How can I manage my Sudden Sensorineural Hearing Loss (SSNHL) and tinnitus, especially with fibromyalgia, and what if tinnitus affects my Pure Tone Audiometry (PTA) results?

Managing SSNHL-Related Tinnitus and Audiometric Testing Concerns

Tinnitus Management

Your tinnitus is nearly universal with SSNHL and will likely improve if your hearing recovers, but if it persists, specific management strategies including sound amplification, counseling, and potentially cochlear implantation for severe cases should be pursued. 1

Understanding Your Tinnitus Pattern

• The tinnitus you're experiencing is present in nearly all SSNHL cases and represents a significant psychological and functional burden that may equal or exceed the impact of the hearing loss itself 1
• Your observation that tinnitus worsens at end of day with fibromyalgia is consistent with nerve sensitivity patterns, though this specific interaction isn't addressed in SSNHL guidelines 1
• Recovery of hearing after SSNHL is often accompanied by improvement of the associated tinnitus, so your current treatment focus should remain on hearing recovery 1, 2

Active Tinnitus Management Strategies

Continue using your sound-amplifying stethoscope and consider formal hearing amplification immediately, as 86% of patients with unilateral SSNHL report hearing handicap that amplification can address. 2

• Amplification devices serve dual purposes: they improve hearing AND provide tinnitus masking by restoring auditory input 2
• For your single-sided deafness, CROS (contralateral routing of signal) hearing aids transmit sound from your affected ear to your better ear 2
• If you have any preexisting hearing loss in your better ear, BiCROS hearing aids would be more appropriate 2
• Cochlear implantation is appropriate for severe to profound unrecovered SSNHL, especially with associated tinnitus, with 96% of patients reporting tinnitus improvement 2

Specific Counseling and Support

• You should be assessed using validated tools like the Hearing Handicap Inventory for the Elderly (HHIE) to quantify the impact of both hearing loss and tinnitus 2
• Connect with support groups such as the Hearing Loss Association of America for peer support and practical management strategies 2
• Address safety concerns related to impaired sound localization, including difficulty determining sound origin in your work environment 2

Pure Tone Audiometry (PTA) Concerns

Tinnitus will not invalidate your PTA results—audiometry remains the gold standard for documenting your hearing status and should be performed regardless of tinnitus severity. 1, 3

Why PTA Must Be Done Despite Tinnitus

• You cannot accurately self-assess your hearing recovery without objective audiometry, regardless of what you perceive 3
• PTA is required to confirm diagnosis, establish baseline within 14 days of symptom onset, and document treatment response 3
• The presence of tinnitus does not preclude accurate audiometric testing—audiologists routinely test patients with severe tinnitus 1

Your Testing Timeline

• Initial audiometry should occur within 14 days of symptom onset (which appears to have been done) 3
• Repeat audiometry at 10-14 days from treatment onset to assess response, with improvement defined as ≥10 dB improvement in pure tone average or ≥10% improvement in word recognition score 3
• Final audiometric assessment must occur at 6 months post-treatment, regardless of perceived recovery, to document final outcome and screen for retrocochlear pathology 3

Recovery Expectations

• If you recover ≥50% of hearing loss within the first 2 weeks, you have a better prognosis for final outcome 3
• The majority (54.5%) of patients who ultimately recover achieve improvement within the first 10 days of treatment 3
• However, 45.5% of recoverers show continued improvement between 10 days and 1 month, so don't assume all recovery occurs immediately 3
• Extremely rare cases (1.7%) may show delayed recovery between 3-8 months, emphasizing the need for extended monitoring 3

Tinnitus-Specific Prognosis

• Tinnitus severity is not related to the degree of hearing loss, so severe tinnitus doesn't necessarily predict worse hearing outcomes 4
• However, recovery from severe hearing loss is associated with poorer tinnitus prognosis, meaning if your hearing improves significantly, the tinnitus may persist 4
• Successful treatment of hearing loss can ameliorate tinnitus, but residual tinnitus may persist even with hearing recovery 4

Your Work Adaptations

Your use of a sound-amplifying stethoscope is an appropriate accommodation and represents early adoption of amplification principles that should be formalized with proper hearing devices. 2

• Your observation about possibly hearing flat tones on the affected ear with amplification suggests some residual cochlear function that could benefit from formal amplification 2
• Your natural body positioning to favor your better ear is a compensatory strategy, but proper amplification would reduce this need and improve bilateral hearing in noisy environments like restaurants 1, 2