Introduction
Otology is the medical term for issues relating to the ear. When patients with ear problems seek the help of a physician they may have issues ranging from those as simple as impacted ear wax to more complex problems such as a tumor in the temporal bone. As a result, the field of otology is quite dynamic and diverse.
Ear Pain (Otalgia)
One of the most common reasons patients seek help for their ears is due to ear pain. Ear pain can be caused by a multitude of things including infection, inflammation, a tumor of the ear, or may be related to a problem somewhere else with manifestations in the ear (referred ear pain). The reason for referred ear pain can range from innocuous things such as jaw joint disease (temporomandibular joint or TMJ) to more complex problems such as head and neck tumors.
Hearing Loss
Hearing loss can be present at birth, occur spontaneously, or evolve slowly as we get older. In addition, it can be due to a problem with the hearing organ (cochlea) also know as sensorineural hearing loss, or due to a problem in the middle ear (this includes problems with the ear drum and small bones in the middle ear) also known as conductive hearing loss (for a further description of this type of hearing loss see below).
Hearing loss that occurs at birth (congenital) usually is diagnosed during newborn hearing screening. This type of hearing loss can either be sensorineural or conductive and may occur in isolation or as part of a syndrome. In addition, congenital hearing loss may affect one or both ears. It is important to diagnose congenital hearing loss early, as the sooner children are identified the more likely they are to acquire verbal language and communication skills. Interventions for this type of hearing loss may include preferential seating in school, hearing aids or even surgery.
Hearing loss that occurs suddenly in the adult can be especially troublesome and can be related to a wide variety of disorders including vascular problems (stroke or transient ischemic attack), inflammation (Meniere's disease, sarcoidosis etc), infections (bacterial or viral) or tumors (vestibular schwannoma). After establishing that true hearing loss has occurred and depending on the underlying cause, the otolaryngologist may recommend imaging studies (an MRI or CT scan), an antiviral medication and possibly oral steroids or steroids injected into the middle ear.
Hearing loss may also be due to problems in the middle ear also known as conductive hearing loss. This includes issues with the ear drum or with the bones of the ear such as cholesteatoma, middle ear infections and otosclerosis (for a complete description of these problems see section below).
A final, common cause of hearing loss is related to noise exposure and/or advanced age. These types of hearing losses tend to be treated primarily with amplification (hearing aids).
Ringing in the Ear (Tinnitus)
Ringing in the ear (tinnitus) can be an especially troublesome to a patient and usually occurs in association with hearing loss. This is thought to occur because as actual sound input to the brain diminishes, the brain often deals with this loss by generating sound on its own. Tinnitus can also occur in conjunction with the same causes as hearing loss, and can be difficult to treat. The most common methods for treating tinnitus are hearing aids and masking devices. For patients with tinnitus that does not respond to these methods, patients may be offered tinnitus retraining therapy. This is a method of feedback where the patient is taught to essentially forget the tinnitus is present. Although this requires a great deal of patient effort, with proper teaching this method of tinnitus therapy is highly successful.
Conductive Hearing Loss
These types of hearing losses deal with the middle ear which includes the ear drum, the three middle ear bones and the space that surrounds them. Typically problems with the middle ear occur because of dysfunction of the eustachian tube. The eustachian tube, which equalizes pressure between the middle ear and the throat, can in certain circumstances fail to open properly causing fluid in the middle ear (otitis media) and, in severe circumstances, can cause deposition of debris in the ear known as cholesteatoma. Cholesteatoma is essentially trapt skin in the middle ear which results from negative pressure in the middle ear. This cyst-like matrix secretes enzymes that may erode the hearing bones, thereby causing hearing loss. Treatment of cholesteatoma typically involves removing all of the cyst creating a safe, dry ear. Next, often in a separate procedure spaced several months apart, the middle ear bones are reconstructed to improve hearing. This type of surgery is called a tympanomastoidectomy where the middle ear may be approached from either the ear canal itself or by drilling through the mastoid bone that surrounds it.
An additional cause of hearing loss, and one of the most common reasons patients seek the treatment of an otolaryngologist, are middle ear infections (otitis media with effusion or OME). These infections also usually result from eustachian tube dysfunction which causes secretion of fluid into the middle ear which is secondarily infected by bacteria. This process is more common children due to the small size of their eustachian tubes, but may also occur in adults. OME is typically treated either with antibiotics or for persistent cases by an ear tube (for more information on ear tubes and otitis media click here). Occasionally, the infection spreads beyond the middle ear into the mastoid bone, or even into the brain or its surrounding structures. This can cause dizziness, drainage, meningitis, paralysis of the facial nerve and even a brain abscess. This may require a surgery called a mastoidectomy to facilitate aeration and to clear infection.
Otitis media along with other middle ear problems such as trauma can cause a hole in the ear drum. This perforation interferes with the conduction of sound and therefore incites hearing loss. The drum can be surgically rebuilt using a piece of tissue from the scalp (fascia) during a procedure known as a tympanoplasty. Sometimes this surgery can be done through the ear canal, but for larger holes in the drum, usually an incision behind the ear is necessary for increased exposure.
Lastly, patients may also develop conductive haring loss due to stiffening of the middle ear bones, particularly the small bone known as the stapes. This is known as otosclerosis. Otosclerosis often requires an operation called a stapedotomy for correction of the problem (for more information on stapedotomy and otosclerosis click here).
If you are having problems with your ear and wish to talk to us about it please feel to give us a call.
Other topics in ear disease:
Otosclerosis (click here),
Bone anchored hearing aids (click here)
Outer ear infections (click here)
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