Deafness (including glue
ear)
A total inability to hear is fortunately very rare.
Occasionally children are born with a profound or complete
hearing loss, sometimes in adulthood one acquires hearing
loss, usually only in one ear but there are many causes
of partial hearing loss or commonly there is a gradually
progressive loss as seen in old age. Hearing loss is
described as conductive when there is an inability of
the sound waves in the air to reach the nerves of hearing
(the cochlea). This type of hearing may be treated with
an operation. The other type of deafness is sensorineural
hearing loss where there is a failure of the nerves
or part of the brain. This is not usually treated by
surgery (with the exception of a cochlea implant in
selected cases). It may be treated with a hearing aid.
Let us consider hearing loss in terms of three age groups.
1) Childhood – the sense of hearing is vital for
the development of the child. Without hearing not only
are they unable to respond to their parents and friends
but the child is unable to acquire language. Early detection
and treatment of hearing loss is therefore vital. Fortunately
the National Health Service is embarking on a programme
of universal neonatal screening in order to pick up
young children with severe nerve deafness so that they
can receive expert help and support from a very early
age. Fortunately these cases are rare. Far more common
in childhood is a condition, which goes by many names
including glue ear, serous otitis media or otitis media
with effusion. This is a condition which is very common,
indeed most children will have it at some stage in their
life. For the majority it is a short-lived episode where
thick fluid fills the middle ear and prevents sound
being transmitted from the eardrum to the nerves. Symptoms
of this condition include obvious deafness with the
television being turned up and the child not responding
to commands, but also complaints of the child appearing
frustrated at school and withdrawn, poor language development
and head banging. The majority of children do not need
an operation but are treated by a policy of watchful
waiting.
Watchful waiting implies that an accurate diagnosis
has been made and this requires careful and repeated
testing. Testing hearing in children is not a straightforward
task and requires time and patience and expertise of
a skilled audiologist. It is vital to win the co-operation
and trust of the child to get reproducible and accurate
results. Only after several testings can we be sure
sometimes that the child does not have a sensorineural
loss or a level of hearing that would require some form
of surgical correction or hearing aid. The treatment
options therefore for glue ear are:
1 watchful waiting with allowances being made for the
handicap.
2 A hearing aid, under some circumstances this may be
the preferred option if treatment is necessary but surgery
is not advisable.
3 Surgery, which consists of the insertion of ventilation
tubes or grommets with or without the removal of the
adenoid tissue. Every child is treated on an individual
basis and the wishes of the parents as well as the needs
of the child must always be taken into consideration.
There are however guidelines as to the appropriate use
of surgery and these would include:
(1) a subjective complaint from teachers and/or parents.
(2) Objective evidence of glue ear on examination/tympanometry.
(2) A quantitative assessment of 25dBs hearing loss
in both ears and
(3) persistence of the above for a minimum of three
months.
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Glue Ear links click here:
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The Adult
Glue ear is not as common in adults as it is in children
although occasionally some cases persist into adulthood
and others appear in adulthood. Most of us experience
a degree of hearing loss associated with a cold but
this is usually short lived. If however six or eight
weeks of symptomatic treatment does not improve the
hearing loss adults may also benefit from grommet insertion.
Unlike children this can be done under local anaesthetic
in out patients. The possible causes of hearing loss
in adulthood are many, sensorineural loss may be seen
as part of an inherited condition. People who are exposed
to loud noise whether through their job or recreation
can suffer permanent deafness if they have not worn
adequate ear protection. Other causes of a conductive
loss include a perforated eardrum, scar tissue in the
eardrum or middle ear (tympanosclerosis) or a growth
of skin within the ear known as a cholesteatoma. This
as well as causing hearing loss can cause serious infections.
Sometimes the bones of the middle ear become stiff a
condition known at otosclerosis.
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Later years
Hearing tends to deteriorate in all people with age.
The rate of hearing loss is variable and the effect
depends on the persons lifestyle and other symptoms.
This gradual process results in loss of hearing (presbyacusis)
which is often worse in social circumstances, if there
was a lot of background noise and can cause social isolation.
Most cases can be very successfully treated with the
appropriate hearing aid.
In all cases of hearing loss accurate diagnosis and
assessment is vital. This is where the skills of the
audiologist are important. Your local GP may be able
to access a hearing test depending on local availability.
This clinic provides a comprehensive audiological diagnostic
service in order to determine the cause and possible
treatments for a hearing loss.
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Years links click here:
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Dizziness (Vertigo)
The word dizziness is used by many people to describe
a variety of symptoms, which are often difficult to
put into words. It is a common complaint and there are
many causes of dizziness some of which are relevant
to an ENT surgeon. Other possible causes might be more
properly considered by a Cardiologist (Heart Doctor)
or a Neurologist (Nerve Doctor). Your GP will often
make a decision as to which will be the appropriate
specialist. The hallmark of dizziness, which is due
to disorders of the inner ear, is the symptom of vertigo.
This means the sensation of movement or the room spinning
round. There are many possible causes, some of which
are easy to diagnose and some of which are not. Indeed
in many cases we never make a specific diagnosis although
we are usually able to exclude the sinister and the
treatable. Accurate diagnosis requires a careful review
of the history, physical examination and at the very
least an audiogram to examine the function of the inner
ear. Sometimes more specific tests of the inner ear
may be required. Common causes of vertigo seen in the
ENT clinic include:
1) Meniere’s disease,
2) Benign paroxysmal positional vertigo, (BPPV),
3) Migraine
4) acute labyrinthitis.
Treatment would depend on the
cause. Sometimes a specific treatment is highly successful
and simple such as the Epley manoeuvre for the treatment
of benign paroxysmal positional vertigo. Sometimes the
treatment is more non-specific using sedatives to reduce
over activity of the inner ear, balance organ and sometimes
physiotherapy exercises to encourage rehabilitation.
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Tinnitus
Tinnitus is a very common problem; indeed I think most
people get it at some stage in their life. It may or
may not be associated with hearing loss. For some people
it is a minor irritation, for some people on the other
hand it is a major interference in their lifestyle.
Each patient therefore must be assessed on their merits.
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Tinnitus links click here:
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Ear discharge
The ear produces a variable amount of wax, which normally
comes out of the ear by itself. Some people produce
more than others and can feel that they are producing
discharge, which is in fact the normal production of
wax. A true ear discharge is usually a sign of an infection.
This may be an otitis externa, which is an infection
of the skin of the outer ear or an otitis media, which
is an infection of the middle ear when the eardrum has
burst. Both of these can be very painful and require
treatment. This usually consists of cleaning, anti inflammatories
and often antibiotics either in the form of drops or
sprays in the ear or tablets to be taken by mouth. Sometimes
an ear discharge, which is quite offensive but not particularly
painful, may be the sign of a more serious condition
called a cholesteatoma. In this condition the skin grows
into the bone of the skull and can cause life-threatening
complications. It is important to diagnose and treat
this condition and this usually involves some form of
mastoid surgery.
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