Cholesteatoma

A cholesteatoma is an abnormal skin growth in the middle ear behind the eardrum that is typically caused by repeated ear infections, eustachian tube dysfunction, and/or a tear or pulling inward of the eardrum. 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 damage the surrounding delicate bones of the middle ear, which can lead to hearing loss and in rare cases dizziness, permanent hearing loss, and/or facial muscle paralysis. A rare congenital (present at birth) form of cholesteatoma can occur in the middle ear and elsewhere, such as in the nearby skull bones. However the most common is cholesteatoma resulting from chronic ear infections.

Symptoms of Cholesteatoma

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 and can only be diagnosed 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.

Treatment of Cholesteatoma

Your otolaryngologist/head and neck surgeon will examine your ears to confirm the presence of a cholesteatoma. Initial treatment is aimed at stopping the drainage in the ear by controlling the infection and may include a careful cleaning of the ear, antibiotics, and ear drops. The cholesteatoma's growth traits will also be assessed. A large or complicated cholesteatoma usually requires surgical treatment to protect your ears and hearing health. Hearing and balance tests as well as CT scans (3-D x-rays) of the mastoid may be needed to evaluate your hearing clarity and the extent of damage the cholesteatoma has caused.

In most cases, surgery is performed under general anesthesia to remove the cholesteatoma and to eliminate the infection and create a dry ear. A second surgery, tympanoplasty, is sometimes necessary both to ensure that the cholesteatoma is gone as well as to attempt reconstruction of the eardrum and/or damaged middle ear bones in an effort to improve hearing. Facial nerve repair or procedures to control dizziness are rarely required. Reconstruction of the middle ear is not always possible in one operation; a subsequent operation may be needed six to 12 months later. In cases of severe ear damage, reconstruction may not be possible.

Cholesteatoma surgery is typically an out-patient procedure, however an overnight stay may be necessary for some patients. 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, your otolaryngologist will schedule follow-up office visits to evaluate your results and to check for recurrence. In cases requiring removing cells in the hollow, air-filled spaces in the skull behind the ear (mastoidectomy), office visits every few months are necessary to clean out the mastoid cavity and prevent new infections. Some patients will need lifelong periodic ear examinations.

Cochlear Implants

A cochlear implant is an electronic device that restores partial hearing to those with severe to profound hearing loss, who who do not benefit from a traditional hearing aid worn in or behind the ear. Cochlear implants are surgically implanted in the inner ear and activated by a "companion" device worn outside the ear. Unlike a hearing aid, it does not make sound louder or clearer. A cochlear implant bypasses damaged parts of the auditory system and directly stimulates the hearing nerve, allowing the wearer to receive sound. A cochlear implant has two main components:

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

The external microphone receives sounds, which are sent to the speech processor, which in turn translates the sounds into distinctive electrical signals. These signals are transmitted to the internal electronic stimulator, which sends the signals 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 intelligible sound.
Cochlear Implant Benefits

Cochlear implants are designed only for people for whom hearing aids provide little or no benefit. Hearing impaired children must be at least 12 months old to be considered for a cochlear implant, unless childhood meningitis is responsible for deafness.

A cochlear implant team (otolaryngologist, audiologist, nurse, and others) will determine your candidacy for a cochlear implant and review what you may expect as a result of the cochlear implant. The implant team will also conduct a series of tests, including:

• Ear (Otologic) Evaluation: Your otolaryngologist examines your ear canal and middle 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 your 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. 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 under the skin behind the ear.

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 differences. Your team will ask you to come back to the clinic for regular checkups and readjustment of the speech processor as needed.

Most adult cochlear implant patients notice an immediate improvement in their communication skills. Children require time to benefit from their cochlear implant, because 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 hearing impaired, the number of surviving auditory nerve fibers, and a person's motivation to learn to hear.

Dizziness, Imbalance & Vertigo

Dizziness can be described in many ways, such as feeling light-headed, unsteady, or feeling a floating sensation. Vertigo is a specific type of dizziness characterized by an illusion of movement -- you feel as though you or your surroundings are moving. Some experience dizziness as "motion sickness," a nauseating feeling brought on by the motion of riding in car, airplane, boat or roller coaster. Dizziness, vertigo, and motion sickness all relate to your sense of balance and equilibrium, which is maintained by a complex interaction of the these parts of your nervous system:

• Your inner ear: it monitors your direction of motion, such as turning, forward-backward, rolling, side-to-side, and up-and-down motions.
• Your eyes: they monitor where your body is in its surroundings, such as upside down and right side up, as well as directions of motion.
• Your muscle and joint sensory receptors: they convey which parts of your body are moving.
• Your pressure receptors in the joints of your spine and lower extremities: they tell what part of your body is down and touching the ground.
• Your central nervous system (your brain and spinal cord): it processes all the information from the four other systems to maintain balance and equilibrium.

When your central nervous system receives conflicting messages from your other four systems, you experience motion sickness and/or dizziness.

Causes of Dizziness

A variety of things can cause dizziness. It can be one thing or a combination of things including:

• Circulation: If your brain does not get enough blood flow, you feel light-headed. Nearly everyone has experienced this at one time or another when standing up quickly from a lying-down position. But some people have light-headedness from frequent or chronic poor circulation. This could be caused by arteriosclerosis (hardening of the arteries) and it is most frequently seen in those who have high blood pressure, diabetes, or high levels of cholesterol (blood fats). It is sometimes seen in those with inadequate cardiac (heart) function, anemia (low iron), or hypoglycemia (low blood sugar). Certain drugs also decrease the blood flow to your brain, particularly stimulants such as caffeine and nicotine. Sometimes circulation is impaired by spasms in your arteries caused by emotional stress, anxiety, and tension. Excess salt in your diet can also lead to poor circulation. If your inner ear fails to receive enough blood flow, the more specific type of dizziness—vertigo—occurs. Your inner ear is very sensitive to even the tiniest variations in blood flow, and all of the above causes noted for poor circulation to your brain also apply to your inner ear.
• Neurological Diseases: A number of diseases involving your nerves can affect balance, such as tumors and multiple sclerosis. Although these are uncommon causes, your doctor may perform certain tests to evaluate potential neurological diseases.
• Anxiety: Unconscious hyperventilation (over-breathing) associated with anxiety can be experienced as panic, or a mild dizziness with tingling in your hands, feet, or face.
• Vertigo: this sensation of the world rotating is usually associated with nausea and vomiting and is usually is due to an issue with your inner ear. Common causes of vertigo are, in order of their frequency:
• Benign Positional Vertigo (BPV): this is experienced after a change in head position such as lying down, turning in bed, looking up, or bending over. It usually lasts about 30 seconds and stops when your head is still. It is attributed to a dislodged otoliths (a structure within your inner ear) crystal entering one of your inner ear's semicircular balance canals. BPV can last for days, weeks, or months. The Epley "repositioning" treatment by an otolaryngologist usually cures or provides relief for BPV. After even a mild head injury, BPV is the most common cause of dizziness.
• Meniere's Disease: is a disorder of your inner ear characterized by attacks of vertigo that last for hours; nausea or vomiting; tinnitus (loud noise in your ear that occurs without the presence of external sound); occlusion (a feeling of your ear being full of blocked); and a decrease in hearing clarity.
• Migraine Headache: those with a history of migraine headaches can experience vertigo attacks similar to Meniere's disease, which can occur with or without headache.
• Infection: although viruses can attack your inner ear, they usually attack its nerve connections to the brain, which can cause acute vertigo that lasts for days without hearing loss (vestibular neuronitis). However, a bacterial infection such as mastoiditis (an infection of the bone behind the ear) that extends into the inner ear can result in labyrinthitis (damage to both the hearing and equilibrium function of that ear).
• Injury: if you sustain a skull fracture that damages one inner ear and creates a significant vertigo with nausea and hearing loss, your dizziness will last for several weeks and slowly improve as the other, healthy inner ear takes over. BPV commonly occurs after head injury.
• Allergies: you may experience dizziness and/or vertigo when your are exposed to foods or airborne particles (such as pollens, dust, molds, or dander) to which your are allergic.

Treatment of Dizziness/Imbalance

Your doctor will ask you to describe your dizziness and answer questions about your general health. Along with these questions, your doctor will examine your ears, nose, and throat. Routine health tests will be performed to check your blood pressure, hearing, an functioning of your nerves and balance. You may also experience a CT or MRI scan of your head, special tests of your eye motion after warm or cold water or air is used to stimulate your inner ear {electronystagmography (ENG) or videonystagmography (VNG)}, and potentially blood tests or a cardiology (heart) evaluation. Balance testing may include posturography (evaluation of your posture) and rotational chair testing. Based on your symptoms and their causes, your doctor will work with you to determine your best treatment plan. This may include medications and balance exercises.

The good news is that most cases of dizziness, imbalance and motion sickness are mild and self-treatable. However, severe cases and those that become worse over time should be evaluated by a doctor who specializes in diseases of the ear, nose, throat, equilibrium, and neurological systems.

Ear Cosmetic Surgery - Otoplasty

Ear deformities occur for a number of reasons. Some people are born with microtia (an absent or underdeveloped external ear), or protruding or drooping ears due to weak or poorly formed cartilage. Deformities of the ear also occur due to trauma (such as a dog bite or car wreck) or torn earlobes. Regardless of the origin of your ear deformity, it can be surgically corrected without affecting your hearing, which may improve your appearance and self-confidence.

Correction of Ear Deformities

During development, the formation of your ear is an intricate process involving the moving of skin and adjacent soft tissue to give create the different parts of your ear. If this process is interrupted, it can affect the shaping of your ear from mild folding differences to microtia (absence of the ear and possibly the ear canal). The fold of hard, raised cartilage that shapes the upper portion of the ear does not form in all people; this is called "lop-ear deformity," and it is genetically inherited. The absence of this fold can cause the ear to flop out or stick down. Some children are born without an ear canal, and their hearing can potentially be restored with a bone-anchored hearing aid or it can be surgically opened; the outer ear can also be reshaped to look like the other ear. Those who are born without an ear or lose an ear due to injury can have cosmetic surgery to have an artificial ear surgically attached. Artificial ears are custom-formed to match your other ear. It is also possible to use rib cartilage or a biomedical implant in addition to your soft tissue to construct a new ear.

To correct ears that lack folds, your surgeon places permanent stitches in your upper ear cartilage and ties them to create a fold and prop the ear up. Scar tissue will form later, holding the fold in place. Otoplasty (corrective surgery for your ears) should be considered on ears that 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, which is usually at five or six years old. Having otoplasty at a young age has two distinct benefits: a child's cartilage is more pliable, which makes his/her ear easier to reshape; and s/he will psychologically benefit from the cosmetic improvement. However, you can have otoplasty at any age.

Otoplasty surgery usually takes about two hours. Soft dressings over your ears will be used for a few weeks as protection, and discomfort is typically mild. Headbands are sometimes recommended to hold your ears in place for a month following surgery or for nighttime wear only.

Correction of Torn Earlobes

Earlobe tears usually occur from a child grabbing your earring or catching your earring on clothing. Your earlobe tear can easily be repaired surgically and usually in your doctor's office. Severe ear lobe tears may require a small, triangular notch being cut into the bottom of your ear lobe. A matching flap is created from the tissue on the other side of the tear, and the two sections are then fitted together and stitched. Your earlobes usually heal quickly with minimal scarring. In most cases, your earlobe can be pierced again four to six weeks after surgery to receive light-weight earrings.

Ear Infections, Earaches, Otitis Media & Eustachian Tube Problems

Otitis media means “inflammation of the middle ear” and is a result of a middle ear infection. A middle ear infection 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 as well.

Otitis media can cause severe earache and potential hearing loss. Hearing loss, particularly in children, can impair learning and delay development of speech. When it is quickly and effectively treating, hearing clarity can typically be restored to normal. It is important to have ear infections treated quickly and effectively not only to reduce pain but also to restore hearing clarity and prevent the infection from spreading to nearby areas in the head such as the mastoid (bone behind the ear), which can severely damage hearing.

Causes of Otitis Media

During a cold, allergy, or upper respiratory infection, your eustachian tube (put simply this tube "links" your middle ear to the back of your nose near your soft palate or "back of your throat) can become blocked, and if viruses or bacteria are present, this can lead to a build-up of pus and mucus behind the eardrum. This infection is called acute otitis media. The build-up of pressurized pus and mucus in the middle ear causes pain, swelling, and redness and prevents your eardrum from vibrating properly, which can additionally result in hearing problems. Small children are more susceptible to ear infections because their eustachian tubes are smaller and their shape is different.

Sometimes the eardrum ruptures, and pus drains out of the ear. However, it is more common for the pus and mucus remain in the middle ear because of the swollen and inflamed eustachian tube. This is called middle ear effusion or serous otitis media. After the acute infection has passed, the effusion often remains and can last for weeks, months, or years. Middle ear effusion or serous otitis media have the potential for frequent recurrences of the acute infection and may cause difficulty in hearing.

Diagnosis and Treatment of Otitis Media

Infants and toddlers experiencing an ear infection may pull or scratch at their ear(s), and/or display crying, irritability, fever, hearing problems, and/or ear drainage.

Young children, adolescents, and adults look for may have an earache, feeling of fullness or pressure in the ear(s), fever, hearing problems, dizziness, ear drainage, loss of balance, nausea, and or/vomiting.

Your doctor will use an otoscope (a lighted scope specially designed to magnify the ear) to look for signs of an ear infection: redness in the ear, fluid behind the eardrum, and movement of the eardrum. An audiogram, which tests for hearing loss by presenting a series of tones at various pitches may also be performed as well as a typanogram, which measure the air pressure in the middle ear to see how well your eardrum can move and how your eustachian tube is working.

If an ear infection is diagnosed, your doctor will likely prescribe antibiotics to fight the infection. Other prescribed medications may 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 or special ear drops to reduce pain.

If multiple episodes of acute otitis media occur within a short time, or hearing loss, or chronic otitis media lasts for more than three months, your doctor may recommend referral to an otolaryngologist for placement of ear tubes (see "Ear Tubes" below).

Otitis media may also recur as a result of chronically infected adenoids (glands located in the roof of your mouth, behind your soft palate where your nose connects to your throat) and tonsils. If either adenoids or tonsils become a problem, your doctor may recommend removal of one or both. This can be done at the same time as ventilation tubes are inserted.

Ear Tube Surgery

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), ear tubes can help prevent further infection as well as improve hearing loss. Where these conditions most commonly occur in children, teens and adults can also experience them, and they can lead to hearing loss, speech and balance problems, or changes in the structure of your ear drum. Other, less common conditions that may call for 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. It is 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 infections;
• restore hearing loss caused by middle ear fluid;
• improve balance and/or speech problems;
• improve sleep and behavior issues resulting from chronic ear infections.

Ear Tube Insertion

Ear tubes are inserted in the ear through an outpatient surgical procedure called a myringotomy. A general anesthetic is administered for young children, but some older children and adults may be able to tolerate the procedure without anesthetic. During the procedure, an incision (small hole) is made in the ear drum or tympanic membrane, and the fluid behind the ear drum (in the middle ear) is suctioned out. The incision is usually done under a surgical microscope with a small scalpel, but it can also be accomplished with a laser. The small hole would heal and close within a few days if an ear tube was not placed in the hole to keep it open and allow air (ventilation) to the middle ear. The procedure usually lasts less than 15 minutes, and patients awaken quickly and typically go home within a few hours.

After Ear Tube Surgery

Patients usually experience little or no pain afterward, but grogginess, irritability, and/or nausea from the anesthesia can occur temporarily. Ear drops may be prescribed for a few days. The procedure immediately resolves hearing loss caused by the pre-procedural presence of fluid in the middle ear, although your otolaryngologist will require a post-procedural hearing test to ensure that hearing clarity has improved with the surgery.

To avoid the possibility of bacteria entering the middle ear through the ventilation tube, your doctor may recommend keeping ears dry by using ear plugs or other water-tight devices during bathing or swimming.

Earwax - Cerumen

Earwax, also called cerumen, serves as a self-cleaning agent for your ear canals that has protective, lubricating, and antibacterial properties. Most of the time your ear canals are self-cleaning -- earwax and skin cells slowly move from the eardrum to the ear opening. Assisted by jaw motion and chewing, old earwax is constantly being transported from the ear canal to the ear opening where it usually dries, flakes, and falls out. Absence of earwax may result in dry, itchy ears.

Rather than being formed in the deep part of the ear canal near the eardrum, earwax is formed in the outer one-third of the ear canal. When someone experiences wax blockage against the eardrum, it is typically because s/he has been probing the ear with objects like cotton-tipped applicators, which only push the wax in deeper. Wax blockage is one of the most common causes of hearing loss.

Ear Cleaning

Ear canals usually clean themselves, however occasionally enough earwax accumulates to cause cerumen impaction, which may cause one or more of the following symptoms:

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

To clean your ears, wash your external ear with a cloth, but do not insert anything into the ear canal. Most ear wax blockage responds to home treatments used to soften wax, or the placement of a few drops of mineral oil, baby oil, glycerin, or commercial drops in the ear.

Ear syringing or irrigation is commonly used for cleaning. It can be performed by your doctor 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. If you have a perforated eardrum, tube in the eardrum, diabetes, or a weakened immune system, avoid having your ears irrigated.

Manual removal of earwax is optimal if your eardrum has a perforation or tube, a weakened immune system, diabetes, or narrow ear canals. It is most often performed by an otolaryngologist using suction, special miniature instruments, and a microscope to magnify the ear canal.

Ear candles are not a safe option for wax removal as they may result in serious injury. 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 and since 1996 has undertaken several successful regulatory actions, including product seizures and injunctions.

Consult your doctor if home treatments are not providing results or if so much wax has accumulated that it blocks the ear canal, which can result in decreased hearing clarity and/or a feeling of fullness in your ear.

Hearing Loss in Adults, Children & Infants

Hearing loss is common among older Americans. Although hearing loss is almost inevitable with aging, hearing amplification is highly effective in returning patients to the world of the hearing. Newer technology eliminates or reduces many of the problems with older-type hearing aids, allowing the rehabilitation of patients who may not have been adequately helped in the past.

Of course, not all hearing loss is related to aging. Adults and children of all ages experience hearing loss. Our years of experience recognizing different types of sensorineural hearing loss are most helpful. And should a patient need a hearing aid, one of our staff audiologists will help them find the hearing aid that’s precisely right for their individual needs, budget and lifestyle.

Click here to visit Dalton ENT Hearing Center's website for detailed information on Hearing Loss, Hearing Loss in Infants and Children, Hearing Aids, Hearing Protection, and Assistive Listening Devices.

Otosclerosis

Otosclerosis is 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.

Gradual hearing loss is the most frequent symptom of otosclerosis. Those with otosclerosis will begin to notice that they cannot hear low-pitched sounds or whispers. Other symptoms can include dizziness, tinnitus (noise such as ringing or buzzing in the ears), or balance problems.

Treatment for Otosclerosis

If your hearing loss is mild, your otolaryngologist may suggest monitoring your hearing loss or prescribing a hearing aid to amplify the sound reaching your ear drum. Sodium fluoride is sometimes prescribed as it has been found to slow the progression of otosclerosis. In some patients, a surgical procedure called stapedectomy can restore or improve hearing.

A stapedectomy is an outpatient surgical procedure done under local or general anesthesia. Your surgeon performs the surgery through the ear canal with an operating microscope, removing part or all of the immobilized stapes bone and replacing it with a prosthetic device. This device allows the bones of the middle ear to move once again, stimulating fluid in the inner ear restores or improves hearing.

Most patients return home the evening after their surgery and some experience dizziness the first few days after surgery. Taste sensation may be altered for several weeks or months following surgery, but typically returns to normal.

Perforated Ear Drum or Ruptured Ear Drum

A hole or rupture in the eardrum (tympanic membrane), a thin membrane that separates the ear canal and the middle ear, is called a perforated eardrum or ruptured eardrum. A perforated eardrum is often accompanied by decreased hearing and sometimes liquid discharge. If it caused by injury or becomes infected, the perforation may be accompanied by pain.

Causes of Eardrum Perforation

A hole in the eardrum is usually cause by injury, middle ear infection, or chronic eustachian tube disorders. A perforated eardrum injury can occur if the ear is struck directly, if an object (such as a cotton-tipped applicator or a bobby pin) is pushed too far into the ear canal, after a sudden explosion, or with a skull fracture.

Most eardrum holes resulting from acute ear infection or injury heal on their own within weeks, although some can take several months to heal. It is important to protect the ear from water and trauma while it is healing. Perforations that do not heal on their own may require surgery.

The level of hearing loss you may experience is usually determined by the size of the perforation. A larger hole will cause more significant hearing loss than a smaller hole. If a severe injury such as a skull fracture moves certain bones in the middle ear out of place or injures the inner ear, hearing loss may be serious.

If caused by a sudden traumatic or violent event, the perforation can cause significant hearing loss as well as tinnitus (ringing in the ear). Chronic infection as a result of the perforation can cause longer lasting or worsening hearing loss.

Treatment for Perforated Eardrum

Before treating the perforation, your doctor will likely order a hearing test. If the perforation is very small, your otolaryngologist may choose to observe the perforation over time to see if it will close on its own. 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. This procedure, tympanoplasty, is typically performed during your office visit. Multiple patches may be necessary before the perforation completely closes. If patches do not adequately and quickly close the hole, surgery may be needed.

Swimmer's Ear - Acute Otitis Externa

Swimmer’s ear is a painful condition resulting from inflammation, irritation, or infection that affects the outer ear. These symptoms often occur after water gets trapped in your ear, after which bacteria or fungal organisms spread. Because this condition commonly affects swimmers, it is known as swimmer’s ear, also called acute otitis externa. It 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.

Causes of Swimmer’s Ear

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 must be treated to reduce pain as well as eliminate any effect it may have on your hearing and to prevent the spread of infection.

The most common symptoms of swimmer’s ear are itching inside the ear and pain that gets worse when you tug on your outer ear. You may also experience drainage; a feeling that your ear is blocked or full; decreased hearing; fever; intense pain that may spread to the neck, face, or side of the head; redness and swelling of the skin around the ear; or swollen lymph nodes around the ear or in the upper neck.

Treatment of Swimmer's Ear

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.

For more severe infections, your doctor may prescribe antibiotics designed to be applied directly to the ear. If your ear canal is swollen shut, your doctor may place a wick or sponge in your ear canal so the antibiotic drops will enter the swollen canal more effectively. Pain medication may also be prescribed. If the infection extends beyond the skin of the ear canal, oral antibiotics may also be prescribed. Most infections should clear up in 7-10 days with proper treatment.

If left untreated, complications resulting from swimmer’s ear may include hearing loss, recurring ear infections (chronic otitis externa); bone and cartilage damage (malignant otitis externa).

Click here to visit Dalton ENT Hearing Center's Website for information about custom swim molds for ear and hearing protection while swimming or participating in water-related activities.

Tinnitus

Tinnitus can sound like a high-pitched whistling or buzzing, ringing or hissing. It can also be a more complex sound, like the roar of an ocean. Some people can clearly hear the sound of their tinnitus and are able to live with it quite happily. In others, the sound is terribly annoying and can often drive them to distraction. The sound can be in one or both ears or perceived elsewhere in the head. It is equally common in men and women and can be associated with almost any disorder of the ear.

We have extensive experience in diagnosing and treating tinnitus and understand the association of tinnitus with hearing loss. Our audiologists conduct careful examinations and perform a number of tests, which include hearing tests, balance tests and blood tests. Treatment can include medications, hearing aids, biofeedback training and tinnitus maskers.

Click here to visit Dalton ENT Hearing Center's website for detailed information on Tinnitus.