Autoimmune Inner Ear Disease

What is AIED?

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.

How Does the Healthy Ear Work?

The ear has three main parts: the outer, middle and inner ear. The outer ear (the part you can see) opens into the ear canal. The eardrum separates the ear canal from the middle ear. Small bones in the middle ear help transfer sound to the inner ear. The inner ear contains the auditory (hearing) nerve, which leads to the brain.

Any source of sound sends vibrations or sound waves into the air. These funnel through the ear opening, down the ear, canal, and strike your eardrum, causing it to vibrate. The vibrations are passed to the small bones of the middle ear, which transmit them to the hearing nerve in the inner ear. Here, the vibrations become nerve impulses and go directly to the brain, which interprets the impulses as sound (music, voice, a car horn, etc.).

Symptoms Of AIED

The symptoms of AIED are sudden hearing loss in one ear progressing rapidly to the second ear. The hearing loss can progress over weeks or months. Patients may feel fullness in the ear and experience vertigo. In addition, a ringing, hissing, or roaring sound in the ear may be experienced. Diagnosis of AIED is difficult and is often mistaken for otitis media until the patient develops a loss in the second ear. One diagnostic test that is promising is the Western blot immunoassay.

Treatment For AIED?

Most patients with AIED respond to the initial treatment of steroids, prednisone, and methotrexate, a chemotherapy agent. Some patients may benefit from the use of hearing aids. If patients are unresponsive to drug therapy and hearing loss persists, a cochlear implant maybe considered.

History Of AIED

Until recently it was thought that the inner ear could not be attacked by the immune system. Studies have shown that the perisacular tissue surrounding the endolymphatic sac contains the necessary components for an immunological reaction. The inner ear is also capable of producing an autoimmune response to sensitized cells that can enter the cochlea through the circulatory system.

AIED Research

A multi-institutional clinical study, Otolaryngology Clinical Trial Cooperative Group (OCTCG) co-sponsored by the NIH and the American Academy of Otolaryngology-Head and Neck Surgery Foundation, is being conducted to measure the benefits and risks of treating AIED with two different immunosuppressive drugs: prednisone and methotrexate, a chemotherapy drug.

Better Ear Health

Many medical conditions, such as those listed below, can affect your hearing health. Treatment of these and other hearing losses can often lead to improved or restored hearing. If left undiagnosed and untreated, some conditions can lead to irreversible hearing impairment or deafness. If you suspect that you or your loved one has a problem with their hearing, ensure optimal hearing healthcare by seeking a medical diagnosis from a physician.

Otitis Media

The most common cause of hearing loss in children is otitis media, the medical term for a middle ear infection or inflammation of the middle ear. This condition can occur in one or both ears and primarily affects children due to the shape of the young Eustachian tube (and is the most frequent diagnosis for children visiting a physician). When left undiagnosed and untreated, otitis media can lead to infection of the mastoid bone behind the ear, a ruptured ear drum, and hearing loss. If treated appropriately, hearing loss related to otitis media can be alleviated.

Tinnitus

Tinnitus is the medical name indicating “ringing in the ears,” which includes noises ranging from loud roaring to clicking, humming, or buzzing. Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. The health of these nerve endings is important for acute hearing, and injury to them brings on hearing loss and often tinnitus. Hearing nerve impairment and tinnitus can also be a natural accompaniment of advancing age. Exposure to loud noise is probably the leading cause of tinnitus damage to hearing in younger people. Medical treatments and assistive hearing devices are often helpful to those with this condition.

Swimmer’s Ear

An infection of the outer ear structures caused when water gets trapped in the ear canal leading to a collection of trapped bacteria is known as swimmer’s ear or otitis externa. In this warm, moist environment, bacteria multiply causing irritation and infection of the ear canal. Although it typically occurs in swimmers, bathing or showering can also contribute to this common infection. In severe cases, the ear canal may swell shut leading to temporary hearing loss and making administration of medications difficult.

Earwax

Earwax (also known as cerumen) is produced by special glands in the outer part of the ear canal and is designed to trap dust and dirt particles keeping them from reaching the eardrum. Usually the wax accumulates, dries, and then falls out of the ear on its own or is wiped away. One of the most common and easily treatable causes of hearing loss is accumulated earwax. Using cotton swabs or other small objects to remove earwax is not recommended as it pushes the earwax deeper into the ear, increasing buildup and affecting hearing. Excessive earwax can be a chronic condition best treated by a physician.

Autoimmune Inner Ear Disease

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. Prompt medical diagnosis is essential to ensure the most favorable prognosis. Therefore, recognizing the symptoms of AIED is important: sudden hearing loss in one ear progressing rapidly to the second and continued loss of hearing over weeks or months, a feeling of ear fullness, vertigo, and tinnitus. Treatments primarily include medications but hearing aids and cochlear implants are helpful to some.

Cholesteatoma

A cholesteatoma is a skin growth that occurs in the middle ear behind the eardrum. This condition usually results from poor eustachian tube function concurrent with middle ear infection (otitis media), but can also be present at birth. The condition is treatable, but can only be diagnosed by medical examination. Over time, untreated cholesteatoma can lead to bone erosion and spread of the ear infection to localized areas such as the inner ear and brain. If untreated, deafness, brain abscess, meningitis, and death can occur.

Perforated Eardrum

A perforated eardrum is a hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear. A perforated eardrum is often accompanied by decreased hearing and occasional discharge with possible pain. The amount of hearing loss experienced depends on the degree and location of perforation. Sometimes a perforated eardrum will heal spontaneously, other times surgery to repair the hole is necessary. Serious problems can occur if water or bacteria enter the middle ear through the hole. A physician can advise you on protection of the ear from water and bacteria until the hole is repaired.

Buying a Hearing Aid:
Answers to common questions

I Don’t Hear Well. What Should I Do? What Should I Expect?

First, visit a physician who can refer you to an otolaryngologist (an ear, nose, and throat specialist), because many hearing problems can be corrected medically. If you have ear pain, drainage, excess earwax, hearing loss in only one ear, sudden or rapidly progressive hearing loss, or dizziness, it is especially important that you see an otolaryngologist, as these may be symptoms indicating a serious medical problem. After your exam, the otolaryngologist will help you obtain a hearing assessment from an audiologist (a nonphysician healthcare professional). A screening test from a hearing aid dealer may not be adequate. Many otolaryngologists have an audiologist in their office to assess your ability to hear pure tone sounds and to understand words. The results of these tests will indicate the degree of hearing loss, the type of loss (conductive or sensorineural) and other medical information about your ears and health.

Conductive Hearing Loss

A hearing loss is conductive when there is a problem with the ear canal, the eardrum, and/or the three bones connected to the eardrum. This causes a mechanical (conductive) blockage, preventing the full energy of the sound from reaching your inner ear. Two common reasons for this type of hearing loss are excess wax in the ear canal or fluid behind the eardrum. Medical treatment or surgery may be available for these and other forms of conductive hearing loss.

Sensorineural Hearing Loss

A hearing loss is sensorineural when it results from damage to the inner ear (cochlea) or auditory nerve, often a result of the aging process and/or noise exposure, but also may be secondary to head trauma, systemic illness or infection, or inheritance. Sounds may be unclear or too soft. Sensitivity to loud sounds may occur. Medical or surgical intervention cannot correct most sensorineural hearing losses, but hearing aids may help you reclaim some sounds you are missing as a result of nerve deafness.

Where Do I Purchase Hearing Aids?

Federal regulation prohibits any hearing aid sale unless the buyer has first received a physician’s evaluation, so you will need to see your doctor before you purchase a hearing aid. However, the regulation also says that if you are over 18 and aware of the recommendation for a medical exam, you may sign a waiver to forego it.

An otolaryngologist, audiologist, or independent dispenser can dispense aids. Hearing aids should be custom-fit to your ear and hearing needs. Mail-order hearing aids typically cannot be custom-fit.

What are costs and styles of hearing aids?

Hearing aids vary in price according to style, features, and local market prices. Price can range from hundreds of dollars to more than $2,500 for a programmable, digital hearing aid. Purchase price should not be the only consideration in buying a hearing aid. Product reliability and customer service can save repair costs and decrease frustration of a malfunctioning hearing aid.

There are several styles:

• Behind-the-ear (BTE) aids go over the ear and are connected with tubing to custom-fitted earpieces.
• Open fit receiver-in-the-ear (RITE) aids are a newer design, and while still placed over the ear, they are extremely small and nearly invisible
• In-the-ear (ITE) hearing aids fill the entire bowl of the ear and part of the ear canal.
• Smaller versions of ITEs are called half-shell and in-the-canal (ITC).
• The least visible aids are completely-in-the-canal (CIC).

The best hearing aid for you depends upon your particular hearing loss and listening needs, the size and shape of your ear and ear canal, and the dexterity of your hands. Many hearing aids have tele-coil “T” switches for telephone use and public sound systems.

Other options, such as FM systems and Bluetooth devices in conjunction with hearing aids, may provide the best benefit for some patients.

Will I Need A Hearing Aid For Each Ear?

Usually, if you have hearing loss in both ears, using two hearing aids is best. Listening in a noisy environment is difficult with amplification in one ear only, and it is more difficult to distinguish where sounds are coming from.

What Other Questions Should I Ask?

Ask Ask about future service and repair. Also inquire about the trial period policy and what fees are refundable if you return the hearing aids during that period. And ask about warranty coverage for your hearing aids and the consumers’ protection program for hearing aid purchasers in your state.

What Will Happen At My Hearing Aid Fitting?

The hearing aids will be fitted for your ears. Then, while wearing them, you will be tested for word understanding in quiet and in noise, and for improvement in hearing tones. Real ear measurements may also be done, which determine how much gain your hearing aids give you.

Next, you will receive instruction about the care of your hearing aids and other helpful strategies.

How Should I Begin Wearing The Aids?

Start using your hearing aids in quiet surroundings, gradually building up to noisier environments. Then eventually work up to wearing your hearing aids all waking hours. Keep a diary to help you remember your experiences and report them accurately to your dispenser for adjustments as needed. Report any concerns on a follow-up appointment. Be patient and allow yourself to get used to the aids and the “new” sounds they allow you to hear.

Child Hearing Screening

Why Is Early Childhood Hearing Screening Important For Your Child?

Approximately two to four of every 1,000 children in the United States are born deaf or hard-of-hearing, making hearing loss the most common birth disorder. Many studies have shown that early diagnosis of hearing loss is crucial to the development of speech, language, cognitive and psychosocial abilities. Treatment is most successful if hearing loss is identified early, preferably within the first few months of life. Still, one in every four children born with serious hearing loss does not receive a diagnosis until 14 months old.

When Should A Child’s Hearing Be Tested?

The first opportunity to test a child’s hearing is in the hospital shortly after birth. If your child’s hearing is not screened before leaving the hospital, it is recommended that screening be done within the first month of life. If test results indicate a possible hearing loss,get a further evaluation as soon as possible, preferably within the first three to six months of life.

Is Early Hearing Screening Mandatory?

In recent years, health organizations across the country, including the American Academy of Otolaryngology – Head and Neck Surgery, have worked to highlight the importance of screening all newborns for hearing loss. These efforts are working. Recently, many states have passed Early Hearing Detection and Intervention legislation. A few other states regularly screen the hearing of most newborns, but have no legislation that requires screening. So, check with your local authority or hospital for screening regulations.

How Is Screening Done?

Two tests are used to screen infants and newborns for hearing loss. They areotoacoustic emissions (OAE) and auditory brain stem response (ABR).

Otoacoustic emissions involves placing a sponge earphone in the ear canal to measure whether the ear can respond properly to sound. In normal-hearing children, a measurable “echo” should be produced when sound is emitted through the earphone. If no echo is measured, it could indicate a hearing loss.

Auditory brain stem response is a more complex test. Earphones are placed on the ears and electrodes are placed on the head and ears. Sound is emitted through the earphones while the electrodes measure how your child’s brain responds to the sound.

If either test indicates a potential hearing loss, your physician may suggest a follow-up evaluation by an otolaryngologist.

Signs Of Hearing Loss In Children

Hearing loss can also occur later in childhood. In these cases, parents, grandparents and other caregivers are often the first to notice that something may be wrong with a young child’s hearing. Even if your child’s hearing was tested as a newborn, you should continue to watch for signs of hearing loss, including:

• Not reacting in any way to unexpected loud noises
• Not being awakened by loud noises
• Not turning his/her head in the direction of your voice
• Not being able to follow or understand directions
• Poor language development, or
• Speaking loudly or not using age-appropriate language skills.

If your child exhibits any of these signs, report them to your doctor.

What Happens If My Child Has A Hearing Loss?

Hearing loss in children can be temporary or permanent. It is important to have hearing loss evaluated by a physician who can rule out medical problems that may be causing the hearing loss, such as otitis media (ear infection), excessive earwax, congenital malformations or a genetic hearing loss.

If it is determined that your child’s hearing loss is permanent, hearing aids may be recommended to amplify the sound reaching your child’s ear. Ear surgery may be able to restore or significantly improve hearing in some instances. For those with certain types of very severe hearing loss who do not benefit sufficiently from hearing aids, a cochlear implant may be considered. Unlike a hearing aid, the implant bypasses damaged parts of the auditory system and directly stimulates the hearing nerve, allowing the child to hear louder and clearer sound.

Research indicates that if a child’s hearing loss is remedied by age six months, it will prevent subsequent language delays. You will need to decide whether your deaf child will communicate primarily with oral speech and/or sign language, and seek early intervention to prevent language delays. Other communication strategies such as auditory verbal therapy, lip reading and cued speech may also be used in conjunction with a hearing aid or cochlear implant, or independently.

Children’s Hearing Health

Insight into behavioral benchmarks, risk indicators and hearing tests

• Who might be at risk for hearing loss?
• What to look for in your child?
• How, when, and why should hearing be tested?

Three million children under the age of 18 have some hearing loss, including four out of every thousand newborns. Every parent and caregiver should be watchful of the signs of hearing loss in his or her child and seek a professional diagnosis. Hearing loss can increase the risk of speech and language developmental delays.

Which children may be at risk for hearing loss?

During pregnancy

• Mother had German measles, a viral infection, or flu.
• Mother drank alcoholic beverages.

Newborn (birth to 28 days of age)

• Failed newborn hearing test.
• Weighed less than 3.5 pounds at birth.
• Has an unusual appearance of the face or ears.
• Was jaundiced (yellow skin) at birth and had a blood transfusion.
• Was in neonatal intensive care unit (NICU) for more than five days.
• Received an antibiotic medication intravenously.
• Had meningitis.

Infant (29 days to 2 years)

• Received an antibiotic medication intravenously.
• Had meningitis.
• Has a neurological disorder.
• Had a severe injury with a skull fracture, with or without bleeding from the ear.
• Has recurring ear infections with fluid in ears for more than three months.

Family

• Has one or more individuals with permanent or progressive hearing loss that developed early in life.

What are behavioral signs of hearing loss?

Newborn (birth to 6 months)

• Does not startle, move, cry, or react in any way to unexpected loud noises.
• Does not awaken from loud noises.
• Does not imitate sound.
• Cannot be soothed by voice alone.
• Does not turn his or her head in the direction of your voice.

Young infant (6 months to 12 months)

• Does not point to familiar persons or objects when asked.
• Does not babble, or babbling has stopped.
• By 12 months, does not understand simple phrases by listening alone, such as “wave bye-bye,” or “clap hands.”

Infant (3 months to 2 years)

• Does not accurately turn in the direction of a soft voice on the first call.
• Does not respond to sounds or locate where sound is coming from.
• Does not begin to imitate and use simple words for familiar people and things around the home.
• Does not sound like or use speech like children of similar age.
• Does not listen to TV at a normal volume.
• Does not show consistent growth in the understanding and the use of words.

How, when, and why should hearing be tested?

If you suspect that your child may have hearing loss, discuss it with your doctor. Children of any age can be tested by trained individuals.

Tests for newborns and infants under one year

Hearing tests are painless, and they normally take less than half an hour.

Newborns are tested with either the otoacoustic emissions (OAE) test or the automated auditory brainstem response (AABR) test. During the OAE test, a speaker (or earphone) is placed in the baby’s ear. It sends soft clicking sounds, and a computer records the inner ear’s response to the sounds. In the AABR test, the baby is exposed to certain sounds. Sensors are placed on his or her head to measure brain wave activity in response to the sound.

For infants over six months of age, the diagnostic auditory brainstem response and the visual reinforcement audiometry (VRA) tests are commonly used. The diagnostic auditory brainstem response test is similar to the AABR test, but it provides more information about the precise hearing sensitivity. The VRA test presents a series of sounds through earphones or in an audiologist’s booth. The child is asked to turn toward the sound, then he or she is rewarded with an entertaining visual image.

Tests for older children and adults

Children between two and four years old are tested through conditioned play audiometry (CPA). The children are asked to perform a simple play activity, such as placing a ring on a peg, when they hear a sound. Older children and adults may be asked to press a button or raise their hand.

All children should have their hearing tested before they start school. This could reveal mild hearing losses that the parent or child cannot detect. Loss of hearing in one ear may also be determined in this way. Such a loss, although not obvious, may affect speech and language.

Some causes of hearing loss

Hearing loss can result from earwax or fluid in the middle ears. Many children with this type of temporary hearing loss can have their hearing restored through medical treatment or surgery.

In contrast to temporary hearing loss, some children have “nerve deafness”, or more properly, sensorineural hearing loss, which is permanent. Most of these children have some usable hearing. Few are totally deaf. Early diagnosis, early fitting of hearing aids, and an early start on special educational programs can help maximize the child’s existing hearing.

Please note that this leaflet is not a substitute for an ear examination or a hearing test.

Steps to take

• If you have checked one or more of the indicators above, your child might have hearing loss and you should take him or her for an ear examination and a hearing test. This can be done at any age, even just after birth.
• If you did not check any of these factors, but you suspect that your child is not hearing normally, even if your child’s doctor is not concerned, have your child’s hearing tested, and when appropriate, have his or her speech evaluated by a speech and language pathologist. The test will not hurt your child, and will reassure you.

Child’s 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. It is always difficult for parents to receive bad news about any aspect of their child’s health. Reacting with anger, grief, and even guilt are not unusual when finding out that your child is hearing-impaired. These feelings are best managed by discussing them with a family member, close friend, clergy, or mental health professional. At times, the feeling may also result in a degree of denial. Feel free to seek a second opinion, but it is unadvisable to delay further recommended diagnostic evaluations for your child. The best treatment for hearing loss of any degree is appropriate early intervention. Significant delays may result in irreversible harm to your child’s hearing, speech, language, and eventual educational development. You will come into contact with many healthcare and rehabilitation specialists during the long-term management of your child’s hearing loss. Some of them will be involved early in the journey and again at intervals. Others may step in later on. The following are professionals you will encounter and the role each of them will play in managing your child’s hearing loss. The Audiologist The audiologist is likely to be the first professional you encounter, and possibly the one who gives you the initial news regarding your child’s hearing loss. The audiologist will carry out behavioral or objective testing (such as auditory brainstem responses) or a combination of these approaches to determine the degree and type of hearing loss. The audiologist will also eventually recommend appropriate amplification, following a medical consultation. The audiologist will also provide your child with well-fitting ear molds along with the hearing aids, as he or she grows. The audiologist may also be the professional who provides you with information and referral to an early intervention program. Over time, the audiologist will provide periodic follow-ups to chart your child’s progress and to monitor his or her hearing loss. Otologist, Otolaryngologist, or Pediatric Otolaryngologist (ENT Physician) Upon diagnosis of hearing loss, your child will be referred to an ear, nose, and throat specialist, (otolaryngologist), or one who specializes in childhood ear and hearing problems. This physician’s initial role is to determine the specific nature of the underlying problem that may be at least partially causing the hearing loss. Additionally, the physician will also determine if the problem is medically or surgically treatable, and if so, provide the necessary medical or surgical treatment. Such treatments could include something relatively simple, like the placement of eardrum ventilation tubes, or more complex surgical procedures. The ENT specialist may also refer your child for additional diagnostic procedures such as imaging studies (X-rays, CT-scans, MRI scans) to further define the type and source of hearing loss. The doctor will also provide clearance for hearing aid fitting, after determining if no other intervention is indicated. If it is determined that your child needs a cochlear implant, the otolaryngologist, along with the audiologist, will carry out further tests and examinations, and will carry out the implant surgery. Primary Care Physician: Pediatrician or Family Practitioner Your child’s primary care physician may be either a pediatrician or a family practice doctor. If your child is not diagnosed with a hearing loss in the newborn period but develops hearing loss later in life, it is the responsibility of this doctor to make appropriate referrals to an ear, nose and throat specialist and an audiologist to rule out or diagnose hearing loss. Your child’s primary care doctor may also participate in the treatment of ear infections if they appear, or refer them to an otolaryngologist for treatment. The primary care physician or the otolaryngologist may also provide a referral to a doctor who specializes in medical genetics, to find out if your child’s hearing loss may be hereditary. That may help you determine if a similar hearing loss could occur in your other children. Early Intervention Specialist This professional is typically is someone with an education background. He or she can help you find resources in your community, define family members’ roles in early intervention and management of the hearing loss, and can help you deal with questions regarding future educational placement. This specialist will also help you deal with your observations and concerns about your child and give you information and support regarding your child’s educational needs in the future. Speech/ Language Pathologist (SLP) This professional will evaluate the impact of your child’s hearing loss on speech/language development, and monitor his/her progress, noting if progress with that development is falling behind. If this happens, the SLP may refer back to the audiologist or otolaryngologist to determine if any changes have occurred in your child’s hearing. The SLP will also help your child to learn proper speech production, including correct articulation of speech sounds. If you choose oral communication for your child, in addition to the speech language pathologist your child may also be treated by an auditory-verbal therapist, who can help your child acquire the full range of speech sounds and guide the family to additional medical or audiological treatments. The auditory-verbal therapist will also help the child’s family become familiar with appropriate speech/language, auditory, and cognitive developmental milestones you may expect for a child with hearing loss. Finally, many other people can provide additional assistance for your hard-of-hearing child. Parents of older hard-of-hearing children, and hard-of-hearing adults, can share their experiences with you and may have suggestions for educational and recreational resources in the community.

Cholesteatoma

Insight into ear growths

• What causes a cholesteatoma?
• How is cholesteatoma treated?
• Symptoms and dangers
• and more…

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.

What causes a cholesteatoma?

A cholesteatoma usually occurs because of poor eustachian tube function as well as infection in the middle ear. The eustachian tube conveys air from the back of the nose into the middle ear to equalize ear pressure (“clear the ears”). When the eustachian tubes work poorly, perhaps due to allergy, a cold, or sinusitis, the air in the middle ear is absorbed by the body, creating a partial vacuum in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas weakened by previous infections. This can develop into a sac and become a cholesteatoma. A rare congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common.

How is cholesteatoma treated?

An examination by an otolaryngologist—head and neck surgeon can confirm the presence of a cholesteatoma. Initial treatment may consist of a careful cleaning of the ear, antibiotics, and ear drops. Therapy aims to stop drainage in the ear by controlling the infection. The growth traits of a cholesteatoma must also be evaluated.

A large or complicated cholesteatoma usually requires surgical treatment to protect the patient from serious complications. Hearing and balance tests, and CT scans (3-D x-rays) of the mastoid may be necessary. These tests are performed to determine the hearing level in the ear and the extent of destruction the cholesteatoma has caused.

Surgery is performed under general anesthesia in most cases. The primary purpose of surgery is to remove the cholesteotoma to eliminate the infection and create a dry ear. A second surgery is sometimes necessary both to ensure that the cholesteatoma is gone as well as to attempt reconstruction of the damaged middle ear bones in an effort to improve hearing. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required. Reconstruction of the middle ear is not always possible in one operation; therefore, another operation may be performed six to 12 months later. This operation will attempt to restore hearing and, at the same time, allow the surgeon to inspect the middle ear space and mastoid for residual cholesteatoma.

Surgery is commonly performed in an out-patient setting. For some patients, an overnight stay is necessary. In rare cases of serious infection, prolonged hospitalization for antibiotic treatment may be necessary. Time off from work is typically one to two weeks. After surgery, follow-up office visits are necessary to evaluate results and to check for recurrence. In cases requiring the creation of an open mastoidectomy cavity, office visits every few months are needed to clean out the mastoid cavity and prevent new infections. Some patients will need lifelong periodic ear examinations.

Symptoms and dangers

Initially, the ear may drain fluid with a foul odor. As the cholesteatoma pouch or sac enlarges, it can cause a feeling of fullness or pressure in the ear, along with hearing loss. An ache behind or in the ear, especially at night, may cause significant discomfort.

Dizziness, or muscle weakness on one side of the face (the side of the infected ear) can also occur. Any or all of these symptoms are good reasons to seek medical evaluation.

Cholesteatoma is a serious but treatable ear condition, which can be diagnosed only by medical examination. Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis, and, rarely, death can occur.

Chronic Otitis Media (Middle Ear Infection) and Hearing Loss

What is otitis media?

Otitis media refers to inflammation of the middle ear. When infection occurs, the condition is called “acute otitis media.” Acute otitis media occurs when a cold, allergy, or upper respiratory infection, and the presence of bacteria or viruses lead to the accumulation of pus and mucus behind the eardrum, blocking the Eustachian tube. This causes earache and swelling.

When fluid forms in the middle ear, the condition is known as “otitis media with effusion.” This occurs in a recovering ear infection or when one is about to occur. Fluid can remain in the ear for weeks to many months. When a discharge from the ear persists or repeatedly returns, this is sometimes called chronic middle ear infection. Fluid can remain in the ear up to three weeks following the infection. If not treated, chronic ear infections have potentially serious consequences such as temporary or permanent hearing loss.

How does otitis media affect a child’s hearing?

All children with middle ear infection or fluid have some degree of hearing loss. The average hearing loss in ears with fluid is 24 decibels…equivalent to wearing ear plugs. (Twenty-four decibels is about the level of the very softest of whispers.) Thicker fluid can cause much more loss, up to 45 decibels (the range of conversational speech).

Your child may have hearing loss if he or she is unable to understand certain words and speaks louder than normal. Essentially, a child experiencing hearing loss from middle ear infections will hear muffled sounds and misunderstand speech rather than incur a complete hearing loss. Even so, the consequences can be significant – the young patient could permanently lose the ability to consistently understand speech in a noisy environment (such as a classroom) leading to a delay in learning important speech and language skills.

Types of hearing loss

Conductive hearing loss is a form of hearing impairment due to a lesion in the external auditory canal or middle ear. This form of hearing loss is usually temporary and found in those ages 40 or younger. Untreated chronic ear infections can lead to conductive hearing loss; draining the infected middle ear drum will usually return hearing to normal.

The other form of hearing loss is sensorineural hearing loss, hearing loss due to a lesion of the auditory division of the 8th cranial nerve or the inner ear. Historically, this condition is most prevalent in middle age and older patients; however, extended exposure to loud music can lead to sensorineural hearing loss in adolescents.

When should a hearing test be performed?

A hearing test should be performed for children who have frequent ear infections, hearing loss that lasts more than six weeks, or fluid in the middle ear for more than three months. There are a wide range of medical devices now available to test a child’s hearing, Eustachian tube function, and reliability of the ear drum. They include the otoscopy, tympanometer, and audiometer.

Do children lose their hearing for reasons other than chronic otitis media?

Children can incur temporary hearing loss for other reasons than chronic middle ear infection and Eustachian tube dysfunction. They include:

• Cerumen impaction (compressed earwax)
• Otitis externa: Inflammation of the external auditory canal, also called “swimmer’s ear.”
• Cholesteatoma: A mass of horn shaped squamous cell epithelium and cholesterol in the middle ear, usually resulting from chronic otitis media.
• Otosclerosis: This is a disease of the otic capsule (bony labyrinth) in the ear, which is more prevalent in adults and characterized by formation of soft, vascular bone leading to progressive conductive hearing loss. It occurs due to fixation of the stapes (bones in the ear). Sensorineural hearing loss may result because of involvement of the cochlear duct.
• Trauma: A trauma to the ear or head may cause temporary or permanent hearing loss.

Cochlear Implants

A cochlear implant is an electronic device that restores partial hearing to individuals with severe to profound hearing loss who do not benefit from a conventional hearing aid. It is surgically implanted in the inner ear and activated by a device worn outside the ear. Unlike a hearing aid, it does not make sound louder or clearer. Instead, the device bypasses damaged parts of the auditory system and directly stimulates the nerve of hearing, allowing individuals who are profoundly hearing-impaired to receive sound.

What is normal hearing?

Your ear consists of three parts that play a vital role in hearing—the external ear, middle ear and inner ear.

Conductive hearing: Sound travels along the ear canal of the external ear, causing the ear drum to vibrate. Three small bones of the middle ear conduct this vibration from the eardrum to the cochlea (auditory chamber) of the inner ear.

Sensorineural hearing: When the three small bones move, they start waves of fluid in the cochlea, and these waves stimulate more than 16,000 delicate hearing cells (hair cells). As these hair cells move, they generate an electrical current in the auditory nerve. The electrical signal travels through inter-connections in the brain to specific areas of the brain that recognize it as sound.

How is hearing impaired?

If you have disease or obstruction in your external or middle ear, your conductive hearing may be impaired. Medical or surgical treatment can probably correct this.

An inner ear problem, however, can result in a sensorineural impairment, or nerve deafness. In most cases, the hair cells are damaged and do not function. Although many auditory nerve fibers may be intact and can transmit electrical impulses to the brain, these nerve fibers are unresponsive because of hair cell damage. Since severe sensorineural hearing loss cannot be corrected with medicine, it can be treated only with a cochlear implant.

How do cochlear implants work?

Cochlear implants bypass damaged hair cells and convert speech and environmental sounds into electrical signals and send these signals to the hearing nerve.

A cochlear implant has two main components:

• An internal component that consists of a small electronic device, which is surgically implanted under the skin behind the ear, connected to electrodes that are inserted inside the cochlea.
• An external component, which is usually worn behind the ear, that consists of a speech processor, microphone, and battery compartment.

The microphone captures sound, allowing the speech processor to translate the sound into distinctive electrical signals. These signals or “codes” travel up a thin cable to the headpiece and are transmitted across the skin via radio waves to the implanted electrodes in the cochlea. The electrodes’ signals stimulate the auditory nerve fibers to send information to the brain, where it is interpreted as meaningful sound.

Cochlear implant benefits

Cochlear implants are designed only for individuals who attain almost no benefit from a hearing aid. They must be 12 months of age or older (unless childhood meningitis is responsible for deafness).

Otolaryngologists (ear, nose and throat specialists) perform implant surgery, although not all of them do this procedure. Your local doctor can refer you to an implant clinic for an evaluation. The implant team (otolaryngologist, audiologist, nurse and others) will determine your candidacy for a cochlear implant and review the appropriate expectations as a result of the cochlear implant. The implant team will also conduct a series of tests including:

Ear (otologic) evaluation: The otolaryngologist examines the middle and inner ear to ensure that no active infection or other abnormality precludes the implant surgery.

Hearing (audiologic) evaluation: The audiologist performs extensive hearing tests to find out how much you can hear with and without a hearing aid.

X-ray (radiographic) evaluation: Special X-rays are taken, usually computerized tomography (CT) or magnetic resonance imaging (MRI) scans, to evaluate your inner ear anatomy.

Physical examination: Your otolaryngologist also performs a physical examination to identify any potential problems with the use of general anesthesia needed for the implant procedure.

Cochlear implant surgery

Cochlear implant surgery is usually performed as an outpatient procedure under general anesthesia. An incision is made behind the ear to open the mastoid bone leading to the middle ear space. Once the middle ear space is exposed, an opening is made in the cochlea and the implant electrodes are inserted. The electronic device at the base of the electrode array is then placed behind the ear under the skin.

Is there care and training after the operation?

Several weeks after surgery, your cochlear implant team places the signal processor, microphone, and implant transmitter outside your ear and adjusts them. They teach you how to look after the system and how to listen to sound through the implant. There are many causes of hearing loss and some patients may take longer to fit and require more training, due to individual patient differences. Your team will ask you to come back to the clinic for regular checkups and readjustment of the speech processor as needed.

What can I expect from an implant?

Most adult cochlear implant patients notice an immediate improvement in their communication skills. Children require time to benefit from their cochlear implant as the brain needs to learn to correctly interpret the electrical sound input. While cochlear implants do not restore normal hearing, and benefits vary from one individual to another, most users find that cochlear implants help them communicate better through improved lip-reading. Also, 90 percent of adult cochlear implant patients are able to discriminate speech without the use of visual cues. There are many factors that contribute to the degree of benefit a user receives from a cochlear implant, including:

• How long a person has been deaf,
• The number of surviving auditory nerve fibers, and
• A patient’s motivation to learn to hear.

Your team will explain what you can reasonably expect. Before deciding whether your implant is working well, you need to understand clearly how much time you must commit. It is rare that patients do not benefit from a cochlear implant.

FDA approval for implants

The Food and Drug Administration (FDA) regulates cochlear implant devices for both adults and children and approves them only after thorough clinical investigation.

Be sure to ask your otolaryngologist for written information, including brochures provided by the implant manufacturers. You need to be fully informed about the benefits and risks of cochlear implants, including how much is known about safety, reliability, and effectiveness of a device, how often you must come back to the clinic for checkups, and whether your insurance company pays for the procedure.

Costs of implants

More expensive than a hearing aid, the total cost of a cochlear implant including evaluation, surgery, the device, and rehabilitation can cost as much as $100,000. Fortunately, most insurance companies and Medicare provide benefits that cover the cost.

Cochlear Implants and Meningitis Vaccination

What you should know

Children with cochlear implants are more likely to get bacterial meningitis than children without them. In addition, some children who are candidates for cochlear implants have inner ear abnormalities that may increase their risk for meningitis.

Because children with cochlear implants are at increased risk for pneumococcal meningitis, the Centers for Disease Control and Prevention (CDC) recommends that they receive pneumococcal vaccination on the same schedule recommended for other groups at increased risk for invasive pneumococcal disease. Recommendations for the timing and type of this vaccination vary with age and vaccination history, and should be discussed with a healthcare provider.

The CDC has issued new pneumococcal vaccination recommendations for individuals with cochlear implants. These can be viewed on the CDC website.

• Children who have cochlear implants or are candidates for them, and who have not received any previous doses of PCV7, should receive PCV13. PCV13 is now recommended routinely for all infants and children (see Table 2 in the CDC March 13, 2010 report at the website above for the dosing schedule).
• Older children with cochlear implants (between age 2 and 6) should receive two doses of PCV13 if they have not previously received any PCV7 or PCV13. If they have already completed the four-dose PCV7 series, they should receive one dose of PCV13 (up to age 6).
• Children 6 through 18 with cochlear implants may receive a single dose of PCV13, regardless of whether they’ve previously received PCV7 or the pneumococcal polysaccharide vaccine (PPSV) (Pneumovax®).
• In addition to receiving PCV13, children with cochlear implants should receive one dose of PPSV at age 2 or older, and after completing all recommended doses of PCV13.
• Adult patients (19 and older) who are candidates for a cochlear implant, and those who have received an implant, should receive a single dose of PPSV.
• For both children and adults, the vaccination schedule should be completed two weeks or more before surgery.

Additional facts

• According to the Food and Drug Administration (FDA), as of April 2009, approximately 188,000 people worldwide have received cochlear implants, including roughly 41,500 adults and 25,500 children in the U.S. There are 122 known reports of meningitis in patients in the U.S., who have received cochlear implants, with 64% of these cases in children.
• Meningitis is an infection of the fluid that surrounds the brain and spinal cord. There are two main types of meningitis, viral and bacterial. Bacterial meningitis is the more serious, and the type that has been reported in individuals with cochlear implants. The symptoms, treatment, and outcomes may differ, depending on the cause.
• The vaccines available in the U.S. that protect against most bacteria that cause meningitis are:
  • 13-valent pneumococcal conjugate (PCV13) (Prevnar 13®)
  • 23-valent pneumococcal polysaccharide (PPSV) (Pneumovax®)
  • Haemophilus influenzae type b conjugate (Hib)
  • Tetravalent (A, C, Y, W-135) meningococcal conjugate (Menactra® and Menveo®)
  • Tetravalent (A, C, Y, W-135) meningococcal polysaccharide (Menomune®)
• Meningitis in individuals with cochlear implants is most commonly caused by the bacterium Streptococcus pneumoniae (pneumococcus). Children with cochlear implants are more likely to get pneumococcal meningitis than children without them.
• There is no evidence that children with cochlear implants are more likely to get meningococcal meningitis than other children.
• The Haemophilus influenzae type b (Hib) vaccine is not routinely recommended for those age 5 or older, since most older children and adults are already immune to Hib. However, it can be given to older children and adults who have never received it. Children under age 5 should receive the Hib vaccine as a routine protection, according to the CDC guidelines. Most children born after 1990 receive the Hib vaccine as infants.
• Healthcare providers (family physicians, pediatricians, and otolaryngologists) and families should review the vaccination records of current and prospective cochlear implant recipients to ensure that all recommended vaccinations are up to date.

Earaches and Otitis Media

Insight into otitis media and treatments

• What is otitis media?
• How does the ear work?
• What are the symptoms?

Otitis media means “inflammation of the middle ear,” as a result of a middle ear infection. It can occur in one or both ears. Otitis media is the most frequent diagnosis for children who visit physicians for illness. It is also the most common cause of hearing loss in children. Although otitis media is most common in young children, it occasionally affects adults

Is it serious?

Yes, because of the severe earache and hearing loss it can cause. Hearing loss, especially in children, may impair learning capacity and even delay speech development. However, if it is treated promptly and effectively, 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. (see the symptoms list) Immediate attention from your doctor is the best action.

How does the ear work?

The outer ear collects sounds. The middle ear is a pea-sized, air-filled cavity separated from the outer ear by the paper-thin eardrum. Inside the middle ear are three tiny ear bones. When sound waves strike the eardrum, it vibrates and sets the bones in motion that transmit to the inner ear. The inner ear converts vibrations to electrical signals and sends these signals to the brain. A healthy middle ear has the same atmospheric pressure as air outside of the ear, allowing free vibration. Air enters the middle ear through the narrow eustachian tube that connects the back of the nose to the ear

What causes otitis media?

Blockage of the eustachian tube during a cold, allergy, or upper respiratory infection, and the presence of bacteria or viruses lead to a build-up of pus and mucusbehind the eardrum. This infection is called acute otitis media. The build-up of pressurized pus in the middle ear causes pain, swelling, and redness. Since the eardrum cannot vibrate properly, hearing problems may occur. Sometimes the eardrum ruptures, and pus drains out of the ear. More commonly, however, the pus and mucus remain in the middle ear due to the swollen and inflamed eustachian tube. This is called middle ear effusion or serous otitis media. Often after the acute infection has passed, the effusion remains lasting for weeks, months, or even years. This condition allows frequent recurrences of the acute infection and may cause difficulty in hearing.

What will happen at the doctor’s office?

During an examination, the doctor will use an otoscope to look at and assess the ear. The doctor checks for redness in the ear, and/or fluid behind the eardrum,, and to see if the eardrum moves. These are the signs of an ear infection. Two other tests may also be performed:

• Audiogram—Tests if hearing loss has occurred by presenting tones at various pitches.
• Tympanogram—Measures the air pressure in the middle ear to see how well the eustachian tube is working and how well the eardrum can move.

How should medication be taken?

It is important that all the medications be taken as directed and that you keep any follow-up visits. Often, antibiotics to fight the infection will make the earache go away rapidly, but the infection may need more time to clear up. Other medications that your doctor may prescribe include an antihistamine (for allergies), a decongestant (especially with a cold), or both. Sometimes the doctor may recommend a medication to reduce fever and/or pain. Special ear drops can ease the pain. Call your doctor if you have any questions about yours or your child’s medication, or if symptoms do not clear.

What other treatment may be necessary?

If your child experiences multiple episodes of acute otitis media within a short time, or hearing loss, or chronic otitis media lasts for more than three months, your physician may recommend referral to an otolaryngologist for placement of ventilation tubes, also called pressure-equalization (PE) tubes. This is a short surgical procedure in which a small incision is made in the eardrum, any fluid is suctioned out, and a tube is placed in the eardrum. This tube eventually will fall out on its own and the eardrum heals. There is usually an improvement in hearing and a decrease in further infections with PE tube placement.

Otitis media may recur as a result of chronically infected adenoids and tonsils. If this becomes a problem, your doctor may recommend removal of one or both. This can be done at the same time as ventilation tubes are inserted.

What are the symptoms?

In infants and toddlers, look for: Pulling or scratching at the ear, especially if accompanied by other symptoms; hearing problems; crying, irritability; fever; ear drainage.

In young children, adolescents, and adults look for: earache; feeling of fullness or pressure; hearing problems; dizziness; loss of balance, nausea, vomiting, ear drainage, and/or fever.

Remember, without proper treatment, damage from an ear infection can cause chronic or permanent hearing loss.

Ear Infection and Vaccines

Researchers continue to look for help for children and parents of children who suffer from the most common type of ear infection, called middle ear infection or otitis media (OM).

About 62 percent of children in developed countries will have their first episode of OM by the age of one, more than 80 percent by their third birthday, and nearly 100 percent will have at least one episode by age five. In the U.S. alone, this illness accounts for 25 million office visits annually with direct costs for treatment estimated at $3 billion. Health economists add that when lost wages for parents are included, the total cost of estimated treatments mount to $6 billion.

This is a big problem.

Treatments

The usual treatment options for children with middle ear infections include 1) antibiotics; and 2) surgical insertion of pressure equalizing tubes in the ears. While studies have shown that antibiotics can be helpful in certain cases, excessive use can lead to bacterial resistance, making infections more difficult to treat. Tubes sometimes do not equalize pressure enough or may need reinsertion over time.

What about vaccines?

A vaccine is a preparation administered to stimulate the body’s own defense system to combat specific bacteria or viruses. The first vaccine was introduced in the 18th century for the prevention of smallpox. Today, each vaccine is designed to resemble a particular virus or bacteria (or group of viruses and bacteria). When administered, the vaccine triggers the defense system without actually causing illness. This helps the body to develop a defense (antibodies) against the virus or bacteria so that if they enter the body, you will not get sick. Today, vaccines exist to combat a wide range of viruses and some bacteria.

One of the most common and potentially serious bacteria to cause ear and sinus infections and pneumonia and meningitis is the pneumococcus. Recently a vaccine was developed that is effective against several common strains of pneumococcus.

Your child’s physician will advise you on appropriate vaccines for your child.  If the pneumococcal vaccine is offered to your child, you may want to know:

The conjugate pneumococcal vaccine: This latest advance in pediatric healthcare prevents diseases caused by seven of the most common types of pneumococcal bacteria. It is safe and effective. It protects against serious forms of the disease up to 97 percent of the time, depending on the person. The vaccine is given by a needle. The side effects, which are usually minor and temporary, include some redness, swelling or tenderness from the injection, and a mild fever. Serious side effects, including allergic reactions, are quite rare. It can be given to infants, and there is no other vaccine to prevent pneumococcal disease in children less than two years of age. In 2002 the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommended the vaccine for infants and toddlers under the age of five. See http://www.cdc.gov/nip for more information.

Conjugate vaccines are effective against otitis media in children under the age of five because they have a polysaccharide component linked to a protein component that an infant’s immature defense system can recognize. Children older than five, whose defense systems have matured, may receive a pneumococcal polysaccharide vaccine without the protein component.

How does this relate to otitis media? Here are issues to consider.

Streptococcus pneumoniae bacteria (commonly known as pneumococcus) are thought to cause 50 to 60 percent of cases of otitis media. Before this vaccine was available, each pneumococcal infection caused:

• about five million ear infections;
• more than 700 cases of meningitis;
• 13,000 blood infections (septicemia); and
• other health problems including pneumonia, deafness, and brain damage.

Haemophilus influenzae (NTHi) and Moraxella catarrhalis vaccine

Two other common bacteria that cause ear and sinus infections are nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis. Recently, the National Institutes of Health has issued a license for the first clinical trials for a nontypeable Haemophilus influenzae (NTHi) vaccine. Vaccines to prevent viral infections like the flu that can eventually lead to ear infections should be considered for children with recurring ear infections. These vaccines are usually administered in the fall.

Ear Plastic Surgery Protruding and drooping ears or torn earlobes can be surgically corrected. Exceptionally large ears or those that stick out make children vulnerable to teasing. These procedures do not alter the patient’s hearing, but they may improve appearance and self-confidence. What Is Involved in “Pinning Back” the Ears? Corrective surgery, called otoplasty, should be considered on ears which stick out more than 4/5 of an inch (2 cm) from the back of the head. It can be performed at any age after the ears have reached full size, usually at five or six years of age. Having the surgery at a young age has two benefits: the cartilage is more pliable, making it easier to reshape, and the child will experience the psychological benefits of the cosmetic improvement. However, a patient may have the surgery at any age. The surgery begins with an incision behind the ear, in the fold where the ear joins the head. The surgeon may remove skin and cartilage or trim and reshape the cartilage. In addition to correcting protrusion, ears may also be reshaped, reduced in size, or made more symmetrical. The cartilage is then secured in the new position with permanent stitches which will anchor the ear while healing occurs. Typically otoplasty surgery takes about two hours. The soft dressings over the ears will be used for a few weeks as protection, and the patient usually experiences only mild discomfort. Headbands are sometimes recommended to hold the ears in place for a month following surgery or may be prescribed for nighttime wear only. Can Ear Deformities Be Corrected? The “fold” of hard, raised cartilage that gives shape to the upper portion of the ear does not form in all people. This is called “lop-ear deformity,” and it is inherited. The absence of the fold can cause the ear to stick out or flop down. To correct this problem, the surgeon places permanent stitches in the upper ear cartilage and ties them in a way that creates a fold and props the ear up. Scar tissue will form later, holding the fold in place. Some infants are born without an opening in their middle ear. These ears can be surgically opened, and the outer ear reshaped to look like the other ear. This procedure will restore hearing if the inner ear is intact. Those who are born without an ear, or lose an ear due to injury, can have an artificial ear surgically attached for cosmetic reasons. These are custom formed to match the patient’s other ear. Alternatively, rib cartilage or a biomedical implant, in addition to the patient’s own soft tissue, can be used to construct a new ear. Can Torn Earlobes Be Corrected? Many mothers have had their earlobes torn by a baby’s tug on their earrings. Earrings also catch on clothing and other objects, resulting in torn earlobes. These tears can be easily repaired surgically, usually in the doctor’s office. In severe cases, the surgeon may cut a small triangular notch at the bottom of the lobe. A matching flap is then created from tissue on the other side of the tear, and the two wedges are fitted together and stitched. Earlobes usually heal quickly with minimal scarring. In most cases, the earlobe can be pierced again four to six weeks after surgery to receive light-weight earrings. Does Insurance Pay for Cosmetic Ear Surgery? Insurance usually does not cover surgery solely for cosmetic reasons. However, insurance may cover, in whole or in part, surgery to correct a congenital or traumatic defect. Before cosmetic ear surgery, discuss the procedure with your insurance carrier to determine what coverage, if any, you can expect.

Ear Tubes

Insight into causes and treatment options

• Who needs ear tubes and why?
• What to expect after surgery
• and more…

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.

What are ear tubes?

Ear tubes are tiny cylinders placed through the ear drum (tympanic membrane) to allow air into the middle ear. They also may be called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PE (pressure equalization) tubes.

These tubes can be made out of various materials and may have a coating intended to reduce the possibility of infection. There are two basic types of ear tubes: short-term and long-term. Short- term tubes are smaller and typically stay in place for six months to a year before falling out on their own. Long-term tubes are larger and have flanges that secure them in place for a longer period of time. Long-term tubes may fall out on their own, but removal by an otolaryngologist may be necessary.

Who needs ear tubes and why?

Ear tubes are often recommended when a person experiences repeated middle ear infection (acute otitis media) or has hearing loss caused by the persistent presence of middle ear fluid (otitis media with effusion). These conditions most commonly occur in children, but can also be present in teens and adults and can lead to speech and balance problems, hearing loss, or changes in the structure of the ear drum. Other less common conditions that may warrant the placement of ear tubes are malformation of the ear drum or eustachian tube, Down Syndrome, cleft palate, and barotrauma (injury to the middle ear caused by a reduction of air pressure, usually seen with altitude changes as in flying and scuba diving).

Each year, more than half a million ear tube surgeries are performed on children, making it the most common childhood surgery performed with anesthesia. The average age for ear tube insertion is one to three years old. Inserting ear tubes may:

• Reduce the risk of future ear infection;
• Restore hearing loss caused by middle ear fluid;
• Improve speech problems and balance problems; and
• Improve behavior and sleep problems caused by chronic ear infections.

How are ear tubes inserted in the ear?

Ear tubes are inserted through an outpatient surgical procedure called a myringotomy. A myringotomy refers to an incision (small hole) in the ear drum or tympanic membrane. This is most often done under a surgical microscope with a small scalpel, but it can also be accomplished with a laser. If an ear tube is not inserted, the hole would heal and close within a few days. To prevent this, an ear tube is placed in the hole to keep it open and allow air to reach the middle ear space (ventilation).

What happens during surgery?

A general anesthetic is administered for young children. Some older children and adults may be able to tolerate the procedure without anesthetic. A myringotomy is performed and the fluid behind the ear drum (in the middle ear space) is suctioned out. The ear tube is then placed in the hole. Ear drops may be administered after the ear tube is placed and may be prescribed for a few days. The procedure usually lasts less than 15 minutes and patients awaken quickly.

Sometimes the otolaryngologist will recommend removal of the adenoid tissue (lymph tissue located in the upper airway behind the nose) when ear tubes are placed. This is often considered when a second or third tube insertion is necessary. Current research indicates that removing adenoid tissue concurrent with placement of ear tubes can reduce the risk of recurrent ear infections and the need for repeat surgery.

What happens after surgery?

After surgery, the patient is monitored in the recovery room and will usually go home within an hour or two if no complications occur. Patients usually experience little or no postoperative pain, but grogginess, irritability, and/or nausea from the anesthesia can occur temporarily.

Hearing loss caused by the presence of middle ear fluid is immediately resolved by surgery..

The otolaryngologist will provide specific postoperative instructions, including when to seek immediate attention and to set follow-up appointments. He or she may also prescribe antibiotic ear drops for a few days. An audiogram should be performed after surgery, if hearing loss is present before the tubes are placed. This test will make sure that hearing has improved with the surgery.

To avoid the possibility of bacteria entering the middle ear through the ventilation tube, physicians may recommend keeping ears dry by using ear plugs or other water-tight devices during bathing, swimming, and water activities. However, recent research suggests that protecting the ear may not be necessary. Parents should consult with the treating physician about ear protection after surgery.

Consultation with an otolaryngologist (ear, nose, and throat specialist) may be warranted if you or your child has experienced repeated or severe ear infections, ear infections that are not resolved with antibiotics, hearing loss due to fluid in the middle ear, barotrauma, or have an anatomic abnormality that inhibits drainage of the middle ear.

Possible complications

Myringotomy with insertion of ear tubes is an extremely common and safe procedure with minimal complications. When complications do occur, they may include:

• Perforation – This can happen when a tube comes out or a long-term tube is removed and the hole in the tympanic membrane (ear drum) does not close. The hole can be patched through a surgical procedure called a tympanoplasty or myringoplasty.
• Scarring – Any irritation of the ear drum (recurrent ear infections), including repeated insertion of ear tubes, can cause scarring called tympanosclerosis or myringosclerosis. In most cases, this causes no problem with hearing.
• Infection – Ear infections can still occur in the middle ear or around the ear tube. However, these infections are usually less frequent, result in less hearing loss, and are easier to treat—often only with ear drops. Sometimes an oral antibiotic is still needed.
• Ear tubes come out too early or stay in too long—If an ear tube expels from the ear drum too soon (which is unpredictable), fluid may return and repeat surgery may be needed. Ear tubes that remain too long may result in perforation or may require removal by an otolaryngologist.

Ears and Altitude

Insight into making air travel more comfortable

• Why do ears pop?
• How can air travel cause hearing problems?
• How to help babies unblock their ears?
• and more…

Ear problems are the most common medical complaint of airplane travelers, and while they are usually simple, minor annoyances, they may result in temporary pain and hearing loss. Make air travel comfortable by learning how to equalize the pressure in the ears instead of suffering from an uncomfortable feeling of fullness or pressure.

Why do ears pop?

Normally, swallowing causes a little click or popping sound in the ear. This occurs because a small bubble of air has entered the middle ear, up from the back of the nose. It passes through the Eustachian tube, a membrane-lined tube about the size of a pencil lead that connects the back of the nose with the middle ear. The air in the middle ear is constantly being absorbed by its membranous lining and re-supplied through the Eustachian tube. In this manner, air pressure on both sides of the eardrum stays about equal. If, and when, the air pressure is not equal the ear feels blocked.

The Eustachian tube can be blocked, or obstructed, for a variety of reasons. When that occurs, the middle ear pressure cannot be equalized. The air already there is absorbed and a vacuum occurs, sucking the eardrum inward and stretching it. Such an eardrum cannot vibrate naturally, so sounds are muffled or blocked, and the stretching can be painful. If the tube remains blocked, fluid (like blood serum) will seep into the area from the membranes in an attempt to overcome the vacuum. This is called “fluid in the ear,” serous otitis or aero-otitis. Uncommon problems include developing a hole in the ear drum, hearing loss and dizziness.

The most common cause for a blocked Eustachian tube is the common cold. Sinus infections and nasal allergies are also common causes. A stuffy nose leads to stuffy ears because the swollen membranes block the opening of the Eustachian tube.

How can air travel cause hearing problems?

Air travel is sometimes associated with rapid changes in air pressure. To maintain comfort, the Eustachian tube must open frequently and wide enough to equalize the changes in pressure. This is especially true when the airplane is landing, going from low atmospheric pressure down closer to earth where the air pressure is higher.

Actually, any situation in which rapid altitude or pressure changes occur creates the problem. It may be experienced when riding in elevators or when diving to the bottom of a swimming pool. Deep sea divers, as well as pilots, are taught how to equalize their ear pressure. Anybody can learn the trick too.

How to unblock ears?

Swallowing activates the muscles that open the Eustachian tube. Swallowing occurs more often when chewing gum or when sucking on hard candies. These are good air travel practices, especially just before take-off and during descent. Yawning is even better. Avoid sleeping during descent because swallowing may not occur often enough to keep up with the pressure changes.

During decent, if yawning and swallowing are not effective, pinch the nostrils shut, take a mouthful of air, and direct the air into the back of the nose as if trying to blow the nose gently, you should feel a pressure buildup but do not let the air out your mouth The ears have been successfully unblocked when a pop is heard. This may have to be repeated several times during descent.

Even after landing, continue the pressure equalizing techniques and the use of decongestants and nasal sprays. If the ears fail to open or if pain persists, seek the help of a physician who has experience in the care of ear disorders. The ear specialist may need to release the pressure or fluid with a small incision in the ear drum.

For some people, these techniques may not work. If you fly frequently and have chronic issues with pressure or pain, you doctor may recommend placing small pressure equalization tubes.

How to help babies unblock their ears?

Babies cannot intentionally pop their ears, but popping may occur if they are sucking on a bottle or pacifier. Feed the baby during the flight, and do not allow him or her to sleep during descent. Children are especially vulnerable to blockages because their Eustachian tubes are narrower than in adults.

Is the use of decongestants and nose sprays recommended?

Many experienced air travelers use a decongestant pill or an over the counter nasal spray an hour or so before descent. This will shrink the membranes and help the ears pop more easily. Travelers with allergy problems should take their medication at the beginning of the flight for the same reason. However, avoid making a habit of over the counter nasal sprays. After a few days, they may cause more congestion than relief.

Decongestant tablets and sprays can be purchased without a prescription. However, they should be avoided by people with heart disease, high blood pressure, irregular heart rhythms, thyroid disease, or excessive nervousness. Such people should consult their physicians before using these medicines. Pregnant women should likewise consult their physicians first.

Tips to prevent discomfort during air travel

• Consult with a surgeon on how soon after ear surgery it is safe to fly.
• Postpone an airplane trip if a cold, sinus infection, or an allergy attack is present.
• Patients in good health can take a decongestant pill or nose spray approximately an hour before descent to help the ears pop more easily.
• Avoid sleeping during descent.
• Chew gum or suck on a hard candy just before take-off and during descent.
• When inflating the ears, do not use force. The proper technique involves only pressure created by the cheek and throat muscles.
• These tips may also be used for people who scuba dive.

Earwax

Insight into the proper care of the ears

• Why does the body produce earwax?
• What is the recommended method of ear cleaning?
• When should a doctor be consulted?
• and more…

Good intentions to keep ears clean may be risking the ability to hear. The ear is a delicate and intricate area, including the skin of the ear canal and the eardrum. Therefore, special care should be given to this part of the body. Start by discontinuing the use of cotton-tipped applicators and the habit of probing the ears.

Why does the body produce earwax?

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.

Earwax is not formed in the deep part of the ear canal near the eardrum, but in the outer one-third of the ear canal. So when a patient has wax blockage against the eardrum, it is often because he has been probing the ear with such things as cotton-tipped applicators, bobby pins, or twisted napkin corners. These objects only push the wax in deeper.

When should the ears be cleaned?

Under ideal circumstances, the ear canals should never have to be cleaned. However, that isn’t always the case. The ears should be cleaned when enough earwax accumulates to cause symptoms or to prevent a needed assessment of the ear by your doctor. This condition is called cerumen impaction, and may cause one or more of the following symptoms:

• Earache, fullness in the ear, or a sensation the ear is plugged
• Partial hearing loss, which may be progressive
• Tinnitus, ringing, or noises in the ear
• Itching, odor, or discharge
• Coughing

What is the recommended method of ear cleaning?

To clean the ears, wash the external ear with a cloth, but do not insert anything into the ear canal.

Most cases of ear wax blockage respond to home treatments used to soften wax. Patients can try placing a few drops of mineral oil, baby oil, glycerin, or commercial drops in the ear. Detergent drops such as hydrogen peroxide or carbamide peroxide may also aid in the removal of wax.

Irrigation or ear syringing is commonly used for cleaning and can be performed by a physician or at home using a commercially available irrigation kit. Common solutions used for syringing include water and saline, which should be warmed to body temperature to prevent dizziness. Ear syringing is most effective when water, saline, or wax dissolving drops are put in the ear canal 15 to 30 minutes before treatment. Caution is advised to avoid having your ears irrigated if you have diabetes, a perforated eardrum, tube in the eardrum, or a weakened immune system.

Manual removal of earwax is also effective. This is most often performed by an otolaryngologist using suction, special miniature instruments, and a microscope to magnify the ear canal. Manual removal is preferred if your ear canal is narrow, the eardrum has a perforation or tube, other methods have failed, or if you have diabetes or a weakened immune system.

Why shouldn’t cotton swabs be used to clean earwax?

Wax blockage is one of the most common causes of hearing loss. This is often caused by attempts to clean the ear with cotton swabs. Most cleaning attempts merely push the wax deeper into the ear canal, causing a blockage.

The outer ear is the funnel-like part of the ear that can be seen on the side of the head, plus the ear canal (the hole which leads down to the eardrum). The ear canal is shaped somewhat like an hourglass—narrowing part way down. The skin of the outer part of the canal has special glands that produce earwax. This wax is supposed to trap dust and dirt particles to keep them from reaching the eardrum. Usually the wax accumulates a bit, dries out, and then comes tumbling out of the ear, carrying dirt and dust with it. Or it may slowly migrate to the outside where it can be wiped off.

Are ear candles an option for removing wax build up?

No, ear candles are not a safe option of wax removal as they may result in serious injury. Since users are instructed to insert the 10″ to 15″-long, cone-shaped, hollow candles, typically made of wax-impregnated cloth, into the ear canal and light the exposed end, some of the most common injuries are burns, obstruction of the ear canal with wax of the candle, or perforation of the membrane that separates the ear canal and the middle ear.

The U.S. Food and Drug Administration (FDA) became concerned about the safety issues with ear candles after receiving reports of patient injury caused by the ear candling procedure. There are no controlled studies or other scientific evidence that support the safety and effectiveness of these devices for any of the purported claims or intended uses as contained in the labeling.

Based on the growing concern associated with the manufacture, marketing, and use of ear candles, the FDA has undertaken several successful regulatory actions, including product seizures and injunctions, since 1996. These actions were based, in part, upon violations of the Food, Drug, and Cosmetic Act that pose an imminent danger to health.

What can I do to prevent excessive earwax?

There are no proven ways to prevent cerumen impaction, but not inserting cotton-tipped swabs or other objects in the ear canal is strongly advised. If you are prone to repeated wax impaction or use hearing aids, consider seeing your doctor every 6 to 12 months for a checkup and routine preventive cleaning.

When should a doctor be consulted?

If the home treatments discussed in this section are not satisfactory or if wax has accumulated so much that it blocks the ear canal (and hearing), a physician may prescribe eardrops designed to soften wax, or he may wash or vacuum it out. Occasionally, an otolaryngologist (ear, nose, and throat specialist) may need to remove the wax using microscopic visualization.

If there is a possibility of a hole (perforation or puncture) in the eardrum, consult a physician prior to trying any over-the-counter remedies. Putting eardrops or other products in the ear with the presence of an eardrum perforation may cause pain or an infection. Certainly, washing water through such a hole could start an infection.

Genes and Hearing Loss

One of the most common birth defects is hearing loss or deafness (congenital), which can affect as many as three of every 1,000 babies born. Inherited genetic defects play an important role in congenital hearing loss, contributing to about 60 percent of deafness occurring in infants. Although exact data is not available, it is likely that genetics plays an important role in hearing loss in the elderly. Inherited genetic defects are just one factor that can lead to hearing loss and deafness, both of which may occur at any stage of a person’s lifespan. Other factors may include: medical problems, environmental exposure, trauma, and medications.

The most common and useful distinction in hearing impairment is syndromic versus non-syndromic.

Non-syndromic hearing impairment accounts for the vast majority of inherited hearing loss, approximately 70 percent. Autosomal- recessive inheritance is responsible for about 80 percent of cases of non-syndromic hearing impairment, while autosomal-dominant genes cause 20 percent, less than two percent of cases are caused by X-linked and mitochondrial genetic malfunctions.

Syndromic (sin-DRO-mik) means that the hearing impairment is associated with other clinical abnormalities. Among hereditary hearing impairments, 15 to 30 percent are syndromic. Over 400 syndromes are known to include hearing impairment and can be classified as: syndromes due to cyotgenetic or chromosomal anomalies, syndromes transmitted in classical monogenic or Mendelian inheritance, or syndromes due to multi-factorial influences, and finally, syndromes due to a combination of genetic and environmental factors.

Variable expression of different aspects of syndromes is common. Some aspects may be expressed in a range from mild to severe or different combinations of associated symptoms may be expressed in different individuals carrying the same mutation within a single pedigree. An example of variable expressivity is seen in families transmitting autosomal dominant Waardenburg syndrome. Within the same family, some affected members may have dystopia canthorum (an unusually wide nasal bridge due to sideways displacement of the inner angles of the eyes), white forelock, heterochromia irides (two different-colored irises or two colors in the same iris), and hearing loss, while others with the same mutation may only have dystopia canthorum.

How Do Genes Work?

Genes are a road map for the synthesis of proteins, which are the building blocks for everything in the body: hair, eyes, ears, heart, lung, etc. Every child inherits half of its genes from one parent and half from the other parent. If the inherited genes are defective, a health disorder such as hearing loss or deafness can result. Hearing disorders are inherited in one of four ways:

Autosomal Dominant Inheritance: For autosomal dominant disorders, the transmission of a rare allele of a gene by a single heterozygous parent is sufficient to generate an affected child. A heterozygous parent has two types of the same gene (in this case, one mutated and the other normal) and can produce two types of gametes (reproductive cells). One gamete will carry the mutant form of the gene of interest, and the other the normal form. Each of these gametes then has an equal chance of being used to form the offspring. Thus the chance that the offspring of a parent with an autosomal dominant gene will develop the disorder is 50 percent. Autosomal dominant traits usually affect males and females equally.

Autosomal Recessive Inheritance: An autosomal recessive trait is characterized by having parents who are heterozygous carriers for mutant forms of the gene in question but are not affected by the disorder. The problem gene that would cause the disorder is suppressed by the normal gene. These heterozygous parents (A/a) can each generate two types of gametes, one carrying the mutant copy of the gene (a) and the other having a normal copy of the gene (A). There are four possible combinations from each of the parents, A/a, A/A, a/A, and a/a. Only the offspring that inherits both mutant copies (a/a) will exhibit the trait. Overall, offspring of these two parents will face a 25 percent chance of inheriting the disorder.

X-linked Inheritance: A male offspring has an X chromosome and a Y chromosome, while a female has two copies of the X chromosome only. Each female inherits an X chromosome from her mother and her father.   On the other hand, each male inherits an X chromosome from his mother and a Y chromosome from his father. In general, only one of the two X chromosomes carried by a female is active in any one cell while the other is rendered inactive. This is why when a female inherits a defective gene on one X chromosome, the normal gene on the other X chromosome can usually compensate. As males only have one copy of the X chromosome, any defective gene is more likely to manifest into a disorder.

Mitochondrial Inheritance: Mitochondrias, small powerhouses within each cell, also contain their own DNA. Interestingly, the sperm does not have any mitochondria, and consequently, only the mitochondria in the egg from the mother can be passed from one generation to the next. This leads to an interesting inheritance pattern where only affected mothers (and not affected fathers as their sperms do not have mitochondria) can pass on a disease from one generation to the next. Sensitivity to aminoglycoside antibiotics can be inherited through a defect in mitochondrial DNA and is the most common cause of deafness in China!

In the last decade, advances in molecular biology and genetics have contributed substantially to the understanding of development, function, and pathology of the inner ear. Researchers have identified several of the various genes responsible for hereditary deafness or hearing loss, most notably the GJB2 gene mutation. As one of the most common genetic causes of hearing loss, GJB2-related hearing loss is considered a recessive genetic disorder because the mutations only cause deafness in individuals who inherit two copies of the mutated gene, one from each parent. A person with one mutated copy and one normal copy is a carrier but is not deaf. Screening tests for the GJB2 gene are available for at risk individuals to help them determine their risk of having a child with hearing problems.

Hearing Loss

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.

How does the hearing sense work?

Hearing is a complex and intricate process. The ear is made up of three sections: the outer ear, the middle ear, and the inner ear. These parts work together so you can hear and process sounds. The outer ear, or pinna (the part you can see), picks up sound waves and directs them into the outer ear canal.

These sound waves travel down the ear canal and hit the eardrum, which causes the eardrum to vibrate. When the eardrum vibrates, it moves three tiny bones in your middle ear. The middle ear is a small air-filled space between the eardrum and the inner ear. These bones form a chain and are called the hammer (or malleus), anvil (or incus), and stirrup (or stapes). The movement of these bones transmits and amplifies the sound waves toward the inner ear.

The third bone in the chain, the stapes, interfaces with fluid which fills the hearing portion of the inner ear – the cochlea. The cochlea is lined with cells that have thousands of tiny hairs on their surfaces. As the fluid wave travels through the cochlea, it causes the tiny hairs to move. The hairs change the mechanical wave into nerve signals. The nerve signals are then transmitted to your brain, which interprets the sound.

Hearing Loss and Ear Infection

What is otitis media and ear infection?

Otitis media refers to inflammation of the middle ear. When an abrupt infection occurs, the condition is called “acute otitis media.” Acute otitis media occurs when a cold, allergy, and the presence of bacteria or viruses lead to the accumulation of pus and mucus behind the eardrum, blocking the Eustachian tube. This can cause earache and fever.

When fluid sits in the middle ear for weeks, the condition is known as “otitis media with effusion.” This occurs in a recovering ear infection. Fluid can remain in the ear for weeks to many months. If not treated, chronic ear infections have potentially serious consequences such as temporary hearing loss.Why do children have more ear infections than adults?

To understand earaches, and ear infections, you must first know about the Eustachian tube, a narrow channel connecting the inside of the ear to the back of the throat, just above the soft palate and uvula. The tube allows drainage of fluid from the middle ear, which prevents it from building up and bursting the thin ear drum. In a healthy ear, the fluid drains down the tube, assisted by tiny hair cells, and is swallowed.

The tube maintains middle ear pressure equal to the air outside the ear, enabling free eardrum movement. Normally, the tube is collapsed most of the time in order to prevent the many germs residing in the nose and mouth from entering the middle ear. Infection occurs when the Eustachian tube fails to do its job. When the tube becomes partially blocked, fluid accumulates in the middle ear, trapping bacteria already present, which then multiply. Additionally, as the air in the middle ear space escapes into the bloodstream, a partial vacuum is formed that absorbs more bacteria from the nose and mouth into the ear.

Children have Eustachian tubes that are shorter, more horizontal, and straighter than those of adults. These factors make the journey for the bacteria quick and relatively easy. It also makes it harder for the ears to clear the fluid, since it cannot drain with the help of gravity. A child’s tube is also floppier, with a smaller opening that easily clogs.

How does otitis media affect hearing?

Most people with middle ear infection or fluid have some degree of hearing loss. The average hearing loss in ears with fluid is 24 decibels…equivalent to wearing ear plugs. (Twenty-four decibels is about the level of the very softest of whispers.) Thicker fluid can cause much more loss, up to 45 decibels (the range of conversational speech).

Suspect hearing loss if one is unable to understand certain words and speaks louder than normal.

Types of hearing loss

Conductive hearing loss is a form of hearing impairment where the transmission of sound from the environment to the inner ear is impaired, usually from an abnormality of the external auditory canal or middle ear. This form of hearing loss can be temporary or permanent. Untreated chronic ear infections can lead to conductive hearing loss. If fluid is filling the middle ear, hearing loss can be treated by draining the middle ear and inserting a tympanostomy tube. The other form of hearing loss is sensorineural hearing loss, hearing loss due to abnormalities of the inner ear or the auditory division of the 8th cranial nerve. Historically, this condition can occur at all ages, and is usually permanent.

When should a hearing test be performed related to frequent infections or fluid?

A hearing test should be performed for children who have frequent ear infections, hearing loss that lasts more than six weeks, or fluid in the middle ear for more than three months. There are a wide range of medical devices now available to test a child’s hearing, Eustachian tube function, and flexibility of the ear drum. They include the otoscopy, tympanometer, and audiometer.

Do people lose their hearing for reasons other than chronic otitis media?

Children and adults can incur temporary hearing loss for other reasons than chronic middle ear infection and Eustachian tube dysfunction. They include:

• Cerumen impaction (compressed earwax)
• Otitis externa: Inflammation of the external auditory canal, also called “swimmer’s ear.”
• Cholesteatoma: A mass of horn shaped squamous cell epithelium and cholesterol in the middle ear, usually resulting from chronic otitis media• Otosclerosis: This is a disease of the otic capsule (bony labyrinth) in the ear, which is more prevalent in adults and characterized by formation of soft, vascular bone leading to progressive conductive hearing loss. It occurs due to fixation of the stapes (bones in the ear). Sensorineural hearing loss may result because of involvement of the cochlear duct.
• Trauma: A trauma to the ear or head may cause temporary or permanent hearing loss.

How the Ear Works

The ear has three main parts: the outer ear (including the external auditory canal), middle ear, and inner ear. The outer ear (the part you can see) opens into the ear canal. The eardrum (tympanic membrane) separates the ear canal from the middle ear. The middle ear contains three small bones which help amplify and transfer sound to the inner ear. These three bones, or ossicles, are called the malleus, the incus, and the stapes (also referred to as the hammer, the anvil, and the stirrup respectively). The inner ear contains the cochlea which changes sound into neurological signals and the auditory (hearing) nerve, which takes sound to the brain.

Any source of sound sends vibrations or sound waves into the air. These funnel through the ear opening, down the external ear canal, and strike your eardrum, causing it to vibrate. The vibrations are passed to the three small bones of the middle ear, which transmit them to the cochlea. The cochlea contains tubes filled with fluid. Inside one of the tubes, tiny hair cells pcik up the vibrations and convert them into nerve impulses. These impulses are delivered to the brain via the hearing nerve. The brain interprets the impulses as sound (music, voice, a car horn, etc.).

Hyperacusis—An increased sensitivity to everyday sounds What Is Hyperacusis? Hyperacusis is a condition that arises from a problem in the way the brain’s central auditory processing center perceives noise. It can often lead to pain and discomfort. Individuals with hyperacusis have difficulty tolerating sounds which do not seem loud to others, such as the noise from running faucet water, riding in a car, walking on leaves, dishwasher, fan on the refrigerator, shuffling papers. Although all sounds may be perceived as too loud, high frequency sounds may be particularly troublesome. As one might suspect, the quality of life for individuals with hyperacusis can be greatly compromised. For those with a severe intolerance to sound, it is difficult and sometimes impossible to function in an every day environment with all its ambient noise. Hyperacusis can contribute to social isolation, phonophobia (fear of normal sounds), and depression. Prevalence And Causes Of Hyperacusis Many people experience sensitivity to sound, but true hyperacusis is rare, affecting approximately one in 50,000 individuals. The disorder can affect people of all ages in one or both ears. Individuals are usually not born with hyperacusis, but may develop a narrow tolerance to soundOther common causes include: Head injury Ear damage from toxins or medication Lyme disease Air bag deployment Viral infections involving the inner ear or facial nerve (Bell’s palsy) Temporomandibular joint (TMJ) syndrome There are a variety of neurologic conditions that may be associated with hyperacusis, including: Post-traumatic stress disorder Chronic fatigue syndrome Tay-Sach’s disease Some forms of epilepsy Valium dependence Depression Migraine headaches Hyperacusis is seen in brain-injured children (due to the universal sensory sensitivity), some autistic children, and some children with cerebral palsy). Diagnosis of Hyperacusis Individuals who suspect they may have hyperacusis should seek an evaluation by an otolaryngologist (ear, nose, and throat doctor). The initial consultation is likely to include a full audiologic evaluation (with a hearing test), a recording of medical history, and a medical evaluation by a physician. Counseling about evaluation findings and treatment options may also be provided at that time. Treatment for Hyperacusis There are no specific corrective surgical or medical treatments for hyperacusis. However, sound therapy may be used to “retrain” the auditory processing center of the brain to accept everyday sounds. This involves the use of a noise-generating device worn on the affected ear or ears. Those suffering from hyperacusis may be uncomfortable with placing sound directly in their ear, but the device produces a gentle static-like sound (white noise) that is barely audible. Completion of sound therapy may take up to 12 months, and usually improves sound tolerance. Because social situations are often painfully loud for those with hyperacusis, withdrawal, social isolation, and depression are common. Hearing Loss Hearing tests usually indicate normal hearing sensitivity and often register at minus decibel levels. Counter to what one might think, this does not mean that those with hyperacusis hear better than others. Instead, it is a clear indication of a problem in the way the brain processes sound. Hearing loss coupled with low tolerance to sound is another termed recruitment, a condition where soft sounds cannot be heard and loud sounds are intolerable (or distorted). For example, a person with recruitment may have hearing loss below 50 decibels, while at the same time sound above 80 decibels may be intolerable. The result is a narrow range of comfortable hearing. Relation to Tinnitus Hyperacusis is strongly associated with tinnitus, a condition commonly referred to as “ringing in the ears.” Nearly 36 million Americans suffer from tinnitus; an estimated one of every thousand also has hyperacusis. Individuals can have tinnitus and hyperacusis at the same time.

Infant Hearing Loss

If your newborn child:

• does not startle, move, cry or react in any way to unexpected loud noises,
• does not awaken to loud noises,
• does not turn his/her head in the direction of your voice,
• does not freely imitate sound, or
• has failed a newborn hearing screening test,

then he or she may have some degree of hearing loss.

More than three million American children have a hearing loss, and an estimated 1.3 million of them are under three years of age. Parents and grandparents are usually the first to discover hearing loss in a baby, because they spend the most time with them. If at any time you suspect your baby has a hearing loss, discuss it with your doctor. He or she may recommend evaluation by an otolaryngologist—head and neck surgeon (ear, nose and throat specialist) and additional hearing tests.

Hearing loss can be temporary, caused by ear wax, middle ear fluid, or infections. Many children with temporary hearing loss can have their hearing restored through medical treatment or minor surgery.

However, some children have sensorineural hearing loss (sometimes called nerve deafness), which is permanent. Most of these children have some usable hearing, and children as young as three months old can be fitted with hearing aids.

Early diagnosis is crucial in the management of pediatric hearing loss. When diagnosis is delayed, there can be significant impact on speech and language development. Early fitting of hearing or other prosthetic aids, and an early start on special education programs can help maximize a child’s existing hearing. This means your child will get a head start on speech and language development.

Know the Power of Sound

Sound is measured in decibels (dB). Each decibel is one tenth of a bel, which is a unit that measures the intensity of sound.  For every six decibels, the intensity of the sound doubles.   At 90 dB of uninterrupted sound, the limit of safe noise exposure is eight hours.  For each six dB increase of uninterrupted sound thereafter, the limit of safe exposure is reduced by half.

It is important to know the approximate intensity of sound around you to protect your hearing. Click here to use the Interactive Loudness Scale.

Noise and Hearing Protection

Insight into maintaining auditory health

• Can noise hurt my ears?
• How does the ear work?
• How can I protect myself against noise?
• and more…

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.

What causes hearing loss?

The ear has three main parts: the outer, middle and inner ear. The outer ear (the part you can see) opens into the ear canal. The eardrum separates the ear canal from the middle ear. Small bones in the middle ear help transfer sound vibrations to the inner ear. Here, the vibrations become nerve impulses, which the brain interprets as music, a slamming door, a voice and so on.

When noise is too loud, it begins to kill the nerve endings in the inner ear. Prolonged exposure to loud noise destroys nerve endings. As the number of nerve endings decreases, so does your hearing. There is no way to restore life to dead nerve endings; the damage is permanent. The longer you are exposed to a loud noise, the more damaging it may be. Also, the closer you are to the source of intense noise, the more damaging it is.

How can I tell if a noise is dangerous?

People differ in their sensitivity to noise. As a general rule, noise may damage your hearing if you are at arm’s length and have to shout to make yourself heard. If noise is hurting your ears, your ears may ring, or you may have difficulty hearing for several hours after exposure to the noise. Noise is characterized by intensity, measured in decibels; pitch, measured in hertz or kilohertz; and duration.

Can noise affect more than my hearing?

A ringing in the ears, called tinnitus, commonly occurs after noise exposure and often becomes permanent. Some people react to loud noise with anxiety and irritability, an increase in pulse rate and blood pressure, or an increase in stomach acid. Very loud noise can reduce efficiency in performing difficult tasks by diverting attention from the job.

How can I protect myself against noise?

Wear hearing protectors, especially if you must work in an excessively noisy environment. You should also wear them when using power tools, noisy yard equipment, or firearms, or riding a motorcycle or snowmobile. Hearing protectors come in two forms: earplugs and earmuffs.

Earplugs are small inserts that fit into the outer ear canal. They must be sealed snugly so the entire circumference of the ear canal is blocked. An improperly fitted, dirty, or worn-out plug may not seal properly and can result in irritation of the ear canal. Plugs are available in a variety of shapes and sizes to fit individual ear canals and can be custom-made. For people who have trouble keeping them in their ears, the plugs can be fitted to a headband.

Earmuffs fit over the entire outer ear to form an air seal so the entire circumference of the ear canal is blocked, and they are held in place by an adjustable band. Earmuffs will not seal around eyeglasses or long hair, and the adjustable headband tension must be sufficient to hold earmuffs firmly in place.

Earplugs and earmuffs can be found at most pharmacies.

Will I hear other people and machine problems if I wear hearing protectors?

Just as sunglasses help vision in very bright light, so hearing protectors enhance speech understanding in very noisy places. Even in a quiet setting, a normal-hearing person wearing hearing protectors should be able to understand a regular conversation.

Hearing protectors do slightly reduce the ability of those with damaged hearing or poor comprehension of language to understand normal conversation. However, it is essential that persons with impaired hearing wear earplugs or muffs to prevent further inner ear damage in very noisy places.

It has been argued that hearing protectors might reduce a worker’s ability to hear the noises that signify an improperly functioning machine. However, most workers readily adjust to the quieter sounds and can still detect such problems. If a worker is already hearing impaired, he or she needs expert advice about how to protect against further damage. In some cases hearing aids can and should be used under earmuffs.

How can I tell if my hearing is damaged?

Hearing loss usually develops over a period of several years. Because it is painless and gradual, you might not notice it. What you might notice is a ringing or other sound in your ear (tinnitus), which could be the result of long-term exposure to noise that has damaged hearing nerves. Or you may have trouble understanding what people say; they may seem to be mumbling, especially when you are in a noisy place such as a crowd or a party. This could be the beginning of high-frequency hearing loss; a hearing test will detect it.

If you have any of these symptoms, they may be caused by impacted wax or an ear infection, which are relatively easy to correct. However, you may suffer from noise-related hearing loss. In any case, take no chances with noise—the hearing loss it causes is permanent. If you suspect hearing loss, consult a physician with special training in ear care and hearing disorders (called an otolaryngologist or otologist). This doctor can diagnose your hearing problem and recommend the best way to manage it. For more information on the laws for on-the-job noise exposure, please refer to the information provided atwww.entnet.org.

Sound Measurements

Decibels (dB) measure the intensity of sound. The scale runs from the faintest sound the human ear can detect, which is labeled 0 dB, to more than 180 dB, the noise at a rocket pad during launch. Most experts agree that continual exposure to more than 85 decibels is dangerous. Recent studies show an alarming increase in noise-related hearing loss in young people.

Approximate examples of decibel levels:

• Faintest sound heard by human ear – 0 dB
• Whisper, quiet library – 30 dB
• Normal conversation, sewing machine, typewriter – 60 dB
• Lawnmower, shop tools, truck traffic – 90 dB
• Chainsaw, pneumatic drill, snowmobile – 100 dB
• Sandblasting, loud rock concert, auto horn – 115 dB
• Gun muzzle blast, jet engine (such noise can cause pain and even brief exposure injures unprotected ears) – 149 dB
• The Occupational Safety and Health Administration’s limit for noise without hearing protectors – 140 dB

Pitch is the frequency of sound vibrations per second measured in hertz or kilohertz, and duration. A low pitch, such as a deep voice or a tuba, makes fewer vibrations per second than a high voice or violin—the higher the pitch, the higher the frequency. Loss of high-frequency hearing also can make speech sound muffled.

Noise-Induced Hearing Loss In Children

The National Institute on Deafness and Other Communication Disorders reports approximately 28 million Americans have lost some or all of their hearing, including 17 in 1,000 children under age 18. Noise exposure is increasingly common in the age of iPods and other personal music players. Overexposure to noise can cause both temporary and permanent hearing loss.

Loudness of common sounds:

• 30 decibels (dBA) – whisper
• 60 decibels – Normal conversation
• 60 – 80 decibels – Cars to a close observer
• Above 85 decibels – Can cause permanent hearing loss

Although 10 million Americans suffer irreversible noise-induced hearing loss, with 30 million more exposed to dangerous noise levels each day, very little has been reported on the risk of such hearing loss in children.

How does noise exposure cause hearing loss?

Very loud sounds damage the inner ear by damaging the hair cells of the cochlea. When loud sounds are exposed to the ear for a short time, one may experience what’s called a temporary threshold shift, or a temporary hearing loss. This hearing loss may be accompanied by tinnitus (a ringing in the ears). One may recover from the temporary loss. But if the ear is exposed to loud sounds over longer periods of time, the hair cells can be permanently damaged, causing permanent sensorineural hearing loss.

Should MP3 player use be limited?

The maximum sound from an iPod Shuffle has been measured at 115 decibels, a level that can cause hearing loss to listeners of all ages. A survey sponsored by the Australian government found that about 25 percent of people using portable stereos had daily noise exposures high enough to cause hearing damage. Further research from the Netherlands reports that 90 percent of adolescents listened to music through earphones on MP3 players, almost half used high-volume settings, and only 7 percent used a noise limiter.

Researchers at Boston Children’s Hospital determined that listening to a portable music player with headphones at 60 percent of their potential volume for one hour a day is relatively safe. The maximum volume limit is adjustable on many current MP3 players.

Why earplugs are important at concerts

Parents should be aware that various medical studies have found sound levels at rock concerts often to be significantly higher than 85 dBA, with some reports suggesting that sound intensity may reach 90 dBA to as high as 122 dBA.

To experience 85 dBA, listen to an electric shaver or a busy urban street. If levels are maintained at values greater than 85 dBA for long periods of time, this may lead to a significant noise exposure. Frequent concertgoers may experience some potentially irreversible hearing loss from their experience.

A research study, “Incidence of spontaneous hearing threshold shifts during modern concert performances” (Opperman, Reifman, Schlauch, Levine; Otol-HNS 2006, 134:4: 667-673), examined sound intensity throughout a well known concert venue, and the effectiveness of earplugs. The findings stated that sound pressure levels appeared equally hazardous in all parts of the concert hall, regardless of the type of music played. Accordingly, you should use earplugs at every type of musical concert, regardless of your distance to the stage.

A good rule of thumb: When a child accompanies a parent to any activity or location with excessive noise, ear protection should be worn by the entire family.

Pediatric Obesity and Ear, Nose and Throat Disorders

Today in the United States, studies estimate that 34 percent of U.S. adults are overweight and an additional 31 percent (approximately 60 million) are obese. Combined, approximately 127 million Americans are overweight or obese. Some 42 years ago, 13 percent of Americans were obese, and in 1980 15 percent were considered obese.

Alarmingly, the number of children who are overweight or obese has doubled in the last two decades as well. Currently, more than 15 percent of 6- to 11-year-olds and more than 15 percent of 12- to 19-year-olds are considered overweight or obese.

What is the difference between designated “obese” versus “overweight?”

Unfortunately, the words overweight and obese are often interchanged. There is a difference:

• Overweight: Anyone with a body mass index (BMI) (a ratio between your height and weight) of 25 or above (e.g., someone who is 5-foot-4 and 145 pounds) is considered overweight.
• Obesity: Anyone with a BMI of 30 or above (e.g., someone who is 5-foot-4 and 175 pounds) is considered obese.
• Morbid obesity: Anyone with a BMI of 40 or above (e.g., someone who is 5-foot-4 and 233 pounds) is considered morbidly obese. “Morbid” is a medical term indicating that the risk of obesity related illness is increased dramatically at this degree of obesity.

Obesity can present significant health risks to the young child. Diseases are being seen in obese children that were once thought to be adult diseases. Many experts in the study of children’s health suggest that a dysfunctional metabolism, or failure of the body to change food calories to energy, precedes the onset of disease. Consequently, these children are at risk for Type II Diabetes, fatty liver, elevated cholesterol, SCFE (a major hip disorder), menstrual irregularities, sleep apnea, and irregular metabolism. Additionally, there are psychological consequences; obese children are subject to depression, loss of self-esteem, and isolation from their peers.

Pediatric obesity and otolaryngic problems

Otolaryngologists, or ear, nose and throat specialists, diagnose and treat some of the most common children’s disorders. They also treat ear, nose and throat conditions that are common in obese children, such as:

Sleep apnea:

Children with sleep apnea literally stop breathing repeatedly during their sleep, often for a minute or longer, usually ten to 60 times during a single night. Sleep apnea can be caused by either complete obstruction of the airway (obstructive apnea) or partial obstruction (obstructive hypopnea—hypopnea is slow, shallow breathing), both of which can wake one up. There are three types of sleep apnea—obstructive, central, and mixed. Of these, obstructive sleep apnea (OSA) is the most common. Otolaryngologists have pioneered the treatment for sleep apnea; research shows that one to three percent of children have this disorder, often between the age of two-to-five years old.

Enlarged tonsils, which block the airway, are usually the key factor leading to this condition. Extra weight in obese children and adults can also interfere with the ability of the chest and abdomen to fully expand during breathing, hindering the intake of air and increasing the risk of sleep apnea.

The American Academy of Pediatrics has identified obstructive sleep apnea syndrome (OSAS) as a “common condition in childhood that results in severe complications if left untreated.” Among the potential consequences of untreated pediatric sleep apnea are growth failure; learning, attention, and behavior problems; and cardio-vascular complications. Because sleep apnea is rarely diagnosed, pediatricians now recommend that all children be regularly screened for snoring.

Middle ear infections:

Acute otitis media (AOM) and chronic ear infections account for 15 to 30 million visits to the doctor each year in the U.S. In fact, ear infections are the most common reason why an American child sees a doctor. Furthermore, the incidence of AOM has been rising over the past decades. Although there is no proven medical link between middle ear infections and pediatric obesity there may be a behavioral association between the two conditions. Some studies have found that when a child is rubbing or massaging the infected ear the parent often responds by offering the child food or snacks for comfort.

When a child does have an ear infection the first line of treatment is often a regimen of antibiotics. When antibiotics are not effective, the ear, nose and throat specialist might recommend a bilateral myringotomy with pressure equalizing tube placement (BMT), a minor surgical procedure. This surgery involves the placement of small tubes in the eardrum of both ears. The benefit is to drain the fluid buildup behind the eardrum and to keep the pressure in the ear the same as it is in the exterior of the ear. This will reduce the chances of any new infections and may correct any hearing loss caused by the fluid buildup.

Postoperative vomiting (POV) is a common problem after bilateral myringotomy surgery. The overall incidence is 35 percent, and usually occurs on the first postoperative day, but can occur up to seven days later. Several factors are known to affect the incidence of POV, including age, type of surgery, postoperative care, medications, co-existing diseases, past history of POV, and anesthetic management. Obesity, gastroparesis, female gender, motion sickness, pre-op anxiety, opiod analgesics, and the duration of anesthetic all increase the incidence of POV. POV interferes with oral medication and intake, delays return to normal activity, and increases length of hospital stay. It remains one of the most common causes of unplanned postoperative hospital admissions.

Tonsillectomies:

A child’s tonsils are removed because they are either chronically infected or, as in most cases, enlarged, leading to obstructive sleep apnea. There are several surgical procedures utilized by ear, nose and throat specialists to remove the tonsils, ranging from use of a scalpel to a wand that emits energy that shrinks the tonsils.

Research conducted by otolaryngologists found that:

Morbid obesity was a contributing factor for requiring an overnight hospital admission for a child undergoing removal of enlarged tonsils. Most children who were diagnosed as obese with sleep apnea required a next-day physician follow-up.

A study from the University of Texas found that morbidly obese patients have a significant increase of additional medical disorders following tonsillectomy and adenoidectomy for obstructive sleep apnea or sleep-disordered breathing when compared to moderately obese or overweight patients undergoing this procedure for the same diagnosis. On average they have longer hospital stays, a greater need for intensive care, and a higher incidence of the need for apnea treatment of continuous positive airway pressure upon discharge from the hospital. The study found that although the morbidly obese group had a greater degree of sleep apnea, they did benefit from the procedure in regards to snoring, apneic spells, and daytime somnolence.

What you can do

If your child has a weight problem, contract your pediatrician or family physician to discuss the weight’s effect on your child’s health, especially prior to treatment decisions. Second, ask your physician about lifestyle and diet changes that will reduce your child’s weight to a healthy standard.

Perforated Eardrum

• What is a perforated eardrum?
• What causes eardrum perforation?
• How is hearing affected by a perforated eardrum?
• and more…

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 sometimes discharge. The perforation may be accompanied by pain if it is caused by an injury or becomes infected.

What causes eardrum perforation?

A perforated eardrum can occur from trauma, infection, or chronic Eustachian tube disorders.. A perforated eardrum from trauma can occur:

• If the ear is struck directly
• With a skull fracture
• After a sudden explosion
• If an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the ear canal

Middle ear infections may cause pain, hearing loss, and spontaneous rupture (tear) of the eardrum, resulting in a perforation. In this circumstance, there maybe infected or bloody drainage from the ear. In medical terms, this is called otitis media with perforation. Symptoms of acute otitis media include a sense of fullness in the ear, diminished hearing, pain, and fever.

In patients with chronic Eustachian tube problems the ear drum may become weakened and perforate.

On some occasions a small hole may remain in the eardrum after a previously placed pressure-equalizing (PE) tube falls out or is removed by the physician.

Most eardrum perforations resulting from trauma or an acute ear infection heal on their own within weeks of rupture, although some may take several months to heal. During the healing process the ear must be protected from water and trauma. Eardrum perforations that do not heal on their own may require surgery.

How is hearing affected by a perforated eardrum?

Usually the size of the perforation determines the level of hearing loss – a larger hole will cause greater hearing loss than a smaller hole. The location of the perforation also affects the degree of hearing loss. If severe trauma (e.g., skull fracture) dislocates the bones in the middle ear which transmit sound, or injures the inner ear structures, hearing loss may be severe.

If the perforated eardrum is caused by a sudden traumatic or explosive event, the loss of hearing can be great and tinnitus (ringing in the ear) may occur. Chronic infection as a result of the perforation can cause persistent or progressive hearing loss.

How is a perforated eardrum treated?

Before attempting any correction of the perforation, a hearing test should be performed. The benefits of closing a perforation include prevention of water entering the middle ear while showering, bathing, or swimming (which could cause ear infection), improved hearing, and diminished tinnitus. It also may prevent the development of cholesteatoma (skin cyst in the middle ear), which can cause chronic infection and destruction of ear structures.

If the perforation is very small, an otolaryngologist may choose to observe the perforation over time to see if it will close spontaneously. He or she might try to patch a patient’s eardrum in the office. Working with a microscope, your doctor may touch the edges of the eardrum with a chemical to stimulate growth and then place a thin paper patch on the eardrum. Usually with closure of the tympanic membrane, hearing is improved. Several applications of a patch may be required before the perforation closes completely. If your physician feels that a paper patch will not provide prompt or adequate closure of the hole in the eardrum, or if paper patching does not help, surgery may be required.

There are a variety of surgical techniques, but most involve grafting tissue such as fascia or cartilage across the perforation to allow healing. The name of this procedure is called tympanoplasty. Surgery is typically quite successful in repairing the perforation, restoring or improving hearing, and is often done on an outpatient basis.

Your doctor will advise you regarding the proper management of a perforated eardrum.

Quick Glossary for Good Ear Health

Your child has an earache. After your first visit to a physician you may hear some of the following terms related to the diagnosis and treatment of this common childhood disorder.

Acute otitis media – the medical term for the common ear infection. Otitis refers to an ear inflammation, and media means middle. Acute otitis media is an infection of the middle ear, which is located behind the eardrum. This diagnosis includes fluid effusion trapped in the middle ear.

Adenoidectomy – removal of the adenoids, also called pharyngeal tonsils. Some believe their removal helps prevent ear infections.

Amoxicillin – a semi-synthetic penicillin antibiotic often used as the first-line medical treatment for acute otitis media or otitis media with effusion. A higher dosage may be recommended for a second treatment.

Analgesia – immediate pain relief. For an earache, it may be provided by acetaminophen, ibuprofen, and auralgan.

Antibiotic – a soluble substance derived from a mold or bacterium that inhibits the growth of other bacterial micro-organisms.

Antibiotic resistance – a condition where micro-organisms continue to multiply although exposed to antibiotic agents, often because the bacteria has become immune to the medication. Overuse or inappropriate use of antibiotics leads to antibiotic resistance.

Audiometer – an electronic device used in measuring hearing for pure tones of frequencies, generally varying from 125–8000 Hz, and speech (recorded in terms of decibels).

Azithromyacin – an antibiotic prescribed for acute otitis media due to Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Also known by its brand name, Zithromax^®.

Bacteria – organisms responsible for about 70 percent of otitis media cases. The most common bacterial offenders are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis.

Chronic otitis media – when infection of the middle ear persists, leading to possible ongoing damage to the middle ear and eardrum.

Decibel – one tenth of a bel, the unit of measure expressing the relative intensity of a sound. The results of a hearing test are often expressed in decibels.

Effusion – a collection of fluid generally containing a bacterial culture.

First-line agent – The first treatment of antibiotics prescribed for an ear infection, often amoxicillin.

Myringotomy – an incision made into the ear drum.

Otitis media without effusion – an inflammation of the eardrum without fluid in the middle ear.

Otitis media with effusion – the presence of fluid in the middle ear without signs or symptoms of ear infection. It is sometimes called serous otitis media. This condition does not usually require antibiotic treatment.

Otitis media with perforation – a spontaneous rupture or tear in the eardrum as a result of infection. The hole in the ear drum usually repairs itself within several weeks.

OtoLAM™ – a myringotomy performed with computer-driven laser technology (rather than manual incision with a conventional scalpel).

Pneumatic otoscopy – a test administered for the middle ear consisting of an inspection of the ear with a device capable of varying air pressure against the eardrum. If the tympanic membrane moves during the test, normal middle ear function is indicated. A lack of movement indicates either increased impedance, as with fluid in the middle ear, or perforation of the tympanic membrane.

Recurrent otitis media – when the patient incurs three infections in three months, four in six months, or six in 12 months. This is often an indicator that a tympanostomy with tubes might be recommended.

Second line treatment – antibiotics prescribed when the first line of treatment fails to resolve symptoms after 48 hours.

Trimethoprim Sulfamethoxazole – an alternative first line treatment for children allergic to amoxicillin.

Tympanostomy tubes – small tubes inserted in the eardrum to allow drainage of infection.

Do not hesitate to seek clarification from your physician if he or she uses a term that you do not fully understand.

Swimmer’s Ear

Insight into acute otitis externa

• What causes swimmer’s ear?
• What are the signs and symptoms?
• How is swimmer’s ear treated?
• and more…

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.

What causes swimmer’s ear?

A common source of the infection is increased moisture trapped in the ear canal, from baths, showers, swimming, or moist environments. When water is trapped in the ear canal, bacteria that normally inhabit the skin and ear canal multiply, causing infection of the ear canal. Swimmer’s ear needs to be treated to reduce pain and eliminate any effect it may have on your hearing, as well as to prevent the spread of infection.

Other factors that may contribute to swimmer’s ear include:

• Contact with excessive bacteria that may be present in hot tubs or polluted water
• Excessive cleaning of the ear canal with cotton swabs
• Contact with certain chemicals such as hair spray or hair dye (Avoid this by placing cotton balls in your ears when using these products.)
• Damage to the skin of the ear canal following water irrigation to remove wax
• A cut in the skin of the ear canal
• Other skin conditions affecting the ear canal such as eczema or seborrhea

What are the signs and symptoms?

The most common symptoms of swimmer’s ear are itching inside the ear and pain that gets worse when you tug on the auricle (outer ear). Other signs and symptoms may include any of the following:

• Sensation that the ear is blocked or full
• Drainage
• Fever
• Decreased hearing
• Intense pain that may radiate to the neck, face, or side of the head
• Swollen lymph nodes around the ear or in the upper neck. Redness and swelling of the skin around the ear

If left untreated, complications resulting from swimmer’s ear may include:

Hearing loss. When the infection clears up, hearing usually returns to normal.

Recurring ear infections (chronic otitis externa). Without treatment, infection can continue.

Bone and cartilage damage (malignant otitis externa). Ear infections when not treated can spread to the base of your skull, brain, or cranial nerves. Diabetics and older adults are at higher risk for such dangerous complications.

To evaluate you for swimmer’s ear, your doctor will look for redness and swelling in your ear canal. Your doctor also may take a sample of any abnormal fluid or discharge in your ear to test for the presence of bacteria or fungus (ear culture) if you have recurrent or severe infections.

How is swimmer’s ear treated?

Treatment for the early stages of swimmer’s ear includes careful cleaning of the ear canal and use of eardrops that inhibit bacterial or fungal growth and reduce inflammation. Mildly acidic solutions containing boric or acetic acid are effective for early infections.

How should ear drops be applied?

• Drops are more easily administered if done by someone other than the patient.
• The patient should lie down with the affected ear facing upwards.
• Drops should be placed in the ear until the ear is full.
• After drops are administered, the patient should remain lying down for a few minutes so that the drops can be absorbed.

If you do not have a perforated eardrum (an eardrum with a hole in it) or a tympanostomy tube in your eardrum, you can make your own eardrops using rubbing alcohol or a mixture of half alcohol and half vinegar. These eardrops will evaporate excess water and keep your ears dry. Before using any drops in the ear, it is important to be sure you do not have a perforated eardrum. Check with your otolaryngologist if you have ever had a perforated, punctured, or injured eardrum, or if you have had ear surgery.

For more severe infections, your doctor may prescribe antibiotics to be applied directly to the ear. If the ear canal is swollen shut, a sponge or wick may be placed in the canal so the antibiotic drops will enter the swollen canal more effectively. Pain medication may also be prescribed. If you have tubes in your eardrum, a non oto-toxic (do not affect your hearing) topical treatment should be used. Topical antibiotics are effective for infection limited to the ear canal. Oral antibiotics may also be prescribed if the infection goes beyond the skin of the ear canal.

Follow-up appointments are very important to monitor improvement or worsening, to clean the ear again, and to replace the ear wick as needed. Your otolaryngologist has specialized equipment and expertise to effectively clean the ear canal and treat swimmer’s ear. With proper treatment, most infections should clear up in 7-10 days.

Why do ears itch?

An itchy ear may be caused by a fungus or allergy, but more often from chronic dermatitis (skin inflammation) of the ear canal. Otolaryngologists also treat allergies, and they can often prescribe an eardrop, cream, or ointment to treat the problem.

Tips for prevention

• A dry ear is unlikely to become infected, so it is important to keep the ears free of moisture during swimming or bathing.
• Use ear plugs when swimming
• Use a dry towel or hair dryer to dry your ears
• Have your ears cleaned periodically by an otolaryngologist if you have itchy, flaky or scaly ears, or extensive earwax
• Don’t use cotton swabs to remove ear wax. They may pack ear wax and dirt deeper into the ear canal, remove the layer of earwax that protects your ear, and irritate the thin skin of the ear canal. This creates an ideal environment for infection.

Tinnitus

Insight into causes and treatments for tinnitus

• What causes tinnitus?
• How is tinnitus treated?
• What can help me cope?
• and more…

Nearly 36 million Americans suffer from tinnitus or head noises. It may be an intermittent sound or an annoying continuous sound in one or both ears. Its pitch can go from a low roar to a high squeal or whine. Prior to any treatment, it is important to undergo a thorough examination and evaluation by your otolaryngologist and audiologist. An essential part of the treatment will be your understanding of tinnitus and its causes.

What causes tinnitus?

Tinnitus is commonly defined as the subjective perception of sound by an individual, in the absence of external sounds. Tinnitus is not a disease in itself but a common symptom, and because it involves the perception of sound or sounds, it is commonly associated with the hearing system. In fact, various parts of the hearing system, including the inner ear, are often responsible for this symptom. At times, it is relatively easy to associate the symptom of tinnitus with specific problems affecting the hearing system; at other times, the connection is less clear.

Most of the time, the tinnitus is subjective—that is, the internal sounds can be heard only by the individual. Occasionally, tinnitus is “objective,” meaning that the examiner can actually listen in with a stethoscope or an ear tube and hear the sounds the patient hears. Tinnitus may be caused by different parts of the hearing system. At times, for instance, it may be caused by excessive ear wax, especially if the wax touches the ear drum, causing pressure and changing how the ear drum vibrates. Other times, loose hair from the ear canal may come in contact with the ear drum and cause tinnitus.

Middle ear problems can also cause tinnitus, such as a middle ear infection or the buildup of new bony tissue around one of the middle ear bones which stiffens the middle ear transmission system (otosclerosis). Another cause of tinnitus from the middle ear may be muscle spasms of one of the two tiny muscles attached to middle ear bones. In this case, the tinnitus can be intermittent and at times, the examiner can also hear the patient’s sounds.

Most subjective tinnitus associated with the hearing system originates in the inner ear. Damage and loss of the tiny sensory hair cells in the inner ear (that can be caused by different factors) may be commonly associated with the presence of tinnitus. It is interesting to note that the pitch of the tinnitus often coincides with the area of the maximal hearing loss.

One of the preventable causes of inner ear tinnitus is excessive noise exposure. In some instances of noise exposure, tinnitus is the first symptom before hearing loss develops, so it should be considered a warning sign and an indication of the need for hearing protection in noisy environments. Certain common medications can also damage inner ear hair cells and cause tinnitus. These include non-prescription medications such as aspirin, one of the most common and best known medications that can cause tinnitus and eventual hearing loss. As we age, the incidence of tinnitus increases. Hearing loss associated with aging (also known as presbycusis) typically involves loss of and damage to the hair cells.

A special category is tinnitus that sounds like one’s heartbeat or pulse, also known as pulsatile tinnitus. At times, the presence of pulsatile tinnitus may signal the presence of a vascular tumor in the general vicinity of the middle and inner ear. When noting this type of tinnitus, it is advisable to consult a physician as soon as possible to rule out the presence of this type of vascular tumor.

Conditions that affect the hearing nerve can also cause tinnitus, the most common being benign tumors, typically originating from one of the balance nerves in close proximity to the hearing nerve. These are commonly referred to as acoustic neuroma or vestibular schwannoma. Tinnitus caused by an acoustic neuroma is usually unilateral and may or may not be accompanied initially by a hearing loss.

Tinnitus may also originate from lesions on or in the vicinity of the hearing portion of the brain, called the auditory cortex. These can be traumatic injuries with or without skull fracture, as well as whiplash-type injuries common in automobile accidents. Benign tumors known as meningiomas that originate from the tissue that protects the brain may also be a cause for tinnitus that originates from the brain.

There are a number of non-auditory conditions that can cause tinnitus, as well as lifestyle factors. Hypertension or high blood pressure, thyroid problems, and chronic brain syndromes can all cause tinnitus without any specific auditory problems. Stress and fatigue may cause tinnitus, or can contribute to an exacerbation of an existing case. Poor diet and lack of exercise that may cause blood vessel and heart problems may also either cause it or exacerbate an existing condition. It is also possible that tinnitus could be caused by food or beverage allergies, but these causes are not well documented and are difficult to sort out.

How is tinnitus treated?

In most cases, there is no specific, tried-and-true treatment for ear and head noise. If an otolaryngologist finds a specific cause for your tinnitus, he or she may be able to offer specific treatment to eliminate the noise. This determination may require extensive testing, including x-rays and other imaging studies, audiological tests, tests of balance function, and other laboratory work. However, most of the time, other than linking the presence of tinnitus to sensory hearing loss, specific causes are very difficult to identify. Although there is no specific medication for tinnitus, occasionally medications may be tried and some may help to reduce the noise.

What are some other tinnitus treatment options?

• Alternative treatments, such as mindful meditation
• Amplification (hearing aids)
• Cochlear implants or electrical stimulation
• Cognitive therapy
• Drug therapy
• Sound therapy/tinnitus retraining therapy (TRT)
• TMJ treatment

Can other people hear the noise in my ears?

Not usually, but sometimes they are able to hear a certain type of tinnitus (typically the pulsatile tinnitus mentioned earlier). This is called “objective tinnitus,” and it is caused either by abnormalities in blood vessels around the outside of the ear, or by muscle spasms, which may sound like clicks or crackling inside the middle ear.

Can children be at risk for tinnitus?

It is relatively rare but not unheard of for patients under 18 years old to have tinnitus as a primary complaint. However, it is possible that tinnitus in children is significantly under-reported, in part because young children may not be able to express this complaint. Also, in children with congenital sensorineural hearing loss that may be accompanied by tinnitus, this symptom may be unnoticed because it is something that is constant in their lives. In fact, they may habituate to it; the brain may learn to ignore this internal sound. In pre-teens and teens, the highest risk for developing tinnitus is associated with exposure to high intensity sounds, specifically listening to music. In particular, virtually all teenagers use personal MP3 devices and nearly all hand-held electronic games are equipped with ear buds. It is difficult for a parent to monitor the level of sound children are exposed to. Therefore, the best and most effective mode of prevention of tinnitus in children is proper education relative to excessive sound exposure, as well as monitoring by parents or other caregivers.

Tips to lessen the severity of tinnitus

• Avoid exposure to loud sounds and noises.
• Get your blood pressure checked. If it is high, get your doctor’s help to control it.
• Decrease your intake of salt. Salt impairs blood circulation.
• Avoid stimulants such as coffee, tea, cola, and tobacco.
• Exercise daily to improve your circulation.
• Get adequate rest and avoid fatigue.
• Stop worrying about the noise. Recognize your head noise as an annoyance and learn to ignore it as much as possible. It is part of you.

What can help me cope?

Concentration and relaxation exercises can help to control muscle groups and circulation throughout the body. The increased relaxation and circulation achieved by these exercises can reduce the intensity of tinnitus in some patients.

Masking a head noise with a competing sound at a constant low level, such as a ticking clock or radio static (white noise), may make it less noticeable. Tinnitus is usually more bothersome in quiet surroundings. Products that generate white noise are available through catalogs and specialty stores.

Hearing aids may reduce head noise while you are wearing them and sometimes cause the noise to go away temporarily. If you have a hearing loss, it is important not to set the hearing aid at excessively loud levels, as this can worsen the tinnitus in some cases. However, a thorough trial before purchase of a hearing aid is advisable if your primary purpose is the relief of tinnitus.

Tinnitus maskers can be combined within hearing aids. They emit a competitive but pleasant sound that can distract you from head noise. Some people find that a tinnitus masker may even suppress the head noise for several hours after it is used, but this is not true for all users.

Travel Tips for the Hearing Impaired

Insight for hearing-impaired travelers

• What are common problems?
• What arrangements can be made?
• How should hearing aids be handled when traveling?
• and more…

Travel is an important part of our lives. Whether for business or vacation, traveling can be as stressful as it is enjoyable, and for more than 20 million people in the U.S. with hearing loss, travel can be especially difficult.

What are common problems?

• Inability to hear or understand airline boarding and in-flight announcements
• Difficulty making reservations
• Inability to hear hotel room telephones, someone knocking on the door, or warning signals such as smoke alarms
• Difficulty using public telephones, hotel phones, cell phones etc.
• Inability to hear or understand scheduled events such as planned activities, tours, museum lectures and live performances
• Lack of oral and/or sign language interpreters
• Lack of accommodations for hearing dogs

What arrangements can be made?

• Try to make all travel arrangements in advance. Once transportation arrangements have been made, request written confirmation to ensure that information is correct. Always inform the ticket representative that you are hearing-impaired.
• If possible, meet with a travel agent to allow the opportunity for lip reading, or if necessary, written exchange to help confirm travel plans. Agents can contact airlines, hotels, and attractions to make necessary reservations.
• Travel information and reservation services are also available on the internet. Be sure to print copies of important information such as confirmation numbers, reservations, and maps. Keep copies of travel arrangements, including confirmation numbers, easily available.
• Arrive early at the airport, bus terminal, or train station. Tell the agent at the boarding gate that you are hearing-impaired and need to be notified in person when it’s time to board.
• Check the display board repeatedly while waiting in the terminal to confirm your flight destination and departure time as there may be delays or the departure gate may change. Confirm the flight number and destination before boarding.
• Inform the flight attendant that you are hearing-impaired and request that any in-flight announcements be communicated to you in person. Consider reserving aisle seats so that you may easily communicate with the flight staff.
• Do not be afraid to ask for help from fellow travelers—most are more than willing to offer assistance.

How should hearing aids be handled when traveling?

• If you wear a hearing aid, be sure to pack extra batteries and tubing. These may be difficult to obtain in some places.
• Strongly consider taking a dehumidifier for drying your hearing aids each night to prevent moisture problems, especially if your destination has a warm, humid climate.
• To prevent loss, avoid storing your hearing aid equipment in checked luggage. Keep an extra set of batteries in a separate piece of luggage to prevent total loss of hearing aid use.

What other resources are available?

• Many major airlines and transportation companies have Telecommunications Device for the Deaf (TDD) services to assist passengers.
• Hand-held personal communication devices (e.g., cellular phones and smartphones) provide the ability to send and receive text messages without the need to access public resources. Ask your travel agent or check your reservation website to see if this option is available.
• All public telephones should now have a “blue grommet” attachment to the handset indicating it is compatible with the “T” switch or telephone program in hearing aids. Some public phones have an amplifying headset, or you can purchase a pocket amplifier from your audiologist or hearing aid dispenser. Cellular phones have solved many of these problems. All manufacturers have models that are also compatible with your hearing aid. You can search the internet by typing in “HAC phones” (hearing aid compatible) to get more information.
• Smartphones often have applications for travelling. Such programs or email programs can store reservation information. Some applications offer real-time alerts for changes in flight plans, and others have maps that can provide directions.

What other devices are helpful?

There are many visual alert systems and listening devices than can be useful while traveling.

• Telephone amplifiers and induction couplers can be attached to public or hotel phones and can help increase the volume of the telephone. Induction couplers also make the telephone compatible with your hearing aid telecoil. Telephone manufacturers produce handsets such as the G6 and G66, which plug easily into any modular telephone. Using your own compatible cellular phone, however, not only eliminates these problems, but is also less expensive.
• There are small portable visual alert systems available that flash light when the telephone rings or fire alarm sounds. These can be transported and easily installed in hotel rooms. In the U.S. they should be provided if you ask.
• FM listening systems can provide direct amplification in large areas using radio frequency. They can help the hearing-impaired traveler listen to lectures, tours, etc., by simply having the speaker use a transmitter microphone, broadcasting the presentation over the radio waves to the receiver.
• Portable infrared systems can be used with hotel televisions and radios. These transmit sound via invisible infrared light to a listener’s receiver.
• Portable wake-up alarms can be used to flash a light or vibrate a bed or pillow. A cellular phone can also work as a vibrating alarm.
• Portable TV band radios can be tuned to compatible TV channels and listened to through an earphone. You can set the volume to suit yourself and watch TV without disturbing others, or you can turn on the closed captioning (CC) feature of the TV so that you can read the dialogue. There may be a ‘CC’ button on the TV remote control, or you may have to activate closed captioning through the TV’s menu options.

Will I need to take my hearing aids out for security screening?

In most cases, hearing aids worn on the ears will not set off of the alarms during security screening at airports. Keeping the hearing aids on will allow you to communicate with the security officers during screening, if necessary. It is ok to ask a security officer if it would be advisable to take your hearing aids off; however, body worn hearing aids and personal listening devices may contain enough metal parts that they should be packed in your carryon bag. The security scanner will not harm your hearing aids or other related devices.

Lodging

• Carry printed copies of lodging reservations, dates and prices.
• Inform the receptionist at the front desk that you are hearing-impaired. This is very important in case of emergency.
• Certain major hotel chains now provide visual alerting devices to help the hearing-impaired traveler recognize the ring of the telephone, a knock on the door, or a fire/emergency alarm. Contact the hotel in advance to make the necessary arrangements.

There are many things that hearing-impaired people can do to help make their travels safe, comfortable, and enjoyable. Don’t avoid travelling because of hearing loss. Planning ahead and informing your fellow travelers, transportation hosts, and hotel clerks that you are hearing-impaired are a few suggestions to help your trip run smoothly. Lastly, obtain any necessary devices—and enjoy yourself!

What You Should Know About Otosclerosis

What Is Otosclerosis?

The term otosclerosis is derived from the Greek words for “hard” (scler-o) and “ear” (oto). It describes a condition of abnormal bone growth around the stapes bone, one of the tiny bones of the middle ear. This 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 tympanic membrane (ear drum). These vibrations cause movement of the ear drum, which transfers the vibrations 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 tiny sensory hair cells in the inner ear, which connect with the auditory (hearing) nerve. The hearing nerve then carries sound information to the brain, resulting in hearing of sound. When any part of this process is compromised, hearing is impaired.

Who Gets Otosclerosis And Why?

It is estimated that ten percent of the adult Caucasian population is affected by otosclerosis. The condition is less common in people of Japanese and South American decent and is rare in African Americans. Overall, Caucasian, middle-aged women are most at risk.

The hallmark symptom of otosclerosis, slowly progressing hearing loss, can begin anytime between the ages of 15 and 45, but it usually starts in the early 20’s. The disease can develop in both women and men, but is particularly troublesome for pregnant women who, for unknown reasons, can experience a rapid decrease in hearing ability.

Approximately 60 percent of otosclerosis cases have a genetic predisposition. On average, a person who has one parent with otosclerosis has a 25 percent chance of developing the disorder. If both parents have otosclerosis, the risk goes up to 50 percent.

Symptoms Of Otosclerosis

Gradual hearing loss is the most frequent symptom of otosclerosis. Often, individuals with otosclerosis will first notice that they cannot hear low-pitched sounds or whispers. Other symptoms of the disorder can include dizziness, balance problems, or a sensation of ringing, roaring, buzzing, or hissing in the ears or head known as tinnitus.

How Is Otosclerosis Diagnosed?

Because many of the symptoms typical of otosclerosis can be caused by other medical conditions, it is important to be examined by an otolaryngologist (ear, nose and throat doctor) to eliminate these other causes. After an examination, the otolaryngologist may order a hearing test. The typical finding on the hearing test is a conductive hearing loss in the low frequency tones. This means that the loss of hearing is due to an inability of the sound vibrations to get transferred into the inner ear. Based on the results of this test and the exam findings, the diagnosis of otosclerosis can be made. The otolaryngologist will suggest treatment options.

Treatment For Otosclerosis

If the hearing loss is mild, the otolaryngologist may suggest continued observation or a hearing aid to amplify the sound reaching the ear drum. Sodium fluoride has been found to slow the progression of the disease and is sometimes prescribed. In some cases of otosclerosis, a surgical procedure called stapedectomy can restore or improve hearing.

What Is A Stapedectomy?

A stapedectomy is an outpatient surgical procedure done under local or general anesthesia. The surgeon performs the surgery through the ear canal with an operating microscope. It involves removing part or all of the immobilized stapes bone and replacing it with a prosthetic device. The prosthetic device allows the bones of the middle ear to resume movement, which stimulates fluid in the inner ear and improves or restores hearing.

Modern-day stapedectomy has been performed since 1956 with a success rate of approximately 90 percent. In rare cases (about one percent of surgeries), the procedure may worsen hearing.

Otosclerosis affects both ears in eight out of ten patients. For these patients, ears are operated on one at a time; the worst hearing ear first. The surgeon usually waits a minimum of six months before performing surgery on the second ear.

What Should I Expect After A Stapedectomy?

Most patients return home the evening after surgery and are told to lie quietly on the un-operated ear. Oral antibiotics may be prescribed by the otolaryngologist. Some patients experience dizziness the first few days after surgery. Taste sensation may also be altered for several weeks or months following surgery, but usually returns to normal.

Following surgery, patients may be asked to refrain from nose blowing, swimming, or other activities that may get water in the operated ear. Normal activities (including air travel) are usually resumed two to four weeks after surgery.

Notify your otolaryngologist immediately if any of the following occurs:

• Sudden hearing loss
• Intense pain
• Prolonged or intense dizziness
• Any new symptom related to the operated ear

Since packing is placed in the ear at the time of surgery, hearing improvement may not be noticed until it is removed about one to three weeks after surgery. The ear drum will heal quickly, generally reaching the maximum level of improvement within two weeks.

When Your Child Has Tinnitus

Tinnitus is a condition where the patient hears a ringing or other noise that is not produced by an external source. This disorder can occur in one or both ears, range in pitch from a low roar to a high squeal, and may be continuous or sporadic. This often debilitating condition has been linked to ear injuries, circulatory system problems, noise-induced hearing loss, wax build-up in the ear canal, medications harmful to the ear, ear or sinus infections, misaligned jaw joints, head and neck trauma, Ménière’s disease, or an abnormal growth of bone of the middle ear. In rare cases, slow-growing tumors on auditory, vestibular, or facial nerves can cause tinnitus as well as deafness, facial paralysis, and balance problems. The American Tinnitus Association estimates that more than 50 million Americans have tinnitus problems to some degree, with approximately 12 million people having symptoms severe enough to seek medical care.

Tinnitus is not uncommon in children. Although it is as common as in adults, children generally do not complain of tinnitus. Researchers believe that a child with tinnitus considers the noise in the ear to be normal, as it has usually been present for a long time. A second explanation of the discrepancy is that the child may not distinguish between the psychological impact of tinnitus and its medical significance.

Continuous tinnitus can be annoying and distracting, and in severe cases can cause psychological distress and interfere with your child’s ability to lead a normal life. The good news is that most children with tinnitus seem to eventually outgrow the symptom. It is unusual to see a child carry the problem into adulthood.

If you think your child has tinnitus, first arrange an appointment with your family physician or pediatrician. If the child does not have a specific problem with the ears such as middle ear inflammation with thick discharge, then it may be necessary to have your child referred to an otolaryngologist (ear, nose, and throat specialist).

What treatment may be offered.

Most people, including children, who are diagnosed with tinnitus find that there is no specific problem underlying their tinnitus. Consequently, there is no specific medicine or operation to “cure” the problem. However, experts suggest that the following steps be taken with the child diagnosed with tinnitus:

• Reassure the child: Explain that this condition is common and they are not alone. Ask your physician to describe the condition to the child in terms and images that they can understand.
• Depending on the nature of the tinnitus, the doctor may order further testing, such as a hearing test, a CT scan, or MRI.
• Explain that he/she may feel less distressed by their tinnitus in the future: Many children find it helpful to have their tinnitus explained carefully and to know about ways to manage it. This is partly due to a medical concept known as “neural plasticity,” where children’s are more able to change their response to all kinds of stimulation. If carefully managed, childhood tinnitus may not be a serious problem.
• Use sound generators or provide background noise. Sound therapy, which makes tinnitus less noticeable, has been used to treat adults for some time, and can also be used with children. If tinnitus occurs on a regular basis, with sound therapy the child’s nervous system can adapt to the condition. The sound can be environmental, such as a fan or quiet background music.
• Have hearing-impaired children wear hearing aids. A child with tinnitus and hearing loss may find that hearing aids can help improve the tinnitus. Hearing aids can pick up sounds children may not normally hear, which in turn will help their brains filter out their tinnitus. It may also help them by taking the strain out of listening. Straining to hear can make your child’s brain focus on the tinnitus noises.
• Help your child to sleep with debilitating tinnitus. Severe tinnitus may lead to sleep difficulties for the young patient. Ask your otolaryngologist the best strategy to adopt if your child cannot sleep.
• Finally, help your child relax. Some children believe their tinnitus gets worse when they are under stress. Discuss appropriate stress-relieving techniques with your pediatrician or family physician.