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30.12.2014
Menieres disease is characterized by a cyclical pattern of sudden hearing loss, tinnitus (ringing in the ears) followed by vertigo. As mentioned under tinnitus the frequency of the noise with Menieres is in the low pitch area. In the beginning of the disease treatment in about 80% of cases is by salt restriction to 1500 mg per day and the use of a potassium sparing diuretic such as Dyazide or Maxzide. When there is Menieres disease affecting both sides, a treatment with 60 mg of prednisone per day for several weeks with slow tapering is considered a therapeutic trial. If this improves the condition, this is considered to be proof that this type of Menieres disease is due to autoimmune inner ear disease. This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. During diving and flight elevation or landing, the pressure is changing To adapt to it, pressure of middle ear should be changed accordingly by opening up the eustachian tube. Pure tone audiogram is necessary as it usually shows conductive hearing loss.  However if inner ear is involved, sensorineural hearing loss may be seen.
For blood or fluid in the middle ear, observation is suggested.  But it can be drained by myringotomy if it is not subsided after a period of time. If there is inner ear injury, conservative management such as bed rest and drugs is recommended.  But if hearing deteriorates progressively, surgical exploration and operation would be suggested.
Acute otitis media is acute infection of the middle ear which is either due to viral or bacterial infection.
After AOM, some fluid may accumulate in the middle ear resulting in conductive hearing loss. While the majority of eardrum perforation heals spontaneously, some perforations persist due to unresolved infection or Eustachian tube dysfunction. Normally the middle ear and external ear canal is separated by the thin membrane called tympanic membrane or ear drum. It is different from the usual CSOM (chronic suppurative otitis media) that skin "grows" inside the middle ear and mastoid process and forms a "tumour-like" plague.
It is usually presented as sudden onset of sustained vertigo and dys-equilibrium accompanied by a spontaneous wobbling of eyeballs lasting from 3 to 7 days followed by gradual resolution.
Basically it only needs supportive treatment with relief of dizziness during the acute episode.
The patient with BPPV (Benign Paroxysmal Positional Vertigo) experiences severe spinning associated with a change of head position.
A test called Dix-Hallipike maneuver is done for eliciting nystamus (wobbling of eyeballs) and vertigo caused by posterior canal BPPV. In general, the theory of canalithiasis, which is well accepted as the explanation of BPPV (Benign Paroxysmal Positional Vertigo)?
It is a condition where a benign tumor is arising from the eighth cranial nerve which is called vestibulocochlear nerve (mostly involves the vestibular nerve rather than the cochlear nerve). The classic presentation of acoustic neuroma would be unilateral progressive sensorineural hearing loss. We can either treat it with hearing aids or operative treatment which is called stapedectomy. Systemic steroid is the evidence based treatment of choice as it can suppress the inflammation caused by the viral infection. If you or someone you know has suffered from Sudden Hearing Loss, contact an audiologist to see if there is anything that can be done to help!  Maybe a hearing aid or a CROS system, or even a Cochlear Implant referral.  Just know you are not alone, and although we don’t know what causes Sudden Hearing Loss and that makes it hard to treat it, more advances are being made all the time. Meniere’s disease is characterized by fluctuations in hearing, episodes of dizziness, tinnitus and a feeling of pressure in the ear. Over time, the severe cases gradually burn out; however, the price for this is usually good hearing.
It is important to make sure that there is nothing seriously wrong that may be causing the symptoms of inner ear disease. Not all tests will be needed and each is ordered when the specific information that it produces is helpful in confirming the cause, delineating the amount of damage, and, in some cases, to determine which ear is affected by the illness. The ear will look normal in Meniere’s disease and there will be no evidence of middle ear or Eustachian tube problems. The mainstay of treatment for Meniere’s disease involves drugs to reduce the dizziness and drugs to reduce the fluid overload of the inner ear. On occasion, we find in our blood work that there is an abnormality suggesting the possibility that an autoimmune disorder may underlie the disease. With close follow-up and the aforementioned medical therapy, approximately 80-85% of patients with Meniere's disease will be controlled. Only a minority of patients need surgery; however, when medical treatment fails and there are incapacitating symptoms, patients and doctors then need to consider this next level of treatment. This is an ear operation that is done to drain and open the endolymphatic sac, the site that is responsible for resorbing inner ear fluid. This operation is reserved for patients who have good hearing but severe vertigo, and who either have failed the endolymphatic sac procedure or only wish to undergo one, definitive operation. This is a procedure that attempts to drain fluid and create a fistula upstream rather than down at the endolymphatic sac. This is an excellent, safe, definitive destructive procedure in which the balance organs are systematically drilled away under general anesthesia. This is an outpatient procedure that capitalizes on the known toxicity of this antibiotic to the inner ear. Over time, enough of the antibiotic will be absorbed into the inner ear to cause a destructive effect on the balance system.
Each of these techniques is designed to alleviate the symptoms of a patient with intractable Meniere's disease.
Sensorineural hearing loss (SNHL) occurs when there is damage to the inner ear (cochlea) or to the nerve pathways from the inner ear to the brain. Sometimes a conductive hearing loss occurs in combination with a sensorineural hearing loss. When it comes to Endonasal Cranial Adjusting, ear infections and hearing loss overlap in their explanation.
Chiropractic spinal adjusting has also been shown to help ear drainage by restoring nerve signals to the Tensor Veli Palatini (TVP) muscle (which is responsible for contracting and helping ear drainage).  Thus, healing can occur.


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For over 17 years, the NYOG has specialized in the ear, nose and throat, and ranks among the country's leading diagnostic and treatment centers for otolaryngology-related illnesses. The most common cause of hearing loss in children is otitis media, the medical term for a middle ear infection or inflammation of the middle ear. Tinnitus is the medical name indicating “ringing in the ears,” which includes noises ranging from loud roaring to clicking, humming, or buzzing.
An infection of the outer ear structures caused when water gets trapped in the ear canal leading to a collection of trapped bacteria is known as swimmer’s ear or otitis externa. Earwax (also known as cerumen) is produced by special glands in the outer part of the ear canal and is designed to trap dust and dirt particles keeping them from reaching the eardrum. A perforated eardrum is a hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear. At this point the management of care would be given over to a rheumatologist who likely will consider the use of methotrexate. For otitis externa (ear canal infection), ear toilet, topical antibiotic eardrops with or without oral antibiotic is the standard treatment. Except paediatric cases with bilateral OME and hearing impairment, we may observe for any resolution of OME with time.
The most frequently cited occurrence of this symptom follows rolling over in bed or getting into bed and assuming a lying-on-back position. When we turn or move our head or change our positions, the stone-like substances in the ampulla ( the organ for sense of balance)moves and irritate the said organ.
Normally, the lesions are removed by excision and the specimen is then checked by pathologist. These include a typical sensorineural (nerve-type) deafness seen on audiometry, and often an ear that, despite the hearing loss, perceives sounds as being too loud and quite annoying.
The diuretics alone will not help if a liberal salt intake is occurring, so we recommend a 1200-1500mg low salt diet. The information about their effects on Meniere's disease is spotty and anecdotal at best.
No patient should ever have to suffer from continued severe vertigo in this disease, as it can always be remedied. The procedure takes approximately 1-2 hours and requires a three-to-five-day hospital stay.
It is a procedure that can be performed in thirty minutes under local anesthesia and as an outpatient. This drug, in drop preparation, is instilled on a daily basis into the ear canal or through a catheter into the middle ear through a small hole made in the eardrum.
Unfortunately, the drops also have a potential to destroy hearing and cause tinnitus, so it must be used with great caution in hearing ears. This discussion is to allow you to reiterate what your doctor has told you and should not be substituted for a frank discussion about your own personal case. NYOG physicians have consistently been recognized among the city's foremost doctors within their areas of specialization. Treatment of these and other hearing losses can often lead to improved or restored hearing. This condition can occur in one or both ears and primarily affects children due to the shape of the young Eustachian tube (and is the most frequent diagnosis for children visiting a physician).
Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. In this warm, moist environment, bacteria multiply causing irritation and infection of the ear canal.
Usually the wax accumulates, dries, and then falls out of the ear on its own or is wiped away. It occurs when the body’s immune system attacks cells in the inner ear that are mistaken for a virus or bacteria. This condition usually results from poor eustachian tube function concurrent with middle ear infection (otitis media), but can also be present at birth. A perforated eardrum is often accompanied by decreased hearing and occasional discharge with possible pain. After several hours, at the most 24 hours, this episode is over, only to return in a few weeks again.
In about 20% of patients with Menieres disease that is confined to one ear, surgery would be advisable.
Some cases can be caused by head or ear trauma, some by middle ear infection, some by autoimmune or allergic problems, some by inner ear syphilis and, on occasion, by a virus. Since these provide symptomatic relief, they usually are needed only when dizziness is present.
The diuretics that are most commonly prescribed are hydrochlorothiazide (HCTZ), Maxzide, aldactone, Lasix (furosemide), or Diamox (acetazolamide). The side effects of prolonged steroid use are significant, so they must be used carefully. However, you might wish to experiment by avoiding them for a period of time to see if they particularly affect you.
This operation will usually not cause hearing loss, but carries with it the risks associated with any ear operation: hearing loss, dizziness, and facial nerve weakness.
In this microsurgery, the facial nerve is first positively identified by electrical stimulation, and then the eight nerve is exposed and the balance portion is identified and cut.
Since the balance nerve has been cut and no information gets to the brain from the diseased labyrinth, some unsteadiness, particularly in the dark or with quick turns, can remain permanently. Hearing will be lost from the procedure, so it is recommended for patients with severe vertigo and poor hearing.
Because absorption of the drops is unpredictable and susceptibility varies, the end result will vary from patient to patient. Each child, ranging in age from 27 days to 5 years, was given a series of chiropractic adjustments.
Staffed by an exceptional team of board-certified physicians and specialists, the NYOG adheres to a comprehensive disease management approach to ensure its patients receive the best possible care of their sinus, head and neck, hearing and balance, speech and swallowing, and sleep apnea conditions.


If you are experiencing pain for more than 24 hours, come in and see us for a consultation. If left undiagnosed and untreated, some conditions can lead to irreversible hearing impairment or deafness. When left undiagnosed and untreated, otitis media can lead to infection of the mastoid bone behind the ear, a ruptured ear drum, and hearing loss. The health of these nerve endings is important for acute hearing, and injury to them brings on hearing loss and often tinnitus. Although it typically occurs in swimmers, bathing or showering can also contribute to this common infection.
Patients with severe Meniere’s disease may have repeated spells of vertigo that may come frequently and without warning.
Up to 40% of the cases will eventually become bilateral; however, if bilateral disease has not occurred within the first five years, the chances of occurrence in the other ear drops significantly.
It is known that the end result is that the inner ear cannot get rid of the inner ear fluid (endolymph) that is constantly being produced, somewhat akin to glaucoma developing in the eye. Some patients who are having multiple spells on a daily basis find that a low dose of these medications, taken around the clock, help them considerably.
Some diuretics also cause potassium to be lost in the urine, so potassium replacement is a must. However, when an immune cause is identified, steroids plus diuretics may be the only effective treatment and the disease can be put into remission by such a regimen. It is a good choice for patients with severe dizziness and relatively poor hearing, especially if they are elderly and might have a hard time compensating after destruction of their balance system.
This has a high cure rate for vertigo (90-95%), but in elderly people with poor vision or any preexistent brain dysfunction, there can be a problem adjusting to the loss of balance function. The results show that close to 80% of the children in this study experienced NO ear infections within the six-month period following their initial visits. As well, its facial plastics practice offers a broad array of facial reconstructive surgeries and cosmetic procedures. If you suspect that you or your loved one has a problem with their hearing, ensure optimal hearing healthcare by seeking a medical diagnosis from a physician. Hearing nerve impairment and tinnitus can also be a natural accompaniment of advancing age. In severe cases, the ear canal may swell shut leading to temporary hearing loss and making administration of medications difficult. Using cotton swabs or other small objects to remove earwax is not recommended as it pushes the earwax deeper into the ear, increasing buildup and affecting hearing. Therefore, recognizing the symptoms of AIED is important: sudden hearing loss in one ear progressing rapidly to the second and continued loss of hearing over weeks or months, a feeling of ear fullness, vertigo, and tinnitus.
Over time, untreated cholesteatoma can lead to bone erosion and spread of the ear infection to localized areas such as the inner ear and brain. Sometimes a perforated eardrum will heal spontaneously, other times surgery to repair the hole is necessary. Balance disorders can also make a patient lack concentration, have trouble focusing, and find it difficult to navigate through a supermarket or a shopping mall. The normal site within the inner ear that resorbs fluid is the endolymphatic sac that lies under the mastoid bone and up against the brain covering known as dura mater.
Eating fresh bananas and oranges helps but is not usually sufficient to keep up with the potassium depletion. We usually do not perform this surgery solely for hearing loss, as it is impossible to predict if hearing will improve with time following the surgery.
The major drawback to this procedure is that there may be significant hearing loss from it (especially at high frequencies) and, over time, symptoms might return due to closure of the internal fistula. Exposure to loud noise is probably the leading cause of tinnitus damage to hearing in younger people. Treatments primarily include medications but hearing aids and cochlear implants are helpful to some.
The unpredictability of the vertigo spells can be dangerous, particularly when driving or working at any heights where precise balance is required. In this case, the surgeon must estimate the percentage of the nerve that is balance and perform the neurectomy without exact knowledge of how much of the nerve carries hearing fibers and how much carries balance.
Medical treatments and assistive hearing devices are often helpful to those with this condition.
A physician can advise you on protection of the ear from water and bacteria until the hole is repaired.
In severe cases, the incapacitating nature of this disorder and its unpredictability can create stress and some neurotic behavior that develops as a coping mechanism. We recommend that diuretics be continued until no symptoms remain in the ear, exclusive of tinnitus, which may never completely resolve. Since vertigo is the compelling reason for doing the surgery, we usually recommend that we err on the side of taking more of the nerve rather than less, in order to ensure relief from vertigo, even at the expense of some hearing. Once the dizziness ceases and inner ear pressure and hearing loss improve, a slow withdrawal of the medication can begin.
The risks of the surgery include deafness, persistent dizziness, facial nerve weakness, meningitis, cerebrospinal fluid leakage, stroke and bleeding.
Usually we suggest that if twice a day diuretics are prescribed, then they be cut back to once a day for several weeks.
In fact, some women will have exacerbations premenstrually, when they take birth control pills or estrogen replacement hormones. At that point, they can be stopped altogether and used on an as-needed basis, being guided by pressure, lightheadedness, or hearing loss.



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