Otolaryngology Services

Hearing and Balance

Nearly 30 million Americans have impaired hearing. Ear, nose, and throat physicians classify hearing loss as either conductive or sensorineural. A hearing loss is conductive when there is a problem with the ear canal, the eardrum and/or the middle ear including the three bones connected to the eardrum. Common reasons for this type of hearing loss are a plug of excess wax in the ear canal or fluid behind the eardrum. Medical treatment or surgery may be available for these and more complex forms of conductive hearing loss.

A hearing loss is sensorineural when it results from damage to the inner ear (cochlea) or auditory nerve. Medical or surgical intervention cannot correct most sensorineural hearing losses but hearing aids may help. A mixed hearing loss is a combination of both conductive and sensorineural type hearing problems.

Hearing loss diagnostic tests:

• Comprehensive audiogram
• Tympanogram
• Auditory Brainstem Response (ABR)
• Electronystagmography (ENG)
• Electroneuronography (ENOG)
• Electrocochleography (ECOG)

Otitis Media

Otitis media means inflammation of the middle ear. Middle ear infections often occur as a complication of a cold, allergies, nose and throat infection or enlarged adenoids. When the bottom of the eustachian tube becomes blocked normally produced fluids build up in the middle ear. The trapped fluid can become infected by a virus or bacteria, causing pain and swelling of the eardrum. Trapped fluid causes temporary and mild hearing loss. This is called Otitis media with effusion and may last for up to three months. This often indicates a dysfunction of the Eustachian tube.

Otitis Media is serious because of the severe earache and hearing loss it can create. Hearing loss, especially in children, may impair learning capacity and even delay speech development. If it is diagnosed and treated promptly, hearing can almost always be restored to normal. Otitis media is also serious because the infection can spread to nearby structures in the head, especially the mastoid.

Symptoms of Otitis Media

• Ear pain
• Loss of appetite
• Irritability
• Poor sleep
• Fever
• Drainage from the ear
• Difficulty hearing
• Ear Infections

Otitis media is generally not serious if it is promptly and properly treated. Treatment methods include:

• Antibiotics
• Pain relief (Acetaminophen or ibuprofen)
• Myringotomy – Myringotomy, surgical insertion of tubes. Small metal or plastic tubes are inserted through the eardrum to equalize pressure between the middle and outer ear. This outpatient procedure is usually performed under general anesthesia.

Dizziness

Some people describe a balance problem by saying they feel dizzy, lightheaded, unsteady, or giddy. This feeling of imbalance or dysequilibrium, without a sensation of turning or spinning, is sometimes due to an inner ear problem. Some people describe their balance problem by using the word vertigo; they often say that they or their surroundings are turning or spinning. Vertigo is frequently due to an inner ear problem.

Balance

Both dizziness and vertigo relate to the sense of balance and equilibrium. Your sense of balance is maintained by a complex interaction of the following parts of the nervous system:

• The inner ears (the labyrinth), which monitor the directions of motion, such as turning, or forward-backward, side-to-side, and up-and-down motions.
• The eyes, which monitor the body’s orientation and directions of motion.
• The skin pressure receptors, which tell what part of the body is down and touching the ground.
• The muscle and joint sensory receptors, which tell what parts of the body are moving.
• The central nervous system, which processes all the bits of information from the four other systems.

The symptoms of dizziness appear when the central nervous system receives conflicting messages from the other four systems.

Dizziness has multiple causes. If your brain does not get enough blood flow, you feel light-headed. Some people have light headedness from frequent poor circulation because of arteriosclerosis or hardening of the arteries, high blood pressure, diabetes, high levels of cholesterol, inadequate cardiac function, or anemia. Certain drugs also decrease the blood flow to the brain, especially stimulants such as nicotine and caffeine. Excess salt in the diet also leads to poor circulation. Sometimes circulation is impaired by spasms in the arteries caused by emotional stress, anxiety, and tension.

The more specific type of dizziness, vertigo, occurs if the inner ear falls to receive enough blood flow. The inner ear is very sensitive to minor alterations of blood flow and all of the causes mentioned for poor circulation to the brain also apply specifically to the inner ear. In addition, the problem can be caused by:

Injury – A skull fracture that damages the inner ear produces a profound and incapacitating vertigo with nausea and hearing loss.

Infection – Viruses, such as those causing the common cold or flu, can attack the inner ear and its nerve connections to the brain.

Allergy – Some people experience dizziness and/or vertigo attacks when they are exposed to foods or airborne particles to which they are allergic.