Hearing Loss Disorders

Presbycusis

Presbycusis is an age-related condition that refers to the loss of hearing that gradually occurs in most individuals as they grow older. Sounds seem less clear and lower in volume, making it difficult to hear and understand speech. Symptoms of presbycusis may include:

  • Conversations are difficult to understand, especially when there is background noise
  • Certain sounds seem overly loud or irritating
  • Speech of others seems mumbled or slurred
  • Tinnitus (a ringing sound in one or both ears)

Causes of Presbycusis

Presbycusis is a sensorineural hearing loss caused by aging and the loss of hair cells, the sensory receptors in the inner ear. Sensorineural hearing loss occurs when there is damage to the inner ear (cochlea), or to the nerve pathways from the inner ear (retrocochlear) to the brain. Sensorineural hearing loss usually cannot be medically or surgically corrected. It is a permanent loss.

Repeated exposure to daily traffic sounds or construction work, noisy offices or loud music can cause hearing loss. Hereditary factors play a part, as well as aging, various health conditions, and side effects of some medicines (aspirin and certain antibiotics).

Evaluation and Treatment

  1. Your doctor will ask for a complete medical history and will perform a thorough physical examination. Diagnostic tests may include:
    • A hearing test (audiogram )
  2. You will be referred to an audiologist , who will answer all your questions about hearing aids and other techniques used to alleviate the symptoms of presbycusis.

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Conductive Hearing Loss

Conductive hearing loss occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones, or ossicles, of the middle ear. Conductive hearing loss involves a reduction in sound level, or the ability to hear faint sounds. This type of hearing loss can often be medically or surgically corrected.

There can be several reasons for conductive hearing loss including:

  • TM perforation
  • Otosclerosis
  • Cholesteatoma
  • Chronic Infection
  • Trauma

TM perforation

Tympanic perforation is a tear in the eardrum, establishing a connection between the middle and external ear. Symptoms can include pain, bleeding or discharge, if the ear is infected. Ringing of the ears (tinnitus), and hearing loss usually occur. Trauma, infection, and pressure are the most common causes. The majority of traumatic TM perforations heal spontaneously in a few days to several months. However, if there are persistent infections, or the TM perforations do not heal on their own, surgery is recommended.

Otosclerosis

Otosclerosis is a disorder of the bone housing the inner ear. This usually occurs just in front of the third ear bone (stapes). This build up of excess bone prevents the third middle ear bone from vibrating normally. Symptoms include slowly progressive hearing loss and tinnitus ( the sensation of noise in the ear). While it is unknown why a patient may develop otosclerosis, it does run in families. If the hearing loss begins to interfere in one’s activities, either a surgery called stapedotomy is performed to replace the fixated bone, or a hearing aid can be used to hear better.

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Mastoiditis

Mastoiditis is an inflammation or infection of the mastoid bone, the part of the skull containing your ear. The mastoid consists of air cells that drain into the middle ear. Mastoiditis can sometimes occur if a middle ear infection (acute otitis media) is not treated properly.

Symptoms of Mastoiditis:

  • Pain behind the ear
  • Redness or swelling of the bone behind the ear
  • Drainage from an ear infection

Causes of Mastoiditis

Mastoiditis usually occurs when the inflammation of the middle ear infection advances into the mastoid air cells. Occurrences of mastoiditis have been reduced with the use of antibiotics for ear infections and “Ear tubes”. Mastoiditis may be caused by various bacteria.

Evaluation and Treatment

  1. Your doctor will ask for a complete medical history and will perform a thorough physical examination. Different diagnostic studies may be ordered, including imaging studies, lab tests and detailed physical examinations. These may include:
    • Inspection of the outer ear
    • Examination of the eardrum using a microscope, an instrument specially designed to examine the ear.
    • Tympanometry is a test that detects any changes in pressure in the middle ear
    • Culture from the infected ear

Additional tests may include:

  • CT scan
  • Magnetic resonance imaging (MRI)
  • Lumbar puncture
  1. Treatment of Mastoiditis sometimes requires hospitalization, and may require surgery to remove the infected bone of the mastoid area.
  2. A myringotomy may be recommended; this is a simple procedure that involves making a small opening in the eardrum to drain the fluid and placing a small tube.

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Otitis externa

Otitis externa is an infection of the ear canal, the tubular structure that allows sounds to hit the eardrum. It is usually treated very easily with antibiotic drops. Symptoms of this ear infection may be:

  • Pain in the ear or while chewing
  • Itching of the ear or earlobes
  • Drainage from the ear
  • Trouble hearing properly

Causes of Otitis Externa

Otitis externa affects the skin of the ear canal between the eardrum and the outside of the ear. The ear canal can become easily infected because it is dark, warm and bacteria (germs) or fungus may grow there. Frequent swimming can lead to an infection known as “swimmer’s ear”.

Evaluation and Treatment

  1. Your doctor will ask for a complete medical history and will perform a thorough physical examination. Different diagnostic studies may be ordered, including imaging studies, lab tests and detailed physical examinations. These may include:
    • Inspection of the outer ear
    • Examination of the eardrum using a microscope, an instrument specially designed to examine the ear.
    • A thorough examination of the head and neck will be performed to look for possible complications and rule out other potentially more serious problems.
  2. Your doctor will remove any pus or drainage. A sponge wick can be placed in the ear canal if the canal is very swollen.
  3. Most cases of Otitis externa are treated with ear drops. Ear drop medications will contain substances to treat the infection and relieve the discomfort. Your doctor may also recommend oral antibiotics, in pill or liquid form.
  4. You will be asked to keep your ear dry, usually by placing a cotton ball coated with Vaseline in your ear while showering.

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Otitis media

Otitis media is an ear infection that affects the middle ear, the space between the eardrum and the inner ear that contains the three small bones (ossicles), It is very important to treat Otitis media, as it can become a chronic condition leading to hearing loss or cholesteatoma.

Symptoms of this ear infection may include:

  • Pain in the ear
  • Drainage from the ear
  • Trouble hearing properly

Causes of Otitis Media

Otitis media most commonly follows a “cold’ or sinus infection.

Otitis media can occur when there is a build up of fluid in the middle ear.

Evaluation and Treatment

  1. Your doctor will ask for a complete medical history and will perform a thorough physical examination. Different diagnostic studies may be ordered, including imaging studies, and detailed physical examinations. These may include:
    • Examination of the eardrum using a microscope, an instrument specially designed to examine the ear.
    • A thorough examination of the head and neck will be performed to look for possible complications and rule out other potentially more serious problems.
  2. Deletion
  3. Your doctor may recommend oral antibiotics, if he or she suspects the infection is bacterial. In the case of a viral infection, most doctors prescribe a wait and see approach. This avoids unnecessarily administering antibiotics. TylenolTMor ibuprofen can be used to ease discomfort.
  4. If the pain is severe, a myringotomy may be recommended; this is a simple procedure that involves making a small opening in the eardrum to drain the fluid and placing a small tube.

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Perforated eardrum

A perforated eardrum is a tear or a hole in your eardrum (tympanic membrane), the thin membrane that separates your ear canal from your middle ear. This membrane vibrates when sound waves strike it, starting the process of converting sound waves into nerve impulses that travel to your brain. Damage to your eardrum interrupts the hearing process and may impair your hearing.

A ruptured eardrum can be painful, particularly at first. Signs and symptoms may include:

  • Sharp, sudden ear pain or discomfort if struck in the ear
  • Drainage from your ear (can be clear, bloody, or pus-filled)
  • Hearing loss
  • Ringing in your ear (tinnitus), or severe ache in the ear

Causes of a perforated eardrum

  • Acute or chronic infection
  • External injury to the ear; slap to the ear or a penetrating injury
  • Explosions

Evaluation and Treatment

  1. Your doctor will ask for a complete medical history and will perform a thorough physical examination. Different diagnostic studies may be ordered, including imaging studies, lab tests and detailed physical examinations.
  2. If your ear is draining clear or pus-filled fluid, your doctor may take a sample. When examined under a microscope, the exact nature of your infection may be identified, allowing for better treatment.
  3. Your doctor will most likely prescribe eardrops to encourage healing of the perforation of the eardrum.
  4. Most recently ruptured eardrums heal within a few weeks without treatment. If the tear or hole in your eardrum doesn't heal by itself, you may need surgical treatment.
  5. There are two surgical options for a perforated eardrum:
    1. Eardrum patch. If the tear in your eardrum is small, your doctor may recommend a procedure to seal the tear with a paper patch. Your doctor will touch the edges of your eardrum with a chemical to stimulate growth and then place a thin paper patch on your eardrum. Your ear may need up to three or four applications of a patch before the perforation closes completely. This is done in the office with the aid of a surgical microscope
    2. Tympanoplasty. Your doctor may recommend surgery if an ear drum patch does not work, or if the hole is too large to expect a paper patch to work. During a surgical procedure called a tympanoplasty, your doctor will place a tissue patch under the perforation, allowing it to heal. Tympanoplasty is usually successful in closing the hole permanently and restoring hearing. If, during the operation, one of the small bones of the middle ear is found to have been damaged by the infection, a man-made replacement can be used in an attempt to improve the hearing loss.

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Acoustic neuroma

An acoustic neuroma (vestibular schwannoma) is a benign (non-cancerous) tissue growth on the eighth cranial nerve leading from the brain to the inner ear. This nerve has two distinct parts, associated with transmitting sound and sending balance information to the brain from the inner ear. Symptoms of an acoustic neuroma include:

  • Tinnitus (ringing in the ear)
  • Trouble hearing in one ear
  • Dizziness or vertigo
  • Feeling of fullness in the ear

Causes of Acoustic Neuroma

No one knows the exact reason why an acoustic neuroma begins to grow, and there is no hereditary link. The neuromas usually grow slowly over a period of years, and expand in size from their site of origin. When large, they can displace normal brain tissue. tumors can press on the trigeminal nerve, which is the nerve of facial sensation.

Evaluation and Treatment

  1. Your doctor will ask for a complete medical history and will perform a thorough physical examination. Different diagnostic studies may be ordered, including imaging studies, and detailed physical examinations. These may include:
    • Audiogram
    • MRI with contrast
    • Auditory brainstem response test
  2. Depending on the size of the neuroma, your doctor may prescribe a wait and see attitude. These tumors grow over a number of years and some tumors stop growing naturally. Your doctor will order a series of MRIs over time, to track the growth of the neuroma.
  3. If the neuroma has continued to show growth or is a size where brain function is impaired, your doctor may recommend surgery or radiation therapy.
    • Radiation therapy is performed using a gamma knife . This is performed in conjunction with the neurosurgeons and uses focused radiation beams to minimize damage to the surrounding tissues. The goal is to prevent further tumor growth.
    • Surgery, if necessary, will involve a team approach using a Neurotologist and a Neurosurgeon.
      Fitzgerald, one of the country’s most renowned ENT surgeons, is an expert in treating acoustic neuromas.

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Cholesteatoma

A cholesteatoma is a skin cyst in your middle ear and/or the mastoid bone that can cause chronic middle ear infections and damage the structure of your ear.

Symptoms of a cholesteatoma include:

  • Hearing loss in one ear
  • Pain or numbness in the ear or around the ear
  • Drainage from the ear
  • Dizziness or vertigo

Causes of Cholestetoma

Cholesteatoma is usually the result of complications from a chronic ear infection. They can also result from a birth defect. They form because long-term swelling in the eustachian tube leads to negative pressure in the middle ear. This pulls a part of the eardrum (tympanic membrane) inward, creating a sac or cyst that fills with old skin cells and other waste material. The cyst usually becomes infected. The cyst may cause the middle ear bones to be damaged or destroyed.

Evaluation and Treatment

  1. Your doctor will ask for a complete medical history and will perform a thorough physical examination. Different diagnostic studies may be ordered, including imaging studies, and detailed physical examinations. These may include:
    • CT scan
    • Audiogram
  2. Surgery: Your doctor will probably recommend surgery to remove the cholesteatoma. This is done to remove the infection and protect the bones from further damage. There are several surgeries for treating a cholesteatoma. They may include:
    • TympanomastoidectomyIn this surgery, your doctor will make an incision behind your ear so that the inside of your ear can be reached. Any growth or infected bone is then removed, and packing will be placed in your ear to promote healing.

       Complications of Cholesteatoma.

  • Inner ear hearing loss or deafness
  • Brain infections; meningitis, brain abscess
  • Blockage of the large veins on the surface of the brain
  • Facial paralysis

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Eustachian Tube dysfunction

The Eustachian tube connects the middle ear to the nasal cavity, and equalizes middle ear pressure with outside pressure. When your ear "pops" on an elevator or in an airplane, it is because the Eustachian tube has opened and equalized pressure. Tubal opening occurs every two minutes 24 hours a day. Eustachian tube dysfunction (ETD) comes about when this tube does not open properly.

Symptoms of ETD may include:

  • Pain or fullness in the ears and/or jaw
  • Severe pain when flying
  • Hearing loss
  • Minor balance problems

Causes of ETD

  • Allergies
  • “Colds” or sinus infections

Evaluation and Treatment

  1. Your doctor will ask for a complete medical history and will perform a thorough physical examination. Different diagnostic studies may be ordered, including imaging studies, lab tests and detailed physical examinations. These may include:
    • Tympanometry- a method of recording pressure in the ear
    • Audiogram- hearing test
    • CT scan of the sinuses and back part of the nasal passages.
  2. Your doctor will recommend treating ETD with

medicines, such as decongestants, and/or nasal topical steroids. He or she may recommend kits to irrigate the nose with salt water. Oral steroids might be used for a short time to get the earto “open up”

3.Your doctor may recommend surgery to relieve the symptoms of ETD. A ventilation tube will be placed in your ear drum to open the tube.This is a simple procedure that involves making a small opening in the eardrum to drain the fluid and placing a small tube. It also makes the ear vulnerable to infection so precautions are given to keep water out of the ear.

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