Audiology Report Analysis

1. Tympanometry (226 Hz probe tone, 400 daPa/s)

• Both ears show Type As (shallow A) tympanograms - the peak is present (ruling out fluid/effusion), but compliance is slightly reduced compared to typical Type A. The audiologist has correctly labelled this "B/L 'As' Type Tympanogram."
• Type As is classically associated with increased stiffness of the ossicular chain (e.g., early otosclerosis) or a slightly stiffened tympanic membrane, but it does not indicate active middle ear disease or effusion.
• MEMRs (Middle Ear Muscle Reflexes) are present - this is a reassuring finding, indicating the stapedial reflex arc is intact.
• No indication of conductive pathology is confirmed by the audiologist.

2. Pure Tone Audiometry (PTA)

Right Ear - Air Conduction (AC) Thresholds (dB HL):

Right Ear - Bone Conduction (BC) Thresholds (dB HL):

Left Ear - Air Conduction (AC) Thresholds (dB HL):

Left Ear - Bone Conduction (BC) Thresholds (dB HL):

Key Audiometric Findings:

• Right ear: Mild high-frequency dip, worsening progressively from 2k to 8k Hz (25 to 50 dB). AC and BC thresholds track closely together, meaning no significant air-bone gap - this pattern is consistent with sensorineural (inner ear/nerve) involvement rather than conductive loss.
• Left ear: Thresholds are largely within or near normal limits across frequencies. The pattern is flat and well within the 0-25 dB normal range at most tested frequencies.
• Air-bone gaps are minimal in both ears, confirming the audiologist's finding of no conductive pathology.

3. Session Diagnosis Summary

Clinical Significance & Recommendations

1. ENT Consultation - warranted because:
   • The right ear shows a high-frequency sensorineural pattern (worsening at 2k-8k Hz), which needs further investigation to identify any underlying cause (e.g., noise-induced hearing loss, early age-related change, or other cochlear pathology).
   • The Type As tympanogram bilaterally, while not acutely pathological, should be correlated clinically by ENT to rule out early ossicular stiffening.
2. Follow up SOS (as needed) - appropriate given the borderline/minimal findings. Active monitoring is the right approach at this stage.
3. No hearing aids required at this time - thresholds are within minimal-to-normal range and do not meet criteria for amplification.

• Cummings Otolaryngology Head and Neck Surgery (tympanogram type interpretation and audiogram analysis)

Betahistine (Letapin-16) - Is It Appropriate for This Patient?

What the Medicine Is

• Improving microvascular circulation in the stria vascularis of the cochlea (inner ear blood supply)
• Reducing endolymphatic pressure
• Inhibiting activity of the vestibular nuclei (balance centres in the brain)

What Betahistine Is Prescribed For

• Meniere's disease - the main licensed indication (episodic vertigo + tinnitus + fluctuating hearing loss)
• Vestibular vertigo - dizziness/spinning sensation from inner ear dysfunction
• Tinnitus - ringing in the ears (though evidence is limited)
• Inner ear-related hearing fluctuation

Does It Match This Patient's Audiological Findings?

• Dizziness or vertigo episodes
• Tinnitus (ringing/buzzing in the ear)
• A sense of ear fullness
• Possible early/suspected Meniere's disease or vestibular hydrops

Is the Prescription Appropriate?

"There is insufficient evidence from high quality randomized trials to say whether or not betahistine has any effect on Menière's. It may reduce vertigo, and possibly tinnitus, but does not seem to influence the hearing loss itself."

• Scott-Brown's Otorhinolaryngology Head & Neck Surgery

• For vertigo/tinnitus - betahistine can help
• For the hearing loss itself - it will not reverse or improve the audiometric thresholds
• Standard dose is 16 mg three times a day (which matches the pack prescribed)

Key Precautions to Know

Bottom Line

• Scott-Brown's Otorhinolaryngology Head & Neck Surgery, Vol. 1 - Betahistine pharmacology section

That Symptom Is a Classic Sign - Here Is What It Means

The Specific Symptom Explained

• You increase external pressure against the eardrum
• This mechanically counteracts the open tube effect
• Sound temporarily normalises - which is exactly what you describe

How This Fits the Audiogram

Other Symptoms of Patulous Eustachian Tube to Watch For

• Autophony - your own voice sounds abnormally loud or hollow in that ear (like talking in a barrel)
• Hearing your own breathing in the ear
• Aural fullness that worsens when upright and improves when lying down or bending forward (because bending forward creates venous engorgement that naturally closes the tube)
• Symptoms that fluctuate through the day
• Worsening with exercise, dehydration, or weight loss

What Causes the Eustachian Tube to Stay Open?

• Weight loss (the fatty tissue around the tube reduces, leaving it slack)
• Dehydration (reduced tissue turgor)
• Hormonal changes (pregnancy, oral contraceptives)
• Nasal decongestant overuse - these shrink nasal tissue and can also shrink the tube lining
• Excess caffeine intake
• Chronic stress or fatigue

Does Betahistine Help This Specifically?

Important Reassurance

"Aural fullness may be more bothersome in patients with patulous Eustachian tube... symptoms may be alleviated by maneuvers that close the tube, such as bending over, which creates venous engorgement of the tissues of the tubal orifice."

• Shambaugh Surgery of the Ear

"Most patients with patulous eustachian tube dysfunction can be managed conservatively, beginning with limiting decongestants and caffeine, increasing hydration, and using topical mucosal irritants such as hypertonic saline."

• Cummings Otolaryngology Head and Neck Surgery

Why You Should Continue the Medication

What You Should Actually Do

The Key Point

The 3 Things That Will Actually Help the Blocked Feeling

1. Drink significantly more water today - dehydration is the #1 trigger for patulous Eustachian tube symptoms
2. Stop or reduce coffee/tea - even one or two cups a day can aggravate this
3. When the ear feels blocked - bend forward (put your head between your knees for 10-15 seconds) - this naturally closes the tube and gives quick relief

One Clear Rule

Never stop a prescription medicine without telling your doctor first.