Associates in Otolaryngology

What are the different types of hearing loss?

Conductive, Sensorineural, Mixed and Central are the main types of hearing loss.

Conductive Hearing Loss:

Conductive hearing loss occurs with cerumen, or wax, in the external canal, a perforation or hole in the ear drum, negative pressure in the middle ear due to the Eustachian tube not functioning well, fluid in the ears, a cholesteatoma (sac of dead cells), or problems with the small bones. It may be improved or cured with removal of the wax, medication, or surgery — sometimes very simple surgery. In the above diagram, conductive hearing loss occurs in the ear canal, ear drum, or middle ear.

Sensorineural Hearing Loss:

“Nerve type” hearing loss, usually called sensorineural, is due to problems of the cochlea, or inner ear, the nerve from the ear to the brain (cochlear nerve), or in the brain. In this case, tests may be required to be certain that a tumor is not present and to determine if there might be other associated problems. Treatment is usually with a hearing aid and occasionally with surgery. Some patients with poor speech discrimination (not understanding words even if the sound is loud enough) will not benefit from hearing aids.

Mixed Hearing Loss:

This type of loss occurs when both conductive and sensorineural hearing losses are present at the same time. This sometimes occurs and may require various treatment modalities.

Central Hearing Loss:

This type of hearing loss occurs when the signal makes its way through the middle and outer ear systems successfully, but the brain is unable to process the information.

Hearing Assessment

An audiogram is graphical representation of a hearing test that is generally performed in a sound suite using sophisticated, calibrated equipment. A certified audiologist administers the test. Headphones are placed over or in the person’s ears, and tones are presented to each ear, one at a time. The softest level at which the sounds can be heard is recorded as the threshold of hearing.

Auditory Brainstem Response Testing

Auditory brainstem response testing uses computer equipment to record the auditory nerve’s response to sounds delivered to the ears via headphones. The response is recorded from recording disks placed on the patient’s head. This testing is used primarily to diagnose hearing loss in infants and very young children who can’t reliably respond to testing or in adults for site-of-lesion testing.

Auditory brainstem response testing is also used to determine the function of the auditory nerve in adults. This type of testing is often called site-of-lesion testing, and is similar to the auditory brainstem response testing of infants and young children.

Electronystagmogram (VNG)

An electronystagmogram (VNG) measures normal eye movement and involuntary rapid eye movements called nystagmus. It also checks the muscles that control eye movements. ENG checks how well the eyes, inner ears, and brain help you keep your balance and position (such as when you change from lying down to standing).

There is an interaction between the eyes, eye muscles and the inner ear balance system. During an electronystagmography or ENG test, eye movements are recorded by electrodes placed around the eyes or by special video cameras fitted on goggles placed over the eyes. A computer analyzes the eye movements and provides information about the kind of messages the inner ear is sending to control the movement of the eyes through the central nervous system. This is currently the best way to check how well the inner ear balance mechanism works.

During the first part of the test, the patient stares at a spot or a light. Next, they watch a light moving on a bar. The third part of the test records eye movements as the patient lies on a bed in different positions (lying on right side, left side, etc.). During the final portion of the test, warm and/or cool water or air will be placed in the outer ear canals.

Why It Is Done

An electronystagmogram (VNG) is done to find where the problem is in the inner ear, brain, or nerves connecting them that is causing dizziness, vertigo, or a loss of balance. It is also done to find any damage to structures or nerves in the inner ear, brain, or nerves connecting them.

Electrococleography (ECOG)

ECOG is a variant of brainstem auditory evoked response (BAER) where the recording electrode is placed on the tympanic membrane (ear drum). It is intended to diagnose Meniere’s disease, and particular, hydrops (swelling of the inner ear). ECOG may also be abnormal in perilymph fistula and in sudden hearing loss. The cochlear microphonic of ECOG may be normal in auditory neuropathy as well as other disorders in which the cochlea is preserved but the auditory nerve is damaged. ECOG’s have also been used to as a indicator of the temporary threshold shift that may follow noise injury.

How it is done

The technique involves placing the electrode on the tympanic membrane, a location across the middle ear from the cochlea. The ear is stimulated with alternating polarity clicks (although tone bursts can also be used). The objective is to record wave-1 (there are 5 waves), with greater accuracy and to detect the “summating potential”, which is a shoulder on wave 1. In some instances, the cochlear microphonic is inspected. A person with an intact cochlear microphonic but reduced or absent wave 1, might have a 8th nerve site of lesion. In other words, the sound gets to the cochlea (creating the microphonic), but doesn’t make it into the brainstem (i.e. no waves 1-5)

Results

ECOG results are reported as an SP/AP ratio, for which a ratio of 0.5 or greater is considered abnormal. While some labs use 0.35 instead, The sensitivity of the SP/AP ratio to Meniere’s disease 60-71%. The sensitivity is said to be higher if it is performed during a symptomatic period), but it is difficult to get patients scheduled for the test when they are symptomatic. Also, some authors disagree that sensitivity is increased when patients are symptomatic.

Hearing & Balance

Both hearing and balance occur within the ear.

In hearing, sound waves pass from the outer ear into the auditory canal. They strike the eardrum, making it vibrate.

These vibrations travel to the middle ear, setting into motion three tiny bones: the hammer, anvil, and stirrup.

The vibrations continue through the cochlea and deep into the inner ear, which contain a fluid reservoir.

As fluid ripples across membranes, it stirs tiny hairs connected to nerve endings. The stimulated nerve endings carry impulses into the brain where they are interpreted as sound.

Also located in the inner ear is the equilibrium, or balance center. The center sends continuous messages about the body’s position to the brain. This information helps us maintain.

Otoacoustic Emission (OAE)

The primary purpose of otoacoustic emission (OAE) tests is to determine cochlear status, specifically hair cell function. This information can be used to (1) screen hearing (particularly in neonates, infants, or individuals with developmental disabilities), (2) partially estimate hearing sensitivity within a limited range, (3) differentiate between the sensory and neural components of sensorineural hearing loss, and (4) test for functional (feigned) hearing loss. The information can be obtained from patients who are sleeping or even comatose because no behavioral response is required.

The normal cochlea does not just receive sound; it also produces low-intensity sounds called OAEs. These sounds are produced specifically by the cochlea and, most probably, by the cochlear outer hair cells as they expand and contract. The presence of cochlear emissions was hypothesized in the 1940s on the basis of mathematical models of cochlear nonlinearity. However, OAEs could not be measured until the late 1970s, when technology created the extremely sensitive low-noise microphones needed to record these responses.

The 4 types of otoacoustic emissions are as follows:

• Spontaneous otoacoustic emissions (SOAEs) – Sounds emitted without an acoustic stimulus (ie, spontaneously)
• Transient otoacoustic emissions (TOAEs) or transient evoked otoacoustic emissions (TEOAEs) – Sounds emitted in response to an acoustic stimuli of very short duration; usually clicks but can be tone-bursts
• Distortion product otoacoustic emissions (DPOAEs) – Sounds emitted in response to 2 simultaneous tones of different frequencies
• Sustained-frequency otoacoustic emissions (SFOAEs) – Sounds emitted in response to a continuous tone

Tympanometry

Tympanometry is a test where air pressure in the ear canal is varied to test the condition and mobility (movement) of the ear drum (tympanic membrane) and is useful in detecting disorders of the middle ear.

Tympanometry determines the functionality of the tympanic membrane by observing its response to waves of pressure, and measuring the air pressure of the middle ear.

The normal air pressure inside the middle ear is 100 (a very small amount). The tympanic membrane motion should appear smooth and symmetrical.

Abnormal Tympanometry results may be indicative of any of the following:

• fluid in the middle ear
• perforated ear drum
• impacted ear wax
• scarring of the tympanic membrane
• lack of contact between the conduction bones of the middle ear
• a tumor growing in the middle ear

The test is initiated by performing a visual inspection of the external auditory canal of the patient with an otoscope to evaluate the ear canal of the patient and to ensure that there is a clear path to the ear drum. A probe tip then is inserted into the ear of the individual that will change the air pressure in the patient’s ear, produce a pure tone, and measure the body’s responses to the sound and different pressures.

During the test, it is important for the patient not to speak, move, swallow, or startle. All these actions can alter the pressure in the middle ear and invalidate the test results. The sounds heard during the test may be loud and potentially startling, so a conscious effort of the patient is required to avoid a startle reflex.

We offer a full range of digital hearing aids, up to top of the range devices delivering breakthrough technology to give you back your quality of life.

We offer a full range of hearing aid styles…

• Cosmetic 
  Hearing aids have come a long way. Open-Fit offer a small cosmetic solution when compared to conventional hearing aids. Their discreet design makes them hardly noticeable.
• Comfort 
  Open-Fit hearing aids are light-weight by design, which means they fit comfortably on your ear. Also, since your ear canal remains open you won’t experience the “plugged” feeling often associated with traditional styles.
• Clarity 
  Open-Fit models focus on delivering high pitch sounds to your ear, which are crucial in understanding speech and providing clearer communication. In addition, Open-Fit hearing aids allow both natural and amplified sound to enter into your ear.

The model you choose can affect the quality of the sound you hear.

An ‘open fit’ hearing aid allows natural low frequency sounds into your ear allowing you to hear a more natural sound.

• In The Ear (ITE)
  A custom made hearing aid that fits into the concha bowl of your ear. In The Ear hearing aids can fit moderate to severe hearing losses.
• Completely In the Canal (CIC)
  A custom made hearing aid that fits into your ear canal. Completely In the Canal hearing aids can fit up to a moderate hearing loss.
• Behind The Ear (BTE)
  A generic device that sits behind your ear and is attached to a custom made ear-mould which sits in your ear. Behind the ear hearing aids can fit up to profound hearing losses.

No matter which device you choose, your hearing aids will be custom made and individually programmed to suit your particular hearing loss and circumstances.

Are two hearing aids better than one?

In most cases, it’s better to have two hearing aids. Wearing two (binaural) hearing aids allows more information to reach your brain and makes it easier to hear speech against background noise. You’ll have more balanced hearing with two hearing aids, preventing the need to turn your head toward the sound if you’re wearing only one. And wearing two hearing aids means neither of the devices needs to be turned up as loudly as when you’re wearing just one. That should prevent some feedback. Still, financial limitations or other problems may prevent some people from wearing two hearing aids.

Epley’s Maneuver

The Epley Maneuvers, also known as the Canalith Repositioning Procedure (CRP), are designed to treat benign paroxysmal positional vertigo (BPPV) through induced out-migration of free-moving pathological densities in the endolymph of a semicircular canal, using timed head maneuvers and applied vibration.

In simpler terms, canaliths (calcium carbonate crystals) are normally attached atop a membrane in the otolith organ (or gravity center) of the inner ear. These crystals can break off for various reasons, most commonly, injury or disease, and migrate into a semicircular canal. Then, when the head position is changed, the canaliths shift, abnormally stimulating the nerve sensor (cupula) of the affected semicircular canal and creating a sensation of movement (vertigo). In treatment, the head is maneuvered so as to guide the canaliths (also referred to as otoliths or cupuloliths, depending on their placement) back though the labyrinth to where they originated. To facilitate this process, the canaliths can be tracked by observing the eye movements they cause, and by applying an oscillator to the skull. In most medical facilities, this maneuvering is done by hand with the patient lying on a table.

Vertigo Causes

Vertigo, or dizziness, usually results from a disorder in the peripheral vestibular system (i.e., structures of the inner ear). Dizziness also may occur as a result of a disorder in the central vestibular system (i.e., vestibular nerve, brainstem, and cerebellum). In some cases, the cause of vertigo is unknown.
Peripheral vestibular disorders include the following:

• Benign paroxysmal positional vertigo (BPPV; most common peripheral disorder; may be accompanied by hearing loss, reduced cognitive function, and facial muscle weakness)
• Cogan’s syndrome (inflammation of connective tissue in the cornea; results in vertigo, ringing in the ears [tinnitus], and loss of hearing)
• Ménière disease (fluctuating pressure of inner ear fluid [endolymph]; results in severe vertigo, ringing in the ears [tinnitus], and progressive hearing loss)
• Ototoxicity (i.e., ear poisoning)
• Vestibular neuritis (inflammation of vestibular nerve cells; may be caused by viral infection)

Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) usually affects one of the sensing tubes in the inner ear called the posterior semicircular canal. BPPV occurs when debris made up of calcium carbonate and protein (called otoliths or ear crystals) builds up in and moves around in the posterior semicircular canal. BPPV also can affect the anterior canal or the horizontal canal.

When the head is moved in certain ways (e.g., turning in bed, looking up, bending over), the calcium crystals move around and trigger inner ear sensors, causing a brief sensation of spinning. Inner ear degeneration (usually occurs in elderly patients), head trauma, and inner ear infection (e.g., otitis media, labyrinthitis) can cause BPPV. (See Epley Maneuver)

Ototoxicity

Some medications and environmental chemicals (e.g., lead, mercury, tin) can cause ototoxicity (i.e., ear poisoning), which may result in damage to the inner ear or the 8th cranial nerve (acoustic nerve) and cause vertigo. The damage can be permanent or temporary.

Long-term use or high doses of certain antibiotics (e.g., aminoglycosides including streptomycin, gentamicin) and antineoplastics (e.g., cisplatin, carboplatin) can cause permanent ototoxicity.
Medications that may cause temporary ototoxicity include the following:

• Anticonvulsants (e.g., phenytoin, carbamazepine)
• Antidepressants (e.g., clomipramine, amoxapine)
• Antihypertensives (e.g., labetalol, enalapril)
• Loop diuretics (e.g., bumetanide, furosemide)
• Pain relievers (e.g., aspirin)
• Prescription and over-the-counter cold medicines
• Quinine (e.g., chloroquine, quinidine)

Alcohol, even in small amounts, can cause temporary vertigo in some people.

Vestibular rehabilitation therapy (VRT)

Vestibular rehabilitation therapy (VRT) is a type of physical therapy used to treat vertigo. The goal of treatment is to minimize dizziness, improve balance, and prevent falls by restoring normal function of the vestibular system.
In VRT, the patient performs exercises designed to allow the brain to adapt to and compensate for whatever is causing the vertigo.

The success of this treatment depends on several factors including the following:

• Age of the patient
• Cognitive function (e.g., memory, ability to follow directions in order)
• Coordination and motor skills
• Overall health of the patient (including the central nervous system)
• Physical strength

Vestibular rehabilitation therapy is designed by a physical therapist under the direction of a physician. In most cases, patients visit the therapist on a limited basis and perform custom-designed exercises at home, several times a day. As the patient progresses, difficulty of the exercises increases until the highest level of balance is attained during head movement, eye movement (i.e., tracking with the eyes), and walking.

According to the American Academy of Neurology, the most effective treatment for benign paroxysmal positional vertigo (BPPV) caused by ear crystals in the posterior semicircular canal, is a technique called the canalith repositioning procedure, or the Epley maneuver.

In this procedure, a physician or physical therapist assists the patient in performing a series of head and body movements, which move the calcium crystals out from the posterior semicircular canal and into another inner ear canal, where they are absorbed by the body. Another technique (called the Semont maneuver) also may be effective, but additional studies are needed.

BPPV that does not respond to canalith repositioning may be treated with meclizine (Antivert®), an oral antiemetic that can be taken up to 3 times a day, or only as needed. Meclizine may cause drowsiness, dry mouth, and blurred vision.

Meniere’s Disease

Meniere’s Disease (MD or endolymphatic hydrops) is a disorder of the inner ear associated with a change in the volume of fluid inside a portion of the inner ear called the labyrinth, which includes the membranous labyrinth and the bony labryinth.

Symptoms of Meniere

Meniere’s symptoms are due to a problem with the inner ear, the part of the ear responsible for balance as well as hearing. If you have Meniere’s, you’ll recognize these symptoms:

• Vertigo (a spinning or whirling sensation that causes balance problems). Vertigo is often accompanied by nausea, vomiting, and sweating. Attacks of vertigo usually begin suddenly and may last for 20 minutes to several hours. You may have attacks rarely, frequently, or in clusters. The first attack is usually the most intense.
• Problems with hearing. Hearing is often partially or completely lost during vertigo attacks. It’s common for hearing to gradually worsen as the illness progresses.
• Tinnitus (ringing, buzzing, whistling, or roaring noises in the ear). These may come and go or may always be present. The noises may get louder just before a vertigo attack.
• A feeling of pressure or fullness in the ear. This sensation is sometimes felt most strongly right before a vertigo attack.
• You may feel fine between attacks, or hearing or balance problems may continue between attacks. Although Meniere’s usually affects only one ear, it can occasionally develop in both ears.

Meniere’s Disease Treatment

In the United States, the most conservative long-term treatment for Meniere’s disease (aimed at reducing the severity and number of attacks) involves adhering to a reduced-sodium diet and using diuretics, or “water pills.” The goal of this treatment is to reduce inner ear fluid pressure. Some physicians, more commonly outside of the United States, also weigh the potential efficacy of using betahistine HCl (Serc) as a vestibular suppressant for Meniere’s disease.

Medications

Medications that are used during an attack to reduce the vertigo, nausea, and vomiting include diazepam (Valium), promethazine (Phenergan), dimenhydrinate (Dramamine Original Formula), and meclizine hydrochloride (Antivert, or Dramamine Less Drowsy Formula). Vestibular rehabilitation therapy is sometimes used to help with the imbalance that can plague people between attacks. Its goal is to help retrain the ability of the body and brain to process balance information.

Another recently introduced, conservative treatment approach employs a device to deliver a series of low-pressure air pulses designed to displace inner ear fluids. The use of this device is approved for general use by the U.S. Food and Drug Administration (FDA) and is currently undergoing clinical trials in the United States.

For the 20-40% of people who do not respond to medication or diet, a physician may recommend a chemical labyrinthectomy, which destroys vestibular tissue with injections into the ear of an aminoglycoside antibiotic (gentamicin). Another less conservative treatment is surgery to relieve the pressure on the inner ear (although this is not as widely used now as it was in the past) or to destroy either the inner ear or the vestibular nerve, so that balance information is not transmitted to the brain.

Learning More About Meniere’s

Seek out information on Meniere’s. Knowledge will help you take charge and stop Meniere’s from running your life. The organization below can tell you more about Meniere’s. It can also help you find local support groups, where you can talk to others with Meniere’s.

Ear Foundation (Meniere’s Network)
Nashville, Tennessee
(800) 545-4327
(615) 329-7807 (TDD/TTY)

Background:

Tinnitus means noise or “ringing” in the ears and nearly 36 million Americans suffer from tinnitus. More than 7 million people are afflicted so severely that they cannot lead normal lives. Tinnitus may be intermittent or it may be continuous.

Causes of Tinnitus:

Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. Advancing age is generally accompanied by a certain amount of hearing nerve impairment and tinnitus. If you are younger, exposure to loud noise (rock concerts, personal stereo with headphones, “boom boxes”) is the most likely cause of tinnitus, and often damages hearing as well.

Infrequent causes of tinnitus:

• Cerumen (ear wax).
• Otosclerosis (calcium deposits around the stapes, or “stirrup” bone in the middle ear, or around the inner ear).
• Allergies, high or low blood pressure, tumors, diabetes, thyroid problems, arthritis of the spine in the neck, or an injury to the head or neck.
• Medications such as anti-inflammatory drugs, antibiotics, sedatives, antidepressants, and aspirin.
• Vascular tumors in the ear. If you hear your own heartbeat, you should be evaluated by an otolaryngologist for one of these.
• Atherosclerosis, or “hardening of the arteries”.

Treatment for Tinnitus:

Treatment will be different for each case of tinnitus, depending upon the cause. It is important to see an otolaryngologist (ENT doctor) to investigate the cause of your tinnitus so that the best treatment can be determined.

In most cases, there is no specific treatment for ear and head noise. If your otolaryngologist finds a specific cause of your tinnitus, he or she may be able to eliminate the noise. Extensive testing including X-rays, balance tests, and laboratory work may be necessary. Finally, the precise cause of the tinnitus may not be determined.

Occasionally, medicine may help the noise. The medications used are varied, several may be tried to see if they help, and there may be significant side effects.

Self-help for Tinnitus:

The following can help lessen the severity of your 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, chocolate, 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.
• Concentration and relaxation exercises can help to control muscle groups and circulation throughout the body and decrease the tinnitus in some patients.

Masking:

• Tinnitus is usually more bothersome in quiet surroundings.
• A competing sound at a constant low level, such as a ticking clock or radio static (white noise), may mask the tinnitus and make it less noticeable. Set the dial of an FM radio between two stations so that you hear static.
• Products that generate white noise are also available through catalogs and specialty stores.
• Hearing aids: If you have a hearing loss, hearing aids may reduce head noise while wearing them and sometimes cause it to go away temporarily.
• Tinnitus maskers can be combined within hearing aids. They emit a competitive but pleasant sound that can distract you from head noise.

If you have tinnitus or head noise, it is extremely important that you have a thorough examination and evaluation by an otolaryngologist. An essential part of your treatment will be your understanding of tinnitus and its causes.

Most children hear and listen from birth. They learn to talk by imitating the sounds around them and the voices of their parents and caregivers. But that’s not true for all children. In fact, about 2 or 3 out of every 1,000 children in the United States are born deaf or hard-of-hearing. More lose their hearing later during childhood. Many of these children may need to learn speech and language differently, so it’s important to detect deafness or hearing loss as early as possible.

How early should I have my baby’s hearing screened?

Your baby should have a hearing screening within the first month of life. If hearing loss is suspected, make sure a hearing expert, called an audiologist, tests your baby’s hearing by 3 months of age. If hearing loss is confirmed, it’s important to consider the use of hearing devices and other communication options by 6 months of age.

Where can my baby’s hearing be screened?

Many hospitals automatically screen all newborns for hearing loss. Some screen only those newborns at high risk for hearing loss, such as babies with a family history of deafness or hearing problems, low birth weight, or certain other medical conditions. Even if your baby doesn’t have risk factors, being screened is important, because many children with no risk factors have hearing loss. Even children whose parents and grandparents hear normally may be born with a hearing loss. Find out what your hospital does. If you and your baby are already home and you don’t know if your baby’s hearing was tested, ask the doctor or the clinic where your baby’s records are.

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.

How will my baby’s hearing be screened?

Two hearing tests are used to screen babies. In both tests, no activity is required from your child other than lying still.

• Otoacoustic emissions (OAE) tests can show whether parts of the ear respond properly to sound. During this test, a sponge earphone is placed into the ear canal. The ear is stimulated with sound, and the “echo” is measured. The echo is found in everyone who hears normally. If there is no echo, it could indicate a hearing loss.
• Auditory brain stem response (ABR) tests check how the brain stem (the part of the nerve that carries sound from the ear to the brain) and the brain respond to sound. During this test, your child wears earphones, and electrodes are placed on the head and ears. A mild sedative may be given to help keep your child calm and quiet during the test. The nurse or doctor sends sounds through the earphones and measures the electrical activity in your child’s brain when he or she should be hearing. If your child doesn’t respond consistently to the sounds presented during either of these tests, your doctor may suggest a follow up hearing screening and a referral to an audiologist for a more comprehensive hearing evaluation.

Why is it important to have my baby’s hearing screened early?

The most important time for a child to be exposed to and learn language is in the first 3 years of life. In fact, children begin learning speech and language in the first 6 months of life. Research suggests that those who have hearing impairment and get intervention have better language skills than those who don’t. The earlier you know about deafness or hearing loss, the sooner you can make sure your child benefits from strategies that will help him or her learn to communicate.

How can I recognize hearing loss during early childhood?

Even though screening is designed to detect hearing loss as early as possible, some children don’t develop hearing loss until later in life. In those instances, parents, caregivers, or grandparents are often the first to notice. Even if you’ve had your baby’s hearing tested, you should look for signs that your baby is hearing well.

For example, during the first year, notice whether your baby reacts to loud noises, imitates sounds, and begins to respond to his or her name. At age 2, ask yourself whether or not your child plays with his or her voice, imitates simple words, and enjoys games like peek-a-boo and pat-a-cake. Is he or she using two-word sentences to talk about and ask for things? At age 3, notice whether or not he or she begins to understand “not now” and “no more” and follows simple directions. If for any reason you think your child is not hearing well, talk to your doctor.

If my child has a hearing loss, can hearing be improved?

A variety of assistive devices and strategies are helpful for children who are hard-of-hearing. Some examples of these devices are listed here. An audiologist can help you to determine whether these or other devices can help your child.

• Hearing aids are instruments that make sounds louder. They are worn in or behind the ear and come in several different shapes and sizes. Hearing aids can be used for varying degrees of hearing loss, moderate or severe. An audiologist will fit a hearing aid that will work best for your child’s hearing loss. Hearing aids can be expensive, so you’ll want to find out whether they have a warranty or trial period. You’ll also want to talk with your insurance provider to understand what is covered and what isn’t.
• Cochlear (COKE-lee-ur) implants have three parts: a headpiece, a speech processor, and a receiver. The headpiece is worn just behind the ear where it picks up sound and sends it to the speech processor. The speech processor, a beeper-sized device that can fit in a pocket or on a belt, converts the sound into a special signal that is sent to the receiver. The receiver, a small round disc about the size of a quarter that a surgeon has placed under the skin behind one ear, sends a sound signal to the brain. Not all children who have hearing loss should get cochlear implants. Doctors and hearing experts think they’re best for children who have a profound hearing loss and won’t benefit from hearing aids.

As children get older, many other devices are available to help them hear. Some devices help children hear better in a classroom. Others make talking on the phone or watching television easier. For example, auditory training systems and loop systems can help eliminate or lower other noises and make it easier for your child to hear someone in a crowded room or group setting. Others, such as FM systems and personal amplifiers, are better for one-on-one conversations.

Otitis media is a condition in which inflammation occurs behind the eardrum (the thin sheet of tissue that passes sound waves between the outer and middle ear). It is usually due to bacteria or viruses, which are often related to a recent cold or allergy problem. In many cases, both ears are affected.

Otitis media is most common in young children, whose ear anatomy is not yet fully developed. Children under age 5, boys, bottle-fed infants, and children in daycare run the greatest risk of infection. Although much less common, otitis media can also occur in older children and adults.

Otitis media can be painful and they tend to disrupt sleep- for you as well as for your child. But this isn’t the full extent of the problem. Otitis media can also limit the eardrum’s flexibility, reducing your child’s ability to hear. This could make it harder for your child to learn to talk. Depending on when the hearing problem starts and how long it lasts, your child’s learning ability could be affected.

What Causes Middle Ear Fluid?

Otitis media results in fluid within the middle ear. It is common for children to have middle ear infections. And some children with middle ear infection later have:

• Middle ear fluid.
• Blockage of the Eustachian tube.
• Cold or flu
  There is no one cause for middle ear fluid. Often, your child’s health care provider will not know what caused the middle ear fluid.

How Can Middle Ear Fluid be Prevented?

Recent studies show that children who live with smokers and who spend time in group child care have more ear infections.
Because some children who have middle ear infections later get middle ear fluid, you might help prevent middle ear fluid by:

• Keeping your child away from cigarette smoke.
• Trying to keep your child away from playmates who are sick.

Medical Management

Most children have had at least one middle ear infection by the age of 2. Treatment may depend on whether the problem is acute or chronic, as well as how often it comes back and how long it lasts. The doctor may prescribe medication and then watch to see how healing progresses. For many children, taking antibiotics and reducing risk factors are all the treatment that’s needed.

If this is your child’s first or second acute infection, the doctor may prescribe antibiotics and suggest a period of “watchful waiting”. During this time, your child’s ears will probably be retested to look for any eardrum or hearing changes.

In most cases, fluid outlasts the acute infection by two or three weeks. If the fluid buildup becomes chronic, however, the doctor may watch your child for up to several months. Why? Because even chronic fluid may go away with time – provided that no new infection occurs.

Some behaviors or surroundings increase your child’s risk of ear infection. Reducing such risk factors can be a benefit at any point in treatment.
The tips below may help:

• If your child goes to group daycare, he or she runs a greater risk of getting colds or flu. Help prevent these illnesses by teaching your child to wash his or her hands often.
• If food allergies are a problem, identify the food that triggers the reaction and help your child avoid it. In some children, eating or drinking dairy products causes tissues around the Eustachian tube to swell. This may make a blockage more likely

Antibiotics may be used as a short- or long-term treatment, depending on whether the ear problem is acute or chronic. Either way, antibiotics will be effective only in treating bacterial infections. For an acute middle ear infection, the doctor may prescribe 7 to 14 days of antibiotic treatment. In a case of chronic fluid, the doctor may suggest using antibiotics to prevent any new infection while waiting for the fluid to go away. Such antibiotic use may last weeks or months.

Although most children can take antibiotics without problems, side effects can occur. Some children get stomach upset, including vomiting or diarrhea. Some get rashes, hives, puffy eyes, or yeast infections. In rare cases, an allergic reaction may cause breathing problems that require immediate medical care. If your child shows any type of reaction during antibiotic use, call the doctor.

Surgical Management

In some cases, medical care alone cannot control middle ear problems. If your child has hearing loss or if fluid still remains after several months, surgery may be recommended to treat the middle ear. An ENT (ear, nose, and throat) specialist (also called an otolaryngologist) will examine your child and talk with you about the surgical procedure. If you decide on surgery, you’ll be told how to prepare your child and you’ll be informed about the anesthesia.

As a parent, you may find it difficult to consider surgery for your child. You’re not alone. Many parents feel this way, despite knowing that the procedure can improve their child’s health. If necessary, give yourself a little time before making a decision. This way, emotions are less likely to affect your judgment. A talk with your child’s pediatrician or primary care doctor may help. If you decide on surgery, you’ll work with the specialist’s office to set a date. The doctor may want to see your child a day or two before surgery to make sure he or she doesn’t have a cold.

During surgery. the ENT specialist removes the fluid from your child’s middle ear and places a tiny tube in the eardrum. This tube creates a very small tunnel between the outer ear canal and the middle ear. This tunnel balances air pressure on both sides of the eardrum and prevents fluid buildup, even if your child’s Eustachian tube becomes blocked again. In most cases, surgery can be done on both ears in less than 30 minutes. If adenoid problems are also being treated, surgery takes a little longer.

Once your child is asleep, the ear canal is cleaned. Then, using an operating microscope and special surgical instruments, the ENT specialist makes a small slit in the eardrum (tympanostomy).

Next, a hollow instrument is passed through the slit in the eardrum. Using gentle suction, the fluid is withdrawn through the instrument. In some cases, a fluid sample may be sent to a lab. If the infection is still active, the lab may identify whether it is viral or bacterial.

After the fluid is removed, the ENT specialist inserts a tiny tube into the same slit in the eardrum (tympanostomy). Once in position, the shape of the tube helps keep it in place. Tubes can be made of plastic or metal, and they vary slightly in size and shape. The ENT specialist chooses the tube most likely to provide the best results for your child.

After surgery is completed, your child will be taken to a recovery area. There, nurses will monitor your child’s condition until the anesthesia wears off. Once fully awake, your child should be able to go home. in fact, even after adenoid surgery, most patients go home the same day. Although your child can soon return to normal activities, be aware of the signs that require calling the doctor.

Following surgery, cotton may be placed in your child’s ears, and he or she may be given medication for pain relief. Within a half-hour, your child will wake up. You may be allowed into the recovery room at this time, depending on the facility.

When you join your child, don’t be alarmed if he or she is upset. Anesthesia may reduce self-control, causing some children to cry or scream. You can help calm your child by acting normally and speaking softly.

Although your child is unlikely to have problems after surgery, call the doctor for any of the following:

• The ear bleeds heavily or keeps bleeding after the first 48 hours
• Sticky or discolored fluid drains out of the ear after the first 48 hours.
• Your child has a high fever that does not drop.
• Your child is dizzy, confused, extremely drowsy, or has a change in mental state.

Tonsillectomy

Talk to your child about his or her feelings and provide strong reassurance and support throughout the process. Encourage the idea that the procedure will make him/her healthier. Be with your child as much as possible before and after the surgery. Tell him/her to expect a sore throat after surgery. Reassure your child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward. If your child has a friend who has had this surgery, it may be helpful to talk about it with that friend.

If the patient or patient’s family has had any problems with anesthesia, the surgeon should be informed. If the patient is taking any other medications, has sickle cell anemia, has a bleeding disorder, is pregnant, has concerns about the transfusion of blood, or has used steroids in the past year, the surgeon should be informed.

A blood test and possibly a urine test may be required prior to surgery. Generally, after midnight prior to the operation, nothing (chewing gum, mouthwashes, throat lozenges, toothpaste, water) may be taken by mouth. Anything in the stomach may be vomited when anesthesia is induced, and this is dangerous.

When the patient arrives at the hospital or surgery center, the anesthesiologist or nursing staff may meet with the patient and family to review the patient’s history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery.

Once the patient is put to sleep, a retractor is placed into the oral cavity to allow for proper exposure of the tonsils. Next, each tonsil is dissected using either electrocautery or radiofrequency ablation (See coblation tonsillectomy below) with blood vessels sealed along the way. Once the tonsils are removed, any bleeding areas are sealed and a small amount of anesthetic is injected into the area of dissection. The adenoids are usually visualized thereafter with a mirror and removed if appropriate.

Coblation tonsillectomy is a new technique that uses radiofrequency energy and a salt solution. This requires less heat energy which spares the surrounding tissues from burn injury, thus leading to less post-operative pain. More information is available at http://www.arthrocareent.com/wt/page/index

There are several post-operative symptoms that may arise. These include (but are not limited to ) swallowing problems, vomiting, fever,. throat pain, and ear pain. Occasionally, bleeding may occur after surgery. If the patient has any bleeding, your surgeon should be notified.

Adenoidectomy

The adenoid pad is a structure located in the back of the nasal passageway. A retractor is placed into the mouth and used to help visualize the most posterior area of the oral cavity. A mirror is then used to visualize the adenoid pad. A number of techniques are available for adenoidectomy including electrocautery, radiofrequency ablation, and curettage. Care is taken to remain midline to avoid injury to the Eustachian tube openings. Once the back portion of the nasal passageway is clearly visualized, the procedure is complete.

Since the adenoid pads lack nerve endings, the post-operative course is fairly well tolerated. There is minimal pain and bleeding is quite rare. Nasal congestion is commonly encountered after surgery and improves as the swelling gradually subsides over the next several days.

Examining Your Child

The physical exam helps the doctor determine the specific type of ear problem affecting your child. The exam also helps identify any respiratory illnesses, such as bronchitis, pneumonia, or strep throat.

If the doctor suspects a middle ear problem, otoscopy is almost always performed. Using a special device (otoscope) to look down the ear canal, the doctor views the eardrum and any fluid behind it. If your child can sit still for several minutes, the eardrum and middle ear may be tested to learn how well they are working. Tympanometry and acoustic reflex testing both use a probe to send air and sound through the outer ear. Tympanometry measures the amount of sound bouncing off the eardrum. The purpose is to evaluate the eardrum’s flexibility and its response to loud sounds

The nasal passages and throat are also examined. If your child’s tonsils (masses of tissue near the back of the throat) are greatly enlarged, the doctor may check the adenoids (pads of tissue in the upper part of the throat) as well. The adenoids are located near the site where the Eustachian tube opens into the throat. Their job is to help filter inhaled germs before they reach the lungs. If the adenoids themselves get infected, they may swell. After repeated infections, the adenoids may remain enlarged, blocking the Eustachian tube opening. In some cases, germs stopped by the adenoids may enter the Eustachian tube and spread to the middle ear. Adenoid-related ear problems happen more often in older children and adults.

To learn if a young child has trouble hearing, the doctor or a hearing specialist may talk or play with the youngster. The child’s response to changes in the speaker’s voice helps identify hearing loss. Older children and adults may be given an audiometric test. In some cases, young children with chronic fluid may also be tested. During audiometry, sound waves are sent into the outer ear or vibrations are passed through the bones behind the ear. The listener signals every time he or she hears a tone. Test results are used to identify the types of sounds that can and cannot be heard.

If the doctor suspects a problem with the structure of your child’s ear, a special test may be done. A computed tomography (CT) scan shows the images of the middle ear bones or bone surrounding the ear. Magnetic resonance imaging (MRI) is used to check for soft tissue problems, such as nerve damage or tumors. To identify an inner ear problem, a sophisticated hearing test may be done to pinpoint any problem with the nerve pathways that send signals to the brain. These tests take time to perform, but they do not cause pain.