Ears and Hearing

 

 

Ear problems affect people of any age and can impact our ability to communicate and function affectively. Our team of physicians and the highly-trained audiologists of the Central Texas ENT work together to deliver the most state-of-the-art diagnostic and treatment options to our patients. Central Texas Ear, Nose & Throat Specialists is dedicated to maintaining the health of your ears, from pediatric ear infections to age-related hearing loss. We’re here to help.

A sudden loss of hearing is considered an ENT emergency. The most important part of the treatment is to be evaluated by an ENT specialist as soon as possible. The ear must be examined and an audiogram must be performed in order to determine the cause of the sudden change in hearing.

otitis

   Otitis Externa (Swimmers Ear)

is an infection involving the skin of the external ear canal. This is different from otitis media, or middle ear infection, in which the infection is behind the eardrum. Otitis externa leads to swelling of the ear canal skin and is frequently associated with severe pain as well as ear blockage. It usually leads to severe tenderness of the ear canal, which can be detected by pulling on the earlobe.

Prevention: The most important steps to prevent otitis externa include keeping ears dry and avoiding the use of Q-tips. For individuals, such as swimmers, evaporating moisture from the ear canal after swimming by placing alcohol drops, or using a hair dryer to dry the ear canal, can decrease the frequency of infections.

Treatment: Physical examination by the physician reveals a tender, swollen ear canal, frequently filled with infected debris. Commonly, the ear canal may be entirely swollen shut.  The mainstay of treatment for otitis externa is topical antibiotic drops placed in the ear canal. (After an infection has started, alcohol drops are not effective, and will only cause burning and pain) The ear doctor may need to clean infected debris from the ear canal to speed healing. Also, if the ear canal is too swollen to allow drops to be placed, your doctor may need to place a small sponge, or wick, in the ear canal to draw the drops past the obstruction. Oral antibiotics may be necessary for particularly severe infections.

   Otitis Media (Middle Ear Infection)

is an infection of the middle ear space. This condition occurs very frequently in children and less commonly in adults. The otitis media typically results from Eustachian tube dysfunction, which leads to blockage of the natural drainage pathway from the ear to the back of the nasal airway. Eustachian tube dysfunction is very common in children, and is likely worsened by viral infections such as the common cold and possibly nasal allergies.  The otitis media typically occurs in phases. The initial inflammatory infection is called acute otitis media, and can cause pain and hearing loss. Once the acute inflammation has subsided, the middle ear fluid may drain in a short time, or the fluid may be retained, leading to otitis media with effusion. This fluid collection can remain for several months in some cases, but does not typically cause pain. This condition can cause significant conductive hearing loss.

Treatment: Most cases of acute otitis media resolve without antibiotic treatment, but some require antibiotic treatment and analgesics. Rare cases can progress to more serious infections of the mastoid or brain. Surgical drainage may be considered if there is prolonged duration of hearing loss. Ventilation tubes can be placed for recurrent or prolonged cases.

Myringotomy and tube placement: In adults, the ventilation tube can typically be placed in the office under local anesthesia. In children, the procedure is performed as an outpatient surgery that takes a few minutes. The surgery is performed through the ear canal. The ventilation tube provides a secondary path of middle ear ventilation that helps the middle ear stay clear of retained fluids. It is the most effective method of keeping fluid from accumulating in the middle ear.

   Dizziness

is a condition in which the patient’s ability to orient him or herself in space is altered. This condition can lead to symptoms of vertigo (spinning or abnormal sense of motion), imbalance, or sense of lightheadedness. This can occur as a result of inner ear, brain or a combination of these and other disorders. At Central Texas Ear, Nose & Throat Specialists our team of physicians and audiologists work together to bring you the best possible solutions for your balance problems. There are four different types/causes.

  • Benign Paroxysmal Postional Vertigo: BPPV is the most common cause of vertigo or dizziness. Symptoms consist of brief episodes of spinning lasting less than 30 seconds that occur when an individual lies down in bed, sits up from bed, rolls over in bed, or tilts the head forward or backward. If the condition is not resolving spontaneously, treatment can include a procedure to reposition the otoliths within the ear, called an Epley maneuver.
  • (Meniere’s Disease) Endolymphatic hydrops:  is a condition in which the fluid balance in the inner ear is disturbed. This can occurs as a results of inner ear inflammation, trauma, or for unclear reasons. Endolymphatic hydrops resulting from unclear reasons is called Meniere’s disease. Treatment can consist of a simple change in the patients diet or the use of hearing aids.
  • Labyrinthitis and Vestibular Neuronitis: are conditions of true vertigo. The patient experiences a sensation that the surrounding environment is spinning. The onset is usually sudden. Half of the cases are preceded by an upper respiratory tract infection or cold. The sensation of vertigo usually lasts for several hours or several days. It is unusual for this phase to last more than 48 hours. This is caused by a viral infection of the inner ear (labrynthitis) or the nerve going to the inner ear (vestibular neuritis). The viral infection weakens the inner ear on one side, which creates an asymmetry within the balance centers of the brainstem. This creates a constant sense of unsteadiness. The disequilibrium is tolerable at rest but sudden movements of the head or body will trigger vertigo or light-headedness. As the affected inner ear recovers, the sensation of balance gradually returns.
  • Vestibular Migraine: People who suffer from chronic dizziness may be suffering from Vestibular Migraine. This condition involves a sense of disequilibrium rather than vertigo. Disequilibrium is a feeling that either the patient or the environment is swaying. Most patients describe it as “unsteadiness.” It is a sense of slow, rotational movement of one’s surrounding which can be mild or debilitating. The sensation can last from seconds to weeks and has a wide variety of manifestations. The exact neurological pathways responsible for a vestibular migraine are not completely understood. Treatments include observation, vestibular physical therapy or medical therapy. The medical therapies designed to treat vestibular migraine are the same medications used as prophylactic therapy for migraine headaches.

   Conductive Hearing Loss

Many times, the cause of the sudden change in hearing can be easily identified and treated. Common causes include a wax impaction, an ear infection of a foreign body in the ear. This is called a conductive hearing loss. There are two types.

  • Otosclerosis and Stapedectomy: is a condition in which the stapes bone becomes fixated by abnormal bone growth over time. This condition results in a conductive hearing loss that can become severe over time. Otosclerosis can usually be diagnosed with an otolaryngology examination and hearing test. The hearing can be restored with a surgical procedure called stapedectomy. Hearing aids can be helpful in patients who do not desire surgical treatment.
  • Ossicular Chain Abnormalities: The sound conduction system in the middle ear consists of three small bones called ossicles. These bones can be damaged by recurrent ear infections, trauma or previous surgery. This disruption results in a conductive hearing loss that can become severe over time. Ossicular chain abnormalities can be diagnosed with an otolaryngology examination and hearing test. The hearing can be restored with a surgical procedure called ossicular chain reconstruction. Hearing aids can be helpful in patients who do not desire surgical treatment.

   Nerve Hearing Loss (Idiopathic Sudden Sensorineural Hearing Loss):

ISSHL is defined as a loss of at least 30 dB in 3 contiguous frequencies over a time course of 72 hours or fewer. The cause of this disease is unknown, but there are several theories including viral, vascular, traumatic and autoimmune mechanisms.

Treatment: typically consists of a short (< 4 week) course of oral steroids initiated as soon as possible after onset of symptoms. Other treatments such as antiviral medications have been reported but are rarely done. A MRI study of the nerves in the ear is often required to evaluate for brain tumors that can cause a sudden loss of hearing. In most studies of the ISSNHL, patient who initiate steroid treatment within the first 72 hours after the onset of the hearing loss have better outcomes. Younger patients (<65) seem to recover better. Low frequency hearing losses recover better than high-frequency losses and mild-to-moderate hearing losses recover better than severe hearing losses.

Other Treatment Options: a new treatment has been suggested called a trans-tympanic steroid injection. This procedure can be performed in the ENT’s office. Steroids are injected directly into the middle ear space. These injections are generally done weekly as long as the patient continues to respond with improved hearing. This treatment is usually offered to patients who fail to respond to standard oral steroid therapy. In some cases, this treatment has been effective at restoring hearing. It is also an option in patients who cannot tolerate oral steroids.

   Acoustic Neuroma:

otherwise known as a vestibular schwannoma, is an uncommon benign tumor that arises from the hearing and balance nerve. These tumors typically grow slowly over time.

Symptoms:

include hearing loss and tinnitus (ringing) on one side. The hearing loss typically worsens slowly over time, but it can sometimes be of sudden onset. Some patients also develop imbalance or spinning dizziness (vertigo). In more advanced cases, there can be chronic headache, facial numbness, clumsiness, and visual loss.

Treatment Options:

There are a variety of possible treatments for an acoustic neuroma. The factors that help determine the best course of action depends on the patient’s age, health status, tumor size, nature and degree of symptoms, and patient preference. Observation of the tumor, radiation, or surgery to remove the tumor. Options should be discussed with your ENT specialist at Central Texas ENT.

   Tinnitus:

is an abnormal sensation of sound when there is no actual physical sound present.  The condition is often associated with hearing loss of various causes.  The most common causes of hearing loss and tinnitus in adults are noise exposure and age-related loss (presbycusis).  In some cases, tinnitus can occur without significant hearing loss, due to head injury or other factors.  Tinnitus can arise from neck and jaw muscle tension and occasionally from side effects of certain medications. The unrelenting noise can cause the individual significant mental anguish. The severity of tinnitus often decreases over time but in some cases may remain permanently bothersome.

Treatment:

the most effective treatment for the tinnitus is to reduce or eliminate the hearing loss.  In some cases, surgery can restore hearing. However, in many cases, the hearing loss is not surgically correctable, so a hearing aid is the most effective treatment. “Masking” is the technique of covering up tinnitus with background “white” noise to make it less apparent. Tinnitus maskers are devices that look like hearing aids and that produce a masking noise in the ear to suppress the tinnitus. Patients can create their own masking noise at home with devices that create white noise, such as fans, air conditioners, static from the radio, or with the “ocean sounds” on certain clock radios. There are numerous other treatments that are offered by various facilities that may or may not be useful.  These treatments include medications (vitamins, antidepressants, anti-seizure medications, anti-anxiety medications), biofeedback, and tinnitus retraining programs with or without the use of tinnitus maskers.

   Ear Wax:

Excessive earwax, or cerumen, is not a glamorous topic, but is one of the most common reasons for a trip to the ear, nose and throat doctor. Wax impacted in the ear canal most commonly leads to ear blockage and hearing loss, but can also cause pain, and sometimes contribute to infection and dizziness. Removing the wax impaction generally leads to rapid relief of these symptoms.

Tips on treating earwax:

  • Do not use Q-tips
  • Over the counter wax removal drops can be tried, but are frequently ineffective.
  • See your ear, nose and throat doctor for removal of impacted earwax.

   Cholesteatoma:

results from abnormal migration of the eardrum skin into the middle ear and area behind the ear called the mastoid. Over time the cholesteatoma typically destroys the bony structures of the ear. Without proper treatment, serious complications such as acute mastoid infection or brain infection may result. The infection is usually treated with antibiotic ear drops, but surgery is usually needed to remove the cholesteatoma permanently. Most patients will need to keep water out of the ear with ear plugs or a cotton ball with Vaseline.

Treatment:

Both chronic otitis media and cholesteatoma usually require surgical management in addition to medical treatment. The procedure is an outpatient surgery that takes 2 to 3 hours. It is performed under general anesthesia. The surgery is performed through an incision behind the ear.

   Congenital Aural Atresia:

In rare cases, children are born without a well-formed external ear (microtia) and/or ear canal (aural atresia). These children have very poor hearing due to lack of the ear canal, ear drum, and malformation of the hearing bones. Their inner ear and hearing nerve are usually normal. In cases of unilateral (single sided) atresia, with normal hearing on the other side, no specific early treatment is needed. If there is bilateral atresia with bilateral hearing loss, the affected child will be at significant risk for delay in speech and language development. Such children should be fitted with a bone conduction hearing aid as soon as possible.

   Tympanic Membrane Perforation:

essentially a hole in the eardrum, which can result from ear infections, injury, and previous surgery such as ventilation tube placement.  In addition to hearing loss, eardrum perforations can result in ear infection and drainage.  The infection is usually treated with antibiotic ear drops.  Most patients will need to keep water out of the ear with ear plugs or cotton ball with Vaseline.

Treatment:

surgical repair called a tympanoplasty. The procedure is a relatively short outpatient surgery that is performed under local or general anesthesia.  The surgery is performed through the ear canal or through an incision behind the ear. The hole in the eardrum is repaired using the patient’s own tissue, called fascia.  In some cases, the hearing bones (ossicles) are damaged by previous infection or trauma and can usually be repaired at the same time. Antibiotic eardrops are used in the ear after surgery.  Regular activities are started the next day.  Patients are typically seen at one and three weeks after surgery to ensure proper healing.  A hearing test is obtained one to two months after surgery. Hearing aids can be helpful for patients who desire improved hearing function but who do not desire surgical treatment.

   Cochlear Implant:

cochlear

are small, electronic devices used to correct hearing loss in those that are completely deaf or severely hard-of-hearing. While a cochlear implant does not restore normal hearing, it helps deaf people interpret the sounds around them and bypass the damaged parts of the ear. Cochlear implants can benefit children and adults alike, as long as they are over 12 months old. Thousands of Americans receive implants each year. The success of cochlear implants varies depending on individual factors such as how long a person has been deaf, how many nerve fibers they have left and their motivation to hear.

  • Evaluation Process: Patients with hearing loss undergo a full ear, nose & throat evaluation in addition to testing such as audiogram and imaging such as MRI or CT. Based on the medical evaluation, the treatment options for the hearing loss will be presented to you. Those who are possible candidates for the cochlear implant undergo other special hearing testing to see if they are candidates for the procedure.
  • Treatment: The procedure is an outpatient surgery that takes about an hour and a half. It is performed under general anesthesia. The surgery is performed through an incision behind the ear. The surgery consists of removing part of the mastoid bone and placing the cochlear implant.
  • Expectations: Cochlear implants do not provide the same type of sensation as normal hearing. Cochlear implant users typically continue to hear “better” over time with continued use of the implant. The hearing function a year after the initial hook-up is usually much better than the hearing function initially. Patients who learned to speak and understand language prior to losing their hearing typically have better results than those who lost their hearing prior to language acquisition during childhood. In general, better performance is expected if the implantation is performed soon after the hearing loss occurs.