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Author: admin, 20.06.2014. Category: Severe Tinnitus Symptoms

This 1-minute video gives a quick overview of the anatomy of hearing, and the causes and types of hearing loss. Conductive hearing loss is caused by any condition or disease that blocks or impedes the movement of sound through the outer or middle ear.
Generally, we can treat the cause of a patient’s conductive hearing loss, giving them complete or partial improvement in hearing. A mixed hearing loss is a combination of conductive and a sensorineural hearing loss in the same ear. The outer ear consists of the auricle (unlabelled), the external auditory canal, and the lateral surface of the tympanic membrane (TM). There are several other audiological tests that are also commonly abnormal in persons with conductive hearing loss. Tympanometry usually is either flat (as shown below), or shows an abnormally large volume (indicating a perforation). Other tests that may be helpful in confirming conductive hearing loss are OAE testing and temporal bone CT scan. Causes include a buildup of ear wax, a foreign body in the ear canal, otosclerosis, typanosclerosis (as shown above), superior canal dehiscence (which can also cause a conductive hyperacusis), external or middle ear infections (otitis externa or media), allergy with serous otitis media (fluid in middle ear), trauma to the ossicular chain such as temporal bone fracture, tumors of the middle ear such as a glomus tumor, erosion of the ossicular chain (cholesteatoma) and perforation of the tympanic membrane. A hole in the ear drum, which is called a tympanic membrane perforation, causes a conductive hearing loss.
It is generally attributed to previous ear infections or trauma (such as a tube insertion). The last step in the chain of signal transmission between sound in the air and movement of fluid in the inner ear is the middle ear.
There are three small bones interposed between the large ear drum, and the small hole (oval window) across which sound is transmitted into the inner ear. Complete ossicular chain discontinuity usuall results in a large, flat conductive hearing loss.
Characteristically, hearing aids work well for conductive hearing loss, and very good hearing results can be obtained.
Surgical treatment is also generally available for conductive hearing loss as it is always due to a mechanical problem.
Most surgical treatments for otosclerosis or middle ear disease involve opening of the middle ear and repair under direct vision. However, in our opinion (which is not representative of general opinion of ear surgeons), we think it is preferable to use a hearing aid until hearing becomes unservicable, and then move onto an implanted hearing aid, and skip the middle ear surgery part altogether.
There are many causes of hearing problems ranging from something as simple as wax blocking the ear canal to serious medical problems requiring medical intervention. Sensorineural Hearing Loss – A sensorineural loss is the result of damage to the nerve fibers in the inner ear.
Conductive Hearing Loss – Conductive hearing loss is caused by any malfunction or obstruction of the outer or middle ear. Episodic vertigo is the most common reason for patients to seek and pursue treatment for Meniere’s disease. If episodes of vertigo persist despite changes in diet, medication called diuretics can be helpful. Other options are available and include transtympanic decadron or gentamicin, decadron perfusion of the inner ear, endolymphatic sac surgery, vestibular neurectomy and labyrinthectomy surgery. Steroid treatment of the inner ear may offer beneficial effects for the symptoms of Meniere’s disease. A powerful way of delivering steroid to the inner ear is by injection into the middle ear through the tympanic membrane.
There is a 1% chance of a persistent 1 mm perforation of the eardrum at the injection site. This form of treatment involves injection of medication through the eardrum into the middle ear. A shunt is placed in the endolymphatic sac, a reservoir for endolymph, to shuttle fluid out of the sac and into a cavity created in the mastoid.


Step 3: A mastoidectomy is done exposing the semicircular canals, venous sinus, and dura covering the brain. Step 4: Spinal fluid is drained and the brain relaxes, exposing the trigeminal nerve (responsible for the conduction of facial sensation), the vestibulocohlear nerve (hearing and balance), and the facial nerve. This is an operation to divide the balance nerves and interrupt the connection between the inner ear and the brain.
The middle fossa approach is the least commonly used and involves an incision above the ear followed by removal of bone over the brain. Another approach is the retrolabyrinthine approach, which involves incisions behind the ear similar to the endolymphatic shunt procedure. A third approach is the suboccipital approach, which involves an incision further behind the ear and removal of bone over the covering of the brain. Learn how Metropolitan NeuroEar Group gives back to the community through numerous philanthropic efforts.
While this might have been true many years ago, with modern advances in technology, nearly 95% of people with a sensorineural hearing loss can be helped with hearing aids. It is not the hearing aids that make one look older, it is what one may believe they imply.
It uses animation to help you understand how you hear, and what may be happening when your hearing is no longer top-notch. The middle ear includes the medial surface of the eardrum, the ossicular chain of bones, the eustachian tube. These can be immensely troublesome because their removal can be difficult, and infections are common. It is more accurate to say that there is a hearing reduction, as generally hearing is not greatly affected -- a 10 db drop is typical. There also seems to be a weak association with increased serum calcium (de Carvalho et al, 2006) . When these bones are fused (otosclerosis, or ossicular fixation) or broken (ossicular chain discontinuity), a conductive hearing loss is the inevitable result. When combined with a sensorineural hearing loss, this pattern may look superficially like a conductive hearing loss, because there is an air-bone gap. Persons with LVAS may develop hearing loss as well as be unusually vulnerable to inner ear disease associated with head injury.
Recently some groups (Kakehata et al, 2006) are using endoscopy for repair of ossicular chain disturbances -- in our opinion, this is still very investigational and somewhat unreasonable -- when working inside a tiny space, one needs as good an exposure as one can manage. Carhart Notch 2-kHz Bone Conduction Threshold Dip: A Nondefinitive Predictor of Stapes Fixation in Conductive Hearing Loss With Normal Tympanic Membrane. It is commonly caused or exacerbated by the natural aging process, but can also be caused by noise exposure, strong medications, diabetes, stroke, and other circulatory diseases. Reducing or eliminating smoking is not only good for Meniere’s disease but also good for your health in general. Administration of steroids to the inner ear is an attempt to reduce the inflammation within the inner ear. From here, the steroid diffuses through the round window (one of the two openings into the cochlea of the inner ear)membrane and enters the inner ear.
The medication, which is then taken up by the inner ear, destroys the hair cells of the inner ear.
Of the surgical options, this is the most conservative operation with minimal risk to hearing.
The mastoid bone is entered and the endolymphatic sac is decompressed, meaning that the bony covering is removed. The ear may protrude slightly shortly after surgery, but it should return to its original position in two to three weeks. 90-95 percent of patients who undergo this operation for Meniere’s disease will not have another spell of vertigo.
The roof of the canal through which the balance nerves run is removed and the nerves are then divided.


Nearly all patients with Meniere's disease will be vertigo-free after a labyrinthectomy. Using a high-powered drill, the mastoid bone is entered and the semicircular canals are removed.
Sanjay Prasad MD FACS is a board certified physician and surgeon with over twenty years of sub-specialty experience in Otology, Neurotology, advanced head and neck oncologic surgery, and cranial base surgery.
Since most people with hearing impairments hear well in a quiet environment like a doctor’s office, it can be virtually impossible for your physician to recognize the extent of your problem. If you miss a punch line to a joke, or respond inappropriately in conversation, people may have concerns about your mental acuity, your attention span, or your ability to communicate effectively.
If hearing aids help you function like a normal hearing person, for all intents and purposes the stigma is removed. These are most easily removed using an examining microscope, but in some instances, surgical removal is needed. It is presently thought that persons taking calcium supplements are not at increased risk, and also that there is no risk from calcium channel blocker medications. The most common ones are cholesteatoma associated with chronic ear infection (it is not a true tumor) and glomus tumors. Close monitoring of blood pressure and potassium levels by your primary care physician is recommended. During the procedure, the eardrum is elevated and the round window (one of the two openings into the cochlea of the inner ear) membrane is perfused with high-dose steroid.
The medication, Gentamicin, is an antibiotic that is toxic to the hair cells of the hearing and balance organ. Unfortunately, control of vertigo occurs in only 60 percent of patients undergoing this operation.
After the operation, disequilibrium lasts until the brain learns to compensate and adapt to the lack of input from one inner ear. He is chief surgeon and founder of the private practice, Metropolitan NeuroEar Group, located in the metropolitan Washington D.C. Without special training and an understanding of the nature of hearing loss, it may be difficult for your doctor to even realize that you have a hearing problem.
It also reduces the intensity of sound, but may also result in a lack of clarity even when sounds, particularly speech, are loud enough. Practically, this is a very uncommon situation, of much more interest to diagnosticians than patients. This is a relatively painless procedure that involves anesthetizing the tympanic membrane and then injecting the steroid thereafter. The fluid that would normally enter the sac is shunted away from the inner ear and into the cavity created by the surgery, where it is then reabsorbed. This is an operation that is recommended to patients who have no useful hearing in the dysfunctional ear.
At a simplistic level, untreated hearing loss means giving up some of the pleasant sounds you used to enjoy.
We can treat patients with sensorineural hearing loss with amplification through hearing aids. Avoiding adding salt to meals and curtailing intake of snacks high in sodium, including canned foods and fried foods, can be helpful. Just as in vestibular neurectomy, after the operation, disequilibrium lasts until the brain learns to compensate and adapt to the lack of input from one inner ear.
These electrodes detect contractions of the facial muscles, and the signals are transmitted to a speaker so the surgeon may hear the responses.



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