Ear and Audiology
After a baseline hearing test at age 21, we recommend that you have a hearing test every 10 years thereafter until age 50. After age 50, you should have a hearing test every 3 years or if you notice a change in your hearing.
Our hearing evaluations are very thorough. We perform comprehensive hearing assessments for children, adults, and seniors. Our assessments are quick, usually taking no more than 20 minutes. Once completed, we will provide you with a complete report with interpretation of results and recommendations. We will also send a copy of the report to your physician.
Tinnitus is the perception of sound when no external sound is actually present. It is a symptom (not a disease) indicating that something is wrong in the auditory system, which includes the ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound. Tinnitus is often described as a ringing in the ears, but it can also sound like a roaring, clicking, hissing or buzzing. It can affect one or both ears.
Tinnitus symptoms can have a grave effect on one’s daily life, and as a result may cause secondary symptoms of depression, anxiety, mood swings, irritability, and pain. For some people, tinnitus also affects sleep and concentration, or their ability to work and socialize.
Men are at a higher risk for developing tinnitus than women because they are often in occupations that expose them to loud noise over an extended period of time (e.g., factory workers, construction workers, military service, and the music industry). Other factors that may increase a person’s risk for developing tinnitus include age, smoking, and cardiovascular problems.
Unfortunately, there is no cure for tinnitus for patients with chronic (ongoing) symptoms (e.g., people with a sensorineural hearing loss); however, for patients who have an acute (temporary) case of tinnitus, they may see those symptoms go away over time with proper treatment.
There are several treatment options available to help patients experience a better quality of life, no matter the degree or severity of tinnitus they may have. Our audiologists and physicians can discuss any therapies that may be helpful.
Dizziness, or loss of balance, is the second most common complaint heard in doctors’ offices. According to the National Institutes of Health, dizziness will occur in 70% of the nation’s population at some time in their lives. Although very common, acute or chronic problems with balance may indicate serious health risks and limit a person’s everyday living.
Balance disorders may be described in two categories. The first is dizziness, vertigo, or motion intolerance that may occur in acute or sharp attacks lasting only seconds or sometimes for hours. This may be caused or worsened by rapid head movements, turning too quickly, or while walking. The second is a sense of imbalance, unsteadiness, or what some people refer to as a loss of surefootedness.
Causes of Dizziness and Imbalance
Benign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common types of dizziness. This disorder can be seen following a head injury, vestibular neuronitis, Meniere’s disease, or can present alone. Simple everyday movements such as rolling over in bed, sitting up, or bending over can trigger vertigo (spinning sensation).
The vestibular system/inner ear is a complex structure that includes 3 semicircular canals and the utricle and saccule, which contain small crystals called canalith. If the canalith breaks loose, it can float freely into the canals. The canalith is displaced with specific movements, such as bending over or rolling over in bed and sends an incorrect message to the brain resulting in vertigo/dizziness.
BPPV can be treated with repositioning maneuvers. Repositioning progressively moves the canalith out of the semicircular canals into the utricle. When the crystals are in the utricle, they cannot trigger dizziness. Since BPPV can recur, repositioning is sometimes repeated.
Vestibular Neuritis is an inflammation of the auditory/vestibular nerve usually caused by a virus. The inflammation can change or reduce the output of one or both of the balance portions of the inner ear to the brain. This inaccurate inner ear information results in severe dizziness and vertigo. Fortunately, vestibular neuritis usually subsides in time and usually does not recur. When the inflammation affects the auditory portion of the nerve, it causes hearing loss in addition to dizziness and is called labyrinthitis. Certain medications can help in the initial phases to decrease severe symptoms. However, long-term use of medications can actually impede full recovery. Balance exercises (vestibular rehabilitation) can be the most effective treatment for the symptoms associated with vestibular neuritis.
Migraine – Associated Dizziness
Migraines are thought to be caused by vasoconstriction of cranial vessels or neuronal dysfunction. Changes in nerve cell activity and blood flow may result in symptoms such as visual disturbances, vertigo (spinning), motion intolerance, positional vertigo, photophobia (light sensitivity), misophonia (sound sensitivity), and nausea. Migraine associated dizziness may be due to the constriction of blood supply to the cochlear and/or vestibular system. Evaluation for migraine-associated dizziness includes a hearing evaluation, a complete case history, videonystagmography (VNG), and a neurology consultation. Migraine medications have been shown to reduce migraine-associated dizziness successfully.
Meniere’s Disease (Endolymphatic Hydrops)
Meniere’s disease is relatively rare compared to other more common disorders such as vestibular neuritis and benign paroxysmal positional vertigo. A typical Meniere’s attack involves severe spinning vertigo with imbalance, nausea. and vomiting. Characteristically, the attacks are accompanied by fluctuations of hearing and sometimes tinnitus (ringing in the ears). Most patients with Meniere’s Disease describe fullness in one or both ears. The attacks can last for hours but fatigue and nausea may persist for days. Meniere’s Disease is caused by abnormal accumulations of fluid in the inner ear and increases of inner ear pressure. The diagnosis is often made with an accurate history, a hearing test, and specialized tests such as videonystagmography, vestibular evoked myogenic potentials, and videocochleography. The treatment consists of medications, a special low salt diet, and surgery (rarely). Vestibular rehabilitation is considered to be helpful only in cases of persistent, non-fluctuating inner ear injury.
Ototoxicity is the term used to describe damage to the ear caused by toxic substances. This occurs when individuals come into contact with drugs or chemicals that are poisonous to the inner ear or to the nerve that supplies the inner ear (vestibulocochlear nerve). Because the inner ear is involved in both hearing and balance, ototoxicity can result in problems with either one or both of these senses. Symptoms vary considerably from drug to drug and person to person. They range from mild imbalance to severe vertigo and from tinnitus (ringing in the ears) to total hearing loss. If symptoms involve both the right and left inner ears, the patient may not have vertigo, but severe imbalance and blurred vision caused by poor stabilization of the eyes. This loss of vestibular function may cause the inability to tolerate head movement. The diagnosis is based upon the patient’s history, symptoms, and test results. Tests that may be used to determine how much hearing or balance function has been lost include videonystagmography (VNG), auditory brainstem response (ABR), and a hearing evaluation. The treatment consists of eliminating or reducing exposure to ototoxic substances and participating in a vestibular rehabilitation program to promote greater use of vision and muscle sensory information (proprioception). The goal of the treatment is to help the brain become accustomed to the changed information from the inner ear and to assist the individual in developing other ways to maintain balance.
Meniere’s disease is relatively rare compared to other more common disorders such as vestibular neuritis and benign paroxysmal positional vertigo. A typical Meniere’s attack involves severe Acoustic neuromas are rare. Only about 2,000 cases are diagnosed in the United States each year. An acoustic neuroma is a benign tumor on the vestibular portion of the eighth cranial nerve, which connects the inner ear to the brain. An acoustic neuroma may cause vertigo (spinning), unsteadiness, imbalance, or lightheadedness in addition to hearing loss and/or ringing in the affected ear. Most acoustic neuromas are removed by surgery. Other options, including various types of radiation therapy (often called radiosurgery), are available. Each type of treatment entails some risk of a permanent change in hearing, balance, and facial motion. Some people may experience imbalance for several months after surgery.
A perilymph fistula is a tear or defect in the oval window or round window (the thin membranes between the middle and inner ears). When a fistula is present, changes in middle ear pressure will directly affect the inner ear stimulating the balance and/or hearing structures and causing dizziness, vertigo, imbalance, nausea, and vomiting. Individuals may experience ringing, fullness, and/or hearing loss. Symptoms typically worsen with changes in altitude such as elevators, airplanes, or travel over mountains. Additionally, strenuous activity or straining can trigger symptoms. Head trauma is the most common cause of perilymph fistula. However, other activities such as weight lifting or scuba diving can cause a perilymph fistula. Often a fistula can be diagnosed by applying pressure to the ear while measuring eye movements. Perilymph fistulas can heal spontaneously with rest, but sometimes surgery is required.
Superior Canal Dehiscence
Superior canal dehiscence is a balance disorder resulting from a hole in the bone overlying the superior (uppermost) semicircular canal within the inner ear. This abnormal opening can cause dizziness, nausea, and vestibular hyperacusis (vertigo and imbalance triggered by sound). Superior canal dehiscence is thought to result from a congenital condition in which the bone over the superior canal is thinner than normal and thus more vulnerable to damage from gradual erosion or from forces such as violent coughing or a blow to the head. The diagnosis of superior canal dehiscence includes a hearing evaluation, tympanometry, videonystagmography (VNG), vestibular evoked myogenic potentials (VEMP), and bone-imaging studies such as a CT scan. Treatment involves surgically patching the bone overlying the superior (uppermost) semicircular canal followed by vestibular rehabilitation therapy.
The proper function of the balance system requires not only the input for the inner ear but also the appropriate nerve connections in the brain. If the areas of the brain that assist in balance do not get enough blood, even temporarily, dizziness can occur. The causes of vascular dizziness are varied. Arthritis in the neck can cause compression of arteries to the head, cholesterol plaques may narrow the arteries in the brain, and fluctuations in blood pressure may cause dizziness. Special testing such as videonystagmography (VNG), MRI, or Doppler tests may be needed to diagnose these problems accurately.
Natural Aging Process
Maintaining balance is a complex interaction that requires correct information from three sensory receptors, the inner ear, vision, and somatosensory input systems. All three signals must be correctly received by our central nervous system in order to maintain balance. If any component of this complicated system is compromised, the result is a loss of balance. The natural aging process may affect any one or all of these sensory receptors, as well as the central nervous system’s ability to interpret and react to them. Therefore, loss of balance and unsteadiness are common changes seen as a function of aging. Fear of falling is the number one health concern of individuals in their later years. The National Institute of Health statistics indicates that balance-related falls account for 50% of accidental deaths in the population over 65. In addition, nearly 300,000 hip fractures and 3 billion dollars in medical expenses are due to balance-related falls. Vestibular rehabilitation programs have been very successful in helping patients with fall prevention and improved balance and coordination. A complete case history and videonystagmography (VNG) evaluation are necessary to determine whether the imbalance is due to the aging process or other medical conditions. They are also necessary to help ensure an appropriate treatment plan.
According to the National Institute on Deafness and Other Communication Disorders (NIDCD), sudden deafness, or sudden sensorineural hearing loss, strikes one person per 5,000 every year, typically adults in their 40s and 50s. Sudden sensorineural hearing loss usually comes on suddenly and rapidly, and nine out of 10 people with it lose hearing in one ear.
Unfortunately, most people who experience sudden sensorineural hearing loss delay treatment or don’t seek treatment at all, because they think the condition is due to allergies, sinus infections, or ear wax impaction. If you suspect you have sudden sensorineural hearing loss, you should seek immediate medical care, because any delayed treatment could result in a permanent hearing loss.
About 80% of people diagnosed with sudden sensorineural hearing loss do not have any identifiable cause. For the other 20%, causes have been attributed to secondary issues associated with primary illnesses or medical conditions, including:
- Ototoxic Drugs (drugs that affect the sensory cells in the inner ear)
- Autoimmune Diseases (such as Cogan’s Syndrome)
- Trauma (head injury)
- Infectious Diseases
- Blood Circulation Problems
- Tumors (tumors on the nerve that connects the ear to the brain)
- Neurologic Diseases and Disorders (such as Multiple Sclerosis)
- Disorders of the Inner Ear (such as Ménière’s Disease)
For patients that have an undetermined cause for their sudden sensorineural hearing loss, the primary treatment is corticosteroids, as they reduce inflammation, decrease swelling, and help the body fight illness. Patients can either take oral corticosteroids (pill form) or they can have a steroid injection placed behind the eardrum directly into the middle ear where the steroids travel to the inner ear (intratympanic corticosteroid therapy). The injection is a better choice for patients who cannot take oral steroids, but there may be some discomfort associated with this method of delivery.
Patients who seek diagnosis and treatment from doctors who specialize in diseases of the ears, nose, throat, and neck (an otolaryngologist or ENT doctor) have a better chance of restoring most, or all, of their hearing. Of those who seek no diagnosis and treatment, nearly half may have their hearing restored spontaneously within 1 or 2 weeks from the onset of hearing loss.