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Ear

The ear consists of the outer, middle and inner ear. Sound travels through the outer ear and reaches the eardrum, causing it to vibrate. The vibration is then transmitted through three tiny bones (ossicles) in the middle ear. The vibration then enters the inner ear where the nerve cells are. The nerve cells within the inner ear are stimulated to produce nerve signals. These nerve signals are carried to the brain, where they are interpreted as sound.

What is a hole in the eardrum?

A hole in the eardrum is known as a ‘perforation’. It may be caused by an infection or an injury to the eardrum. Quite often a hole in the eardrum may heal itself and sometimes it does not cause any problem. However a hole in the eardrum may cause a discharge from the ear. If the hole in the eardrum is large, then a person’s hearing capacity may be reduced. A normal ear drum. This patient has a hole in their right ear drum.

How is the condition diagnosed?

You will need an examination by an otolaryngologist (ENT specialist) to rule out any hidden infection behind the perforation. The hole in the eardrum can be identified using a special medical instrument called ‘auriscope’/otoscope’. It consists of a magnifying lens and light. Examination with the auriscope is pain free. The amount of hearing loss can be determined only by careful hearing tests. A severe hearing loss usually means that the ossicles are not working properly, or that the inner ear is damaged.

How can a hole in the eardrum be treated?

If the hole in the eardrum has only just occurred, no treatment may be required. The eardrum may simply heal itself. However if an infection is present, the one may need antibiotics. As a precaution you should avoid getting water in the ear until the eardrum heals completely. A hole in the eardrum that is not causing any problems can be left alone. If the hole in the eardrum is causing discharge or deafness, or if you wish to swim, it may be sensible to have the hole repaired. The operation is called a ‘myringoplasty’. You should discuss with your surgeon whether this surgery is appropriate for you.

Aims of the operation

The benefits of closing a perforation include prevention of water entering the middle ear while showering, bathing or swimming (which could cause ear infection). It can be done as part of a mastoid operation. Repairing the eardrum usually leads to good improvement of hearing.

How is the operation done?

Most myringoplasty operations in our institution are done under local anaesthetic, although some surgeons prefer to do it under general anaesthetic. A cut is made behind the ear or above the ear opening. The material used to patch the eardrum is taken from under the skin. This eardrum ‘graft’ is placed against the eardrum. Dressings are placed in the ear canal. You may have an external dressing and a head bandage for a few days. For a small perforation, your surgeon may even be able to plug it without making any cut in the ear. Occasionally, your surgeon may need to widen the ear canal with a drill to get to the perforation.

How successful is the operation?

The operation can successfully close a small hole ninety nine percent of the time (99%) in our hospital.

Possible complications

There are some risks that you must be aware of before giving consent to this treatment. These potential complications are rare and you should consult your surgeon about the likelihood of problems in your specific case.

Taste disturbance:

The taste nerve runs close to the eardrum and may occasionally be damaged. This can cause an abnormal taste on one side of the tongue. This is usually temporary but occasionally it can also be permanent.

Dizziness:

Dizziness is common for a few hours following surgery. On rare occasions, dizziness can last for months or even years if the inner ear is damaged during surgery.

Hearing loss:

In a very small number of patients, severe deafness can happen if the inner ear is damaged.

Tinnitus:

Sometimes the patient may notice noise in the ear, in particular if the hearing loss worsens.

Facial Paralysis:

The nerve for the muscle of the face runs through the ear. Therefore, there is a slight chance of a facial paralysis. The facial paralysis affects the movement of the facial muscles for closing of the eye, to smile or raising the forehead. The paralysis could be partial or complete. It may occur immediately after surgery or have a delayed onset. Recovery can be complete or partial.

What happens after the operation?

The ear may ache a little but this can be controlled with painkillers provided by the hospital. You will usually go home after the head bandage is removed, which is either the day after the operation or sometimes after a couple of days. The stitches will be removed 1-2 weeks after the operation at your doctor’s suggestion. There may be a small amount of discharge from the ear canal. This usually comes from the antiseptic solutions in the ear dressings. Some of the ear dressings may fall out and if this occurs there is no cause for concern. The dressings in the ear canal will be removed after 2-3 weeks by your surgeon at the hospital. You should keep the ear dry and avoid blowing your nose too vigorously. Plug the ear with a cotton wool ball coated with vaseline when you are having a shower or washing your hair. If the ear becomes more painful or is swollen then you should consult your doctor.

How long will I be off work?

The exact time needed off work varies between patients, but as a guide you may need to take 2-3 weeks off work.

Glue ear is common. Up to eight in every ten children (80%) will have a short episode of glue ear before they start primary school. The medical name for glue ear is ‘otitis media with effusion’.

Doctors are not sure about all the causes of glue ear. Sometimes it follows after an ear infection, but many children with glue ear have never had an ear infection. The adenoid in the back of the nose may become infected with coughs and colds and the bacteria spread into the ear causing inflammation. The fluid (or glue) probably forms in the ear as a result of this inflammation.

Often, the hearing loss from glue ear is not enough to be noticed by the parents. Often, it is the child minder or nursery teacher who notices that the child cannot hear that well in a group situation. Sometimes in a younger child, the hearing does not seem to be a problem, but it has been noticed that the child’s speech and language development is slower than his or her friends of the same age.

Some children complain of earache because of the fluid in their ears, some have balance problems or poor attention as a result of glue ear. Sometimes the only problem reported by parents or childminders are behavioral problems. This is probably due to frustration on the part of the child because they are not able to hear properly.

If you have concerns about your child’s hearing or speech and language development, you should refer your child for a hearing test in our hospital.

For most children, the glue ear will get better with no treatment. You will probably be asked to come back for a second hearing test 3-4 months after the first test. Many children usually will get better over this time. Those children who still have problems after this period, what doctors call ‘watchful waiting’ or ‘active monitoring’ will probably be recommended for surgical treatment. This may be grommet surgery or adenoidectomy.

Frequently asked questions

Is there any treatment that will help the glue ear clear away more quickly?

The evidence is that neither medical treatments such as antibiotics or antihistamines nor alternative treatments are any better than waiting for a period of 3 months to see if the glue ear clears on its own.

If my child has glue ear, are there any alternatives to grommets?

Hearing aids will help the hearing and give more time for the glue ear to clear. You can discuss this with your speciah6st.

Should some children with glue ear have hearing aids as a first treatment?

For some children, glue ear can be a problem for much longer than others. In children with Down’s syndrome or cleft palate, hearing aids should be discussed with your speciah6st as a first treatment for glue ear.

What happens if the glue ear is not treated?

Doctors do not really know if any damage occurs to the ear or hearing if the glue ear is not treated. We usually advise treating the problem if it does not clear up on its own to avoid the risk of long-term damage to the ear, and hearing or problems in later h6fe with language skills.

Is glue ear common in adults?

Glue ear is uncommon in adults. However it can follow on from a bad head cold, flu or other viral infections of the ear, nose or sinuses. Rarely though, it can be caused by a serious blockage of the tube that goes from the back of the nose to the ear. (Eustachian tube).Adults with glue ear should be seen by an ENT speciah6st as soon as possible.

What are grommets?

Grommets are very small plastic tubes which sit in a hole in the eardrum. They let air get in and out of the ear which keeps the ear healthy.

Why do we use grommets?

Some people get fluid behind the eardrum. This is sometimes called ‘glue ear’. It is very common in young children, but it can happen in adults too. We don’t know exactly what causes glue ear.

Most young children will have glue ear at some time, but it doesn’t always cause problems. We only need to treat it if it causes problems with hearing or speech, or if it is leading to multiple counts of ear infections.

How are grommets put in?

The grommets are placed in the eardrum under a short general anaesthetic and the procedure is usually performed as a day-case admission to hospital. The operation is carried out down the ear canal so there are no cuts to see on the outside of the ear. A small opening is made in the eardrum using a microscope to magnify the area and the fluid is sucked out of the ear with a fine sucker. The grommet is then placed in the opening in the eardrum. The procedure takes between 10-20 minutes.

How long do grommets stay in for?

Grommets fall out by themselves as the eardrum is constantly growing. They may stay in for six months, or a year, or sometimes even longer in older children. You may not notice when they drop out.

Does my child have to have grommets?

Glue ear tends to get better by itself but this can take a while. We h6ke to leave children alone for the first 3 months because about half of them will get better in this time. After 3 months, we will see your child again and decide whether we need to put in grommets.

If the glue ear is not causing any problems ideally one must just wait for it to settle by itself. If it is causing problems with poor hearing, poor speech or lots of infections, it may be better to put grommets in.

If we do put in grommets, the glue ear may come back when the grommet falls out. This happens to 1 out of 3 children who have grommets put in. Hence we may need to put more grommets in to last until your child grows out of the problem.

Otosclerosis is a common cause of hearing impairment and is hereditary. Someone in earlier generations of your family had the condition and passed it down to you. Similarly, your descendants may inherit this tendency from you, although the hearing impairment may not manifest itself for a generation or two. Being hereditary, diseases such as scarlet fever, ear infection and influenza have no relationship to the development of otosclerosis.

  • Function of the normal ear

The ear is divided into three parts: the external ear, the middle ear and the inner ear. The external ear collects sound, the middle ear mechanism transforms the sound and the inner ear receives and transmits the sound.

Sound vibrations enter the ear canal and cause the eardrum membrane to vibrate. Movements of the membrane are transmitted across the middle ear to the inner ear fluids by three small ear bones. These middle ear bones (hammer or malleus, anvil or incus and stirrup or stapes) act as a transformer, changing sound vibrations in the air into fluid waves in the inner ear. The fluid waves stimulate delicate nerve endings in the hearing canals. Electrical impulses are transmitted on the nerve to the brain where they are interpreted as understandable sound.

  • Types of hearing impairment

The external ear and the middle ear conduct sound; the inner ear receives it. If there is some

difficulty in the external or middle ear, a conductive hearing impairment occurs. If the trouble lies in the inner ear, a sensorineural or nerve hearing impairment is the result. When there is difficulty in both the middle and the inner ear a mixed or combined impairment exists. Mixed impairments are common in Otosclerosis.

  • Hearing impairment from otosclerosis

Had we been able to examine your inner ear bone under a microscope before a hearing impairment developed, we would have seen minute areas of both softening and hardening of the bone. This process may spread to the stapes, the inner ear, or to both these areas

  • Cochlear Otosclerosis

When otosclerosis spreads to the inner ear a sensorineural hearing impairment may result due to interference with the nerve function. This nerve impairment is called cochlear otosclerosis and once it develops it is permanent. In selected cases medication may be prescribed in an attempt to prevent further nerve impairment.

On occasion the otosclerosis may spread to the balance canals and may cause episodes of unsteadiness.

  • Stapedial Otosclerosis

Usually otosclerosis spreads to the stapes or stirrup bone, the final link in the middle ear transformer chain. This stapes rests in a small groove, the oval window, in intimate contact with the inner ear fluids. Anything that interferes with its motion results in a conductive hearing impairment. This type of impairment is called stapedial otosclerosis and is usually correctable by surgery.

The amount of hearing loss due to involvement of the stapes and the degree of nerve impairment present can be determined only by careful hearing tests.

  • Treatment of otosclerosis
  • Medical

There is no local treatment to the ear itself or any medication that will improve the hearing in persons with otosclerosis. In some cases medication may be helpful in preventing further loss of hearing.

  • Surgical

The stapes operation (Stapedectomy / Stapedotomy) is recommended for patients with otosclerosis who are candidates for surgery. This operation is performed under local anesthesia and requires a short period of hospitalization and convalescence. Over 90 percent of these operations are successful in restoring the hearing permanently.

  • Your hearing

Hearing is measured in decibels (dB). A hearing level of 0 to 25 dB is considered normal hearing for conversational purposes. Pure Tone Audiometry tests will reveal the exact level of your hearing loss. The hearing levels are depicted as follows:

Right ear ____________________________________decibels

Left ear ____________________________________decibels

(Conversion to degree of handicap)

25 dB ____________________0%

55 dB (Moderate)_________________45%

30 dB (Mild) _______________8%

65 dB (Severe) ___________________60%

35 dB (Mild) ______________15%

75 dB (Severe) ___________________75%

45 dB (Moderate) __________30%

85 dB (Severe) ___________________90%

SURGERY RECOMMENDATIONS
Depending on the level of hearing handicap and severity of disease, the recommendations may be any of the following:
  • You have a minor degree of stapedial otosclerosis. As such we do not advise surgery at this time.
  • You have unilateral (one ear) otosclerosis. If the stapes operation is successful you will have improved hearing from the involved side, will have less difficulty in determining the direction of sound and should hear better in difficult listening situations.
  • You have good hearing nerve function and are a very suitable candidate for the stapes operation.
  • Your hearing nerve has deteriorated slightly. If the stapes operation is successful, serviceable hearing will be restored to you.
  • Your hearing nerve has deteriorated to some extent. If the stapes operation is successful, you should be able to hear in many situations without an aid, but may need an aid for distant hearing.
  • Your hearing nerve has deteriorated considerably. If the stapes operation is successful, you will gain more benefit from the use of a hearing aid.
  • Your hearing nerve has deteriorated severely. For this reason the chances of surgery improving your hearing are reduced. If surgery should prove successful, your hearing should be improved to the extent that you may be able to use a hearing aid.
  • Your hearing loss is due to inner ear and nerve involvement. As such, surgery would not be of benefit to you at this time. Many of the operations performed today were not available a few years ago. Through ear research we hope to be able to help sensorineural (nerve) hearing impairment in the future.
The stapes operation
  • (Stapedectomy / Stapedotomy)

Stapedectomy is performed through the ear canal under local anesthesia. At times an incision may be made above the ear to remove muscle tissue for use in the operation.

Under high power magnification the eardrum membrane is turned forward and the fixed stapes partially or completely removed. The stapes may be removed with instruments, a drill or in some cases, a laser. Prosthesis is inserted to replace it. The eardrum membrane is then replaced in its normal position. The stapes prosthesis allows sound vibrations to again pass from the eardrum membrane to the inner fluids. The hearing improvement obtained is usually permanent.

The patient may return to work in seven to ten days depending upon occupational requirements. Patients residing outside Chennai area should plan to remain in Chennai for a total of five days including the day of surgery.

One should not plan to drive a car home from the hospital. Air travel is permissible 10 days following surgery.

  • Hearing improvement following stapes surgery

Hearing improvement may or may not be noticeable at surgery. If the hearing improves at the time of surgery, it usually regresses in a few hours due to swelling in the ear. Improvement in hearing may be apparent within 3 weeks of surgery. Maximum hearing, however, is obtained in approximately four months.

The degree of hearing improvement depends on how the ear heals. In the majority of patients the ear heals perfectly and hearing improvement is as anticipated. In some the hearing improvement is only partial or temporary. In these cases the ear usually may be reoperated upon with a good chance of success.

In 2 percent of the cases the hearing may be further impaired due to the development of scar tissue, infection, blood vessel spasm, irritation of the inner ear or a leak of inner ear fluid (fistula).

In less than 1 percent, complications in the healing process may be so great that there is severe loss of hearing in the operated ear, to the extent that one may not be able to benefit from a hearing aid in that ear. For this reason the poorer hearing ear is usually selected for surgery.

When further loss of hearing occurs in the operated ear, to the extent that one may not be able to benefit from a hearing aid in that ear, head noise may be more pronounced. Unsteadiness may persist for some time.

  • Tinnitus

Most patients with otosclerosis notice tinnitus (head noise) to some degree. The amount of tinnitus is not necessarily related to the degree or type of hearing impairment.

Tinnitus develops due to irritation of the delicate nerve endings in the inner ear. Since the nerve carries sound, this irritation is manifested as ringing, roaring or buzzing. It is usually worse when the patient is fatigued, nervous or in a quiet environment.

Following the successful Stapedectomy tinnitus is often decreased in proportion to the hearing improvement.

  • Hearing aids

If you are a suitable candidate for surgery, you are also suitable to benefit from a properly fitted hearing aid. If you have otosclerosis and are not suitable for stapes surgery, you still may benefit from a properly fitted aid.

Fortunately, patients with otosclerosis very seldom go “totally deaf”, but will be able to hear with an electronic aid. The older the patient, the less the tendency for further hearing loss due to the otosclerotic process.

  • Hearing aid donation

If you regain hearing through surgery and there is no longer a need for you to wear hearing aids, it would be greatly appreciated if you would donate your hearing aids to the KKR Hearing Aids. Donated hearing aids are used as “loaners” for the occasional patient who requires hearing aid only for brief time, or who cannot afford to purchase a hearing aid.

  • General comments

If you are a suitable candidate for surgery and do not have the stapes operation at this time, it is advisable to have careful hearing tests repeated at least once a year.

How does the ear work?

The ear consists of the outer, middle and inner ear. The outer ear is covered by skin. The middle ear is covered by a mucus producing membrane. Sound travels through the outer ear and reaches the eardrum, causing it to vibrate. The vibration is then transmitted through three tiny bones (ossicles) in the middle ear. The vibration then enters the inner ear where the nerve cells are. The nerve cells within the inner ear are stimulated to produce nerve signals. These nerve signals are carried to the brain, where they are interpreted as sound.

What is the mastoid bone?

The mastoid bone is the bony prominence that can be felt just behind the ear. It contains a number of air spaces, the largest of which is called the antrum. It connects with the air space in the middle ear. Therefore ear diseases in the middle ear can extend into mastoid bone.

Why is mastoid surgery done?

Operations on the mastoid may be necessary when ear infection within the middle ear extends into the mastoid. Most commonly this is a pocket of skin growing from the outer ear into the middle ear, known as cholesteatoma. This causes infection with discharge and some hearing loss. The pocket gets slowly larger, often over a period of many years, and causes gradual erosion of surrounding structures. Erosion of the ossicles can result in hearing loss. The only effective way to get rid of this pocket of skin is surgery.

A normal ear drum.

A cholesteatoma.

How is mastoid surgery done?

A local or general anaesthetic is used. There are several ways of doing the operation, depending on the extent of the ear disease and the surgeon. They have various names such as atticotomy and mastoidectomy and take between 1-3 hours. It involves a cut either above the ear opening or behind the ear.

The bone covering the infection within the mastoid cells is removed. The resultant bony defect is called a mastoid cavity. Some surgeons leave the mastoid cavity open into the ear canal. This allows the surgeons to inspect the mastoid cavity easily. Other surgeons close up the mastoid cavity with bone, cartilage or muscle from around the ear. You should discuss with your surgeon his/her preferred approach. At the end of the operation, packing will be placed in your ear while it heals.

Does it hurt?

The ear may ache a h6ttle but this can be controlled with painkillers provided by the hospital.

How successful is the operation?

The chances of obtaining a dry, trouble free ear from this operation by our experienced surgeons are over 95%. In some patients it is possible to improve the hearing as well. You should enquire from your surgeon the h6keh6hood of success in your particular case.

Possible comph6cations

There are some risks that you must be aware of before giving consent to this treatment. These potential comph6cations are rare. You should consult your surgeon about the h6keh6hood of problems in your case.

Loss of hearing

In a small number of patients the hearing may be further impaired due to damage to the inner ear. If the disease has eroded into the inner ear, there may be total loss of hearing in that ear.

Dizziness

Dizziness is common for a few hours following mastoid surgery and may result in nausea and vomiting. On rare occasions, dizziness is prolonged.

Tinnitus

Sometimes the patient may notice noise in the ear, in particular if the hearing loss worsens.

Weakness of the face

The nerve that controls movement of the muscles in the face runs inside the ear and may be damaged during the operation, but this risk is rare. If it happens, the face may lose its movement on one side but it is usually temporary.

What happens after the operation?

You will usually go home the day after the operation after the head bandage is removed, or sometimes the same day. There is sometimes some dizziness but this usually settles quickly. The stitches are removed 1 to 2 weeks after the operation. There may be a small amount of discharge from the ear canal. This usually comes from the ear dressings. Some of the packing may fall out. If this occurs there is no cause for concern. It is sensible to trim the loose end of packing with scissors and leave the rest in place. The packing in the ear canal will be removed in the hospital after 2 or 3 weeks.

You will visit our hospital occasionally for follow up of your ear for up to 5 years after the operation. You should keep your ear dry. Plug the ear with a cotton wool ball coated with vaseh6ne when you are having a shower or washing your hair. If the ear becomes more painful or is swollen then you should consult the Ear, Nose and Throat department.

How long will I be off work?

2 weeks.

Is there any alternative treatment?

The only way to remove the infection completely is a mastoid operation. In patients who are unfit for surgery, the only alternative is the regular cleaning of the ear by a speciah6st and the use of antibiotic eardrops. This at best could only reduce the discharge

What is tinnitus?

Tinnitus is a sensation or awareness of sound that is not caused by a real external sound source. It can be perceived in one or both ears, inside the head or in the person's immediate environment. Although it is commonly assumed to be a ringing noise, tinnitus can take almost any form including hissing, whistling, humming and buzzing. Some people even hear musical sounds or sounds resembling indistinct speech. Some people hear a single sound whereas others hear multiple noises. For some, the sound is constant, for others it is constantly changing.

What causes tinnitus?

It is often assumed that tinnitus is caused by damage to the ears. This is true in some cases but it is perfectly possible to have tinnitus with normal ears and normal hearing. Several studies have been performed where people who do not have tinnitus were placed in soundproofed rooms and told to listen intently. In this situation almost everyone becomes aware of a sound sensation.

Many scientists think that tinnitus is generated by random electrical signals that can occur in any part of the hearing pathway. Thus tinnitus may originate in the ears, in the hearing nerve or in the brain. Such random signals are common and usually we are not aware of them happening. Occasionally something happens that causes some people to interpret these random signals as sound. Common triggers for this process are emotional shocks and loss of hearing, either gradual or sudden. However, in many people the trigger is unknown. Once we become aware of the tinnitus signal, it draws the attention of the brain making tinnitus even more distressing. This type of tinnitus is called subjective tinnitus because it is only heard by the sufferer.

A few people have tinnitus that is attributable to a real sound, generated inside the body by blood flow or muscular activity. This type of tinnitus may be detectable by other people, either just by careful listening or by using a stethoscope. This kind of tinnitus is known as objective tinnitus.

What are the symptoms?

Tinnitus is a symptom in itself.

It may be accompanied by hearing loss, dizziness, pain in the ears (otalgia) or dislike of loud sounds (hyperacusis).

Many people with tinnitus also feel that their ears are blocked.

Your specialist will consider these other symptoms when making a diagnosis and developing a plan for your treatment.

How is tinnitus diagnosed?

The first thing your specialist will do to diagnose your condition is to ask some questions about your symptom. This is actually all that is necessary to reach a diagnosis and there is no special ‘tinnitus test’.

Of course your specialist will want to know as much as possible about your hearing and will perform a full examination of your ears. Other areas such as the nose, jaw joints and throat may be examined. If the specialist thinks that you may have objective tinnitus he or she may listen around your ear and neck with a stethoscope. In almost all cases the specialist will arrange some tests. The most common test is a hearing test (pure tone audiogram). There are some hearing tests that try and match the person’s tinnitus but they do not influence treatment greatly. Many specialists therefore do not request these tests. For selected patients, the doctor may wish to order an MRI scan though other tests such as CT scans or ultrasound scans are sometimes utilized. Blood tests may occasionally be required but this is unusual in the diagnosis of tinnitus.

What can I do to help myself?

Tinnitus is extremely common. Approximately 1 in 10 of the population have some degree of tinnitus. In most people, the symptom is mild and does not interfere greatly with their lives. Many people think that tinnitus will never go away. This is incorrect and with time most tinnitus lessens or disappears. Knowledge of these simple facts can help many people to cope with it. Most people with tinnitus find that it appears louder if they are sitting somewhere very quiet. Having a little bit of quiet background sound from a radio, CD player or television can help. Many people notice that their tinnitus becomes more distressing if they become stressed or anxious. Learning to try and avoid stressful situations can help. There have been anecdotal reports that certain foods and drinks can exacerbate tinnitus. People may therefore put themselves on exclusion diets. Caution should be urged in this respect; there is a little if any scientific evidence to support the theory that food causes tinnitus.

Treatment options

Although there is no simple pill or operation to cure the majority of cases of tinnitus there are several strategies that are very helpful in ameliorating the condition. For people with mild tinnitus simple explanation and reassurance may be all that is required. For more intrusive tinnitus a form of counseling may prove helpful. This can be administered as a standalone therapy or as part of a wider treatment strategy such as Tinnitus Retraining Therapy (TRT) which is a mixture of counseling and sound therapy. If tinnitus is associated with hearing loss then trying to correct the hearing loss is usually very helpful. Depending on the cause of the hearing impairment, medication, surgery or hearing aids may be needed. Sound therapy can help many people with tinnitus. This can take the form of an electronic device that sits at the person’s bedside and produces low level soothing sound to distract them from their tinnitus at night. During the daytime it is possible to wear a sound generator which is a small device that resembles a hearing aid and produces white noise. Psychological techniques such as Cognitive Behavioral Therapy (CBT) and Mindfulness Meditation can be used in the management of tinnitus; also Relaxation Therapy is very helpful for those who find that stress worsens their problem. For a very small number of people, usually those with objective tinnitus, there may be a drug or surgical procedure that can cure the problem.

Monitoring and reassessment

Tinnitus is such a variable symptom that it is extremely difficult to make any hard and fast rules regarding the long-term management. This is a very individual decision that will be made by you and your specialist.

Uncertainties

There are many questions regarding tinnitus that remains to be answered regarding both the mechanisms by which it is generated and the search for more effective treatments. Various research avenues are currently being explored including the use of certain types of drug and electromagnetic stimulation of the auditory system.

What is Hearing Loss?

Hearing loss is a symptom of a variety of conditions affecting the hearing organ or its nerve connection to the brain. It may be caused by problems affecting the transmission of sound through the eardrum and bones of hearing (called ossicles) to the cochlea (the organ of hearing), or it may be due to problems in the cochlea and the auditory nerve that connects the cochlea to the brain.

Conductive hearing loss is caused when something interferes with the transmission of sound from the ear canal to the cochlea. Sensorineural hearing loss is caused when there is a problem with the cochlea, or the nerve connection from the cochlea to the brain.

What Causes Hearing Loss?

Conductive hearing loss can be due to problems in the ear canal, ear drum (tympanic membrane) or the middle ear bones (ossicles). These three bones are called the Hammer, Anvil and Stirrup (or Malleus, Incus and Stapes).

In children the commonest type of hearing loss is conductive hearing loss. This is usually due to fluid being trapped behind the eardrum. This condition is called glue ear, or Otitis Media with Effusion (OME). The fluid stops the eardrum from vibrating. Sometimes there are other causes for childhood conductive hearing loss. Rarely children may be born with poorly formed middle ear bones, or these structures can be damaged through ear infection.

Conductive hearing loss in adults is less common, but may be due to problems with the bones of hearing or occasionally glue ear. Heavy wax accumulation in the ear canal can also cause a mild degree of conductive hearing impairment.

Infection which damages the ossicles may lead to conductive hearing loss. One such condition is called cholesteatoma. Here infected skin grows around the ossicles. This can restrict movement of the ossicles or even damage their structure and connections. Other conditions may affect the ossicles, for instance the stapes bone can become attached to the surrounding bone which stops it transmitting sound. This is a condition called otosclerosis.

Sensorineural hearing loss is due to loss of sound sensing cells in the cochlea (these are called hair cells) or damage to the nerves that take hearing signals to the brain. There are many causes of this type of hearing loss.

Age related hearing loss is sensorineural, and due to loss of hair cells with ageing it is the commonest cause of hearing loss in adults. Sensorineural loss can also be due to excessive noise exposure in both work situations (industrial noise damage) or through excessively loud music exposure (recreational noise damage). Other causes of sensorineural hearing loss include some prescribed medication, and some infections. Children can also suffer from sensorineural hearing loss, and for some children this is an inherited disorder that may even be present at birth. It can vary from a mild hearing loss to severe deafness.

Finally it is worth remembering that hearing loss can be due to a mixture of conductive and sensorineural causes.

Some types of sensorineural hearing loss require urgent treatment. Please seek medical advice immediately if:

You lose your hearing suddenly i.e over just a few hours or days

If your hearing loss is associated with ear discharge, dizziness or earache

What are the symptoms?

Most adults first start to notice difficulty in following conversation when there is background noise or when more than one person is talking. Often their friends will complain that they don’t listen or that they turn the television volume up too loud. They may become increasingly withdrawn and frustrated that they cannot socialize easily.

In children, parents find that they might be inattentive, or ignore instructions or appear naughty. Listening to the television at high volumes is common and sometimes the child’s teachers will complain. Young children with delayed speech production should always be assessed for hearing loss.

What should you do if you suspect hearing loss?

In most circumstances you should see your doctor, who will be able to examine you for wax impaction and look for signs of ear disease. Your doctor can then arrange hearing tests and if necessary review by an ENT consultant.

Investigations and Treatment

Your doctor or specialist will arrange for you to have hearing tests performed. A variety of tests are available, and special test techniques can be used to assess children, even when they are newborns.

This will help establish the nature and severity of the hearing loss. The severity of the hearing loss is graded mild, moderate, severe and profound. Treatment depends on the severity of the hearing loss and whether it is conductive or sensorineural.

In conductive hearing loss there may be an infection of other disease process that needs to be treated. Treatment may include surgery, both to treat the infection and also restore the hearing.

In cases where the hearing loss is due to a problem with the ossicles (egotosclerosis) surgical hearing restoration is usually possible. This may involve using metal or plastic implants or reusing your existing ossicles to restore the hearing mechanism.

In many cases hearing aids will be advised. These come in different sizes and types to suit different users and hearing needs. The technology in hearing aids is always improving to make them more discreet and offer better sound quality. An example of modern hearing aids is shown in the picture alongside. Your doctor will be able to refer you to our audiology unit for assessment and fitting of hearing aids.

For some patients with specific types of hearing loss a surgically implanted hearing device may be advised. These devices include bone anchored hearing aids and cochlear implants. With modern surgery and high technology devices ENT surgeons are able to offer even the most severely deaf patients useful hearing. There is a hearing restoration solution available for almost everyone who is hearing impaired.

What is dizziness?

Dizziness is a sense of feeling lightheaded or unsteady or woozy that is often accompanied by sensations of swaying, tilting, whirling, spinning, floating or moving that could also be described as vertigo. Dizziness can hit even when you are standing or lying down absolutely still.

What Causes dizziness?

Our body’s balance maintenance system is very complex. For the body to perceive itself in a state of balance, the brain needs to integrate optimal inputs from muscles, joints, eyes and inner ear. If any of these body parts get diseased or if that part of the brain that integrates and analyzes signals received from these parts is affected, dizziness can occur. Because of these complexities, diagnosing the root cause of dizziness becomes a tough and multi-specialty task requiring inputs from different specialists.

That said, inner ear disorders show up as one of the more common cause of dizziness.

Which are the inner ear disorders can cause dizzy spells?
Meniere’s syndrome

This syndrome is connected to your inner ear‘s fluid balance regulatory system. In this condition, the patient gets attack-like episodes with sudden onset of multiple symptoms such as ringing noises in the ear, sense of fullness in the ear, distortion in hearing, loss of hearing, nausea, vomiting and severe dizziness. These attacks can last anywhere from 20 minutes to 24 hours. To treat this, your doctor can prescribe anti-nausea and anti-vertigo medicines along with dietary and medication changes. You will also be advised to quit smoking. If medical treatment is not effective or available, you may be advised to undergo a surgical procedure.

Benign paroxysmal positional vertigo (BPPV)

Your inner ear’s balancing section is equipped with delicate sensory units. BPPV can result from damage inflicted on these units. The symptoms show up as sensations of spinning, dizziness, imbalance, and lightheadedness which are felt when the patient changes his head and body position, for example, at the time of turning over in the bed or bending the head backwards. These sensations usually last no more than a few moments and may range anywhere between mild to moderate to severe. The patient can get complete relief by learning a few simple head and body repositioning maneuvers that can be done anywhere.

Vestibular neuritis (labyrinthitis)

This condition occurs due to inflammation of balance-controlling inner ear nerve cells that is usually caused by an upper respiratory tract viral infection such as influenza. The patient suffers from sudden vertigo spells lasting anywhere between 1-7 days. This condition is eminently treatable with full chances of a complete recovery without requiring any surgery. Your doctor will most likely prescribe medications for symptomatic relief from dizziness and nausea and will recommend a 6-8 weeks’ balance rehabilitation program.

In some cases, dizziness can also result from medications such as those prescribed for seizure disorders (e.g, carbamazepine, phenytoin) or sedatives and antidepressant drugs.

In some cases, dizziness can also result from medicines prescribed for inner ear infections (e.g. gentamicin, streptomycin). Last but not the least, alcohol intake can also cause dizziness.

What should I do if I have dizziness?

We recommend a visit to our ENT specialist. He will undertake the required tests and investigations and may also have to consult other specialists (as we stated earlier, body’s balancing system involves inputs sent to brain from muscles, joints, eyes, and inner ear). Once the underlying cause is diagnosed, you will be given a suitable treatment

Why is detecting deafness in children so very important?

Do you know that a baby starts hearing while still a foetus in the mother’s womb? It is crucial to understand that speech and hearing are intricately interconnected in children. Actually, the first few years are crucial to development of communication skills in babies. Children learn and develop their speaking skills by copying those around them. If they can’t hear properly, they won’t learn to speak properly either. Therefore, if a newborn baby or a toddler suffers from any kind of hearing impairment, it can have a drastic and long lasting negative impact on their speech and communication skills for an entire lifetime. You need to ensure that your baby’s hearing is in good shape at the earliest.

What are the causes of deafness in Children?

Children can suffer from deafness due to many reasons. These could be present from the time of the birth or could have arisen later.

  • Inheritance of malfunctioning genes from parents
  • Presence of Down’s Syndrome or Goldenhar Syndrome with hearing loss as one of the many syndromic disabilities
  • Infection received in the womb such as rubella (German measles), cytomegalovirus, or herpes simplex virus
  • Blood’s Rh factor related complications
  • Premature birth
  • Diabetes in mother
  • Toxaemia during pregnancy
  • Anoxia or lack of oxygen

Post-birth conditions in children that can cause deafness at any age:

  • Ear infections (otitis media)
  • Ototoxic medicines that damage the auditory system
  • Infectious diseases such as encephalitis, meningitis, measles, chickenpox, mumps, or influenza
  • Head injury or trauma to ear
  • Exposure to loud noises
  • Foreign bodies in ear
  • Earwax impaction
  • In rare cases, deafness could be caused by cancers
Do some babies have an increased risk of being deaf at birth?

Yes, some babies are more at risk than other babies. Get your baby checked for deafness if the baby:

  • Has a family history of permanent hearing loss
  • Is born premature or has a birth weight of less than 2 kgs
  • Has low Apgar scores (numbers assigned at birth that reflect the newborn's health status)
  • Required post-birth ventilator support for breathing for more than 10 days
  • Was in neo-natal intensive care unit (NICU) for more than 5 days
  • Had severe jaundice after birth
  • Suffers from hydrocephalus (fluid accumulation in brain)
  • Suffered meningitis
  • Has received exposure to ototoxic medications that can cause damage to the ear
  • The mother suffered some illness (e.g. rubella) during pregnancy
Is it possible to test hearing at a very young age?

Yes, it is absolutely possible to conduct hearing tests, whatever the age of the child. However, the type of testing will vary from child to child depending on their age / level of development. Some hearing evaluations employ interactive games to engage the child, some other do not need any behavioural response from them. Hearing tests are specialized assessments that require professionals trained in diagnostic hearing testing techniques and auditory rehabilitation of adults and children. They are called audiologists. Nevertheless, as hearing tests for children need special diagnostic equipment and set up along with advanced training, not every audiologist is able to test hearing of children.

How can deafness in children be treated?

The imperative first step is to assess the child’s hearing and pinpoint the condition that’s responsible for its loss. If the cause is treatable through surgical intervention, the ENT surgeon undertakes it. For example, if the deafness is due to a condition called the secretory otitis media, the surgeon will conduct a surgery called myringotomy grommet to restore hearing.

On the other hand, if the underlying condition is incurable, rehabilitation is the next step that needs to be taken at the earliest. First, hearing assessments are carried out and then based on the result, hearing aids may be prescribed. Hearing aids amplify the sounds around the child to make him or her hear what they have been missing and thus provides the stimuli to their growth as well as speech and language development.

However, not all children are suitable for hearing aids. Some children with higher severities or hearing loss configurations may require other types of technological assistance such as the BAHA hearing system or a cochlear implant. These alternatives can be used along with speech therapy, special education, and FM (frequency modulated) or IR (infrared) systems to provide superior access to auditory information in afflicted children.

About Us

Gajanan Hospital ENT Clinic is one of the leading centers for the treatment of diseases of the ear, nose and throat in the Ahmednagar. Established by Dr. Gajanan Kashid in 2007.The service of humanity with the highest standards of ethics and professionalism. The clinic has many firsts to its credit:

adress

  • Dr.Gajanan Kashid
    Gajanan Hospital & Advanced Endoscopic ENT Surgery Centre & Snoaring Treatment Centre
    Plot no 8, satbhai mala,
    Delhi Gate
    AHMEDNAGAR-414 001.
    Maharashtra, India
  • Tel -: (0241) 2325424 / 2325425
  • Email -: entgajanan@gmail.com entgajanan@rediffmail.com

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