Ears

 

Hearing

 

Hearing is critical for learning, business and pleasure. Hearing loss is one of the most common, underappreciated and scientifically neglected afflictions in medicine. Although the importance of good hearing can hardly be overestimated, it has not been appreciated by the public, or even by the medical community. Over 40 million Americans have hearing loss, and there is still a stigma attached to deafness. Little has changed from the days when society had to be admonished: Thou shalt not curse the deaf.  Although hearing loss may not be widely regarded as a punishment from God, it is still seen as an embarrassing infirmity, or a sign of aging or senility, and it is associated with a loss of sexual attractiveness. Too often our patients do not seek medical attention of their own accord. Many deny and tolerate hearing loss for a considerable period of time before being coerced by  a family member to seek medical care. Patients accept eyeglasses easily, but it is unusual to tell someone that he needs a hearing aid without causing distress. This is every bit as common in our 70-year old patients as it is in our teenagers.

 

When hearing loss occurs early in childhood, its devastating consequences are more obvious than when it occurs insidiously in adult life. Normal psychological maturation involves progression from oneness with a child's mother to self-image definition. In this process, the child develops patterns of human interrelationship and modes of emotional expression. A substantial hearing deficit in infancy interferes with this process. It delays self-image development, impairs the child's expression of needs, and often results in alienation from the child's family--sometimes to a permanent deficit in his ability to establish relationships. Severe hearing loss makes learning a mammoth task for the child, and he frequently reacts with frustration or isolation. The personality distortion that results from this sequence affects the person and his family throughout their lives.

 

Even more mild forms of hearing loss early in life can cause great difficulty. We frequently see a child who developed within normal limits but is not doing well in school, is inattentive, and is frequently considered "not too bright." It is uncommon to discover a moderate hearing loss in such a child. When the hearing loss is corrected, the parents invariably report that he is "like a different person." Fortunately, many of the hearing impairments that lead to these and other consequences are preventable.

 

When hearing loss occurs in an adult, more subtle manifestations of many of the same problems may be found. Most people with age-induced or noise-induced hearing loss hearing in the high frequencies first, making it difficult for them to distinguish consonants, especially s, f, t, and z. This makes a person strain to understand what is being said in everyday conversation. He knows that there is speech because he can hear the vowels, but he cannot easily distinguish the difference between "yes" and "get." This makes talking to his spouse, going to the movies, going to church, and other pleasures that most of us take for granted stressful chores. It is also the unrecognized source of considerable marital discord. For example, a man who has worked hard for many years in a weaving mill or as a boilermaker usually has a substantial hearing loss, especially if he has not worn ear protectors. When he comes home and sits down to read a newspaper, if his wife starts talking from another room (especially if there is competing noise such as running water or air conditioners), he will be able to hear her talking but not understand her words. Before long, it becomes so difficult to say "what" all the time that he stops listening. Soon she thinks he doesn't pay any attention to her or love her anymore, and neither of them realizes that he has a hearing loss underlying their friction. Busy otologists see this scenario daily in the office.  Although each of these patients can be helped through counseling and rehabilitation, we still have no cure for most cases of sensorineural deafness. Despite that, there is relatively little support for research. We undergo a constant barrage of requests for funds for sight, cancer, muscular dystrophy, multiple sclerosis, and numerous other entities, but it is hard to remember the last call for help for the deaf.

 

Although otologic advances have made almost all forms of conductive hearing loss surgically curable, sensorineural hearing loss can be treated and potentially cured in only a few conditions (Meniere's disease, syphilis, hypothyroidism, and a few others). Despite advances in our understanding of hearing loss and in hearing aid technology which make it possible to improve the lives of almost every patient with hearing loss, deafness prevention is still our best cure. A thorough understanding of the function of the ear and related structures reveals many possibilities for prevention of injury, and restoration of function. Avoidance of damaging noise, ototoxic drugs, insufficient treatment of diseases such as syphilis, and other measures often prevent hearing loss. Even when sensorineural hearing loss occurs, systematic, comprehensive assessment may reveal a treatable underlying cause. Fortunately, this is true in an increasing number of patients, as medical knowledge increases.

 

Today, although not all hearing loss can be cured, virtually every patient with hearing impairment can be helped through accurate diagnosis, understanding, education, medication, aural rehabilitation, amplification, and/or cochlear implantation. Major advances have been made in the last few decades, and even more may be anticipated as exploration continues into the mysteries of the inner-ear and ear-brain interface. 

 

Click here to read an article by Dr. Robert Sataloff regarding hearing health.   Then click the X in the upper right corner of the document to return to this page.

 

The above excerpt is taken from: Sataloff RT, and Sataloff J.  1980.  Hearing loss.  Marcel Dekker:  New York.

 

 

 

Balance

 

The importance of normal balance is self-evident. Even people who can hear and speak well, cannot function effectively in society if they cannot drive, or even walk without falling because of balance dysfunction (dizziness or vertigo). In the United States alone, dizziness accounts for over 11,000,000 physician visits annually, and it is the most common reason for visits to a physician in patients over 65 years old. Balance disorders also can result in fatal falls and motor vehicle accidents.

 

Vertigo, like deafness and tinnitus, is a subjective experience and is a symptom, not a disease. Its cause must be sought carefully in each case. The term "dizziness"  or "vertigo" is used by patients to describe a variety of sensations, many of which are not related to the vestibular system. It is convenient to think of the balance system as a complex conglomerate of senses that each send the brain information about one's position in space. Components of the balance system include the vestibular labyrinth, the eyes, neck muscles, proprioceptive nerve endings, cerebellum, and other structures. If all sources provide information in agreement, one has no equilibrium problem.  However, if most of the sources tell the brain that the body is standing still, for example, but one component says the body is turning left, the brain becomes confused and we experience dizziness. It is the physician's responsibility to systematically analyze each component of the of the balance system to determine which component  or components are providing incorrect information, and whether correct information is being provided and analyzed in an aberrant fashion by the brain. Typically, labyrinthine dysfunction is associated with a sense of motion.  It may be true spinning, a sensation of being on a ship or of falling, or simply a vague sense  of imbalance when moving.  In many cases, it is episodic. Fainting, light headedness, body weakness, spots before the eyes, general light-headedness, tightness in the head, and loss of consciousness are generally not of vestibular origin. However, such descriptions are of only limited diagnostic help. Even some severe peripheral (vestibular or eighth nerve) lesions may produce only mild unsteadiness or no dizziness at all, such as seen in many patients with acoustic neuroma. Similarly, lesions outside the vestibular system may produce true rotary vertigo, as seen with trauma or microvascular occlusion in the brain stem, and with cervical vertigo.

 

The above excerpt is taken from: Sataloff RT, and Sataloff J.  1980.  Hearing loss.  Marcel Dekker:  New York.

 

 

 

 

Tinnitus

 

Tinnitus (ear noise) is said to affect 35,000,000 Americans, and is one of the most challenging symptoms in otology and medicine. It has been speculated that tinnitus may be the result of a continuous stream of discharges along the auditory nerve to the brain caused by abnormal irritation in the sensorineural pathway. Though no sound is reaching the ear, the spontaneous nerve discharge may cause the patient to experience a false sensation of sound. Although this theory sounds logical, there is as yet no scientific proof of its validity.

 

Tinnitus is a term used to describe perceived sounds that originate within a person, rather than in the outside world.  Although nearly everyone experiences mild tinnitus momentarily and intermittently, continuous tinnitus is abnormal, but not unusual. The National Center for Health Statistics reported that about 32% of all adults in the United States acknowledges having had tinnitus at some time. Approximately 6.4% characterize the tinnitus as debilitating or severe. The prevalence of tinnitus increases with age up until approximately 70 years and declines thereafter. This symptom is more common in people with otologic problems, although tinnitus also can occur in otologically normal patients. Nodar reported that apparently 13% of school children with normal audiograms report having tinnitus at least occasionally. Sataloff studied 267 normal elderly patients with no history of noise exposure or otologic disease and found 24% with tinnitus. As expected, the incidence is higher among patients who consult an otologist for any reason. Fowler questioned 2000 consecutive patients, 85% of whom reported tinnitus. Heller found that 75% of patients complaining of hearing loss reported tinnitus, and Graham found that approximately 50% of deaf children also complained of tinnitus. According to Glasgold and Altmann, nearly 80% of patients with otosclerosis have tinnitus, and House and Brackman reported that 83% of 500 consecutive patients with acoustic neuromas had tinnitus.

 

One of the surprising features about tinnitus is that not everybody has it. After all, the cochlea is exquisitely sensitive to sounds, and relatively loud sounds are being produced inside each human head: the rushing of blood through the cranial arteries, the noises made by muscles in the head during chewing. That an individual rarely hears these body noises may be explained partially by the way that the temporal bone is situated in the skull and by the depth at which the cochlea is embedded in the temporal bone. The architecture and the acoustics of the head ordinarily prevent the transmission of these noises through the bones of the skull to the cochlea and thus to consciousness; yet the cochlea is built and situated in a way so that normally it can respond to very weak sounds carried by the air from outside the head. Only when there are certain changes in the vascular walls--perhaps caused by arteriosclerosis--or in the temporal bone structure does the ear pick up these internal noises. The patient may say that he hears his own pulse as a result of a vascular disorder, and it may seem to be louder when the room is quiet, or at nigh when he is trying to go to sleep. Pressing on various blood vessels in the neck rarely stops this type of tinnitus, unassociated with hearing loss.

 

The above excerpt is taken from: Sataloff RT, and Sataloff J.  1980.  Hearing loss.  Marcel Dekker:  New York.