Hearing Loss Help  

by Neil Bauman, Ph.D.

Otosclerosis (OH-toe-sklare-OH-sis) is a condition where spongy bone grows in the middle ear and often “fixes” the stapes (stirrup), the third bone in the middle ear, to the oval window so it can’t vibrate freely. The result is a conductive hearing loss. To correct this condition, an ear specialist performs a surgical procedure called a stapedectomy (stay-pee-DEK-toe-me). He typically removes the fixated stapes and replaces it with a plastic or metal prosthesis.

Now comes the insidious part. IF the prosthesis contains any magnetic metal (iron, nickel, cobalt), then you mustn’t have an MRI or you can totally destroy your life in a heartbeat and never know about it until too late. This actually happened to “Stephanie” (not her real name). Here is her story. She writes:

I came upon your article “Protect Your Balance System—Or Else…” and was so happy to find something that describes me so well.

Five years ago I had a MRI done. I explained to the attendant that I have a wire [the stapes prosthesis] in my inner ear to help with my hearing loss. (I had this surgery back in 1972. I had it looked at again in 1985.) However, in 2004, the hospital did a CT scan and said there was no wire there. I then had the MRI. Immediately upon coming out of the machine, I discovered I had lost my balance. I could not walk. I was nauseated, I could not hear as well, and the noise in my head was unbearable.

To make a long story short, I had to have emergency surgery on my ear to see if any fluid was draining [perilymphatic fistula]. I then had to take physiotherapy for two years for my balance. My eyesight also changed 50%, but has since gone back to the way it was.

After this fiasco, the hospital had another look at my CT scan and they saw the wire but it was too late. Please let people know just how much damage can be done to your body if doctors miss finding this metal prosthesis.

My ENT said the damage to my inner ear was like getting hit in the head with a baseball bat at full speed. (That is what the tiny stapes prosthesis did to my inner ear under the influence of the powerful magnets in the MRI machine.)

I have come a long way in healing but I still have issues. I am still learning everyday about things I cannot do. My first time going to a movie after the MRI was a disaster. I had to keep my head down during most of the movie. I was sick to my stomach, and my head felt like it was spinning. But I did not know this was from the damage caused because of the MRI and having a wire in my head.

I also lost more hearing in my ear. But it is different now than before. I can hear sounds, but I cannot tell where they are coming from. You can be right behind me talking but I do not know where you are. I call out to the person (usually my family) asking where are you. (To them, this is funny but it certainly gets to me at times.)

Also, if two people are talking, I cannot tell what they are saying. I can hear their voices, but the sounds are jumbled together.

If I am talking on the phone and another noise presents itself (like someone asking something of me) I lose the conversation on the phone and I don’t know what the other noise is, or what the person has said. Trying to cope in public—talking to people—is difficult. Ordering a coffee, lunch, etc. with noise around me is very hard. To see the look on the other person’s face, like I am retarded, is hard on me. I usually get my husband, or my girls, to order for me instead. It
makes me want to stay home because it is the only place I am comfortable. Needless, to say, I have not returned to work.

You talk about the emotional side of hearing loss, and until you go through this yourself, it is hard for other people to understand. My family is still trying very hard to understand what I can no longer do.

I can no longer multi-task. I cannot do two things at once. After 5 years, I still see this in my everyday life. For example, I cannot walk down the stairs with something in each hand. I have to put my body against the wall to steady myself and even then it is difficult, and my legs are very shaky. I cannot ride a bike anymore. It was such a shock to me when I first tried. My hands were shaking the handle bars back and forth with such force, that I could not stop. (I keep trying every year, but it is the same every time, and has not improved.) I will never get on a circus ride again in my life.

Walking is interesting. I feel every dip or hump in the road or sidewalk that no one else feels. My body thinks I just stepped down into a two foot hole, or I will not notice when the pavement has gone up and I stumble. I constantly “bump” up against my husband when we are walking together.

When I am in a store shopping, I cannot look at something one way and then turn my head to the other side because I get dizzy and it feels like I am being quickly shoved. This feeling goes away quickly, but if I continue to turn my head side to side, I get “shoved” again. Think how many times you turn your head side to side in a day.

When I stand in the shower, I plant my feet firmly against the sides of the tub, so my hands are free to wash my hair. I can keep my eyes closed a little while now—long enough to rinse the soap out.

And yes, when the lights are out or dimmed, I hold onto furniture, walls, etc. to get around.

You talked about memory and being distracted. I have been telling my husband I don’t “feel smart” like I used to. I have trouble finding words to have a conversation. I have to look at the person talking with such an intense stare, and try as hard as I can to hear and understand and remember what they are saying. It is so hard to understand why I am like this and explain to my doctor, or husband, or family that I feel dumb. I knew there was something wrong, but did not realize it was related to the damage done to my inner ear.

Needless to say I have slowed down in life, which is why I only feel comfortable at home.

Sometimes when I feel “down”, I think my family is better off without me and my problems. I know this is not true, but I can’t help feel like that at times. I have given them a copy of your article and asked them to read it. I think what makes all of this so difficult, is the fact that if you look at me, I look perfectly “normal” but I’m not.

“Stephanie’s” tragic story reveals the enormous life-changing differences that can result from destroying the inner-ear hearing and balance mechanisms in just one ear (and its even worse if it happens in both ears).

Therefore, if you’ve had a stapedectomy where a metal prosthesis was put in your middle ear, do not ever allow an MRI to be done on your body. Some of the prostheses used in stapedectomies are now made of plastic. If that is your situation, having an MRI shouldn’t be a problem, but check with your ear doctor to be sure.

by Neil Bauman, Ph.D.

A lady wrote:

I am a 30 year old female who received my first hearing aid at 8 years old. I had a stapedectomy at age 17. I was told I had congenital fixation of my stapes and bilateral vestibular aqueduct syndrome and some nerve damage. I have a combination of sensorineural and conductive hearing loss. My hearing was pretty stable until pregnancy at which point we have noticed a pattern where during pregnancy it gets worse, then it gets a little better after pregnancy but does not return to the way it was before pregnancy. (There have been four pregnancies). I am wondering if there are any options for me in terms of restoring my hearing, or if I should not have any more children. Is there a possibility that birth control will also affect my hearing? At this point my hearing loss is becoming hard to handle, despite two top of the line hearing aids.

From what you have said, it appears that you have two conditions that can cause hearing loss.

First, you appear to have otosclerosis. The stapedectomy was to try to fix it. Interestingly enough, otosclerosis often first shows up at puberty (hence your need for a stapedectomy at 17), then worsens with each pregnancy (as you have found so far) and has one final crack at the cat at menopause.

Second, it appears you also have Large Vestibular Aqueduct Syndrome (LVAS). I assume by “bilateral vestibular aqueduct syndrome” you really mean large (or enlarged) vestibular aqueduct syndrome (LVAS/EVAS). With LVAS you can lose hearing from atmospheric and other pressure changes. In your case, straining during childbirth could have caused a drop in hearing. Sometimes the hearing comes back, or  partially comes back, in a couple of weeks or so. Again, this might have happened in your case as well although I have never heard of a person having both otosclerosis and LVAS.

Typically, the otosclerosis causes a conductive hearing loss, while LVAS causes a sensorineural hearing loss.

Now to answer your real questions—whether there are any options for you in terms of restoring your hearing, and whether you should have any more children or not.

Often otosclerosis can be helped by surgery (stapedectomy). Sometimes bone eventually overgrows the prosthesis so another surgery may be necessary. I’d talk it over with your ear specialist and see whether having more surgery would likely help restore the conductive component of your hearing.

As for the sensorineural component of your hearing, there is nothing medically doctors can do for you.

On the question of having more children, that is up to you of course. My viewpoint is have as many children as you want in spite of losing more hearing with each pregnancy. You already know that you can cope—not that it is easy—but you can do it.

You also asked, “Is there a possibility that birth control pills will also affect my hearing?”

Good thing you asked this question as it appears not many people seem to know the answer. Any birth control pills containing Estradiol, or any HRT (hormone replacement therapy) pills containing Estriol can definitely harm your hearing if you have otosclerosis. In my book, “Ototoxic Drugs Exposed” I have this warning for both of these drugs. It reads: “Warning—if you have otosclerosis you should not use Estradiol/Estriol if you have a worsening of your otosclerosis, or if your otosclerosis deteriorates during pregnancy as you may experience a further drop in your hearing. If you do decide to take Estradiol/Estriol and have otosclerosis, you should be under close medical supervision. Furthermore, you should weigh the long term benefits against the risks to your hearing.”

Since your hearing loss is “becoming hard to handle, despite two top of the line hearing aids” you may want to investigate whether you are eligible for cochlear implants. They will bypass both your middle ear and inner ear and their various problems. I see that as a viable option for you.