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As an overview, low frequency (or tone) sensorineural hearing loss (LF SNHL or LT SNHL) is unusual, and mainly reported in Meniere's disease as well as related conditions such as low CSF pressure. Le Prell et al (2011) suggested that low frequency hearing loss was detected in 2.7% of normal college student's ears.
Oishi et al (2010) suggested that about half of patients with LTSNHL developed high or flat hearing loss within 10 years of onset. The new international criteria for Meniere's disease require observation of a low-tone SNHL.
Gatland et al (1991) reported fluctuation in hearing at low frequencies with dialysis was common, and suggested there might be treatment induced changes in fluid or electrolyte composition of endolymph (e.g. Although OAE's are generally obliterated in patients with hearing loss > 30 dB, for any mechanism other than neural, this is not always the case in the low-tone SNHL associated with Meniere's disease. The lack of universal correspondence between audios and OAE's in low-tone SNHL in at least some patients with Meniere's, suggests that the mechanism of hearing loss may not always be due to cochlear damage. Of course, in a different clinical context, one might wonder if the patient with the discrepency between OAE and audiogram might be pretending to have hearing loss. Papers are easy to publish about genetic hearing loss conditions, so the literature is somewhat oversupplied with these.
Bespalova et al (2001) reported that low frequency SNHL may be associated with Wolfram syndrome, an autosomal recessive genetic disorder (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness). Bramhall et al (2008) a reported that "the majority of hereditary LFSNHL is associated with heterozygous mutations in the WFS1 gene (wolframin protein). Eckert et al(2013) suggested that cerebral white matter hyperintensities predict low frequency hearing in older adults. Fukaya et al (1991) suggested that LFSN can be due to microinfarcts in the brainstem during surgery. Ito et al (1998) suggested that bilateral low-frequency SNHL suggested vertebrobasilar insufficiency. Yurtsever et al (2015) reported low and mid-frequency hearing loss in a single patient with Susac syndrome.
There are an immense number of reports of LTSNHL after spinal anesthesia and related conditions with low CSF pressure.
Fog et al (1990) reported low frequency hearing loss in patients undergoing spinal anesthesia where a larger needle was used. Waisted et al (1991) suggested that LFSNHL after spinal anesthesia was due to low perilymph pressure.


Wang et al reported hearing reduction after prostate surgery with spinal anesthesia (1987). We have encountered a patient, about 50 years old, with a low-tone sensorineural hearing loss that occured in the context of a herpes zoster infection (Ramsay-Hunt). LTSNHL is generally viewed as either a variant of Meniere's disease or a variant of sudden hearing loss, and the same medications are used.
Frequency: The sound frequency or pitch (measured in Hertz) is plotted on the X (horizontal) axis. Intensity: The sound Intensity or loudness (measured in decibels) is plotted on the Y (vertical) axis.
The softest sound a person hears 50% of the times, at each frequency is his Hearing Threshold at that frequency. The difference between the air conduction thresholds of the right and left ear is more than 40db.
By comparing the air conduction and bone conduction thresholds, we can determine if the hearing loss is conductive, sensorineural or mixed. The audiogram shows normal bone conduction thresholds while the air conduction thresholds show a hearing loss greater than 20db (remember 0- 20 db is normal range). Examples: Wax, glue ear, otitis media, perforation of the tympanic membrane, or ossicular abnormalities. Both the air and bone conduction thresholds are above 20db but the difference between the air and bone conduction threshold is more than 10db. Fig 6: Mixed hearing loss with a conductive loss of 50db at 250hz and 1K, 45 at 500hz and 2k, 65db at 4k and 75db at 8k. Type B: Is a flat, horizontal trace, indicating fluid in the middle ear (in the presence of normal ear canal Volume).
The authors of this document have attempted to provide information that is medically sound and up-to-date. It shows her in action doing roller derby and encourages others dealing with hearing loss to not let their disability stop them from enjoying life. Fixers is a project of the Public Service Broadcasting Trust, funded by the National Lottery through the Big Lottery Fund, and featured on ITV.
To us, this seems a little overly stringent, compared to the earlier 1995 AAO criteria that just required any kind of hearing loss, but criteria are better than no criteria.
That being said, genetic conditions should not be your first thought when you encounter a patient with LTSNHL.


One would think that diabetes insipidus is so rare that hearing loss is probably not the main reason these individuals are seeking attention.
These patients are extremely rare because there isn't much microsurgery done close to the brainstem. We are dubious about the conclusion of this paper because it is different than nearly every other paper in the literature. We are dubious that this has any applicability to humans and we have never seen a patient with lithium toxicity with any LFSNHL. We have observed this occasionally ourselves, but of course, the usual pattern is a conductive hyperacusis. We find this somewhat plausible as pregnancy and delivery might be associated with spinal anesthesia, with changes in collagen, and with gigantic changes in hormonal status.
It is the softest sound that a person with normal hearing would be able to hear at least 50% of the times. It is done to prevent nontest ear from detecting the sound presented to the test ear by crossover.
The compliance (inverse of stiffness) of the tympano-ossicular system is charted against various pressure changes. There is a large literature about genetic causes, mainly in Wolfram's syndrome ( diabetes insipidus, diabetes mellitus, optic atrophy, and deafness), probably because it is relatively easier to publish articles about genetic problems.
He defined LTSNH as that the sum of the three low frequencies (125, 250, 500) was more than 100 dB, and the sum of the 3 high frequencies (2, 4, 8) was less than 60 dB.
In other words, Wolfram's is probably not diagnosed mainly by ENT's or audiologists, but rather by renal medicine doctors, as DI is exceedingly rare, while LTSNHL is not so rare in hearing tests.
That being said, it is very rare to encounter any substantial change in hearing after pregnancy. Roughly speaking, the frequency patterns of hearing loss are divided up into: Low-frequency, mid-frequency, high-frequency, notches, and flat.



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