Hearing & Balance Disorders - Otology/Neurotology
Dizziness / Meniere's Disease
Many people experience tinnitus - a ringing, swooshing, or other type of noise that seems to originate in the ear or head. In most cases, tinnitus is not a serious problem and can be treated, or, in time, will simply go away.
Tinnitus is not a disease but a symptom of an underlying condition. One of the most common conditions associated with tinnitus is presbycusis (hearing loss with age). Tinnitus is also associated with conditions such as wax in the outer ear canal, middle ear infections, otosclerosis (fixation of the middle ear bone), Meniere's disease (a problem affecting both hearing and balance) and problems beyond the inner ear such as acoustic neuroma, (a small, rare tumor of the acoustic nerve). If head noises persist, particularly if they are on one side or are associated with loss of hearing or dizziness, medical attention is recommended.
Tinnitus with an obvious cause, such as an object in the ear canal or a middle ear infection, can usually be treated easily. For tinnitus associated with conditions for which there is no treatment, such as conditions for which there is no treatment, such as presbycusis, "masking" sounds produced by FM static or hearing aids may help. The low volume "hiss" or amplified environmental noises block the more offensive tinnitus sounds.
Acoustic neuromas constitute 6 to 10% of all brain tumors. They are benign and usually are slow growing. Their early symptoms are deceptive because they are like those with many less serious problems.
The cells that form an acoustic neuroma are called schwann cells and make up the lining of the eighth cranial nerve as it passes through a tiny canal, which connects the inner ear to the brain. Unknown events lead to an overproduction of schwann cells. As they multiply, they form a small tumor which fills the canal.
As the tumor expands, it extends into the brain assuming a pear shape and putting pressure on the nerves and brain. By this time the patient may have had some of the symptoms that an acoustic tumor can cause - hearing impairment in one ear, ear noise called tinnitus, and fullness in the ear. Other symptoms which may develop include unsteadiness or imbalance and facial numbness or twitching. Continued growth can produce further symptoms, and death ay eventually result if the tumor goes undiagnosed and untreated.
The diagnosis of acoustic neuroma is made after a patient reports one-sided hearing loss, and the appropriate tests are done to locate the cause. Sophisticated audiometry testing can suggest that an acoustic neuroma is the cause of a hearing problem. CT and MRI scans are used to make the final diagnosis.
The good news for the person diagnosed with an acoustic tumor is that one is commonly cured the modern treatment. Surgery is the best treatment for most patients. The surgery is often done by a two-specialist team made up of a neurosurgeon (brain surgeon) and a neurotologist (ear surgeon).
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Meniere's Disease / Dizziness
Meniere's disease is a disorder of the inner ear that causes episodes of vertigo, tinnitus, a feeling of fullness or pressure in the ear, and fluctuating hearing loss. A typical attack of Meniere's disease may be preceded by fullness or aching in one or both ears. Hearing fluctuation or tinnitus (ringing or sounds in the ears) may also precede an attack. An acute attack of Meniere's disease is believed to result from fluctuating pressure of the fluid within the inner ear. The underlying cause of Meniere's disease is unknown. A Meniere's episode generally involves severe vertigo (spinning), imbalance, nausea, and vomiting. The average attack lasts two to four hours. After a severe attack, most people find that they are extremely exhausted and must sleep for several hours.
In some people, Meniere's episodes may occur in a cluster; this is, several attacks may occur within a short time. In other cases, weeks, months, or even years may pass between episodes. Between the acute attacks, most people are free of symptoms or note only mild imbalance and tinnitus.
In 75% of the cases, Meniere's disease is confined to one ear, while in the other 25%, both ears are involved. In most cases, a progressive hearing loss occurs in the affected ear(s). Although an acute attack can be incapacitation, the disease itself is not fatal.
Studies have shown that the disease affects about 46 out of 100,000 people. The majority of people with Meniere's disease are over 40 years of age, with equal distribution between men and women.
How do I manage an acute attack ?
During an acute attack, lie down on a firm surface. Stay as motionless as possible and keep your eyes open and fixed on a stationary object. Do not try to drink or sip water, because you may vomit. Stay like this until the severe vertigo (spinning) passes, then get up SLOWLY. After the attack subsides, you'll probably feel very tired and need to sleep for several hours. If vomiting persists and you are unable to take fluids for longer than 24 hours, call your doctor.
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What can be done to reduce the symptoms?
Between attacks, different medication may be prescribed to help regulate the fluid pressure in your inner ear, thereby reducing the severity and frequency of the Meniere's episodes.
A low salt diet regimen will probably be recommended. This is an important part of treatment for virtually all patients with Meniere's disease. Experience has shown that STRICT adherence to this dietary regimen will result in significant improvement in most patients.
The purpose of treatment between attacks is to prevent or reduce the number of episodes and to decrease the chances of further hearing loss. A permanent tinnitus or progressive hearing loss may be the consequence of long-term Meniere's disease.
How might this condition affect my lifestyle?
Strict adherence to the low salt diet regimen is difficult and may require changes in lifelong eating patterns. Explain to your family and friends how important it is that you maintain your diet; solicit their help.
Also, because the acute symptoms of Meniere's disease are episodic, it is important to explain to your family and friends what might happen when you have an attack. Then, if the symptoms occur when they are present, they will understand and not be overly frightened.
You may be able to protect yourself from injury if you feel that an attack is about to begin. Some attacks may occur during the night, so be sure you have a night light on; you'll be relying more on vision to help maintain your balance. You will want to make sure that the path to the bathroom is free of throw rugs, furniture or other obstructions.
As you learn more about your disease, you will understand the symptoms and be more successful in coping with them.
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Over 25 million Americans have some degree of hearing loss. People with hearing loss find it difficult to talk with family and friends. They may also have trouble understanding a doctor's advice, responding to warnings, and hearing doorbells and alarms. Children with hearing loss may have difficulty developing speech and language.
Many disorders can affect the hearing of children and adults. One of the most easily diagnosed is an ear infection, where antibiotics are the most common treatment. Hearing loss can also occur due to exposure to loud noise, medications, earwax accumulation, infections, head or ear trauma, hereditary factors, aging, or disease processes.
Do You Have a Hearing Loss?
While hearing loss can occur at any time in life, it does occur to most people as they age. Hearing loss can be due to exposure to loud noise, medications, infections, head or ear trauma, congenital or hereditary factors, aging, disease processes and many other causes. The vast majority of hearing problems do not require medical or surgical intervention, although good health practice dictates that those with a hearing loss be evaluated by an Otolaryngologist. Ask yourself these questions:
- Do you frequently ask people to repeat themselves?
- Do feel that other people mumble?
- Does your family complain about the level of the television?
- Do you have difficulty understanding women and children's voices?
- Are you having problems understanding conversations over the phone?
- Do your family or friends comment that you may have a hearing loss?
- Do you have ringing or buzzing sounds in your ears?
- Do you find yourself leaning forward or favoring one ear?
If you have answered yes to any of these questions, or you feel they apply to a family member or friend, please call our office and make an appointment for a hearing consultation.
Tips for Better Communication
- Talk face-to-face with people.
- Speak at a natural pace. Do not speak too fast or too slow. If a person with a hearing loss does not understand what you have said, rephrase and repeat.
- At a restaurant or in a large group, the person with hearing impairment should try to position themselves with their back against a wall. Avoid having your back to a large group of people.
- Try to obtain the hearing impaired person's attention before you begin talking to them.
- Try to reduce background noises while talking.
- Do not cover your mouth when speaking. Avoid talking with gum or food in the mouth or while smoking. This will interfere with lip reading.
- Reduce the distance between the speaker and the listener (do not try to communicate between two different rooms in the house).