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Otology and Neuro-otology (Hearing, Facial Nerve and Balance Disorders)

History of Otology and Neuro-otology at Mount Sinai | Hearing Loss | Cholesteatoma | Tinnitus | Balance Disorders (Dizziness and Vertigo) | Meniere's Disease

• Debra Fried, M.S., C.C.C.
• Eric E. Smouha, M.D.

History of Otology and Neuro-otology at Mount Sinai [top]

There is a rich history of otology and neuro-otology at Mount Sinai. Dr. Samuel Rosen was a pioneer in otology, particularly noted for stapes mobilization for otosclerosis during the early 1950s. Today, Mount Sinai provides treatment for a broad range of adult and pediatric otologic and neuro-otologic disorders. The multidisciplinary team of physicians and allied health care professionals include representation by experts in otology, neuro-otology, and cranial base surgery; neurosurgery, neurology; geriatric medicine; opthalmology; rehabilitative medicine; clinical neurophysiology; audiology; physical therapy; speech pathology; psychology and psychiatry, and neuroradiology.

Hearing Loss [top]

What is hearing loss?

Hearing loss is more than just a sound barrier - it can negatively impact the quality of life and cause a sense of complete isolation for those who suffer from it. There are approximately 24 million people in the United States who have a significant loss of hearing. Fortunately, there are mechanisms that can improve hearing. People with hearing loss do not have to feel alone.

What are the causes of hearing loss?

There are many causes of hearing loss. Among the most common are:

• Ear infections
• Certain medications some of whose resulting hearing loss is reversible and some of whose is not. For instance, high doses of aspirin can cause hearing loss but the effect is reversed when the dose is reduced or discontinued. Certain chemotherapy agents, for instance, Cis-platinum, can cause irreversible hearing loss.
• Excessive noise exposure
• Heredity
• Birth defects
• Traumatic injury (such as a head injury)
• Tumors
• The natural aging process. About 30 percent of people over the age of 60 have hearing loss. It is the third most common chronic problem affecting the aging population.

What are the symptoms of hearing loss?

Hearing loss is often difficult to recognize. It is usually easiest to tell if you have a hearing loss if you are doing one or more of the following:

• Continually turning up the volume on your TV
• Having difficulty hearing conversational speech
• Having difficulty hearing in group situations and when there is background noise (e.g. in a restaurant)
• Asking people to repeat themselves often
• speech does not sound clear. You might think that other people are mumbling.

What is the treatment for hearing loss?

Thanks to today's various technological innovations, most people can be helped with hearing aids and assistive listening devices. There are a variety of devices available for the hearing impaired. Examples of recent technological advances include programmable and digitally programmable (computerized) circuits to help people hear better in a variety of listening situations.

All hearing aids are custom-fitted. There is a wide range of styles to choose from, depending on the degree and type of hearing loss, as well as cosmetic, comfort, and lifestyle considerations. The various styles include in-the-ear, in-the-canal, completely-in-the-canal (inconspicuous), behind-the-ear, eyeglass models, and body worn hearing aids.

Cochlear Implants, requiring a surgical procedure, are appropriate for the severely to profoundly hearing impaired who cannot be helped with a hearing aid.

A Bone Conduction Hearing Aid and a Bone Anchored Hearing Aid (BAHA) are for those requiring a hearing aid who have good inner ear "nerve" function but cannot use a conventional hearing aid. The BAHA requires a minor surgical procedure.

Assistive Listening Devices

Some examples of assistive listening devices include:

• Telephone devices for the deaf (TDD)
• Infrared listening devices for the theater, movies, television
• Alerting devices such as lights flashing when the doorbell or telephone rings; the bed shaking when the alarm clock or smoke detector sounds
• Telephone amplifiers

Cholesteatoma [top]

What is a cholesteatoma?

A cholesteatoma, often taking the form of a cyst or a pouch, is a skin growth that occurs in the middle ear behind the eardrum. It is usually caused by repeated infection. 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 are the signs and symptoms of a cholesteatoma?

A cholesteatoma may result in foul smelling fluid draining from the ear, pressure in the ear, earaches and a hearing loss. Dizziness, or facial muscle weakness on one side of the face (the side of the infected ear) can also occur.

What is the treatment for a cholesteatoma?

In order to stop or control the infection, patient's with a cholesteatoma must have their ears cleaned and use antibiotics. A large or complicated cholesteatoma usually requires surgery to be removed.

Tinnitus [top]

What is tinnitus?

Tinnitus is noise in the ears such as ringing, buzzing, pulsations, or clicking. According to the American Academy of Otolaryngology, nearly 36 million Americans suffer from this discomfort. More than seven million people are severely afflicted.

What are the causes of tinnitus?

Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. There are many causes of tinnitus - hearing loss, advancing age, exposure to loud noises, a small plug of wax in the ear canal, allergies, high or low blood pressure, a tumor, diabetes, thyroid problems, injury to the head or neck, and certain medications such as antibiotics, sedatives, antidepressants, and aspirin.

What is the treatment for tinnitus?

In most cases, there is no specific treatment for ear and head noise, and oftentimes definitive causes cannot be identified. However, there are certainly steps you can take to lessen the severity of tinnitus:

• Avoid exposure to loud sounds and noises
• Speak to a doctor to see how to lower or control your blood pressure if it is high
• Decrease your intake of salt
• Avoid stimulants such as coffee, tea, cola, and tobacco
• Exercise daily to improve your circulation
• Get adequate rest and avoid fatigue
• concentration and relaxation techniques
• Surround yourself with constant background noise (white noise or environmental sounds, particularly at night when tinnitus may interfere with sleep)
• Use hearing aids to help to reduce the noise
• Use a tinnitus masker (worn like a hearing aid, emitting sounds similar to your tinnitus) if a hearing aid is not required
• Biofeedback therapy

Balance disorders (Dizziness and Vertigo) [top]

What is Dizziness?

Dizziness is a common medical complaint where people feel a sensation of movement or of losing their spatial orientation. Over 90 million Americans aged 17 or older have experienced dizziness or difficulty with balance. Arriving at the correct diagnosis and treatment can be a very difficult and time consuming medical process. Fortunately, in most instances, the cause of dizziness is not very serious, and the problem may well resolve in time. The sensation of dizziness is frequently accompanied by other symptoms, such as unsteadiness, lightheadedness, or anxiety.

What is Vertigo?

Vertigo is defined as an hallucination of motion. Frequently the sensation may be one of turning or spinning.

What are the causes of balance disorders?

About half of all balance disorders are related to inner ear problems. Balance disorders are almost always caused by insufficient blood flow to the brain. They are related to various physiological conditions often associated with anxiety. In addition, they can also be caused by head injuries, ear infections, and viruses.

What is the treatment for balance disorders?

Symptoms of balance disorder can sometimes go away on their own as the inner ear heals or the nervous system learns to compensate for the disorder. Other balance disorders can be cured or controlled by individualized treatment programs.

Meniere's Disease [top]

What is Meniere's Disease?

Meniere’s disease is a disorder of the inner ear that can affect one or both ears.

What are the symptoms of Meniere's Disease?

Symptoms of Meniere's disease include:

• Episodes of dizziness or vertigo
• Fluctuating hearing loss
• Tinnitus (ringing, clicking, buzzing, or pulsations in the ear)
• Feeling of constant fullness around the ear
• Distortion of sounds

What is the cause of Meniere’s disease?

Unfortunately, the cause is not known. But it is thought to be triggered by an immune, metabolic, infectious, traumatic, allergic, or other injury to the inner ear.

What is the treatment for Meniere’s Disease?

The goal of treatment is to decrease the frequency of attacks and manage the episodes when they occur. Sufferers should avoid tobacco, alcohol, caffeine, and sodium. Regular exercise, adequate rest, and control of other medical problems may be helpful as well. In addition, stress reduction is important. Some medications may be prescribed to reduce the severity and frequency of attacks. Hearing aids can be prescribed to compensate for the loss of hearing.