Dr. C’s Ear Blog

Tinnitus and Hyperacusis

by Sujana S. Chandrasekhar MD • Dr. C’s Ear Blog, Featured

Dear readers,

Last night there was a show on TV with a subplot about one of the main characters having tinnitus (ear noise) and hyperacusis (exquisite sensitivity to sound). There were some mischaracterizations which I’d like to address.

Tinnitus (often called ‘ringing in the ears’) is the abnormal perception of sound that is not present in the environment. It can be perceived as a high-pitched whine, a loud hiss, a roar, clanging, crickets, or any other type of noise. The exact mechanism by which tinnitus occurs is not known, however, our theories in 2008 are significantly more scientifically exact than they were previously.

We know that our inner ears produce their own sounds. These ‘cochlear microphonics’ are used when we test newborn babies for hearing loss by measuring otoacoustic emissions. In general, our inner ear’s sounds are masked by environmental sounds and we do not perceive the cochlear microphonics. However, when a large group of young people were tested in a very quiet environment with no other stimuli, nearly all of them perceived their own tinnitus after a period of 30 to 45 minutes. Transient tinnitus is a frequent phenomenon and poses no danger.

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Ear Wax – CAN live with it; DON’T have to remove it!

by Sujana S. Chandrasekhar MD • Dr. C’s Ear Blog

Dear reader,

New guidelines were just released a week ago for the management of cerumen (ear wax). A panel of very respected health care providers, including ear-nose-and throat specialists, audiologists, internists, pediatricians, family practitioners, geriatricians, and nurses, was convened to look into the incidence and prevalence of ear wax, how often it becomes a problem to treat, and various methods of treatment for it.

The bottom line is that your grandmother was right – don’t put anything smaller than your elbow in your ear. For people who need something that sounds more scientific, read on!

Yours,

Dr. Chandrasekhar

Here is my summary of the data: [I’ve only interjected my opinion once – imagine that!] Read more »

Swimmer’s Ear (Otitis Externa)

by Sujana S. Chandrasekhar MD • Dr. C’s Ear Blog, Featured

Dear reader,

Summer is in full swing, and many of you may be beset by external ear infections (otitis externa [OE]), also known as ‘swimmer’s ear.’ This condition is a skin infection limited to the external ear canal, and can be caused by swimming or other ear water exposure, scratching the ear with a cotton-tipped applicator or other device (such as a hair pin), or something foreign entering the ear canal – dirt, sand, even small bugs. It manifests with pain, ear drainage, and sometimes hearing loss.

Treatment is straightforward, but if not treated early or correctly, things can of course get complicated. The vast, vast, vast majority of patients with OE do not need oral antibiotics at all.

OE is correctly treated by cleaning the ear under otoscopic or microscopic guidance, i.e., by a physician, and then having the patient apply ear drops once or twice daily for several days.

During and immediately after treatment, the patient should prevent any water (shower, lake, pool, ocean) from entering the ear by using commercially available ‘water protection’ ear plugs or by using cotton balls in the ear coated with petrolatum jelly to make them waterproof. Dry cotton in the ears will very effectively wick the water into the ear canals, accomplishing exactly the opposite of the goal. Read more »

The Gift of Hearing

by Sujana S. Chandrasekhar MD • Dr. C’s Ear Blog, Featured

Dear readers,

It turns out I chose a very emotionally rewarding profession.

The other day I received a letter from a patient of mine who had had a cochlear implant. She was writing to tell me that she was blowing out the 5th anniversary candles of her surgery – her ‘rebirth’ as a hearing person. Another patient of mine, who became progressively deaf with each pregnancy, told me that she was able to hear her son’s voice for the first time ever after receiving her cochlear implant when her son was 8 years old! Her implant surgery was done nearly 10 years ago, and she loves dancing to Christmas music. I saw a little boy in the office whom I implanted several months ago. It’s a good thing I keep tissue boxes in the rooms, since his new amazing speech and conversation brought tears of joy to my eyes!

Cochlear implants are for patients who have severe to profound hearing loss in both ears, and cannot benefit from hearing aids. Until relatively recently, those patients had no chance of entering the hearing world. They either joined the Deaf world and became fluent in sign language, and/or they became great face readers and used a variety of different visual cues in order to participate in Hearing life. Then, in the 1960s, two brilliant and forward thinking pioneers of hearing restoration, Dr. Graeme Clarke in Australia and Dr. William House in Los Angeles, CA, decided to change that. Apparently they were almost considered heretics at the beginning – imagine thinking you could stick an electrode in the inner ear and the patient would hear! – but those initial naysayers were proven wrong. About 100,000 people around the world have received cochlear implants, enabling these profoundly deaf people to hear.

But it’s not just the miracle of cochlear implants that I can use to help people to hear.

There’s a disease called otosclerosis that causes the third tiny bone in the middle ear (the stapes or stirrup) not to move properly. Most of these patients can benefit from stapedectomy surgery that restores normal middle ear bone functions and restores hearing over 95% of the time. This is, I must say, one of the most fun and challenging operations that I perform. In under 45 minutes, I can take someone from being hearing-impaired to normal hearing! I had one patient undergo stapes surgery in October one year, and that year for the holidays she was inundated with hearing-themed presents – an ipod, CDs, etc. A number of my stapes surgery patients have commented that they didn’t realize how much they were missing due to their hearing loss, until after their surgeries! Read more »

Meniere’s Disease and Politics

by Sujana S. Chandrasekhar MD • Dr. C’s Ear Blog

Dear reader,

As Thanksgiving Day approaches, I thought I’d give some advice to those out there with Meniere’s disease. MD is a disorder of the balance of the fluids of the inner ear. It can be devastating, as it causes hearing loss, tinnitus (roaring in the ears), and spinning vertigo. Luckily, the symptoms are episodic and the patient is usually fine between episodes. Classically, MD affects young women starting in their 20s or 30s, but it can affect both genders and all ages.

The first episode of classic MD (with all three of the symptoms of hearing loss, tinnitus and vertigo) is terrifying for the patient and anyone who happens to be around. It’s often immediately followed by a trip to the ER. Once the patient gets to an otolaryngologist (ear-nose-throat specialist) or an otologist (ear specialist), appropriate targetted treatment can be started. This involves strict dietary restrictions of (1) salt to less than 2000 to 2500 mg of Sodium per day, (2) caffeine to no more than 1 or maximally 2 cups or cans per day, (3) nicotine to none, and (4) alcohol to minimal, with one glass of water to be consumed per alcohol equivalent [one beer, one wine, or one mixed drink] consumed. Patients should also try to drink a good amount of water (4 to 6 glasses per day) and minimize internalization of external stressors. Some MD patients respond to reduction in certain types of carbohydrates as well as sugars and/or artificial sweeteners.

I take umbrage (isn’t that a neat phrase?) with some of my colleagues who make dire predictions of the future to MD patients. No, this disease does not have to be quality of life-ending. The vast majority (over 80%) of MD patients have very nice control of their symptoms with the dietary and attitudinal changes described above, and perhaps with some medications taken either daily or when the symptoms crop up. Very few patients need injections into their ears of either steroids or gentamicin, or surgery. A very small minority of patients end up with disabling MD.

Read more »

Welcome

by Sujana S. Chandrasekhar MD • Dr. C’s Ear Blog

Dear reader,

I would like to use this blog to discuss news, publications, and other matters of interest that relate to the ear, hearing, balance, lateral skull base and facial nerve. My hope is that in this type of forum topics can be discussed in greater depth than is usual. I am known to be quite opinionated, especially on subjects that I hold dear, like the ear, so expect some fireworks!

Sujana Chandrasekhar, MD