Ear, Hearing and Balance
Autoimmune inner ear disease (AIED) is an inflammatory condition of the inner ear. It occurs when the body’s immune system attacks cells in the inner ear that are mistaken for a virus or bacteria. AIED is a rare disease occurring in less than one percent of the 28 million Americans with a hearing loss.
As the parent of a child with newly diagnosed hearing loss, you will have many questions and concerns regarding the nature of this problem, its effects on your child’s future, treatment options, and resources. This brief guide will give you necessary initial information, and provide guidance about the availability of resources, and the respective roles of different care providers.
An abnormal skin growth in the middle ear behind the eardrum is called cholesteatoma. Repeated infections and/or a tear or pulling inward of the eardrum can allow skin into the middle ear. Cholesteatomas often develop as cysts or pouches that shed layers of old skin, which build up inside the middle ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear leading to hearing loss that surgery can often improve. Permanent hearing loss, dizziness, and facial muscle paralysis are rare, but can result from continued cholesteatoma growth.
Dizziness, vertigo, and motion sickness all relate to the sense of balance and equilibrium. Researchers in space and aeronautical medicine call this sense spatial orientation, because it tells the brain where the body is “in space:” what direction it is pointing, what direction it is moving, and if it is turning or standing still.
What causes Middle Ear Infection? Blockage of the Eustachian tube during a cold, allergy, or respiratory infection and the presence of bacteria or viruses lead to the accumulation of fluid behind the eardrum. This is an infection called Otitis Media. The primary treatment for Otitis Media is antibiotic therapy. Treatment for repeated antibiotic failures includes the placement of ear tubes.
|Symptoms of ear infection can be:||For infants or toddlers look for:|
|Feeling of fullness or pressure||Crying, Irritability|
|Dizziness, loss of balance||Vomiting|
|Ear drainage||Ear drainage|
|Fever||Speech delay, balance, “stumbling” problems|
Treatment of Otitis Media
In adults and children, antibiotic therapy is the mainstay of treatment. Allergy treatment (antihistamines, steriod pills or nosesprays, and other treatments) is sometimes helpful. Watchful waiting for residual fluid which is not infected is often suggested. For resistent ear infections not responding to medical therapy or watchful waiting, then a drainage with pressure equalizing tubes can be suggested. This is a minor procedure to be done in the office for most adults and older children or under a brief anesthetic for young children and infants.
Cerumen or earwax is healthy in normal amounts and serves as a self-cleaning agent with protective, lubricating, and antibacterial properties. The absence of earwax may result in dry, itchy ears. Most of the time the ear canals are self-cleaning; that is, there is a slow and orderly migration of earwax and skin cells from the eardrum to the ear opening. Old earwax is constantly being transported, assisted by chewing and jaw motion, from the ear canal to the ear opening where it usually dries, flakes, and falls out.
You may have hearing loss, and not even be aware of it. People of all ages experience gradual hearing loss, often due to the natural aging process or long exposure to loud noise. Other causes of hearing loss include viruses or bacteria, heart conditions or stroke, head injuries, tumors, and certain medications. Treatment for hearing loss will depend on your diagnosis.
Also called idiopathic endolymphatic hydrop,s Ménière’s disease describes a set of episodic symptoms including vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. Episodes typically last from 20 minutes up to 4 hours. Hearing loss is often intermittent, occurring mainly at the time of the attacks of vertigo. Loud sounds may seem distorted and cause discomfort. Usually, the hearing loss involves mainly the lower pitches, but over time this often affects tones of all pitches. After months or years of the disease, hearing loss often becomes permanent. Tinnitus and fullness of the ear may come and go with changes in hearing, occur during or just before attacks, or be constant.
Otosclerosis describes a condition of abnormal growth in the tiny bones of the middle ear, which leads to a fixation of the stapes bone. The stapes bone must move freely for the ear to work properly and hear well.
Hearing is a complex process. In a normal ear, sound vibrations are funneled by the outer ear into the ear canal where they hit the ear drum. These vibrations cause movement of the ear drum that transfers to the three small bones of the middle ear, the malleus (hammer), incus (anvil), and stapes (stirrup). When the stapes bone moves, it sets the inner ear fluids in motion, which, in turn, start the process to stimulate the auditory (hearing) nerve. The hearing nerve then carries sound energy to the brain, resulting in hearing of sound. When any part of this process is compromised, hearing is impaired.
A hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear, is called a perforated eardrum. The medical term for eardrum is tympanic membrane. The middle ear is connected to the nose by the eustachian tube, which equalizes pressure in the middle ear.
A perforated eardrum is often accompanied by decreased hearing and occasional discharge. Pain is usually not persistent.
Affecting the outer ear, swimmer’s ear is a painful condition resulting from inflammation, irritation, or infection. These symptoms often occur after water gets trapped in your ear, with subsequent spread of bacteria or fungal organisms. Because this condition commonly affects swimmers, it is known as swimmer’s ear. Swimmer’s ear (also called acute otitis externa) often affects children and teenagers, but can also affect those with eczema (a condition that causes the skin to itch), or excess earwax. Your doctor will prescribe treatment to reduce your pain and to treat the infection.
Tinnitus is the name for the common sensation of “ringing in the ears” or “noises in the ears.” This is a common symptom that is quite varied in nature and severity. Tinnitus can come and go, or it can be constant. When it is constant or severe, it can be annoying and distracting. While it can’t be be cured, there are some things that can be done to improve the tinnitus.
There are many possible causes of tinnitus. Some causes are as minor as “ear wax”,while other reasons may be more serious. This may include infection, a ruptured eardrum, “ear fluid,” or other causes of hearing dysfunction.
Torn earlobes are a common problem with pierced earlobes. They are most-commonly completely torn through, but occasionally patients will come in with the piercing enlarged and a small bridge of skin remaining.
Though a relatively small defect, torn earlobes are difficult to repair well. There are a large number of ways to repair them, which usually indicates that there is not a “best” way for everyone. Each defect requires an evaluation and plan to fit that specific lobe’s defect. Surgery is usually performed in the office under local anesthesia and takes about 20 minutes per side. The edges of the torn piercing are freshened and sewn back together, either in a straight line or with specially constructed skin flaps.
Earmolds are used for a numerous reasons and come in various forms and price points. They may be used for protection from noise or water, for custom personal music listening (i.e., custom MP3 earphones or professional music monitors) and as part of hearing amplification devices. Sometimes off the shelf, universal fit earphones/earplugs are all that are needed. Custom earmolds, when required or desired, are more expensive and require impressions of the ear canal and outer ear. These impressions should be made be a professional.
Painful ear infections are a rite of passage for children—by the age of five, nearly every child has experienced at least one episode. Most ear infections either resolve on their own (viral) or are effectively treated by antibiotics (bacterial). But sometimes ear infections and/or fluid in the middle ear may become a chronic problem leading to other issues, such as hearing loss, or behavior and speech problems. In these cases, insertion of an ear tube by an otolaryngologist (ear, nose, and throat specialist) may be considered.
Myringoplasty is the surgical repair of the ear drum only (not the ossicles). It is usually used on very small holes in the ear drum (15% or less of the total surface area of the ear drum). Myringoplasties are performed in the office for adults and in the operating room for children or people who may have difficulty staying still. The success rate is about 80%.
One in 10 Americans has a hearing loss that affects his or her ability to understand normal speech. Age-related hearing loss is the most common cause of this condition and is more prevalent than hearing loss caused by excessive noise exposure. However, exposure to excessive noise can damage hearing, and it is important to understand the effects of this kind of noise, particularly because such exposure is avoidable.
The American Academy of Otolaryngology-Head and Neck Surgery recognizes stapedectomy or stapedotomy as the procedure of choice and most cost-effective treatment of conductive hearing loss due to otosclerosis and certain other disorders.
A tympanoplasty is a surgical procedure that repairs or reconstructs the eardrum (tympanic membrane) to help restore normal hearing. This procedure may also involve repair or reconstruction of the small bones behind the tympanic membrane (ossiculoplasty) if needed. Both the eardrum and middle ear bones (ossicles) need to function well together for normal hearing to occur.
Tinnitus management devices come in several forms. Medical evaluation and clearance should always be obtained prior to any treatment or management for tinnitus. White noise devices produce a quiet, shushing sound that may cover up the tinnitus and afford relief. They can either be worn like hearing instruments or, much like a radio, produce sound within the room. Specific devices that produce ‘fractal tones’ may also help reduce or eliminate the tinnitus while being worn. These devices may also be used as hearing instruments, both helping with the tinnitus and improving hearing perception when the need arises.