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.
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turned up and the child not responding to commands, but also complaints of the child appearing frustrated at school and withdrawn, poor language development and head banging.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:
- Watchful waiting with allowances being made for the handicap.
- A hearing aid, under some circumstances this may be the preferred option if treatment is necessary but surgery is not advisable.
- 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:
- A subjective complaint from teachers and/or parents.
- Objective evidence of glue ear on examination/tympanometry.
- A quantitative assessment of 25dBs hearing loss in both ears and
- Persistence of the above for a minimum of three months.
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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.
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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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:
- Meniere’s disease,
- Benign paroxysmal positional vertigo, (BPPV),
- 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 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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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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