Echo Sensation in Recovering SSNHL
The echo sensation you're experiencing is most likely autophony—a phenomenon where you hear your own voice or internal sounds abnormally loudly in the affected ear—which commonly occurs during the recovery phase of SSNHL as hearing partially returns but the ear's normal acoustic mechanics remain disrupted.
Understanding Your Recovery Pattern
Your hearing improvement from >120 dB to 85 dB represents significant recovery, which is encouraging given the severity of your initial loss 1, 2. The decreasing tinnitus and emergence of this echo sensation are actually positive signs that your auditory system is beginning to recover 1.
Why the Echo Occurs
Primary Mechanism: Autophony During Recovery
Partial hearing restoration creates acoustic imbalance: As your cochlear function partially recovers, you regain some ability to perceive sound, but the ear's normal sound processing and dampening mechanisms remain impaired 1, 2.
Middle ear fluid or inflammation: The intratympanic steroid injections you received (4 shots) can cause temporary middle ear effusion or inflammation, which alters how sound resonates in your ear canal and middle ear space 1.
Eustachian tube dysfunction: Post-injection inflammation or the healing tympanic membrane (from the 4 needle punctures) can cause temporary Eustachian tube dysfunction, leading to pressure changes that create echo-like sensations 1.
Secondary Considerations
Tympanic membrane healing: With 4 IT injections, your eardrum has been punctured multiple times and is in various stages of healing, which can create abnormal acoustic properties temporarily 1.
Perilymph concentration changes: The high-dose steroids (both IT and systemic 60mg prednisone) alter inner ear fluid dynamics, which can affect how sound waves travel through your cochlea 1.
What This Means Clinically
Positive Prognostic Indicators
Your 35 dB improvement (>120 dB to 85 dB) places you in the "significant recovery" category, which occurred in 32-47% of patients in salvage therapy studies 1.
Decreasing tinnitus correlates with continued recovery: This suggests ongoing resolution of cochlear inflammation 1, 2.
The echo sensation emerging during recovery is common and typically resolves as the ear continues to heal over weeks to months 1.
Expected Timeline
Tympanic membrane healing: Should be complete within 2-4 weeks after your last IT injection 1.
Middle ear fluid resolution: Typically resolves within 2-6 weeks post-treatment 1.
Continued hearing improvement: Can occur up to 3 months after treatment initiation, with most improvement in the first 2 months 1.
Management Recommendations
Immediate Actions
Follow-up audiogram: Should be performed now (after completing treatment) and again at 1.5-3 months to document continued recovery 1.
Tympanic membrane inspection: Your ENT should verify that all injection sites have healed properly and there's no persistent perforation 1.
Tympanometry: Can identify middle ear fluid or Eustachian tube dysfunction contributing to the echo sensation 1.
Monitoring for Complications
Persistent perforation risk: Rare (occurs in <5% of cases) but should be ruled out if echo persists beyond 4-6 weeks 1.
Watch for signs of infection: Pain, drainage, or worsening symptoms would require immediate evaluation 1.
Common Pitfalls to Avoid
Don't assume the echo means treatment failure: This sensation during recovery is normal and doesn't indicate worsening hearing loss 1, 2.
Don't pursue additional aggressive treatment at this stage: You've already received appropriate salvage therapy (4 IT injections plus systemic steroids), and further intervention is unlikely to help and may cause harm 1.
Don't ignore persistent symptoms beyond 6-8 weeks: If the echo sensation doesn't improve by then, reassessment for other causes (persistent perforation, middle ear pathology) is warranted 1.
Bottom Line
The echo sensation is an expected part of your recovery process and should gradually resolve over the next 4-8 weeks as your tympanic membrane fully heals, any middle ear fluid resolves, and your auditory system continues to recover 1. Your significant hearing improvement and decreasing tinnitus are encouraging signs that you're on a positive recovery trajectory 1, 2.