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Ear

Hearing and Deafness

Hearing loss is a common disability and can affect people of all ages. Hearing loss can either be sudden or progressive, single sided or bilateral, conductive or sensorineural (see below).

ENT Surgeons are the medical specialists who are best able to determine the most appropriate investigation and management for patients with hearing loss.

Conductive hearing loss occurs when sound waves are blocked from entering the inner ear – with problems like wax, ear drum damage, glue ear or injured hearing bones. Conductive hearing loss can be managed with office treatments, medicines or sometimes surgery.

Sensorineural hearing loss occurs when sound waves entering the inner ear are not translated properly into electrical impulses that travel to the brain. The commonest form of this type of deafness is age related symmetrical hearing loss. Damage to the hearing organ (cochlea), the hearing nerve or even the brain can interfere with one’s sensorineural hearing. After appropriate investigation, treatment usually includes hearing aids or occasionally other devices such as cochlear implants.

Sudden hearing loss is of particular importance as early treatment is vital in maximizing outcomes. If your hearing deteriorates over a very short period it is important to contact our offices for an urgent assessment.

Hearing Aids

The specialists at ENT Victoria are happy to provide advice for patients seeking hearing aids – and to treat the medical conditions that may be impacting their hearing. ENT Victoria has made a conscious decision not to sell hearing aids as our prime focus is on the medical and surgical management of hearing loss. For our patients seeking hearing aid assessment and advice we recommend Neurosensory – a company founded on the basis of integrity and quality. Please refer to their website for further information.

Ear Infections

Ear infections are common in Australia as we love to spend time around water.

Outer ear canal infections are usually the result of water exposure in the setting of damaged or inflamed ear canals. Frequent cotton-bud use and swimming are common causes. Itch, discharge, blockage and pain can all occur. The best treatment is gentle cleaning by a qualified ENT surgeon and the right topical drops. Oral antibiotics are rarely useful. Occasionally ear canal wicks (mini-tampons) are needed to treat more aggressive canal infections.

Rarely ear canal infections can spread to adjacent bone in the canal and lead to severe infections. These are more common in diabetics and often need in-hospital management. 

Middle ear infections are possibly the most common medical condition on Earth. They generally affect young children with poor drainage pathways and cause pain, fever, irritability and reduced hearing. Sometimes the infection can overwhelm the ear drum and lead to rupture with discharge. Oral antibiotics are often prescribed but the benefit of antibiotics is often minimal.

Occasionally some children can suffer many ear infections and require assessment for possible ventilation tube (grommet) placement.

Inner ear infections are uncommon and manifest as dizziness, ringing in the ears, hearing loss or a combination of all three. They are usually viral and generally settle spontaneously. Occasionally there is permanent hearing loss in the affected ear.

Ear Drum Perforation

Depending on the size and location of ear drum holes, they can cause hearing loss or be associated with ear discharge. Most ear drum perforations due to trauma will heal on their own but occasionally they need surgical correction. Sometimes ear drums perforate after infections or after sudden changes in pressure. Most ear drum surgery can be done down the ear canal itself or from behind the ear, using a patient's own tissues as a graft. Surgery is not very painful and can often be done as a day case. Successful healing occurs in 80-90% of cases.

Otosclerosis

An inherited cause of hearing loss, otosclerosis tends to cause gradual loss of hearing in the 20's and 30's and usually affects both ears. The condition causes a stiffening of the third hearing bone (stapes) and options for correction include surgery or a hearing aid. Surgery (Stapedectomy) involves removing the third hearing bone with a laser and then replacing it with a tiny metal prosthesis. It is done under a general anaesthetic and can sometimes be done as day surgery.

Cholesteatoma

These are benign skin growths that develop in the ear drum. They often present with recurrent ear infections, discharge, hearing loss and sometimes pain. Cholesteatomas take a long time to grow and are often associated with a long history of ear problems. They can occur in children or adults and require surgery to fix them. Some cholesteatoma surgery is performed in multiple stages, depending on the location and extent of the disease. The hearing loss associated with the condition is sometimes permanent but each individual case is different. Workup includes thorough history and examination (often with a microscope) and investigation is with CT scanning and hearing tests.

Tinnitus 

This is an extremely common and troubling symptom. It relates to the ringing in the ears that is usually associated with hearing loss. If it is associated with slow gradual age related hearing loss, it is best managed by an audiologist with a special interest in the condition eg: Neurosensory Audiologists or Dineen and Westcott specialist Audiologists.   

Another excellent resource is the Tinnitus Association of Victoria..

Noise in the ears that is single sided or pulsatile (in rhythm with the heart beat) can rarely represent a more significant problem and warrants examination by an ENT surgeon. Hearing tests and occasionally scans are needed to clarify the diagnosis.

Exostoses  (Surfer’s ear)

These are benign bone growths that occur over many years in the setting of cold water exposure. If they grow large enough they can block hearing or become frequently infected. Occasionally they can lead to a water-logged ear that remains full 24 hours after water exposure.

If any of these symptoms occur it may be worth considering having the excess bony growths removed. This is done under a general anaesthetic and can take as long as 3 hours. Surgery is usually performed from behind the ear and can be done as a day case. A bandage is worn for 24 hours and recovery can take up to 1 week. Swimming is best avoided for up to 8 weeks after surgery.