Disorders of the Ear
The auditory system enables us to hear and helps us maintain balance and body position. When something goes wrong in the auditory system, you can experience a wide variety of symptoms. Ear conditions affect people of all ages and can be either chronic or temporary.
At Santa Cruz Ear, Nose and Throat Medical Group, we have a diverse group of professionals with a variety of background and training ready to assist you with your hearing health.
How We Hear
Hearing begins with the outer ear (external auditory canal). When a sound is made outside, the sound waves, or vibrations, enter through the outer ear and travel to the eardrum (tympanic membrane). The eardrum vibrates and the vibrations are passed to three tiny bones in the middle ear called the ossicles (malleus, incus, stapes). The ossicles amplify the sound and transmit the sound waves to the inner ear and the fluid-filled hearing organ (cochlea).
When the sound waves reach the inner ear, they are converted into electrical impulses. The auditory nerve sends the signals to the brain where they are interpreted as sound and meaning. The inner ear is also responsible for maintaining balance.
Hyperacusis is a rare disorder that causes ordinary sounds that are otherwise normal to most people to sound intolerably loud, and sometimes painful. People who suffer from the disorder may even perceive normal environmental sounds to be too loud and uncomfortable enough to avoid these situations (e.g. car engines, dishes clanging, shuffling paper, or even loud conversation). Many people with hyperacusis have normal hearing.
Hyperacusis can develop suddenly or gradually, occur in one or both ears and is often accompanied by tinnitus (ringing or buzzing in the ear); it can be caused by a number of factors. The most common relates to damage to the cochlea from exposure to loud noises such as those found in certain work environments, rock concerts, gunfire and fireworks. Other causes may include, drugs, Bell’s palsy, Lyme disease, Meniere's disease, Temporomandibular Joint Syndrome (TMJ), head injury, Posttraumatic stress disorder, postoperative surgery, head trauma (e.g. airbag deployment in cars) or autism.
Treatment is based on the notion of desensitization, and increasing sound intensity (loudness) from a low level gradually over time. Depending on the cause, hyperacusis may also get better over time. Specifically, in cases of trauma to the brain or auditory system, there is a chance that the sensitivity to sounds will become more tolerable. In all cases, professional counseling with qualified individuals can be beneficial.
Otosclerosis is a condition that affects the malleus, incus and stapes bones of the middle ear. It is a common cause of hearing loss in young adults. The classic symptom of otosclerosis is slowly progressing hearing loss beginning between the ages of 15-45, but usually starts in the early 20s. In otosclerosis, the stapes begins to fuse with the surrounding bone, eventually becoming fixed so it cannot move. Sound waves can no longer be effectively transmitted into the inner ear.
Otosclerosis can develop in both women and men, but is particularly problematic for pregnant women who, for unknown reasons, sometimes experience a rapid decrease in hearing ability. Often, individuals with otosclerosis first notice that they cannot hear low-pitched or soft sounds. Other symptoms can include dizziness, balance problems, or tinnitus – a sensation of ringing, roaring, buzzing or hissing in the ears.
Otosclerosis can be treated with either a hearing aid or surgery. An operation called a stapedotomy to restore hearing may be an option. Under either general or local anesthesia, a cut is made inside the ear canal and the top portion of the stapes is removed. A small opening is made at the base of the stapes and a plastic or metal implant placed into the ear conducts sound from the remaining ossicles into the inner ear. This is a delicate procedure that is usually very successful – but as with any surgery, it carries a small risk of complications. If you have been diagnosed with otosclerosis, you should discuss the risks and benefits of both surgery and hearing aids with your surgeon.
Autoimmune inner ear disease (AIED)
AIED is a rare condition of progressive hearing loss or dizziness (less than one percent of all cases of sensorineural hearing loss or dizziness) caused by antibodies or immune cells inappropriately attacking the inner ear. It occurs when the body's immune system attacks the inner ear cells that are mistaken for a virus or bacteria. Until recently it was not thought that the inner ear could be attacked by the body’s own immune system.
Diagnosis can be difficult because AIED can mimic other disorders exhibiting sensorineural hearing loss. In most cases, a reduction of hearing is accompanied by tinnitus (ringing, buzzing, hissing) that occurs over weeks or months. Variations of the condition are attacks of bilateral hearing loss and tinnitus that resemble Meniere’s disease, and episodes of dizziness in addition to abnormal blood tests for antibodies. Approximately 50 percent of patients with AIED have symptoms related to balance (dizziness or unsteadiness).
Steroid responsiveness is the most useful approach for diagnosis; typically a bilateral progressive sensorineural hearing loss that responds to steroids confirms the diagnosis. The standard treatments for autoimmune manifestations are drugs that suppress immune function. Before treatment is begun, it is imperative to understand, and never ignore, the side effects of immunosuppressive drugs. With the proper precautions, treatment can be safe and the results can be remarkable.
Otitis media is an inflammation of the middle ear and may be caused by bacteria or virus. When the Eustachian tubes, which connect the middle ear to the nose, get blocked, mucus, pus and bacteria build up behind the tympanic membrane (eardrum), causing pressure and pain. When infection occurs, it is called acute otitis media (AOM).
When a discharge from the ear persists or repeatedly returns, it is known as chronic middle ear infection. Fluid can remain in the ear several weeks following the infection. If not treated, chronic ear infections can result in temporary or permanent hearing loss.
Although acute otitis media can occur at any age, it is most common in children between the of ages three months and three years. At this age, the angle of the Eustachian tube is more horizontal, rendering it structurally and functionally inefficient. Most cases of AOM improve without specific treatment. Cases that require treatment may be managed with antibiotics and analgesics.
If a patient has a bulging eardrum and is experiencing severe pain, a myringotomy (surgical incision of the eardrum) to release the fluid may be done. The eardrum usually heals within a week. Children who have recurring episodes of otitis media may have a tympanostomy tube (ear tube) surgically inserted in the eardrum to enable the fluid to drain from the middle ear and keep it aerated.
If you have questions or concerns regarding your ear health, one of our professionals is ready to help you find the right treatment!