Treatments: Ears: Hearing

Treatments for sudden sensorineural hearing loss

Once sudden sensorineural hearing loss has been confirmed (and differentiated from sudden hearing loss due to fluid or wax), expedient treatment is necessary to maximize the potential for recovering hearing. Treatment involves some form of steroids (pill form, injection, or both) and additional testing (such as an MRI scan of the inner ear and nerve), which is to look for a possible growth pinching the hearing nerve. Monitoring progress weekly with a hearing test is necessary in the few weeks after initial treatment.

Medical treatment for fluid or infection causing hearing loss

Fluid behind the ear drum (an area called the middle ear), whether non-infected (sterile) or infected (pus), cause hearing loss due to the dampening of vibrations that would normally move the ear drum and the three bones of the inner ear. Ridding the middle ear of this fluid typically restores hearing back to baseline. After evaluation and diagnosis, specifically to rule out special circumstances, most middle ear infections are treated with antibiotics, and possibly a nasal steroid spray, a nasal decongestant, a reflux medicine, and a technique of periodically popping the ears. If these are ineffective after an adequate trial (about 5 days), a procedure may become necessary. When the fluid is not infected, hearing loss still may occur, and the same treatments as noted above for the infections (minus the antibiotic) are typical. If the problem persists, which happens in a minority of cases, a small hole may be placed in the ear drum (with or without a tube) to let the fluid out. This usually restores hearing very close to baseline.

pneumatic equalization (ear vent) tubes

Simple and very effective, an ear tube (also called pneumatic equalization tube, or ear ventilation tube) may be placed in a matter of minutes and work by doing the following:

1. Allow air pressure to equalize on each side of the ear drum (not dependent on the Eustachian tube)

2. Allow fluid of pus from the middle ear space to drain out

3. Allow antibiotic drops to get into the middle ear space

Technically, a small incision is made in the ear drum first, and the tube is placed in this hole to work as a grommet to keep the small hole from healing sooner than desired.

The tube usually stays in place for 1-3 years, although sometimes the body extrudes them sooner and other times, the body may retain it much longer. If no longer needed, the tube may be removed and the hole remaining may be patched.

HEARING AIDS

Hearing aids come in many different sizes and with many different capacities. Like glasses, hearing aids are custom fit to each ear. Major advances in hearing aid technology have made them easily adjustable for the user’s current situation (dinner party, listening to music, etc.) and can connect with your cell phone or a directional microphone disguised as a pen, so you can point it to a speaker of interest in a meeting, for example.

• How to Find the Right Hearing Aid for You article on ENTHealth.org.

Repair of a perforated ear drum

Some perforations in the ear drum are large enough to prevent efficient conversion of sound waves into movement of the tympanic membrane and the three ossicles. Other times, the perforation may allow water to enter the middle ear space behind the ear drum and cause infections. In either case, repair techniques are available to close the perforation, restore the water-tight barrier, and maximize hearing.

Tinnitus (“phantom” noise in ear)

Tinnitus, a perceived noise in the absence of any environmental sound, may have no cure, but there are several treatments for this vexing problem. In brief, distracting noise (such as “white noise"), use of hearing aids, getting good sleep, getting daily exercise, and avoiding known dietary triggers (caffeine, ibuprofen and similar medications, apple cider vinegar, among others), avoiding topical causes (sunscreen), and even cognitive behavioral therapy may help. Of course, prevention of tinnitus or its progression is important, and this is accomplished by avoiding excessive noise exposure and avoiding medications that hurt the inner ear (such as certain malaria medications and intravenous antibiotics).

Cros and Bi-Cros HEARING AIDs

If one ear is deaf, a person may miss out on their auditory environment. This can be a safety risk (such as a car approaching from that side) or a social and educational problem (hearing someone speak from that side). The concept behind a CROS (contralateral routing of signal) hearing aid is to have a tiny microphone in a device on the non-hearing ear, which transmits the sound to a device with a speaker on the hearing ear. If there is one non-hearing ear and the other ear hears, but not perfectly, then the system can be set up so that the better hearing ear has both sound from the non-hearing side and a traditional hearing aid that amplifies sound from the better hearing ear (bi-CROS hearing aid). These devices are small and look like traditional hearing aids.

OSIA (bone conduction implanted hearing aid)

Have you ever heard sound from something vibrating on your head or teeth? When the outer ear or middle ear does not function for one reason or another, an OSIA implant can be surgically implanted under the scalp into the outer layer of the skull and a separate disk is placed over the skin and held there by a magnet. This device has a microphone to collect acoustic information which is wirelessly transmitted to the implanted hardware which vibrates to transmit the sound waves to the inner ear through bone conduction.

Treatments for cholesteatoma (“skin” growing behind the ear drum)

Cholesteatoma is skin type growth behind the ear drum where skin should not be present. This tissue gets bigger over time and makes enzymes that allow the growth to dissolve the surrounding anatomy, including bone. The mass is often infected. Altogether, this is a dangerous problem that can cause permanent hearing loss and infection around or in the brain. Treatment is surgical, in which the goals are to remove the entire cholesteatoma and preserve as much hearing as possible.

Repair of malleus, incus, stapes (ossicular chain repair)

When one or more of the middle ear ossicles is missing, possibly from cholesteatoma, surgery, or trauma, a prosthesis may be placed that re-connects the ear drum to the inner ear.

Stapes surgery for otosclerosis (stapedectomy, stapedotomy)

When calcium and boney buildup keeps one of the tiny bones (the stapes) of the middle ear from moving freely, the decreased motion leads to decreased hearing. Surgery to restore freedom of motion of this bone can improve hearing. In general, the worse the hearing loss to begin with, the more room there is for improvement.

Auditory processing disorder

Treatment of auditory processing disorder typically focuses on three primary areas: changing learning environment, developing higher-order skills to compensate for the disorder, and efforts to aid any auditory deficit that may also be present. Practice with progressively challenging auditory tasks with a computer or smartphone application, such as the i-Angel Sound app, Earobics, and Fast ForWord may prove helpful. Alternatively, cognitive therapy with an audiologist may be undertaken.