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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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 »

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 »