions
1

What’s wrong with my ear? Suggested diagnoses, please?

This weird hearing problem in my right ear has been driving me nuts for at least a year! I’m hoping some knowledgeable person might be able to steer me towards some diagnostic hints; something which my doctors haven’t been very forthcoming.
Okay, this is what’s going on…

When sounds – particularly music – reach a certain loudness threshold (a little below the level of normal conversation), my right ear sort of “rumbles” in a 1/2 to 3/4 second-delayed “echo” to the incoming sound. This echo is as much felt as heard, feeling like pressure waves akin those coming from a bass drum. I hear sounds quieter than that threshold perfectly. I generally don’t notice it with voices alone, but even rather quiet music – even just soft background solo piano – will always set it off with no exceptions.

This echo is ONLY in my right ear and is monotonic: no matter what the source frequency or loudness, the rumble-echo is always of a fixed frequency and loudness range. To get an idea of what this sounds like, imagine white noise with the frequencies below about 100 Hz and above a few kilohertz removed. The loudness of this echo-rumble is somewhat below conversational level and does not drown out the sound – rather, it adds to the source sounds.

Below that source loudness threshold, my hearing is clear, artifact-free and quite good. It’s by far most noticeable with music, possibly because words have a generally unpredictable pattern and thus the echo isn’t nearly as psychoacoustically obvious. But since music is one of the few things that makes life truly worthwhile (as Nietzsche famously aphorized, “Without music, life would be a mistake”), I find this rumble-echo is an intolerable curse!

I’ve carefully protected my ears and my hearing all my life, so whatever I’m experiencing is not a result of damage from excessive sound levels. I once worked right next to the San Diego airport for several years, and I paid no mind to the people who thought I was ridiculous because I wore ear plugs to and from the car. When I attend concerts, if they over-amplify the music (which is usually the case), I either wear ear plugs or leave. I just love music too much to fail to protect my ears.
Let me make clear that my otolaryngologist has told me several things:

(1) This is definitely NOT tinnitus! (I never hear the problem in a quiet environment).

(2) It’s also not a symptom of hearing loss (my audiograms are excellent in both ears, particularly for a man in his 40’s).

(3) My stapedial functioning appears to be fine.

(4) This is NOT Meniere’s Disease: I’m never dizzy, have no balance problems, no numbness, have no hearing loss, and have no ringing, buzzing, or humming in the ear(s) except under the special circumstances as described above.

(5) It is NOT otitis axterna or related infection.

(6) It’s NOT hyperacusis.

(7) It’s NOT presbycusis.

(8) I have no pain or drainage or what have you.

(9) There’s no indication that it could be an acoustic neuroma, although if no other suggestions are forthcoming, this looks like this is the only option left for me to vigorously pursue (no MRI done yet).

Now, the doctors have muttered about “recruitment”, but that’s absurd (isn’t it?) Recruitment is a medical term which refers to a symptom in which one’s inner ear hair cells are somehow “recruited” to respond preferentially only to certain frequencies. It occurs in those people with significant and generally increasing hearing loss coupled with a seriously curtailed dynamic range response. Below a certain threshold (about 40 db), they hear almost nothing. But above that threshold, sounds suddenly become over-loud and annoying to them.

But there’s no echo involved in recruitment! Furthermore, I am not losing my hearing at all; it’s excellent! So recruitment is definitely out as far as what I’m experiencing, just as is hearing loss, tinnitus, and stapedial reflex problems.

I’m not taking any ototoxic drugs, with the remote possibility of the 80 mg aspirin I take every day. My caffeine intake is fairly low (1 can of Coke per day, no coffee or tea). I’m not taking any antibiotics or diuretics, nor anything else known to be associated with ototoxicity. I have just recently been diagnosed with hypothyroidism, and have started taking Levoxyl 50 mcg daily for it. But keep in mind I’ve been having this ear problem for more than a year, and my doctor doesn’t think I had hypothyroidism until recently (for whatever that’s worth).

So does any medical maven out there have any suggestions as to possible diagnoses that I should investigate and encourage my doctor to investigate?
Thanks sincerely to all those who kindly take the time and trouble to give this a shot…

2

No clue, sorry, but I’ll bump this from Page 2 for ya.

3

so is there anything that happened about a year ago, something that links to the condition, something you began doing, stopped doing, emotional stuff, change or whatever sort…?

4

I am not a medical doctor, but I am an audiologist, so I’ll try taking a whack at this OP.

I seriously doubt that this is related to an acoustic neuroma. Due to the tonotopic arrangement of the auditory nerve, acoustic neuromas almost invariably affect high frequency perception first. What you’re describing does not jibe with any description of symptoms associated with acoustic neuromas.

In your OP, you’ve ruled out just about every other possibility that I would have suggested. I do have a question or two:

You mentioned that you have had your hearing tested. How recently has it been tested? I’m particularly interested in knowing if it has been tested since the symptoms began.

The type of sound you describe is a type of tinnitus. Not all tinnitus is high frequency in nature. The tinnitus associated with conditions such as Meniere’s disease tend to be low-frequency, a kind of “rumbling” sound, or like the sound of water rushing.

This kind of low-frequency tinnitus is often associated with some type of disruption of the fluids within the cochlea. Since you have already ruled out Meniere’s, I would think of labyrinthitis or endolymphatic hydrops as a possibility. While endolymphatic hydrops is strongly associated with Meniere’s, not all cases of endolymphatic hydrops are necessarily Meniere’s.

Which brings to me to my next question: is your diet high in sodium? A diet high in sodium or salt can affect the amount of fluid in the cochlea (and vestibular system). Since this problem is only affecting your right ear, this possibility isn’t the strongest one, but it may be worth exploring.

I hope this helps. And if you haven’t already consulted an otolaryngologist/otologist, I’d suggest that such a specialist be the next person you talk to.

5

Thanks, oh gracious fowl!

As a result, I’ve recieved additional replies. Thanks again!

6

Nothing that was noticeable to me or made any impression. I’ve also checked my pharmacy records and they don’t show that I started anything new or stopped taking anything for a fairly long stretch of time (at least six months on either side). And even on a longer time scale, there was nothing particularly significant except for a bad reaction to my first dose or Celexa about 3 years ago (which I stopped taking immediately).

Of course, the fact that I can’t recall anything significant around that time doesn’t necessarily mean that nothing happened, and someday a stray memory might someday pop up and give me a vital clue.

Thanks, bardos for wading through my OP and taking an interest. I’m grateful.

7

I’m delighted by your response, Atreyu!

But I have to run; I’ll reply later. I just wanted to thank you for now…

8

That’s great! I really wanted to solicit some insights from an audiologist, so I offer my fond thanks for your time.

That’s excellent news! I wasn’t looking forward to having a tumor removed (which is what I understand is the standard treatment.)

My hearing was tested at the otolaryngologist’s just over three weeks ago (the symptoms started approximately one year ago). Both he and one of his colleagues stated that the audiogram from the traditional quiet-room tonal test was remarkably good – especially for a man in his 40’s – with just a small dip at the highest frequency range tested in my right ear only (I think it may have been about 2db, but they failed to give me any significant details or explanation of anything they did). The other types of hearing tests they performed were apparently flawless.

For what it’s worth, during the standard tonal testing nearly all the tones were quite faint and hard for me to hear; I’m not sure how the perception of amplitude is tested – or even involved.

But what my GP and otolaryngologist told me is that with (non-transient) tinnitus, one or another of the associated sounds are always heard, particularly when there’s little or no ambient sound! That doesn’t describe my case at all, since I hear absolutely no such sounds or artifacts until I hear music at a moderate level. All of my investigations into tinnitus have told me that if I don’t hear it during ambient quiet, I don’t have tinnitus. Is this mistaken? Can you guide me to any resources which describe cases of tinnitus in which it’s never heard at all until conversational-level sound is heard?

Well, I don’t think it is, but of course that one’s a bit difficult to answer since sodium seems to be just about everywhere. But I don’t eat much junk food at all, I drink mostly water, and for the last 15 years or so – simply on my own volition (rather than it being suggested by a physician) – I’ve always used potassium chloride salt substitutes instead of regular salt when adding flavoring, in hopes of avoiding high blood pressure (it didn’t work). In fact, I wonder if perhaps my diet is too high in potassium?

Finally, I’ve begun to wonder if perhaps this phenomenon might be related somehow to amplification distortion. Though it’s difficult to be sure about this because of the small sample and the nature of the instrument, the effect seemed much less noticeable this past weekend when I heard live acoustic guitar being played. For what it’s worth, it is most noticeable when watching TV.

Thanks again for contributing your thoughts, and I will happily investigate your suggestions…

I’m still hoping to hear more, but I seem to have either bored my fellow dopers beyond caring, or the peculiarities of this condition have stumped them!