Ears

Conditions that impair ear function can be as minor as wax buildup or as serious as congenital deafness. This section contains valuable information about how to protect your hearing, how to recognize indications of hearing disorders, and what ENT-head and neck physicians can do to evaluate and treat these problems.

 

From ear wax to cochlear implants. Learn more about the wide range of hearing-related topics, below.

 

Your child with a hearing loss can succeed - in school, in work, and in life! It is important to keep this as your focus, whatever your child's age or degree of hearing loss. While you will have the support of many professionals, ultimately you as parents will make many decisions about what is in the best interest of your child. As with all children, there is no magic formula for raising a child with a hearing loss. It helps to maintain a positive attitude, educate yourself about hearing loss, seek out the best resources, and take an active role in your child's education. Most of all, keep in mind that your child is a child first, and a child with a hearing loss second.

This online booklet is written for parents of children of all ages and all degrees of hearing loss. With so much to cover, the information presented here is only a brief overview, supplemented with a variety of reference and resource materials so you can follow up on subjects more thoroughly. In addition, you are encouraged to join the Alexander Graham Bell Association for the Deaf and Hard of Hearing for access to a huge variety of resources, including educational programs for you and your child, a large inventory of books and other publications, video tapes, conferences, and a national support network.

Will your child have a "normal" life? While some mild-moderate losses can be surgically or medically corrected, most hearing loss is a permanent condition. Thus, your child's life will have its challenges. However, these challenges sometimes turn into advantages. For example, the ability to work hard and concentrate more, coupled with the routines of audiologic and language therapy, frequently produces children who are self-disciplined and focused. Moreover, the outcomes for children with hearing loss have greatly improved in the last two decades due to major advances in technology and emphasis on programs of early detection and early intervention.

Emotional Impact of the Diagnosis: Parents can benefit from counseling and support after the diagnosis of hearing loss. Grief, anger, fear and denial are natural responses for hearing parents to feel when they find out their child has a hearing loss. Their expected "normal" child has a problem and this problem is going to present many challenges. We convey love through our words and tone of voice as well as through hugs and kisses. We soothe a child through the sound of our voice, or by singing a lullaby. We teach children that the objects in their room, their toys, their food, and the people around them all have names. We show children how to pronounce words by our example. We discipline and warn children of danger through words as well as actions. How are we going to do this now?

LDeaf parents of deaf children are not necessarily prone to grief because they are already familiar with living in a world without sound. Deaf parents may feel more comfortable with a child who is deaf, because this seems natural. But this isn't the case for most hearing parents, who probably know little or nothing about hearing loss and who may never have known a child with a hearing loss. Many deaf parents will teach their child sign language as naturally as hearing parents unconsciously teach their child to speak. But hearing parents must commit themselves to the goal of helping their child listen and speak in order to participate fully in a hearing world, or the equally arduous task of becoming fluent in sign language and learning about Deaf culture.

Grief is a common emotion and an honest expression of disappointment and fear of the unknown. Grief that is not acknowledged or dealt with can lead to denial of a child's problem, which in turn can lead to procrastination in taking constructive action. Unacknowledged grief can lead to unfocused and displaced anger on the part of parents which can last a lifetime. Acknowledging grief, painful as it may be, will clear away anger and denial, allowing parents to most effectively nurture their child.

An abnormal skin growth in the middle ear behind the eardrum is called cholesteatoma. Repeated infections and/or and a tear or retraction of the eardrum can cause the skin to toughen and form an expanding sac. Cholesteatomas often devolop as cysts or pouches that shed layers of old skin, which build up inside the middle ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare, but can result from continued cholesteatoma growth.

What causes a cholesteatoma?

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

How is cholesteatoma treated?

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

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

Surgery is performed under general anesthesia in most cases. The primary purpose of surgery is to remove the cholesteatoma so that the ear will dry and the infection will be eliminated. Hearing preservation or restoration is the second goal of surgery. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required. Reconstruction of the middle ear is not always possible in one operation; therefore, a second operation may be performed six to 12 months later. The second operation will attempt to restore hearing and, at the same time, allow the surgeon to inspect the middle ear space and mastoid for residual cholesteatoma.

Surgery can often be done on an out-patient basis. For some patients, an overnight stay is necessary. In rare cases of serious infection, prolonged hospitalization for antibiotic treatment may be necessary. Time off from work is typically one to two weeks.

After surgery, follow-up office visits are necessary to evaluate results and to check for recurrence. In cases where an open mastoidectomy cavity has been created, office visits every few months are needed to clean out the mastoid cavity and prevent new infections. Some patients will need lifelong periodic ear examinations. Cholesteatoma is a serious but treatable ear condition which can be diagnosed only by medical examination. Persistant earache, ear drainage, ear pressure, hearing loss, dizziness, or facial muscle weakness need to be evaluated by an otolaryngologist.

Symptoms and dangers

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

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

An ear cholesteatoma can be dangerous and should never be ignored. 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.

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

What Is Normal Hearing?

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

  • Conductive hearing: Sound travels along the ear canal of the external ear causing the ear drum to vibrate. Three small bones of the middle ear conduct this vibration from the ear drum to the cochlea (auditory chamber) of the inner ear.
  • Sensorineural hearing: When the three small bones move, they start waves of fluid in the cochlea, and these waves stimulate more than 16,000 delicate hearing cells (hair cells). As these hair cells move, they generate an electrical current in the auditory nerve. It travels through inter-connections to the brain area that recognizes it as sound.

How Is Hearing Impaired?

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

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

How Do Cochlear Implants Work?

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

The implant consists of a small electronic device, which is surgically implanted under the skin behind the ear and an external speech processor, which is usually worn on a belt or in a pocket. A microphone is also worn outside the body as a headpiece behind the ear to capture incoming sound. The speech processor translates the sound into distinctive electrical signals. These 'codes' travel up a thin cable to the headpiece and are transmitted across the skin via radio waves to the implanted electrodes in the cochlea. The electrodes' signals stimulate the auditory nerve fibers to send information to the brain where it is interpreted as meaningful sound.

Cochlear Implant Benefits

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

Otolaryngologists (ear, nose, and throat specialists) perform implant surgery, though not all of them do this procedure. Your local doctor can refer you to an implant clinic for an evaluation. The evaluation will be done by an implant team (an otolaryngologist, audiologist, nurse, and others) that will give you a series of tests:

  • Ear (otologic) evaluation: The otolaryngologist examines the middle and inner ear to ensure that no active infection or other abnormality precludes the implant surgery.
  • Hearing (audiologic) evaluation: The audiologist performs an extensive hearing test 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 bone.
  • Psychological evaluation: Some patients may need a psychological evaluation to learn if they can cope with the implant.
  • Physical examination: Your otolaryngologist also gives a physical examination to identify any potential problems with the general anesthesia needed for the implant procedure.

Cochlear Surgery

Implant surgery is performed under general anesthesia and lasts from two to three hours. An incision is made behind the ear to open the mastoid bone leading to the middle ear. The procedure may be done as an outpatient, or may require a stay in the hospital, overnight or for several days, depending on the device used and the anatomy of the inner ear.

Is There Care And Training After The Operation?

About one month after surgery, your 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. Some implants take longer to fit and require more training. Your team will probably ask you to come back to the clinic for regular checkups and readjustment of the speech processor as needed.

What Can I Expect from An Implant?

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 lipreading, and over half are able to discriminate speech without the use of visual cues. There are many factors that contribute to the degree of benefit a user receives from a cochlear implant, including:

  • how long a person has been deaf,
  • the number of surviving auditory nerve fibers, and
  • a patient's motivation to learn to hear.

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

FDA Approval For Implants

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

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

Costs Of Implants

More expensive than a hearing aid, the total cost of a cochlear implant including evaluation, surgery, the device, and rehabilitation is around $40,000. Most insurance companies provide benefits that cover the cost. (This is true whether or not the device has received FDA clearance or is still in trial.)

Protruding and drooping ears or torn earlobes can be surgically corrected. Exceptionally large ears or those that stick out make children vulnerable to teasing. These procedures do not alter the patient's hearing, but they may improve appearance and self-confidence.

What Is Involved in "Pinning Back" the Ears?

Corrective surgery, called otoplasty, should be considered on ears which stick out more than 4/5 of an inch (2 cm) from the back of the head. It can be performed at any age after the ears have reached full size, usually at five or six years of age. Having the surgery at a young age has two benefits: the cartilage is more pliable, making it easier to reshape, and the child will experience the psychological benefits of the cosmetic improvement. However, a patient may have the surgery at any age.

The surgery begins with an incision behind the ear, in the fold where the ear joins the head. The surgeon may remove skin and cartilage or trim and reshape the cartilage. In addition to correcting protrusion, ears may also be reshaped, reduced in size, or made more symmetrical. The cartilage is then secured in the new position with permanent stitches which will anchor the ear while healing occurs.

Typically otoplasty surgery takes about two hours. The soft dressings over the ears will be used for a few weeks as protection, and the patient usually experiences only mild discomfort. Headbands are sometimes recommended to hold the ears in place for a month following surgery or may be prescribed for nighttime wear only.

Can Ear Deformities Be Corrected?

The "fold" of hard, raised cartilage that gives shape to the upper portion of the ear does not form in all people. This is called "lop-ear deformity," and it is inherited. The absence of the fold can cause the ear to stick out or flop down. To correct this problem, the surgeon places permanent stitches in the upper ear cartilage and ties them in a way that creates a fold and props the ear up. Scar tissue will form later, holding the fold in place.

Some infants are born without an opening in their middle ear. These ears can be surgically opened, and the outer ear reshaped to look like the other ear. This procedure will restore hearing if the inner ear is intact.

Those who are born without an ear, or lose an ear due to injury, can have an artificial ear surgically attached for cosmetic reasons. These are custom formed to match the patient's other ear. Alternatively, rib cartilage or a biomedical implant, in addition to the patient's own soft tissue, can be used to construct a new ear.

Can Torn Earlobes Be Corrected?

Many mothers have had their earlobes torn by a baby's tug on their earrings. Earrings also catch on clothing and other objects, resulting in torn earlobes. These tears can be easily repaired surgically, usually in the doctor's office. In severe cases, the surgeon may cut a small triangular notch at the bottom of the lobe. A matching flap is then created from tissue on the other side of the tear, and the two wedges are fitted together and stitched.

Earlobes usually heal quickly with minimal scarring. In most cases, the earlobe can be pierced again four to six weeks after surgery to receive light-weight earrings.

Does Insurance Pay for Cosmetic Ear Surgery?

Insurance usually does not cover surgery solely for cosmetic reasons. However, insurance may cover, in whole or in part, surgery to correct a congenital or traumatic defect. Before cosmetic ear surgery, discuss the procedure with your insurance carrier to determine what coverage, if any, you can expect.

Insight into causes and treatment options

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

 

Painful ear infections are a rite of passage for children – by the age of five, nearly every child has experienced at least one episode. Most ear infections either resolve on their own (viral) or are effectively treated by antibiotics (bacterial). But sometimes, ear infections and/or fluid in the middle ear may become a chronic problem leading to other issues such as hearing loss, behavior, and speech problems. In these cases, insertion of an ear tube by an otolaryngologist (ear, nose, and throat surgeon) may be considered.

What Are Ear tubes?

Ear tubes are tiny cylinders placed through the ear drum (tympanic membrane) to allow air into the middle ear. They also may be called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PE (pressure equalization) tubes. These tubes can be made out of plastic, metal, or Teflon and may have a coating intended to reduce the possibility of infection. There are two basic types of ear tubes: short-term and long-term. Short-term tubes are smaller and typically stay in place for six months to a year before falling out on their own. Long-term tubes are larger and have flanges that secure them in place for a longer period of time. Long term tubes may fall out on their own, but removal by an otolaryngologist is often necessary.

Who Needs Ear Tubes?

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

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

  • reduce the risk of future ear infection,
  • restore hearing loss caused by middle ear fluid,
  • improve speech problems and balance prob-lems, and
  • improve behavior and sleep problems caused by chronic ear infections.

 

How Are Ear Tubes Inserted?

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

Ear Tube Surgery

A light general anesthetic (laughing gas) is administered for young children. Some older children and adults may be able to tolerate the procedure without anesthetic. A myringotomy is performed and the fluid behind the ear drum (in the middle ear space) is suctioned out. The ear tube is then placed in the hole. Ear drops may be administered after the ear tube is placed and may be necessary for a few days. The procedure usually lasts less than 15 minutes and patients awaken quickly. Sometimes the otolaryngologist will recommend removal of the adenoid tissue (lymph tissue located in the upper airway behind the nose) when ear tubes are placed. This is often considered when a repeat tube insertion is necessary. Current research indicates that removing adenoid tissue concurrent with placement of ear tubes can reduce the risk of recurrent ear infection and the need for repeat surgery.

What To Expect After Surgery

After surgery, the patient is monitored in the recovery room and will usually go home within an hour if no complications are present. Patients usually experience little or no postoperative pain but grogginess, irritability, and/or nausea from the anesthesia can occur temporarily. Hearing loss caused by the presence of middle ear fluid is immediately resolved by surgery. Sometimes children can hear so much better that they complain that normal sounds seem too loud. The otolaryngologist will provide specific postoperative instructions for each patient including when to seek immediate attention and follow-up appointments. He or she may also prescribe antibiotic ear drops for a few days. To avoid the possibility of bacteria entering the middle ear through the ventilation tube, physicians may recommend keeping ears dry by using ear plugs or other water-tight devices during bathing, swimming, and water activities. However, recent research suggests that protecting the ear may not be necessary, except when diving or engaging in water activities in unclean water such as lakes and rivers. Parents should consult with the treating physician about ear protection after surgery.

Possible Complications

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

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

 

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

Insight into otitis media and treatment

  • What is otitis media?
  • Is it serious?
  • What are the symptoms?
  • and more...

What is otitis media?

Otitis media means inflammation of the middle ear. The inflammation occurs as a result of a middle ear infection. It can occur in one or both ears. Otitis media is the most frequent diagnosis recorded 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 also affects adults occasionally. It occurs most commonly in the winter and early spring months.

Is it serious?

Yes, it is serious because of the severe earache and hearing loss it can create. Hearing loss, especially in children, may impair learning capacity and even delay speech development. However, if it is treated promptly and effectively, hearing can almost always be restored to normal.

Otitis media is also serious because the infection can spread to nearby structures in the head, especially the mastoid. Thus, it is very important to recognize the symptoms (see list) of otitis media and to get immediate attention from your doctor.

How does the ear work?

The outer ear collects sounds. The middle ear is a pea sized, air-filled cavity separated from the outer ear by the paper-thin eardrum. Attached to the eardrum are three tiny ear bones. When sound waves strike the eardrum, it vibrates and sets the bones in motion that transmit to the inner ear. The inner ear converts vibrations to electrical signals and sends these signals to the brain. It also helps maintain balance.

A healthy middle ear contains air at the same atmospheric pressure as outside of the ear, allowing free vibration. Air enters the middle ear through the narrow eustachian tube that connects the back of the nose to the ear. When you yawn and hear a pop, your eustachian tube has just sent a tiny air bubble to your middle ear to equalize the air pressure.

What causes otitis media?

Blockage of the eustachian tube during a cold, allergy, or upper respiratory infection and the presence of bacteria or viruses lead to the accumulation of fluid (a build-up of pus and mucus) behind the eardrum. This is the infection called acute otitis media. The build up of pressurized pus in the middle ear causes earache, swelling, and redness. Since the eardrum cannot vibrate properly, you or your child may have hearing problems.

Sometimes the eardrum ruptures, and pus drains out of the ear. But more commonly, the pus and mucus remain in the middle ear due to the swollen and inflamed eustachian tube. This is called middle ear effusion or serous otitis media. Often after the acute infection has passed, the effusion remains and becomes chronic, lasting for weeks, months, or even years. This condition makes one subject to frequent recurrences of the acute infection and may cause difficulty in hearing.

What will happen at the doctor's office?

During an examination, the doctor will use an instrument called an otoscope to assess the ear's condition. With it, the doctor will perform an examination to check for redness in the ear and/or fluid behind the eardrum. With the gentle use of air pressure, the doctor can also see if the eardrum moves. If the eardrum doesn't move and/or is red, an ear infection is probably present.

Two other tests may be performed for more information:

  • An audiogram tests if hearing loss has occurred by presenting tones at various pitches.
  • A tympanogram measures the air pressure in the middle ear to see how well the eustachian tube is working and how well the eardrum can move.

The importance of medication

The doctor may prescribe one or more medications. It is important that all the medication(s) be taken as directed and that any follow-up visits be kept. Often, antibiotics to fight the infection will make the earache go away rapidly, but the infection may need more time to clear up. So, be sure that the medication is taken for the full time your doctor has indicated. Other medications that your doctor may prescribe include an antihistamine (for allergies), a decongestant (especially with a cold), or both.

Sometimes the doctor may recommend a medication to reduce fever and/or pain. Analgesic ear drops can ease the pain of an earache. Call your doctor if you have any questions about you or your child's medication or if symptoms do not clear.

What other treatment may be necessary?

Most of the time, otitis media clears up with proper medication and home treatment. In many cases, however, further treatment may be recommended by your physician. An operation, called a myringotomy may be recommended. This involves a small surgical incision (opening) into the eardrum to promote drainage of fluid and to relieve pain. The incision heals within a few days with practically no scarring or injury to the eardrum. In fact, the surgical opening can heal so fast that it often closes before the infection and the fluid are gone. A ventilation tube can be placed in the incision, preventing fluid accumulation and thus improving hearing.

The surgeon selects a ventilation tube for your child that will remain in place for as long as required for the middle ear infection to improve and for the eustachian tube to return to normal. This may require several weeks or months. During this time, you must keep water out of the ears because it could start an infection. Otherwise, the tube causes no trouble, and you will probably notice a remarkable improvement in hearing and a decrease in the frequency of ear infections.

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

Allergies may also require treatment.

So, remember . . .

Otitis media is generally not serious if it is promptly and properly treated. With the help of your physician, you and/or your child can feel and hear better very soon.

Be sure to follow the treatment plan, and see your physician until he/she tells you that the condition is fully cured.

What are the symptoms of otitis media?

In infants and toddlers look for:

  • tpulling or scratching at the ear, especially if accompanied by other symptoms
  • hearing problems
  • crying, irritability
  • fever
  • vomiting
  • ear drainage

In young children, adolescents, and adults look for:

  • earache
  • feeling of fullness or pressure
  • hearing problems
  • dizziness, loss of balance
  • nausea, vomiting
  • ear drainage
  • fever

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

Insight into making air travel more comfortable

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

Ear problems are the most common medical complaint of airplane travelers, and while they are usually simple, minor annoyances, they occasionally result in temporary pain and hearing loss.

Why do ears pop?

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

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

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

How Can Air Travel Cause Hearing Problems?

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

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

How To Unblock Ears?

Swallowing activates the muscle that opens the Eustachian tube. You swallow more often when you chew gum or let mints melt in your mouth. These are good air travel practices, especially just before take-off and during descent. Yawning is even better. Avoid sleeping during descent, because you may not be swallowing often enough to keep up with the pressure changes. (The flight attendant will be happy to awaken you just before descent).

SIf yawning and swallowing are not effective, pinch the nostrils shut, take a mouthful of air, and direct the air into the back of the nose as if trying to blow the nose gently. The ears have been successfully unblocked when a pop is heard. This may have to be repeated several times during descent. Even after landing, continue the pressure equalizing techniques and the use of decongestants and nasal sprays. If the ears fail to open or if pain persists, seek the help of a physician who has experience in the care of ear disorders. The ear specialist may need to release the pressure or fluid with a small incision in the ear drum.

How to Help Babies Unlock their Ears?

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

Is the Use of Decongestants and Nose Sprays Recommended?

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

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

Tips to Prevent Discomfort During Air Travel

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

Insight into the proper care of the ears

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

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

Why does the body produce earwax?

Cerumen or earwax is healthy in normal amounts and serves as a self-cleaning agent with protective, lubricating, and antibacterial properties. The absence of earwax may result in dry, itchy ears. Most of the time the ear canals are self-cleaning; that is, there is a slow and orderly migration of earwax and skin cells from the eardrum to the ear opening. Old earwax is constantly being transported, assisted by chewing and jaw motion, from the ear canal to the ear opening where it usually dries, flakes, and falls out.

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

When should the ears be cleaned?

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

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

What is the recommended method of ear cleaning?

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

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

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

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

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

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

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

Are ear candles an option for removing wax build up?

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

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

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

When should a doctor be consulted?

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

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

What can I do to prevent excessive earwax?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Myringotomy – an incision made into the ear drum.

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

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

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

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

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

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

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

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

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

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

What is AIED?

Autoimmune inner ear disease (AIED) is an inflammatory condition of the inner ear. It occurs when the body's immune system attacks cells in the inner ear that are mistaken for a virus or bacteria. AIED is a rare disease occurring in less than one percent of the 28 million Americans with a hearing loss.

How Does the Healthy Ear Work?

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

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

Symptoms of AIED

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

Treatment for AIED

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

History of AIED

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

AIED Research

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

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

Otitis Media

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

Tinnitus

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

Swimmer's Ear

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

Earwax

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

Autoimmune Inner Ear Disease

Autoimmune inner ear disease (AIED) is an inflammatory condition of the inner ear. It occurs when the body's immune system attacks cells in the inner ear that are mistaken for a virus or bacteria. Prompt medical diagnosis is essential to ensure the most favorable prognosis. Therefore, recognizing the symptoms of AIED is important: sudden hearing loss in one ear progressing rapidly to the second and continued loss of hearing over weeks or months, a feeling of ear fullness, vertigo, and tinnitus. Treatments primarily include medications but hearing aids and cochlear implants are helpful to some.

Cholesteatoma

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

Perforated Eardrum

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

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

Because some hearing problems can be medically corrected, first visit a physician who can refer you to an otolaryngologist (an ear, nose, and throat specialist ). If you have ear pain, drainage, excess earwax, hearing loss in only one ear, sudden or rapidly progressive hearing loss, or dizziness, it is especially important that you see an otolaryngologist. Then, get a hearing assessment from an audiologist (a nonphysician health care professional). A screening test from a hearing aid dealer may not be adequate. Many otolaryngologists have an audiologist associate in their office who will assess your ability to hear pure tone sounds and to understand words. The results of these tests will show the degree of hearing loss and whether it is conductive or sensorineural and may give other medical information about your ears and your health.

Conductive Hearing Loss

A hearing loss is conductive when there is a problem with the ear canal, the eardrum and/or the three bones connected to the eardrum. Common reasons for this type of hearing loss are a plug of excess wax in the ear canal or fluid behind the eardrum. Medical treatment or surgery may be available for these and more complex forms of conductive hearing loss.

Sensorinural Hearing Loss

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

Where Do I Purchase Hearing Aids?

Because federal regulation prohibits any hearing aid sale unless the buyer has first received a medical evaluation from a physician, you will need to see your physician before you purchase a hearing aid(s). However, the regulation says that if you are more than 18 years old and are aware of the recommendation to receive a medical exam, you may sign a waiver to forego the exam.

An otolaryngologist, audiologist, or an independent dispenser can dispense aids. Hearing aids should be custom fitted to your ear and hearing needs. Hearing aids purchased by mail-order typically cannot be custom fitted.

Cost Of Hearing Aids

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

Styles Of Hearing Aids

There are several styles of hearing aids:

  • Behind-the-ear (BTE) hearing aids are placed over the ear and connected with tubing to custom-fitted earpieces.
  • In-the-ear (ITE) hearing aids fill the entire bowl of the ear and part of the ear canal.
  • Smaller versions of ITEs are called half-shell and in-the-canal (ITC).
  • The least visible aids are completely-in-the-canal (CIC).

Hearing aid options, which are appropriate for your particular hearing loss and listening needs, the size, and shape of your ear and ear canal, and the dexterity of your hands will all be considered in deciding what type of hearing aid is the best for you. Many hearing aids have special telecoil "T" switches to aid in use of the telephone and certain public sound systems. Discuss your need for a T-coil switch while you are considering hearing aid options.

Will I Need A Hearing Aid For Each Ear?

Usually, if you have hearing loss in both ears, using two hearing aids is best. Listening in a noisy environment is difficult with amplification in one ear only, and it is more difficult to distinguish where sounds are coming from. If, however, the quality of hearing in one ear is very different from the other, one hearing aid may be better than two.

What Other Questions Should I Ask?

  • Ask about charges for the hearing evaluation, dispensing fee(s), and future servicing and repair.
  • Inquire about the trial period policy and what fees are refundable if you return the hearing aid(s) during the trial period.
  • Ask about the warranty coverage for your hearing aids and the consumers' protection program for hearing aid purchasers in your state.

What Will Happen At My Hearing Aid Fitting?

  • The hearing aids will be fitted for your ears.
  • Then, while wearing your hearing aids, you will be tested for word understanding in quiet and in noise and for improvement in hearing tones.
  • Next, you will receive instruction about the care of your hearing aids, the batteries used to power them, a suggested wearing schedule, general expectations, and helpful communication strategies.
  • You will also practice properly inserting and removing the hearing aids and batteries.

How Should I Begin Wearing The Aids?

  • Start using your hearing aids in quiet surroundings, gradually building up to noisier environments.
  • Note where and when that you find the hearing aids beneficial.
  • Be patient and allow yourself to get used to the aids and the "new" sounds they allow you to hear.
  • Keep a diary to help you remember your experiences.
  • Report any concerns on a follow-up appointment.

Why Is Early Childhood Hearing Screening Important For Your Child?

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

When Should A Child's Hearing Be Tested?

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

Is Early Hearing Screening Mandatory?

In recent years, health organizations across the country, including the AmericanAcademy of Otolaryngology – Head and Neck Surgery, have worked to highlight the importance of screening all newborns for hearing loss. These efforts are working. In 2003, more than 85 percent of all newborns in the United States were screened for hearing loss. In fact, some 39 states have passed legislation requiring some form of hearing screening of newborns before they leave the hospital. This still leaves more than a million babies who are not screened for hearing loss before leaving the hospital.

How Is Screening Done?

Two tests are used to screen infants and newborns for hearing loss. They are:

  • Otoacoustic emissions (OAE) involves placement of a sponge earphone in the ear canal to measure whether the ear can respond properly to sound. In normal-hearing children, a measurable "echo" should be produced when sound is emitted through the earphone. If no echo is measured, it could indicate a hearing loss.
  • Auditory brain stem response (ABR) is a more complex test. Earphones are placed on the ears and electrodes are placed on the head and ears. Sound is emitted through the earphones while the electrodes measure how your child's brain responds to the sound.

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

Signs Of Hearing Loss In Children

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

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

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

What Happens If My Child Has A Hearing Loss?

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

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

You will need to decide whether or not your deaf child will communicate primarily with oral speech and/or sign language, and seek early intervention to prevent language delays. Research indicates that habilitation of hearing loss by age six months will prevent subsequent language delays. Other communication strategies such as auditory verbal therapy, lip reading, and cued speech may also be used in conjunction with a hearing aid or cochlear implant, or independently.

What you should know

The CDC and FDA, in partnership with state health departments, have recently completed an investigation that found children with cochlear implants have a higher chance of getting bacterial meningitis than children without cochlear implants. Some children who are candidates for cochlear implants may have factors that increase their risk of meningitis even before they get a cochlear implant. However, this investigation was not designed to determine the risk of meningitis in children who are candidates for cochlear implants but don't have them.

Because people with cochlear implants are at increased risk for meningitis, CDC recommends that people with cochlear implants follow recommendations for pneumococcal vaccinations that apply to members of other groups at increased risk. Recommendations for the timing and type of pneumococcal vaccination vary with age and vaccination history and should be discussed with a health care provider.

Recommendations for people with cochlear implants aged two years and older include the following:

  • Children who have cochlear implants, are aged 2 years and older, and have completed the pneumococcal conjugate vaccine (Prevnar ®) series should receive one dose of the pneumococcal polysaccharide vaccine (Pneumovax ® 23). If they have just received pneumococcal conjugate vaccine, they should wait at least two months before receiving pneumococcal polysaccharide vaccine.
  • Children who have cochlear implants are between 24 and 59 months of age, and have never received either pneumococcal conjugate vaccine or pneumococcal polysaccharide vaccine should receive two doses of pneumococcal conjugate vaccine two or more months apart and then receive one dose of pneumococcal polysaccharide vaccine at least two months later.
  • Persons who are aged 5 years and older with cochlear implants should receive one dose of pneumococcal polysaccharide vaccine.

Additional facts

Worldwide, there are over 90 known reports of people getting meningitis after getting a cochlear implant. This is out of approximately 60,000 people who have cochlear implants.

Meningitis is an infection. The infection is in the fluid that surrounds the brain and spinal cord. There are two main types of meningitis, viral and bacterial. Bacterial meningitis is the most serious type. It is the type that has been reported in people with cochlear implants. Depending on the cause of the meningitis, the symptoms, treatment, and outcomes differ.

Bacterial meningitis can be caused by several different kinds of bacteria. Four vaccines protect against most of these bacteria. The vaccines are:

  • 7-valent pneumococcal conjugate (Prevnar®) (PCV-7)
  • 23-valent pneumococcal polysaccharide (Pneumovax® 23) (PPV-23)
  • Haemophilus influenzae type b conjugate (Hib)
  • Quadrivalent A,C,Y,W-135 meningococcal polysaccharide (Menomune®).

Meningitis in people with cochlear implants is most commonly caused by the bacteria Streptococcus pneumoniae (pneumococcus). Children with cochlear implants are more likely to get pneumococcal meningitis than children without cochlear implants.

None of the children in the investigation had meningococcal meningitis caused by Neisseria meningitidis. There is no evidence that children with cochlear implants are more likely to get meningococcal meningitis than children without cochlear implants.

Who is in day care?

The 2000 census reported that of among the nation's 19.6 million preschoolers, grandparents took care of 21 percent, 17 percent were were cared for by their father (while their mother was employed or in school); 12 percent were in day care centers; nine percent were cared for by other relatives; seven percent were cared for by a family day care provider in their home; and six percent received care in nursery schools or preschools. More than one-third of preschoolers (7.2 million) had no regular child-care arrangement and presumably were under maternal care.

Day care establishments are defined as those primarily engaged in care of infants or children, or in providing pre-kindergarten education, where medical care and/or behavioral correction are not a primary function or major element. Some may or may not have substantial educational programs, and some may care for older children when they are not in school.

What are your child's risks of being exposed to a contagious illness at a day care center?

Medline, a service of the National Library of Medicine and the National Institutes of Health, reports that day care centers do pose some degree of an increased health risk for children, because of the exposure to other children who may be sick.

When your child is in a day care center, the risk is greatest for viral upper respiratory infection (affecting the nose, throat, mouth, voice box) and the common cold, ear infections, and diarrhea. Some studies have tried to link asthma to day care. Other studies suggest that being exposed to all the germs in day care actually IMPROVES your child's immune system.

Studies suggest that the average child will get eight to ten colds per year, lasting ten - 14 days each, and occurring primarily in the winter months. This means that if a child gets two colds from March to September, and eight colds from September to March, each lasting two weeks, the child will be sick more than over half of the winter.

At the same time, children in a day care environment, exposed to the exchange of upper respiratory tract viruses every day, are expected to have three to ten episodes of otitis media annually. This is four times the incidence of children staying at home.

When should your child remain at home instead of day care or school?

Simply put, children become sick after being exposed to other sick children. Some guidelines to follow are:

  • When your child has a temperature higher than 100 degrees, keep him/her at home. A fever is a sign of potentially contagious infection, even if the child feels fine. Schools often advise keeping the child at home until a fever-free period has existed for 24 hours.
  • When other children in the day care facility have a known contagious infection, such as chicken pox, strep throat or conjunctivitis, keep your child at home.
  • Children taking antibiotics should be kept at home until they have taken the medicine for one or two days.
  • If your child is vomiting or has diarrhea, the young patient should not be around other children. Other signs of illness are an inability to take fluids, weakness or lethargy, sunken eyes, a depressed soft spot on top of infant's head, crying without tears, and dry mouth.

Can you prevent your child from becoming sick at a day care center?

The short answer is no. Exposure to other sick children will increase the likelihood that your child may catch the same illness, particularly with the common cold. The primary rule is to keep your own children at home if they are sick. However, you can:

  • Teach your child to wash his or her hands before eating and after using the toilet. Infection is spread the most by children putting dirty toys and hands in their mouths, so check your day care's hygiene cleaning practices.
  • Have your child examined by a physician before enrollment in a day care center or school. During the examination, the physician will:
    • Look for otitis (inflammation) in the ear. This is an indicator of future ear infections.
    • Review with you any allergies your child may have. This will assist in determining if the diet offered at the day care center may be harmful to your child.
    • Examine the child's tonsils for infection and size. Enlarged tonsils could indicate that your child may not be getting a healthy sleep at night, resulting in a tired condition during the day.
  • Alert the day care center manager when your child is ill, and include the nature of the illness.

Day care has become a necessity for millions of families. Monitoring the health of your own child is key to preventing unneccessary sickness. If a serious illness occurs, do not hesitate to have your child examined by a physician.

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

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

This is a big problem.

Treatments

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

What about vaccines?

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

How Do Genes Work?

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

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

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

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

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

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

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

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

What Is Hyperacusis?

Hyperacusis is a condition that arises from a problem in the way the brain's central auditory processing center perceives noise. It can often lead to pain and discomfort. Individuals with hyperacusis have difficulty tolerating sounds which do not seem loud to others, such as the noise from running faucet water, riding in a car, walking on leaves, dishwasher, fan on the refrigerator, shuffling papers. Although all sounds may be perceived as too loud, high frequency sounds may be particularly troublesome. As one might suspect, the quality of life for individuals with hyperacusis can be greatly compromised. For those with a severe intolerance to sound, it is difficult and sometimes impossible to function in an every day environment with all its ambient noise. Hyperacusis can contribute to social isolation, phonophobia (fear of normal sounds), and depression.

Prevalence And Causes Of Hyperacusis

Many people experience sensitivity to sound, but true hyperacusis is rare, affecting approximately one in 50,000 individuals. The disorder can affect people of all ages in one or both ears. Individuals are usually not born with hyperacusis, but may develop a narrow tolerance to sound, most commonly from traumatically loud noises, which can be sudden or cumulative over time. Other common causes include:

  • Head injury
  • Ear damage from toxins or medication
  • Lyme disease
  • Air bag deployment
  • Viral infections involving the inner ear or facial nerve (Bell's palsy)
  • Temporomandibular joint (TMJ) syndrome

There are a variety of neurologic conditions that may be associated with hyperacusis, including:

  • Post-traumatic stress disorder
  • Chronic fatigue syndrome
  • Tay-Sach's disease
  • Some forms of epilepsy
  • Valium dependence
  • Depression
  • Migraine headaches

Hyperacusis is also more common in children with: central auditory processing disorder, learning disabilities, attention deficit disorder (ADD), head injury, autism, and autistic-like behaviors.

Diagnosis Of Hyperacusis

Individuals who suspect they may have hyperacusis should seek an evaluation by an otolaryngologist (ear, nose, and throat doctor). The initial consultation is likely to include a full audiologic evaluation (with a hearing test), a recording of medical history, and a medical evaluation by a physician. Counseling about evaluation findings and treatment options may also be provided at that time.

Treatment For Hyperacusis

There are no specific corrective surgical or medical treatments for hyperacusis. However, sound therapy may be used to "retrain" the auditory processing center of the brain to accept every day sounds. This involves the use of a noise-generating device worn on the affected ear or ears. Those suffering from hyperacusis may be uncomfortable with placing sound directly in their ear, but the device produces a gentle static-like sound (white noise) that is barely audible. Completion of sound therapy may take up to 12 months, and usually improves sound tolerance. Because social situations are often painfully loud for those with hyperacusis, withdrawal, social isolation, and depression are common. For this reason, appropriate counseling may also be an important aspect of treatment.

Hearing Loss

Surprisingly, individuals with hyperacusis have little or no detectable hearing loss. In fact, hearing tests usually indicate normal hearing sensitivity and often register at minus decibel levels. Counter to what one might think, this does not mean that those with hyperacusis hear better than others. Instead, it is a clear indication of a problem in the way the brain processes sound. Hearing loss coupled with low tolerance to sound is termed recruitment, a condition where soft sounds cannot be heard and loud sounds are intolerable (or distorted). For example, a person with recruitment may have hearing loss below 50 decibels while at the same time; sound above 80 decibels may be intolerable. The result is a narrow range of comfortable hearing.

Relation To Tinnitus

Hyperacusis is strongly associated with tinnitus, a condition commonly referred to as "ringing in the ears." Nearly 36 million Americans suffer from tinnitus; an estimated one of every thousand also has hyperacusis. Individuals can have tinnitus and hyperacusis at the same time, or hyperacusis may be a precursor to the development of tinnitus. If both occur at the same time, hyperacusis is generally treated first.

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

It is important to know the approximate intensity of sound around you to protect your hearing.

The National Institute on Deafness and Other Communication Disorders reports that approximately 28 million Americans have lost some or all of their hearing, including 17 in 1,000 children under age 18. There are three types of hearing loss:

Conductive hearing loss:

This occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones of the middle ear. Conductive hearing loss usually involves a reduction in sound level, or the ability to hear faint sounds. This type of hearing loss can be caused by middle ear infection, impacted earwax, or a benign tumor. This type of hearing loss can often be medically or surgically corrected.

Sensorineural hearing loss:

This hearing loss, caused by damage to the inner ear or to the nerve pathways from the inner ear to the brain, is permanent and cannot be medically or surgically corrected. Sensorineural hearing loss not only involves a reduction in sound level, or ability to hear faint sounds, but also affects speech understanding, or ability to hear clearly. Causes of this disorder include drugs that are toxic to the auditory system, and genetic syndromes. Sensorineural hearing loss may also occur as a result of noise exposure, viruses, head trauma, aging, and tumors.

Mixed hearing loss:

Hearing loss can be both conductive and sensorineural. For example, there may be damage in the outer or middle ear and in the inner ear (cochlea) or auditory nerve. When this occurs, the hearing loss is referred to as a mixed hearing loss.

Incidence of this disorder increases with age. For example, approximately 314 in 1,000 people over age 65 have hearing loss and 40 to 50 percent of people 75 and older have a hearing loss.

Although 10 million Americans suffer irreversible noise-induced hearing loss, with 30 million more exposed to dangerous noise levels each day, very little has been reported on children's risk for this type of impairment.

This may soon change. Preteens are attending music concerts with increasing regularity. Additionally, the portable MP3 player, successor to transistor radios and the walkman, is a portable device that can provide up to 15,000 songs through headphones.

Should MP3 player use be limited?

Ear specialists say a whisper is 30 decibels and that a normal conversation is 60 decibels. The sound from an iPod Shuffle has been measured at 115 decibels. A survey sponsored by the Australian government found that about 25 percent of people using portable stereos had daily noise exposures high enough to cause hearing damage. And further research from the United Kingdom determined that young people, ages 18 to 24, were more likely than other adults to exceed safe listening limits.

Researchers at Boston Children's Hospital determined that listening to a portable music player with headphones at 60 percent of its potential volume for one hour a day is relatively safe.

Why earplugs are important at concerts

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

To experience 85 dBA, listen to an electric shaver or a busy urban street. Experts agree that continued exposure to noise above 85 dBA over time will cause hearing loss. Clearly, if levels are maintained at values greater than 85 dBA for long periods of time, this may lead to a significant noise exposure and frequent concertgoers may experience some potentially irreversible hearing loss from this experience.

A research study, "Incidence of Spontaneous Hearing Threshold Shifts during Modern Concert Performances," from the University of Minnesota Medical Center in Minneapolis examined sound intensity throughout a well-known concert venue and the effectiveness of earplugs.

The findings, presented at the 2005 annual meeting stated that sound pressure levels appeared equally hazardous in all parts of the concert hall, regardless of the type of music played. Accordingly, you should use earplugs at every type of musical concert, regardless of your vicinity to the stage.

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

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

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

What is the difference between designated "obese" versus "overweight?"

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

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

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

Pediatric obesity and otolaryngic problems

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

Sleep apnea:

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

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

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

Middle ear infections:

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

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

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

Tonsillectomies:

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

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

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

What you can do

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

What Is Otosclerosis?

The term otosclerosis is derived from the Greek words for "hard" (scler-o) and "ear" (oto). It describes a condition of abnormal growth in the tiny bones of the middle ear, which leads to a fixation of the stapes bone. The stapes bone must move freely for the ear to work properly and hear well.

Hearing is a complex process. In a normal ear, sound vibrations are funneled by the outer ear into the ear canal where they hit the ear drum. These vibrations cause movement of the ear drum that transfers to the three small bones of the middle ear, the malleus (hammer), incus (anvil), and stapes (stirrup). When the stapes bone moves, it sets the inner ear fluids in motion, which, in turn, start the process to stimulate the auditory (hearing) nerve. The hearing nerve then carries sound energy to the brain, resulting in hearing of sound. When any part of this process is compromised, hearing is impaired.

Who Gets Otosclerosis And Why?

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

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

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

Symptoms Of Otosclerosis

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

How Is Otosclerosis Diagnosed?

Because many of the symptoms typical of otosclerosis can also be caused by other medical conditions, it is important to be examined by an otolaryngologist (ear, nose and throat doctor) to eliminate other possible causes of the symptoms. After an ear exam, the otolaryngologist may order a hearing test. Based on the results of this test and the exam findings, the otolaryngologist will suggest treatment options.

Treatment For Otosclerosis

If the hearing loss is mild, the otolaryngologist may suggest continued observation and a hearing aid to amplify the sound reaching the ear drum. Sodium fluoride has been found to slow the progression of the disease and may also be prescribed. In most cases of otosclerosis, a surgical procedure called stapedectomy is the most effective method of restoring or improving hearing.

What Is A Stapedectomy?

A stapedectomy is an outpatient surgical procedure done under local or general anesthesia through the ear canal with an operating microscope. (No outer incisions are made.) It involves removing the immobilized stapes bone and replacing it with a prosthetic device. The prosthetic device allows the bones of the middle ear to resume movement, which stimulates fluid in the inner ear and improves or restores hearing.

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

Otosclerosis affects both ears in eight out of ten patients. For these patients, ears are operated on one at a time; the worst hearing ear first.

What Should I Expect After A Stapedectomy?

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

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

Notify your otolaryngologist immediately if any of the following occurs:

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

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

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

This condition is not uncommon in the pediatric population. Although tinnitus in children is as common as in the adult population, children generally do not complain spontaneously of having tinnitus. Researchers believe that the child with tinnitus considers the noise in the ear to be a normal event, as it has usually been present for a long period of time. A second explanation of this discrepancy lies in the fact that the child may not distinguish between the psychological impact of the tinnitus and its medical significance.

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

If you think your child has tinnitus:

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

What treatment your child may be offered.

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

  1. Most people, including children, who are diagnosed with tinnitus find that there is no specific problem underlying their tinnitus. Consequently, there is no specific medicine or operation to 'cure' tinnitus. However, experts suggest that the following steps be taken with the child diagnosed with tinnitus:
  2. Explain that he/she may feel less distressed by their tinnitus in the future: Many children find it helpful to have their tinnitus explained carefully to them and to know about ways to manage it. This is partly due to a medical concept known as "neural plasticity," resulting in children's brains being more able to change their response to all kinds of stimulation. If it is carefully managed, childhood tinnitus may not be a serious problem.
  3. Use sound generators or provide background noise: Sound therapy has been used to treat adults with tinnitus for some time, and can also be used with children. Sound therapy aims to make tinnitus less noticeable. If tinnitus occurs on a regular basis, then the child's nervous system can, with soundtherapy, adapt to the condition. The sound can be environmental, such as a fan or quiet background music.
  4. Have hearing-impaired children wear hearing aids: A child with tinnitus and a hearing loss may find that hearing aids can help improve the tinnitus. Hearing aids do this by picking up sounds your child may not normally hear, which in turn will help their brain filter out their tinnitus. It may also help them by taking the strain out of listening. Straining to hear can make your child's brain focus on the tinnitus noises.
  5. Helping your child to sleep with debilitating tinnitus: Severe tinnitus may lead to sleep difficulties for the young patient. Ask your otolaryngologist the best strategy to adopt when the child cannot sleep.
  6. Finally, help your child to relax. Some children believe their tinnitus gets worse when they are under stress. Discuss appropriate stress relieving techniques with your pediatrician or family physician.

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

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

Why do children have more ear infections than adults?

Children have Eustachian tubes that are shorter, more horizontal, and straighter than those of adults. These factors make the journey for the bacteria quick and relatively easy. A child's tube is also floppier, with a smaller opening that easily clogs.

Inflammation of the middle ear is known as "otitis media."When infection occurs, the condition is called "acute otitis media." Acute otitis media occurs when a cold, allergy or upper respiratory infection, and the presence of bacteria or viruses lead to the accumulation of pus and mucus behind the eardrum, blocking the Eustachian tube.

When fluid forms in the middle ear, the condition is known as"otitis media with effusion," which can occur with or without infection. This fluid can remain in the ear for weeks to many months. When infected fluid persists or repeatedly returns, this is sometimes called "chronic middle ear infection." If not treated, chronic ear infections have potentially serious consequences such as temporary or permanent hearing loss.

How are recurrent acute otitis media and otitis media with effusion treated?

Some child care advocates suggest doing nothing or administering antibiotics to treat the infection. More than 30 million prescriptions are written each year for ear infections, accounting for 25 percent of all antibiotics prescribed in the United States. However, antibiotics are not effective against viral ear infections (30 to 50 percent of such disorders), may cause uncomfortable side effects such as upset stomach, and can contribute to antibiotic resistance. Medical researchers believe that 25 percent of all pneumococcus strains, the most common bacterial cause of ear infections, are resistant to penicillin, and ten to 20 percent are resistant to amoxicillin.

Is surgery effective against recurrent otitis media and otitis media with effusion?

In some cases, surgery may be the only effective treatment for chronic ear infections. Some physicians recommend the use of laser myringotomy, using a laser to create a tiny hole in the eardrum. The treatment is done in the doctor's office using topical anesthesia (ear drops). Laser myringotomy works by providing several weeks of ventilation for the middle ear. Proponents suggest this can reduce the many courses of antibiotic treatment for severe ear infections and eliminates the need for surgical insertion of tubes with general anesthesia.

Before the procedure:

Prior to the procedure, the otolaryngologist will examine the patient for a description of the tympanic membrane (eardrum) and the middle ear space. An audiometry may be performed to assess patient hearing. A tympanometry will be performed that tests compliance of the tympanic membrane at various levels of air pressure. This test provides a measurement of the extent of middle ear effusion, Eustachian tube function, and otitis media.

The procedure: During the procedure, a small incision is made in the ear drum, the fluid is suctioned out, and a tube is placed. In young children, this is usually done under a light, general anesthesia; older patients may have the procedure performed under local anesthesia. There are over 50 different tube designs, all in different shapes, color, and composition. In general, smaller tubes stay in for a shorter duration, while large inner flanges hold the tube in place for a longer time. Some recent tubes have special surface coatings or treatments that may reduce the likelihood of infection.

After the procedure: Immediately after the procedure, the surgeon will examine the patient for persistent or profuse bleeding or discharge. After one month, the tube placement will be reviewed, and the patient's hearing may be tested. Later, the physician will assess the tube's effectiveness in alleviating the ear infection.

What is the most common surgical treatment for ear infections?

The most common surgical procedure administered to children under general anesthesia is myringotomy with insertion of tympanostomy tubes (TT). A tube is inserted in the middle ear to allow continuous drainage of fluid. The procedure is recommended for treatment of: chronic otitis media with effusion (lasting longer than three months), recurrent acute otitis media (more than three episodes in six months or more than four episodes in 12 months), severe acute otitis media, otitis media with effusion and a hearing loss greater than 30 dB, non-responsiveness to antibiotics, and impending mastoiditis or intra-cranial complication due to otitis media.

If the patient is age six or younger, it is recommended that tubes remain in place for up to two years. Most tubes will fall out without assistance. Otherwise, the specialist will determine when the tubes should be removed.

Your ENT physician will recommend the most effective treatment for your child's ear infection.

Five minute hearing test

  • How does the hearing sense work?
  • What can I do to improve my hearing?
  • Tips to maintain hearing health

You may have hearing loss, and not even be aware of it. People of all ages experience gradual hearing loss, often due to the natural aging process or long exposure to loud noise. Other causes of hearing loss include viruses or bacteria, heart conditions or stroke, head injuries, tumors, and certain medications. Treatment for hearing loss will depend on your diagnosis.

How does the hearing sense work?

The aural or hearing-sense is a complex and intricate process. The ear is made up of three sections: the outer ear, the middle ear, and the inner ear. These parts work together so you can hear and process sounds. The outer ear, or pinna (the part you can see), picks up sound waves and the waves then travel through the outer ear canal.

When the sound waves hit the eardrum in the middle ear, the eardrum starts to vibrate. When the eardrum vibrates, it moves three tiny bones in your ear. These bones are called the hammer (or malleus), anvil (or incus), and stirrup (or stapes). They help sound move along on its journey into the inner ear.

The vibrations then travel to the cochlea, which is filled with liquid and lined with cells that have thousands of tiny hairs on their surfaces. The sound vibrations make the tiny hairs move. The hairs then change the sound vibrations into nerve signals, so your brain can interpret the sound.

Test your hearing

Answer the following questions then calculate your score. To calculate your score, give yourself 3 points for every "Almost always" answer, 2 points for every "Half the time" answer, 1 point for every "Occasionally" answer, and 0 for every "Never." Please note: If hearing loss runs in your family, add an additional 3 points to your overall score.

The American Academy of Otolaryngology—Head and Neck Surgery recommends the following:

0-5 points—Your hearing is fine. No action is required.

6-9 points—Suggest you see an ear, nose, and throat (ENT) specialist.

10+ points—Strongly recommend you see an ear, nose, and throat (ENT) specialist.

I have a problem hearing over the telephone.
Almost always
Half the time
Occasionally
Never

I have trouble following the conversation when two or more people are talking at the same time.
Almost always
Half the time
Occasionally
Never

People complain that I turn the TV volume too high.
Almost always
Half the time
Occasionally
Never

I have to strain to understand conversations.
Almost always
Half the time
Occasionally
Never

I miss hearing some common sounds like the phone or doorbell ring.
Almost always
Half the time
Occasionally
Never

I have trouble hearing conversations in a noisy background, such as a party.
Almost always
Half the time
Occasionally
Never

I get confused about where sounds come from.
Almost always
Half the time
Occasionally
Never

I misunderstand some words in a sentence and need to ask people to repeat themselves.
Almost always
Half the time
Occasionally
Never

I especially have trouble understanding the speech of women and children.
Almost always
Half the time
Occasionally
Never

I have worked in noisy environments (such as assembly lines, contstruction sites, or near jet engines).
Almost always
Half the time
Occasionally
Never

Many people I talk to seem to mumble, or don't speak clearly.
Almost always
Half the time
Occasionally
Never

People get annoyed because I misunderstand what they say.
Almost always
Half the time
Occasionally
Never

I misunderstand what others are saying and make inappropriate responses.
Almost always
Half the time
Occasionally
Never

I avoid social activities because I cannot hear well and fear I'll make improper replies.
Almost always
Half the time
Occasionally
Never

Ask a family member or friend to answer this question: Do you think this person has a hearing loss?
Almost always
Half the time
Occasionally
Never

What can I do to improve my hearing?

  • Eliminate or lower unnecessary noises around you.
  • Let friends and family know about your hearing loss and ask them to speak slowly and more clearly.
  • Ask people to face you when they are speaking to you, so you can watch their faces and see their expressions.
  • Utilize sound amplifying devices on phones.
  • Use personal listening systems to reduce background noise.

Tips to maintain hearing health

  • If you work in noisy places or commute to work in noisy traffic or construction, choose quiet leisure activities instead of noisy ones.
  • Develop the habit of wearing earplugs when you know you will be exposed to noise for a long time.
  • Earplugs quiet about 25 dB of sound and can mean the difference between a dangerous and a safe level of noise.
  • Try not to use several noisy machines at the same time.

Try to keep television sets, stereos and headsets low in volume.

If your newborn child:

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

he or she may have some degree of hearing loss.

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

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

However, some children have sensorineural hearing loss (sometimes called nerve deafness), which is permanent. Most of these children have some usable hearing, and children as young as three months of age can be fitted with hearing aids. Early diagnosis, early fitting of hearing or other prosthetic aids, and an early start on special education programs can help maximize a child's existing hearing. This means your child will get a head start on speech and language development.

Insight into behavioral benchmarks, risk indicators, and hearing tests

  • Checklist for determining hearing loss
  • Hearing tests: How, when, and why
  • What you should do
  • and more...

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

Indicators for hearing loss

During pregnancy

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

Newborn (birth to 28 days of age)

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

Family

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

Infant (29 days to 2 years)

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

Response to the environment

(speech and language development)

Newborn (Birth to 6 Months)

  • Does not startle, move, cry or react in any way to unexpected loud noises.
  • Does not awaken to loud noises.
  • Does not freely imitate sound.
  • Cannot be soothed by voice alone.
  • Does not turn his/her head in the direction of your voice.
  • Does not point to familiar persons or objects when asked.
  • Does not babble, or babbling has stopped.
  • By 12 months does not understand simple phrases by listening alone, such as "wave bye-bye," or "clap hands."

Infant (3 months to 2 years)

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

Hearing tests: How, when, and why

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

Tests for newborns and infants under one year

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

Newborns are tested with either the otoacoustic emissions (OAE) test or the automated auditory brainstem response (AABR) test. During the OAE test, a microphone is placed in the baby's ear. It sends soft clicking sounds, and a computer then records the inner ear's response to the sounds. In the AABR test the child must wear earphones. Sensors are placed on his/her head to measure brain wave activity in response to the sound.

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

Tests for older children and adults

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

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

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

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

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

What you should do

If you have checked one or more of these indicators, your child might have hearing loss and you should take him or her for an ear examination and a hearing test. This can be done at any age, as early as just after birth.

If you did not check any of these factors but you suspect that your child is not hearing normally, even if your child's doctor is not concerned, have your child's hearing tested by an audiologist and when appropriate, have his or her speech evaluated by a speech and language pathologist. The test will not hurt your child.

Unprotected exposure to sounds above 85 decibels for a prolonged period of time can lead to hearing loss. Use the scale below to help determine the approximate decibel levels of sounds around you.

NOTE: Loading time for the Interactive Loudness Scale may vary depending upon your Internet connection speed.

Insight into maintaining auditory health

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

One in 10 Americans has a hearing loss that affects his or her ability to understand normal speech. Age-related hearing loss is the most common cause of this condition and is more prevalent than hearing loss caused by excessive noise exposure. However, exposure to excessive noise can damage hearing, and it is important to understand the effects of this kind of noise, particularly because such exposure is avoidable.

What causes hearing loss?

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

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

How can I tell if a noise is dangerous?

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

Can noise affect more than my hearing?

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

How can I protect myself against noise?

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

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

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

Earplugs and earmuffs can be found at most pharmacies.

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

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

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

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

How can I tell if my hearing is damaged?

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

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

Sound Measurements

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

Approximate examples of decibel levels:

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

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

Insight into ear injuries

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

A hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear, is called a perforated eardrum. The medical term for eardrum is tympanic membrane. The middle ear is connected to the nose by the eustachian tube, which equalizes pressure in the middle ear.

A perforated eardrum is often accompanied by decreased hearing and occasional discharge. Pain is usually not persistent.

What causes eardrum perforation?

The causes of a perforated eardrum are usually from trauma or infection. A perforated eardrum from trauma can occur:

  • If the ear is struck directly
  • With a skull fracture
  • After a sudden explosion
  • If an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the ear canal
  • As a result of acid or hot slag (from welding) entering the ear canal

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

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

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

How is hearing affected by a perforated eardrum?

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

If the perforated eardrum is caused by a sudden traumatic or explosive event, the loss of hearing can be great and tinnitus (ringing in the ear) may be severe. In this case, hearing usually returns partially, and the ringing diminishes in a few days. Chronic infection as a result of the perforation can cause persistent or progressive hearing loss.

How is a perforated eardrum treated?

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

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

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

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

Insight into acute otitis externa

  • What causes swimmer's ear?
  • What are the signs and symptoms?
  • cHow is swimmer's ear treated?
  • and more...

Affecting the outer ear, swimmer's ear is a condition causing pain resulting from inflammation, irritation, or infection. These symptoms are experienced when water gets trapped in your ear allowing bacteria to spread, causing a painful sensation. Because this condition commonly affects swimmers it is known as swimmer's ear. Swimmer's ear affects mostly 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.

What causes swimmer's ear?

A common source of the infection is increased moisture trapped in the ear canal, bathing, or showering, increased humidity or living in warm moist climates may also contribute to this common infection. When water is trapped in the ear canal, bacteria that normally inhabit the skin and ear canal multiply, causing infection and irritation of the ear canal. If the infection gets worse it may affect other areas of the ear. Swimmer's ear needs to be treated to reduce pain and eliminate any effect it may have on your hearing.

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

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

What are the signs and symptoms?

The most common symptoms of swimmer's ear are an itchy ear and mild to moderate pain that gets worse when you tug on the auricle (outer ear). Other signs and symptoms may include any of the following:

  • sensation that the ear is blocked or full
  • drainage
  • fever
  • decreased hearing
  • intense pain that may radiate to the neck, face, or side of the head
  • the auricle may appear to be pushed forward or away from the skull
  • swollen lymph nodes (located in your neck)
  • redness and swelling of the skin around the ear

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

  • Hearing loss. When the infection clears up, hearing usually returns to its normal state.
  • Recurring ear infections (chronic otitis externa). Without treatment, infection can occur.
  • Bone and cartilage damage (malignant otitis externa). When ear infections spread to the base of your skull, brain, or cranial nerves they become painful and dangerous. Diabetics and older adults are more at risk.

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

How is swimmer's ear treated?

Treatment for the early stages of swimmer's ear includes careful cleaning of the ear canal and eardrops that inhibit bacterial growth. Mild acid solutions such as boric or acetic acid are effective for early infections.

How should ear drops be applied?

  • Drops are more easily administered if done by someone other than the patient.
  • The patient should lie down with the affected ear facing upwards.
  • Drops should be placed in the ear until the ear is full.
  • After drops are administered, the patient should remain lying down for a few minutes so that the drops can be absorbed.
  • Cotton balls should not be placed in the ear. The ear needs to absorb the drops and dry naturally.

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

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

Follow-up appointments are very important to monitor progress of the infection, to repeat ear cleaning, and to replace the ear wick as needed. Your otolaryngologist has specialized equipment and expertise to effectively clean the ear canal and treat swimmer's ear. With proper treatment, most infections should heal in 7-10 days.

Why do ears itch?

An itchy ear can be a maddening symptom. Sometimes it is caused by a fungus or allergy, but more often it is from chronic dermatitis (skin inflammation) of the ear canal. One type is seborrheic dermatitis, a condition similar to dandruff in the scalp; the skin is dry, flaky, thickened, and inflammed (irritated). This may be aggravated by certain food groups. Some patients with this problem will do well to decrease their intake of foods that aggravate it, such as greasy foods, carbohydrates (sugar and starches), and chocolate.

An otolaryngologist, a physician who specializes in the structures of the head and neck, also treats allergies. They often prescribe a steroid-containing eardrop, cream or ointment to treat the problem and to be used as needed when the ears itch. There is no long-term cure, but it can be kept controlled.

Tips for prevention

A dry ear is unlikely to become infected, so it is important to keep the ears free of moisture during swimming or bathing.

Do:

  • use ear plugs when swimming
  • use a dry towel or hair dryer to dry your ears
  • have your ears cleaned periodically by an otolaryngologist if you have itchy, flaky or scaly ears, or extensive earwax

Don't:

  • use cotton swabs. They may pack ear wax and dirt deeper into the ear canal, remove the layer of earwax that protects your ear, and irritate the thin skin of the ear canal creating the perfect environment for infection.

Insight into causes and treatments for tinnitus

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

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

What causes tinnitus?

Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. The health of these nerve endings is important for acute hearing, and injury to them brings on hearing loss and often tinnitus. If you are older, advancing age is generally accompanied by a certain amount of hearing nerve impairment and tinnitus. If you are younger, exposure to loud noise is probably the leading cause of tinnitus, and often damages hearing as well.

There are many causes for "subjective tinnitus," the noise only you can hear. Some causes are not serious (a small plug of wax in the ear canal might cause temporary tinnitus). Tinnitus can also be a symptom of stiffening of the middle ear bones (otosclerosis).

Tinnitus may also be caused by allergy, high or low blood pressure (blood circulation problems), a tumor, diabetes, thyroid problems, injury to the head or neck, and a variety of other causes including medications such as anti-inflammatories, antibiotics, sedatives, antidepressants, and aspirin. If you take aspirin and your ears ring, talk to your doctor about dosage in relation to your size.

Treatment will be quite different in each case of tinnitus. It is important to see an otolaryngologist to investigate the cause of your tinnitus so that the best treatment can be determined.

How is tinnitus treated?

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. But, this determination may require extensive testing including X-rays, balance tests, and laboratory work. However, most causes cannot be identified. Occasionally, medicine may help the noise. The medications used are varied, and several may be tried to see if they help.

What are some other tinnitus treatment options?

  • Alternative treatments
  • Amplification (hearing aids)
  • Cochlear implants or electrical stimulation
  • Cognitive therapy
  • Drug therapy
  • Sound therapy
  • TMJ treatment

Can other people hear the noise in my ears?

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

Can children be at risk for tinnitus?

Yes, children are at risk too. However, it is not a common complaint. Like people of all ages, children who are exposed to loud noises are at a higher risk for tinnitus. High-decibel recreational events, like car races, music concerts, or sports games, can damage children's ears. Hearing protection devices should always be worn.

Tips to lessen the severity of tinnitus

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

What can help me cope?

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

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

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

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

Insight for hearing-impaired travelers

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

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

What are common problems?

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

What arrangements can be made?

  • Try to make all travel arrangements in advance. Once transportation arrangements have been made, request written confirmation to ensure that information is correct. Always inform the ticket representative that you are hearing-impaired.
  • If possible, meet with a travel agent to allow the opportunity for lip reading, or if necessary, written exchange to help confirm travel plans. Agents can contact airlines, hotels, and attractions to make necessary reservations.
  • Travel information and reservation services are also available on the internet. Be sure to print copies of important information such as confirmation numbers, reservations, maps, etc.
  • It is important to arrive early at the airport, bus terminal, or train station. Tell the agent at the boarding gate that you are hearing-impaired and need to be notified in person when it's time to board.
  • Confirm the flight number and destination before boarding.
  • Inform the flight attendant that you are hearing-impaired and request that any in-flight announcements be communicated to you in person.

In order to assist individuals who require the use of a Telecommunications Device for the Deaf (TDD), many major airlines and transportation companies have TDD service. Current technology with hand-held personal communication devices provides the ability to send and receive text messages without the need to access public resources.

Is telephone assistance available?

All public telephones should now have a "blue grommet" attachment to the handset indicating it is compatible with the "T" switch in hearing aids. Some public phones have an amplifying headset. Or you may purchase a pocket amplifier from your audiologist or hearing aid dispenser. Cellular phones have solved many of these problems. All manufacturers have models that are also compatible with your hearing aid. You can search the internet by typing in "HAC (hearing aid compatible) phones" to get more information.

What other devices are helpful?

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

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

How should hearing aids be handled when traveling?

If you wear a hearing aid, be sure to pack extra batteries and tubing. These may be difficult to obtain in some places. It would be wise to take a dehumidifier for drying your hearing aids each night to prevent moisture problems, especially if your destination has a warm, humid climate.

There are many things that hearing-impaired people can do to help make their travels safe, comfortable, and enjoyable. Travel does not have to be avoided because of hearing loss. So plan ahead, inform your fellow travelers, transportation hosts, and hotel clerks that you are hearing-impaired, obtain any necessary devices—and enjoy yourself!

Lodging

  • Carry printed copies of lodging reservations, dates, and prices.
  • Inform the receptionist at the front desk that you are hearing-impaired. This is very important in case of emergency.
  • Certain major hotel chains now provide visual alerting devices to help the hearing impaired traveler recognize the ring of the telephone, a knock on the door, or a fire/emergency alarm. It may be advisable, however, to contact the motel in advance to make the necessary arrangements. Services to help in such situations are available. Request a room that is equipped for an individual with hearing loss. When you make a reservation and register at the hotel, confirm that such equipment is available. These communication features are frequently provided free of charge to hotel guests.

Inquire what resources are available for using the internet and e-mail. Does the hotel provide wireless or wired access to the internet? Do you need to bring your own laptop? Is there a business office you can use for these purposes?

Study on pathological growths in the ear.

  • A. Why causes a cholesteatoma? B. How is a cholesteatoma? C. Symptoms and risks D. And more ...

And more ...

An abnormal growth of skin in the middle ear behind the eardrum is a cholesteatoma. Repeated infections and / or a bag of tympanic membrane retraction can cause the skin to thicken and form a sac expansion. Cholesteatomas usually develop as cysts or pouches that shed layers of old skin that grows inside the middle ear. Over time, the cholesteatoma can increase in size and destroy the middle ear ossicles neighbors. Hearing loss, dizziness, and facial muscle paralysis are rare but may be the result of continued cholesteatoma growth.

Hearing loss, dizziness, and facial muscle paralysis are rare but may be the result of continued cholesteatoma growth. Why causes a cholesteatoma?

A cholesteatoma usually arises due to poor function of the Eustachian tube as well as middle ear infection. The eustachian tube leads air from the back of the nose into the middle ear to equalize ear pressure ("popping ears"). When the eustachian tubes work poorly, perhaps due to an allergic cause, a cold or sinusitis, the air in the middle ear is absorbed by the body, creating a partial vacuum in the ear. This vacuum sucks a sac formed from the tympanic membrane, especially in areas weakened by previous infection. This bag can develop and become a cholesteatoma. A rare congenital form of cholesteatoma (present at birth) may occur in the middle ear and elsewhere, as in the proximity of the skull bones. However, the type of cholesteatoma associated with ear infections is the most common.

How is a cholesteatoma?

An examination by an otolaryngologist-head and neck surgeon can confirm the presence of a cholesteatoma. Initial treatment consists of a thorough cleaning of the ear, antibiotics and ear drops. Therapy tends to stop the discharge from the ear by controlling the infection. The growth characteristics of cholesteatoma should also be evaluated.

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

The surgery is performed under general anesthesia in most cases. The primary objective is to remove the cholesteatoma surgery to drain the ear and the infection is eliminated. The preservation or restoration of hearing is the second goal of the surgery. In cases of severe ear destruction, reconstruction may not be possible. The facial nerve repair or procedures to control dizziness are rarely necessary. The reconstruction of the middle ear is not always possible in a single surgical time, so a second surgery may be required within 6 to 12 months. This second operation will attempt to restore hearing and at the same time, allow the surgeon to inspect the middle ear space and mastoid cholesteatoma looking for residual parts.

Surgery can sometimes be done on an outpatient basis. For some patients an overnight stay is necessary. In some rare cases of serious infection will require a prolonged hospitalization for antibiotic treatment. The common employment leave time is one to two weeks.

After surgery, the office monitoring is necessary to evaluate results and to evaluate a possible recurrence. In cases where it has created an open cavity mastioidectomia, monitoring every few months in office is required to clean the mastoid cavity and prevent new infections. Some patients will need regular reviews of your ear throughout his life. Cholesteatoma is a serious condition but treatable ear that can be diagnosed only with a medical examination. Pain in the ear drainage, ear pressure, hearing loss, dizziness or weakness of the muscles of the face should be evaluated by an otolaryngologist.

Symptoms and risks

Initially, the ear can fester with ugly smell. As the cholesteatoma pouch or sac enlarges it can cause a sensation of pressure or full hearing, accompanied by hearing loss. An ache behind or inside the ear, especially at night can cause considerable discomfort.

Dizziness or weakness in the muscles of one half of the face (half the side of the infected ear) can also occur. Any of these symptoms are good reasons to seek medical evaluation.

Cholesteatoma can be dangerous and should never be ignored. Bone erosion can cause the infection to spread to neighboring areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis and rarely death may occur.

What is otitis media and ear infection?

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

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

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

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

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

How does otitis media affect hearing?

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

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

Types of hearing loss

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

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

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

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

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

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

Study of hearing damage

  • a.What is a perforated eardrum?
  • b. What is the cause of perforated eardrum?
  • c. How is hearing affected affected by a perforated eardrum?
  • d.Y more ...

A hole or tear in the eardrum, a thin membrane that separates the ear canal and middle ear is called a perforated eardrum. The middle ear is connected to the nose by the Eustachian tube, which equalizes pressure in the middle ear.
A perforated eardrum is often accompanied by a decrease in hearing and eventual discharge. The pain is usually not persistent.

What is the cause of the perforation?

The causes of perforated eardrum are usually from trauma or infection. Trauma perforation can occur:

  • a. If the ear is injured directly
  • b. With a skull fracture
  • c. After a sudden explosion
  • d. If an object (like hyssop stick) is pushed deep inside the ear canal.
  • e. As a result of acid or boiling water entering the ear canal.

Middle ear infections can cause pain, hearing loss and spontaneous rupture of the tympanic membrane, resulting in a perforation. In this case there may be infected or bloody drainage in the ear. The medical term for this is otitis media with perforation. Symptoms of otitis media include ear full feeling, hearing impaired, pain and fever.

On rare occasions a small hole in the membrane may persist after the placement of a ventilation tube falls out or is removed by the doctor.

Most perforations heal on their own within weeks, although some may take several months to heal. During this process the ear must be protected from water and trauma. The holes do not heal on their own require surgery.

How is hearing affected by a perforated eardrum?

Usually the size of the perforation determines the level of hearing loss - a larger hole will cause a greater loss than a smaller one. The site of the perforation also affects the degree of hearing loss. If severe trauma (eg skull fracture) dislocates the middle ear bones that transmit sound or hurt the inner ear structures, hearing loss can be severe.
If the perforation is caused by a sudden traumatic event or explosion, hearing loss can be significant and tinnitus (ringing in the ear) to be relevant. In this case, the hearing usually returns partially, and the ringing diminishes in a few days. Chronic infection as a result of the perforation can cause a persistent hearing loss or progressive.

How is a perforated eardrum?

Before the correction of the perforation should undergo a hearing test. The benefits of closing a perforation include prevention of water entering the ear while showering, bathing or swimming (which can cause ear infections), improve hearing and reduce tinnitus. You can also prevent the development of cholesteatoma (skin cyst in the middle ear) can cause chronic infection and destruction of ear structures.

If the perforation is very small, an otolaryngologist may elect to keep track of the perforation over time to see if it closes spontaneously. You can try to close the hole in the office. Working with a microscope, the doctor touches the edges of the eardrum with a chemical to stimulate growth and then place a thin paper patch on the eardrum. Usually when you close the perforation hearing improvement. Many applications of this patch (up to three or four) may be needed before the perforation closes completely. If the doctor thinks this paper patch will not lead to adequate closure of the perforation or do not have good results will require surgery.

There are different surgical techniques, but most involve grafting skin tissue through the perforation to allow healing. The name of this procedure is tympanoplasty. The surgery is very successful in repairing the hole, restoring or improving hearing and is usually performed as an outpatient.

Your doctor will advise on appropriate management of a perforated eardrum.

What is otosclerosis?

The term derives from the Greek sclero-otosclerosis (hard) and oto (ear). Describe the condition of an abnormal growth in the small bones of the middle ear leading to the fixation of the stapes. The stapes bone must move freely for the ear to work properly and can be heard properly.

Hearing is a complex process. In a normal ear sound vibrations are conducted through the outer ear into the ear canal where they hit the eardrum. These vibrations cause movement of the membrane that transfers it to the three tiny middle ear bones, the hammer, anvil and stirrup. When the stapes bone moves set in motion the fluid in the inner ear that begins the process of stimulating the auditory nerve. This nerve carries the sound energy to the brain resulting in the interpretation of the sound heard. When any part of this process is compromised hearing is impaired.

Who suffers from Otosclerosis and why?

It is estimated that ten percent of the adult population is affected by otosclerosis Caucasians. The disease is less common in Asians and is rare in African Americans. The middle-aged women are most at risk.

The prominent symptoms of otosclerosis, slow progression of hearing loss can begin anytime between the ages of 15 and 45 years but usually begins in early 20.

This disease can develop in both men and women, but is particularly problematic in pregnant women who, for unknown reasons, have a rapid decline in hearing ability.

Approximately 60 percent of cases of otosclerosis are genetic. On average a person who has one parent with otosclerosis has a 25 percent chance of developing this condition. If both parents have otosclerosis the risk increases to 50 percent.

Symptoms of Otosclerosis.

The gradual loss of hearing is the most frequent symptom of otosclerosis. Often individuals with otosclerosis first notice they can not hear low frequency sounds or whispers. Other symptoms of this disorder may include dizziness, impaired balance or sensation of ringing or roaring in the ears known as tinnitus.

How is otosclerosis diagnosed?

 

Because many of the typical symptoms of otosclerosis can be caused by other diseases, it is important to be examined by an otolaryngologist to rule out other possible causes of these symptoms. After a hearing test, the otolaryngologist may order a hearing test. Based on the results of this examination, the otolaryngologist will suggest treatment options.

Treatment of Otosclerosis

If hearing loss is mild, the otolaryngologist may suggest continued observation and a hearing aid to amplify the sound reaching the eardrum. Sodium fluoride slows the progression of the disease and may be prescribed. In most cases of otosclerosis a surgical procedure called stapedectomy is the most effective method to restore and improve hearing.

What is stapedectomy?

A stapedectomy is an outpatient surgical procedure done under local or general anesthesia through the ear canal under a microscope (no external incisions). Includes the removal of the stirrup fixed and replaced by a prosthesis. This prosthesis allows the middle ear bones to regain movement that stimulates fluid in the middle ear and restores hearing improvement.

The modern stapedectomies have been made since 1956 with a success rate of 90 percent. In some rare cases (about 1 per cent) the procedure may worsen hearing.

Otosclerosis affects both ears in eight out of ten patients. For these patients are operated on one ear at a time. The worst audition first.

What to expect after a stapedectomy?

Most patients go home the day after surgery and are advised to rest quietly on the operated ear. Prescribed oral antibiotics. Some patients experience dizziness the first few days after surgery. The sense of taste can be altered for a few weeks or months after surgery but usually returns to normal.

After surgery, patients should avoid blowing your nose hard, swimming or other activities that bring water to the operated ear. Normal activities (including air travel) are generally taken over two weeks after surgery.

The otolaryngologist should be advised immediately if any of the following:

  • A. Sudden loss of hearing
  • B. Severe pain
  • C. Prolonged or severe dizziness
  • D. Any new symptoms related to the operated ear

 

Since the dressing is placed in the ear at the time of surgery, hearing improvement will not be noticed until it is removed about a week later. The eardrum will heal quickly reaching the maximum level of improvement within two weeks.

 

Why early detection of hearing loss is important for your child?

Approximately two to four of every 1000 children in the United States are born deaf or hard of hearing, making hearing loss the most common abnormality at birth. Many studies have shown that early diagnosis of hearing loss is crucial for language development, cognitive and psychosocial skills.

Treatment is most successful if hearing loss is identified early, preferably during the first month of life. Still one in four children born with severe hearing loss are not diagnosed until the age of three years or more.

When should assess a child's hearing?

The first opportunity to assess a child's hearing is in the hospital just born. If the child's hearing is not evaluated before you leave the hospital assessment is recommended during the first month of life. If tests indicate a possible hearing loss should seek further evaluation as soon as possible, preferably between the first and six months.

Is it mandatory assessment of hearing loss?

In recent years, health organizations, including the American Academy of Otolaryngology have worked to emphasize the importance of early screening or screening all newborns for hearing loss. These efforts have paid off. In 2003 over 85 percent of all newborns in the United States were evaluated looking for hearing loss. In fact, almost all states have made laws requiring some form of evaluation of newborn infants before leaving the hospital. This still leaves more than a million babies are not screened for hearing loss before leaving the hospital.

How is the assessment?

Two tests are used to evaluate hearing loss in children and newborns. They are:

  • A. Otoacoustic emissions (OAE), which involves placing a sponge earphone in the ear canal to measure if the ear respond properly to sound. In children with normal hearing, a measurable echo occurs when sound is emitted through the headset. If no echo is measured may indicate hearing loss.
  • B. Stem evoked potentials (ABR) is a more complex. Headphones are placed in the ears and electrodes are placed on the head and ears. The sound is delivered through the earphones while the electrodes measured as the child's brain responds to sound.

If any of the tests indicate a potential hearing loss, your doctor will suggest a monitoring and evaluation by an otolaryngologist.

Signs of hearing loss in children

Hearing loss can occur in late childhood, after the infant left the hospital. In these cases, parents, grandparents and others caring for the child that are often the first to notice that something happens to that child's hearing. Even if their hearing was tested at the time of birth should continue to be alert to signs of hearing loss such as:

  • A. Not react in any way against unexpected loud sounds.
  • B. Not waking up in front of loud noises
  • C. Do not turn your head in the direction of the voice that speaks to you.
  • D. It is able to follow or understand instructions
  • E. Poor language development
  • F. Speaks or does not use strong language skills appropriate for their age.

If your child shows any of these signs should tell the doctor

What if my child has hearing loss?

Hearing loss in children may be transient or permanent. It is important that hearing loss be evaluated by a doctor who can inquire about problems that may cause the hearing loss, such as otitis media (ear infection), excessive formation of ear wax, birth defects or genetic hearing loss.

If it is determined that hearing loss is permanent, hearing aids may be necessary to amplify the sound reaching the ear of the child. Ear surgery can help to restore or significantly improve hearing in some cases. For those with profound hearing loss who do not benefit enough with hearing aids may be considered a cochlear implant. Unlike hearing aids, the cochlear implant avoids damaged parts of the auditory system and directly stimulates the nerve allowing the child to hear sounds louder and clearer.

You must decide if your child is sent as primary sign or spoken language and to seek early intervention to prevent language delays. Studies indicate that the rehabilitation of hearing loss at the age of six months consistent prevent language delays. Other communication strategies such as verbal hearing therapy, lip reading and sign language can also be used in conjunction with therapy, hearing aids or cochlear implants or independently.

Conditions that impair ear function can be as minor as wax buildup or as serious as congenital deafness. This section contains valuable information about how to protect your hearing, how to recognize indications of hearing disorders, and what ENT-head and neck physicians can do to evaluate and treat these problems.

 

From ear wax to cochlear implants. Learn more about the wide range of hearing-related topics, below.

 

Insight into normal milestones, risk indicators, and hearing tests

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

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

Which children may be at risk for hearing loss?

During pregnancy

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

Newborn (birth to 28 days of age)

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

Infant (29 days to 2 years)

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

Family

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

What are behavioral signs of hearing loss?

Newborn (birth to 6 months)

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

Young infant (6 months to 12 months)

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

Infant (3 months to 2 years)

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

How, when, and why should hearing be tested?

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

Tests for newborns and infants under one year

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

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

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

Tests for older children and adults

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

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

Some causes of hearing loss

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

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

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

Steps to take

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

Feeling unsteady or dizzy can be caused by many factors such as poor circulation, inner ear disease, medication usage, injury, infection, allergies, and/or neurological disease. Dizziness is treatable, but it is important for your doctor to help you determine the cause so that the correct treatment is implemented. While each person will be affected differently, symptoms that warrant a visit to the doctor include a high fever, severe headache, convulsions, ongoing vomiting, chest pain, heart palpitations, shortness of breath, inability to move an arm or leg, a change in vision or speech, or hearing loss.

What is dizziness?

Dizziness can be described in many ways, such as feeling lightheaded, unsteady, giddy, or feeling a floating sensation. Vertigo is a specific type of dizziness experienced as an illusion of movement of one’s self or the environment. Some experience dizziness in the form of motion sickness, a nauseating feeling brought on by the motion of riding in an airplane, a roller coaster, or a boat. Dizziness, vertigo, and motion sickness all relate to the sense of balance and equilibrium. Your sense of balance is maintained by a complex interaction of the following parts of the nervous system:

  • - The inner ear (also called the labyrinth), which monitors the directions of motion, such as turning, rolling, forward-backward, side-to-side, and up-and-down motions.
  • - The eyes, which monitor where the body is in space (i.e., upside down, right side up, etc.) and also directions of motion.
  • - The pressure receptors in the joints of the lower extremities and the spine, which tell what part of the body is down and touching the ground.
  • - The muscle and joint sensory receptors (also called proprioception) tell what parts of the body are moving.
  • - The central nervous system (the brain and spinal cord), which processes all the information from the four other systems to maintain balance and equilibrium.

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

What causes dizziness?

Circulation: If your brain does not get enough blood flow, you feel lightheaded. Almost everyone has experienced this on occasion when standing up quickly from a lying-down position. But some people have light-headedness from poor circulation on a frequent or chronic basis. This could be caused by arteriosclerosis or hardening of the arteries, and it is commonly seen in patients who have high blood pressure, diabetes, or high levels of blood fats (cholesterol). It is sometimes seen in patients with inadequate cardiac (heart) function, hypoglycemia (low blood sugar), or anemia (low iron).

Certain drugs also decrease the blood flow to the brain, especially stimulants such as nicotine and caffeine. Excess salt in the diet also leads to poor circulation. Sometimes circulation is impaired by spasms in the arteries caused by emotional stress, anxiety, and tension.

If the inner ear fails to receive enough blood flow, the more specific type of dizziness—vertigo—occurs. The inner ear is very sensitive to minor alterations of blood flow and all of the causes mentioned for poor circulation to the brain also apply specifically to the inner ear.

Neurological diseases: A number of diseases of the nerves can affect balance, such as multiple sclerosis, syphilis, tumors, etc. These are uncommon causes, but your doctor may perform certain tests to evaluate these.

Anxiety: Anxiety can be a cause of dizziness and lightheadedness. Unconscious overbreathing (hyperventilation) can be experienced as overt panic, or just mild dizziness with tingling in the hands, feet, or face. Instruction on correct breathing technique may be required.

Vertigo: An unpleasant sensation of the world rotating, usually associated with nausea and vomiting. Vertigo usually is due to an issue with the inner ear. The common causes of vertigo are (in order):

  • - Benign Positional Vertigo: Vertigo is experienced after a change in head position such as lying down, turning in bed, looking up, or stooping. It lasts about 30 seconds and ceases when the head is still. It is due to a dislodged otololith crystal entering one of the semicircular balance canals. It can last for days, weeks, or months. The Epley "repositioning" treatment by an otolaryngologist is usually curative. BPV is the commonest cause of dizziness after (even a mild) head injury.
  • - Meniere's disease: An inner ear disorder with attacks of vertigo (lasting hours), nausea, or vomiting, and tinnitus (loud noise) in the ear, which often feels blocked or full. There is usually a decrease in hearing as well.
  • - Migraine: Some individuals with a prior classical migraine headache history can experience vertigo attacks similar to Meniere's disease. Usually there is an accompanying headache, but can also occur without the headache.
  • - Infection: Viruses can attack the inner ear, but usually its nerve connections to the brain, causing acute vertigo (lasting days) without hearing loss (termed vestibular neuronitis). However, a bacterial infection such as mastoiditis that extends into the inner ear can completely destroy both the hearing and equilibrium function of that ear, called labyrinthitis.
  • - Injury: A skull fracture that damages the inner ear produces a profound and incapacitating vertigo with nausea and hearing loss. The dizziness will last for several weeks and slowly improve as the other (normal) side takes over. BPV commonly occurs after head injury.
  • - Allergy: Some people experience dizziness and/or vertigo attacks when they are exposed to foods or airborne particles (such as dust, molds, pollens, dander, etc.) to which they are allergic.

When should I seek medical attention?

Call 911 or go to an emergency room if you experience:

  • - Dizziness after a head injury,
  • - fever over 101°F, headache, or very stiff neck,
  • - convulsions or ongoing vomiting,
  • - chest pain, heart palpitations, shortness of breath, weakness, a severe headache, inability to move an arm or leg, change in vision or speech, or
  • - fainting and/or loss of consciousness

Consult your doctor if you:

  • - have never experienced dizziness before,
  • - experience a difference in symptoms you have had in the past,
  • - suspect that medication is causing your symptoms, or
  • - experience hearing loss.

How will my dizziness be treated?

The 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. Some routine tests will be performed to check your blood pressure, nerve and balance function, and hearing. Possible additional tests may include a CT or MRI scan of your head, special tests of eye motion after warm or cold water or air is used to stimulate the inner ear (ENG—electronystagmography or VNG—videonystagmography), and in some cases, blood tests or a cardiology (heart) evaluation. Balance testing may also include rotational chair testing and posturography. Your doctor will determine the best treatment based on your symptoms and the cause of them. Treatments may include medications and balance exercises.

Prevention tips

  • - Avoid rapid changes in position
  • - Avoid rapid head motion (especially turning or twisting)
  • - Eliminate or decrease use of products that impair circulation, e.g., tobacco, alcohol, caffeine, and salt
  • - Minimize stress and avoid substances to which you are allergic
  • - Get enough fluids
  • - Treat infections, including ear infections, colds, flu, sinus congestion, and other respiratory infections

If you are subject to motion sickness:

  • - Do not read while traveling
  • - Avoid sitting in the rear seat
  • - Do not sit in a seat facing backward
  • - Do not watch or talk to another traveler who is having motion sickness
  • - Avoid strong odors and spicy or greasy foods immediately before and during your travel
  • - Talk to your doctor about medications

Remember: Most cases of dizziness and motion sickness are mild and self-treatable. But severe cases and those that become progressively worse deserve the attention of a doctor with specialized skills in diseases of the ear, nose, throat, equilibrium, and neurological systems.

What is Ménière’s disease?

Ménière’s disease describes a set of episodic symptoms including vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. Episodes typically last from 20 minutes up to 4 hours. Hearing loss is often intermittent, occurring mainly at the time of the attacks of vertigo. Loud sounds may seem distorted and cause discomfort. Usually, the hearing loss involves mainly the lower pitches, but over time this often affects tones of all pitches. After months or years of the disease, hearing loss often becomes permanent. Tinnitus and fullness of the ear may come and go with changes in hearing, occur during or just before attacks, or be constant.

Ménière’s disease is also called idiopathic endolymphatic hydrops and is one of the most common causes of dizziness originating in the inner ear. In most cases only one ear is involved, but both ears may be affected in about 15 percent of patients. Ménière’s disease typically starts between the ages of 20 and 50 years. Men and women are affected in equal numbers. Because Ménière’s disease affects each person differently, your doctor will suggest strategies to help reduce your symptoms and will help you choose the treatment that is best for you.

What are the causes?

Although the cause is unknown, Meniere’s disease probably results from an abnormality in the volume of fluid in the inner ear. Too much fluid may accumulate either due to excess production or inadequate absorption. In some individuals, especially those with involvement of both ears, allergies or autoimmune disorders may play a role in producing Ménière’s disease. In some cases, other conditions may cause symptoms similar to those of Ménière’s disease.

People with Ménière’s disease have a “sick” inner ear and are more sensitive to factors, such as fatigue and stress, that may influence the frequency of attacks.

How is a diagnosis made?

Your physician will take a history of the frequency, duration, severity, and character of your attacks, the duration of hearing loss or whether it has been changing, and whether you have had tinnitus or fullness in either or both ears. When the history has been completed, diagnostic tests will check your hearing and balance functions. They may include:

For hearing

  • - An audiometric examination (hearing test) typically indicates a sensory type of hearing loss in the affected ear. Speech discrimination (the patient’s ability to distinguish between words like “sit” and “fit”) is often diminished in the affected ear.

For balance

  • - An ENG (electronystagmogram) may be performed to evaluate balance function. In a darkened room, eye movements are recorded as warm and cool water or air are gently introduced into each ear canal. Since the eyes and ears work in coordination through the nervous system, measurement of eye movements can be used to test the balance system. In about 50 percent of patients, the balance function is reduced in the affected ear.
  • - Rotational or balance platform testing, may also be performed to evaluate the balance system.

Other tests

  • - Electrocochleography (ECoG) may indicate increased inner ear fluid pressure in some cases of Ménière’s disease.
  • - The auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computed tomography (CT), or magnetic resonance imaging (MRI) may be needed to rule out a tumor occurring on the hearing and balance nerve. Such tumors are rare, but they can cause symptoms similar to Ménière’s disease.

What should I do during an attack of Ménière’s disease?

Lie flat and still and focus on an unmoving object. Often people fall asleep while lying down and feel better when they awaken.

How can I reduce the frequency of Ménière’s disease episodes?

Avoid stress and excess salt ingestion, caffeine, smoking, and alcohol. Get regular sleep and eat properly. Remain physically active, but avoid excessive fatigue. Consult your otolaryngologist about other treatment options.

How is Ménière’s disease treated?

Although there is no cure for Ménière’s disease, the attacks of vertigo can be controlled in nearly all cases. Treatment may include:

  • - A low salt diet and a diuretic (water pill)
  • - Anti-vertigo medications
  • - Intratympanic injection with either gentamicin or dexamethasone.
  • - An air pressure pulse generator
  • - Surgery

Your otolaryngologist will help you choose the treatment that is best for you, as each has advantages and drawbacks. In many people, careful control of salt in the diet and the use of diuretics can control symptoms satisfactorily.

Intratympanic injections involve injecting medication through the eardrum into the middle ear space where the ear bones reside. This treatment is done in the otolaryngologist’s office. The treatment includes either making a temporary opening in the eardrum or placing a tube in the eardrum. The drug may be administered once or several times. Medication injected may include gentamicin or corticosteroids. Gentamicin alleviates dizziness but also carries the possibility of increased hearing loss in the treated ear that may occur in some individuals. Corticosteroids do not cause worsening of hearing loss, but are less effective in alleviating the major dizzy spells.

An air pressure pulse generatoris another option. This device is a mechanical pump that is applied to the person’s ear canal for five minutes three times a day. A ventilating tube must be first inserted through the eardrum to allow the pressure produced by the air pressure pulse generator to be transmitted across the round window membrane and change the pressure in the inner ear. The success rate of this device has been variable.

When is surgery recommended?

Surgery is needed in only a small minority of patients with Meniere’s disease. If vertigo attacks are not controlled by conservative measures and are disabling, one of the following surgical procedures might be recommended:

  • - Endolymphatic sac shunt or decompression procedure relieves attacks of vertigo in one-half to two-thirds of cases and the sensation of ear fullness is often improved. Control is often temporary. Endolymphatic sac surgery does not improve hearing, but only has a small risk of worsening it. Recovery time after this procedure is short compared to the other procedures.
  • - Selective vestibular neurectomy is a procedure in which the balance nerve is cut as it leaves the inner ear and goes to the brain. While vertigo attacks are permanently cured in a high percentage of cases, patients may continue to experience imbalance. Similar to endolymphatic sac procedures, hearing function is usually preserved.
  • - Labryrinthectomy and eighth nerve section are procedures in which the balance and hearing mechanism in the inner ear are destroyed on one side. This is considered when the patient with Ménière’s disease has poor hearing in the affected ear. Labryrinthectomy and eighth nerve section result in the highest rates for control of vertigo attacks.