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Other Ear Diseases

Tinnitus - Non-Pulsatile

Many people have experienced hearing noises in their ears such as ringing, clicking, roaring, buzzing, clinking, or hissing. Usually this will resolve quickly in minutes and without consistent recurrence.  However, when this sound becomes constant, it is called tinnitus. Tinnitus can occur for many reasons, however most commonly it is associated with high frequency sensory neural hearing loss. Essentially, the brain is creating the noise to compensate for the loss in hearing. History of loud sound exposure generally correlate with this. Middle ear problems such as serous otitis media, eardrum perforations, or problems with the bones of hearing can also cause temporary tinnitus. Certain drugs may cause or irritate tinnitus, including chronic use of Aspirin, Ibuprofen or caffeine.

At our office we will perform a complete audiological evaluation including a special tinnitus-hearing test. On occasion imaging of the head may be indicated to rule out intracranial pathology. Treatments for tinnitus will focus on addressing medical causes of tinnitus when identifiable, or masking the sound of tinnitus with hearing aid devices or white noise machines.

Unfortunately there is generally no cure for tinnitus caused by hearing loss or noise damage. Some people may experience great frustration and anxiety when trying to deal with tinnitus on a daily basis. The good news is, most patients do experience habituation within the first year of onset and become less aware of the sound as time goes on.

Pulsatile Tinnitus

Pulsatile tinnitus differs from tinnitus in that it is not a constant sound but has a pulsatile or beating quality, often times in accordance with the heart beat. This form of tinnitus is much less common.  However it could signify a more serious problem involving a problem with blood vessels or arteries.

Just like tinnitus, pulsatile tinnitus is a symptom of a disease rather than a disease in itself. Therefore when pulsatile tinnitus occurs, further testing is required to find what is causing this symptom. Causes include head and neck tumors, artherosclerosis, malformation of capillaries, exposure of the jugular bulb in the middle ear and high blood pressure. Diagnosing the cause of pulsatile tinnitus can be very difficult and may involve multiple imaging studies including MRI of the head, MRA and MRV to evaluated the veins and arteries in the head, an ultrasound of the neck, and/or CT of the head. Treatment is based on findings of the cause of pulsatile tinnitus and may include new medication, frequent monitoring, and possibly surgical intervention.

Myoclonic Tinnitus

Middle ear myoclonus (MEM) is a rare diagnosis of tinnitus that is presumed secondary to abnormal movement of the tensor tympani or stapedius muscles inside of the middle ear space. MEM tinnitus is commonly characterized as clicking, suggested to be due the tensor tympani movement, or buzzing, suggested to be due to stapedius tendon movement.  MEM tinnitus is often objective, being perceptible to other people and the examiner. Treatments include middle ear muscle tendon lysis, however this is not always curative. Muscle relaxers and antispasmodic drugs can also be trialed. Currently there us no agreed upon treatment method for this kind of tinnitus.

Patulous Eustachian tube

The Eustachian tube is a tube that sits behind your sinuses and connects to your ear. Its job is to protect the middle ear by draining out middle ear fluids and maintaining an equalized pressure within the middle ear. Generally, the Eustachian tube opens and closes with certain movements of the jaw such as talking, laughing, yawning, and chewing. Patulous Eustachian tube is a condition where instead of the Eustachian tube opening and closing to maintain middle ear pressures, it remains open. This allows a continual passage of air and sound between the nose and the middle ear causing patients to experience an amplified perception of their own voice and breathing sounds called autophony, as well as ear fullness and mild dizziness. Often patients found with this condition have a recent history of substantial weight loss such as after bariatric surgery, pregnancy, or dietary weight loss, as well as overuse of nasal steroid sprays.  These symptoms can often times mimic other conditions, however a skilled provider can generally diagnose patulous Eustachian tube based on history and a special test called acoustic reflex decay.

Some patients may experience symptom relief by stopping use of decongestants and topical nasal steroid sprays. Patients are also encouraged to increase hydration by drinking more water, especially during exercise. There are many topical medications, which have been tried, however compliance with these meds is hard to maintain, as they are very difficult to apply properly and tend to cause discomfort. Surgical intervention, such as tube placement, may be considered if the symptoms are very bothersome and conservative treatment interventions are ineffective. Unfortunately, this disorder can often times be difficult to treat.

Eustachian tube dysfunction

The Eustachian tube is a tube that sits behind your sinuses and connects the space behind the nose to the middle ear space behind the eardrum. Its job is to protect the middle ear by maintaining an equalized pressure within the middle ear and draining out middle ear fluids. Children commonly have problems with their Eustachian tube as they are often horizontally oriented rather than downward, as in adults. A poorly functioning Eustachian tube keeps it from allowing air into the middle ear, which can cause negative pressure or a buildup of fluid, eventually leading to middle ear effusions and hearing loss.

If medical management with allergy medications and nasal steroids is not enough, surgical intervention includes placement of pressure equalization tubes to prevent infection and hearing loss. Some children will need more than one set of tubes during their period of Eustachian tube dysfunction. In adults, pressure equalization tubes can be placed in the office by one of our trained providers.

Ear Canal Exostosis

Exostosis is the medical term for an abnormal benign growth of bone within the ear canal. It is more commonly referred to as swimmer's or surfer's ear. It is caused by repeated exposure to ocean water regularly (cold water and wind). Cooling of the ear canal stimulates bone growth that narrows the canal and blocks the eardrum. This narrowing traps water and earwax in the canal, often resulting in painful ear infections and hearing loss. At times people will require use of wax softening drops and routine office visits for earwax removal as they can interfere with the normal progression of earwax out of the ear canal. On occasion, when exostosis are completely occluding the ear canal, causing a conductive hearing loss, your provider may consider surgical removal.

Ear Canal Osteoma

Osteomas are pearl-like bony growths in the external ear canal similar to exostosis.  However, these can be small or large, and have a variety of shapes. The larger growths tend to be problematic because they interfere with the natural aeration and drainage of the external ear, at times trapping water or debris in the canal. Similar to exostosis, if these occlude the canal causing hearing loss or interfere with normal earwax migration out of the canal, these may be surgically removed.

Aural Atresia or Microtia (malformations of the ear)

Aural atresia is a condition that occurs in utero when the ear canal fails to form properly and instead of being open like a tunnel, the canal remains closed. This occurs more commonly on one side but may also occur bilaterally. Aural atresia is seen in about 1 in 10,000-20,000 births.

Microtia is a congenital deformity where the pinna (external ear) is underdeveloped or absent. A completely absent pinna is referred to as anotia. Atresia and microtia can occur together.

This condition causes the patient to have a conductive hearing loss. If this occurs bilaterally, the hearing loss can interfere with normal development and cause developmental delays. In these situations, the patient should be fitted with a bone conduction hearing device as soon as possible to avoid these delays.

After 6 years of age, surgical repair of atresia to open the canal may be considered. To assess if the patient meets criteria for surgical intervention, we will order a hearing test to see if the surgery could improve the patients’ hearing, as well as a CT scan of the head to further assess the middle and inner ear structures. If the patient qualifies, surgery may be appropriate and is a decision made by the parents and/or child. Cosmetic repairs can be made for microtia to replace external ear structures.

Temporal Bone Trauma

Trauma of the temporal bone can occur in many forms such as blunt trauma without fracture, blunt trauma with fracture, penetrating trauma, compressive injuries, and thermal injuries. The temporal bone is very dense compared to the face and skull, and requires a tremendous amount of force to sustain fracture. However if this occurs it can cause symptoms of a conductive or sensorineural hearing loss, bloody drainage from the ear, loss of consciousness, vertigo, severe head injury, and facial paralysis. Penetrating temporal bone trauma is seen most commonly with a low-velocity gun-shot wound. This can cause trauma to major vessels, cranial nerves, central nervous system, or destruction of the middle or inner ear. Risks from trauma of the temporal bone include: cerebral spinal fluid leak, perilymph fistula, benign paroxysmal positional vertigo, encephalocele, meningitis, TMJ, carotid-cavernous fistula, facial nerve compression/injury, or pneumocephalus.

Evaluation will include a thorough physical exam and history. Imaging of the head such as a CT or MRI will be performed to measure the extent of damage. Other tests, depending on symptoms, include a hearing test (audiogram), specific vestibular testing including a Dix-Hallpike test to rule out positional vertigo and a fistula test to rule out a perilymph fistula. Treatment depends on the injury and residual symptoms. It can vary from close monitoring, treatment with medication, or surgical intervention to explore and repair damage. Unfortunately some may experience long-lasting affects of trauma to the temporal bone such as permanent hearing loss. If this occurs, depending on the extent of hearing loss, hearing interventions will be discussed in detail including the use of hearing aids, bone anchored hearing aids (BAHA), or cochlear implants