Acute Sudden Sensorineural Hearing Loss

Acute Sudden Sensorineural Hearing Loss is a rare otological condition with an incidence of 5-20 cases per 100,000 people per year. For an unknown reason, 2020 has seen an increase in cases presenting to our clinic. Treatment for this includes steroid therapy in various forms and hyperbaric oxygen. Acute Sudden Sensorineural Hearing Loss should be treated as an otological emergency and your GP or audiologist can call the practice directly to book an urgent appointment. In this scenario DON’T WAIT TO BE CONTACTED.

Ear wax

Ear wax (known as cerumen) is normal. Wax impaction can cause hearing loss, fullness, tinnitus and ear pain. Home ear cleaning may harm your ear canal, cause infection, increase wax impaction, put a hole in your ear drum or result in middle ear injury. Cotton wool buds, hair pins, toothpicks and fingernails are all items our ENT surgeons have found in compacted ear wax removed from patients’ ears. An ear toilet or suctioning will painlessly remove any wax, fungal debris or foreign bodies. We have regular appointments for ear toilets and a referral from your GP lasts for 12 months from the date of your first appointment, so you can attend as many times as necessary.

Otitis Media with Effusion

Otitis media with effusion indicates fluid is trapped behind the ear drum. It is a common condition in children and can cause reversible hearing loss. Acute Otitis Media (middle ear infection) is an infection of this fluid. Symptoms include ear pain, fever, irritability. Sometimes this can rupture with a release of fluid and reduction in symptoms. An examination with an otoscope is recommended and often a hearing test. First line treatment includes treatment of nasal conditions, nose blowing and sometimes antibiotics. Suctioning is recommended to clean out any fluid or debris if a rupture has occurred. If this fails to help grommets are often recommended.

Acute Otitis Externa

Acute otitis externa is commonly referred to as an outer ear inflammation or Swimmer’s Ear and is one of the most common presentations to our clinic. Acute otitis externa is common in North Queensland due to the high temperature and humidity, perspiration and exposure to water from swimming. Pre-existing conditions such as psoriasis, eczema and dermatitis can result in a higher predisposition to otitis externa. It can be either bacterial or fungal in nature and can be associated with a perforated tympanic membrane. Referral to one of our ENT surgeons by your GP is required. An ENT consultation will involve a thorough medical history, list of medications, a head and neck examination, otoscopy and thorough cleaning to remove any mucopurulent debris. The treatment applied will depend upon whether it is bacterial or fungal in nature. Medical treatment must be strictly adhered to resolve the inflammation and/or infection. Follow-up appointment may be required to clear away cream or debris to determine if treatment is effective. Stubborn cases of acute otitis externa can take several visits of supervised treatment by an ENT surgeon to resolve. Call or ask your GP to call our rooms if the case is urgent.

Otorrhea

Otorrhea means discharge from the ear. This is often due to a hole in the ear drum. Otorrhea after grommet insertion is very common. In one study in young children, the incidence was almost 50%. Most will occur shortly after insertion or occur associated with rhinorrhoea (nasal discharge). Occasionally patients will have troublesome otorrhea that is resistant to treatment. Significant risk factors for otorrhea include socioeconomic status, cigarette smoke exposure, rhinorrhoea and craniofacial anomalies such as a cleft palate. A review by an experienced ENT surgeon is recommended. First line treatment includes a proper examination and obtaining a swab for histopathology. Often tissue spearing is recommended to clean out any mucopurulent debris and the use of topical antibiotics.

Intratympanic Dexamethasone perfusion

Intratympanic dexamethasone perfusion or titrations are performed under a sterile environment in our Mackay ENT consultation room to treat Acute Sudden Sensorineural Hearing Loss, Meniere’s disease and other conditions. These perfusions are usually performed in a series over several weeks for the purpose of reducing inflammation of the inner ear. There are side effects to the use of a corticosteroid and these will be discussed prior to consent for perfusion.

Ménière’s Disease

Meniere’s Disease is a disorder of the inner ear which can result in imbalance, vertigo (spinning), hearing loss symptoms, ringing in the ears (tinnitus), pressure symptoms, nausea and vomiting. It was first reported by Prosper Ménière in 1861. Attacks are usually spontaneous and can be associated with low frequency sensorineural hearing loss. It is important to seek a referral to a specialist otologist to ensure you are accurately diagnosed and consider treatment options. Keeping a journal of your symptoms is a good idea to help with correct diagnosis and some tests which might be ordered include an audiogram, MRI and balance testing. Some of the treatments include dietary modification, medications, middle ear injections, vestibular physiotherapy or surgery.

Benign Paroxmyal Positional Vertigo (BPPV)

Another form of dizziness is BPPV which is prompted by head movements such as rolling over in bed or looking up that last for seconds at a time. Severe cases result in an inability to control eye movements. It is useful to keep a diary of your symptoms or, if possible, take a video of your eyes when feeling dizzy. This can be useful for correct diagnosis. A review with a specialist will involve a full medical history (including any head injuries or falls), full head and neck examination, detailed vestibular and ocular examination. The specialist may request an MRI scan, to rule out other causes for the dizziness, and request an electronystagmography (ENG) or videonystagmography (VNG). Treatment may include vestibular physiotherapy, canalith repositioning or surgery.

Implantable Hearing Devices

Implantable Hearing Devices include middle ear implants, bone anchored hearing aids, cochlear implants and brainstem implants. The initial consultation and workup can be done in Mackay however, these devices are NOT currently implanted in Mackay, so you will need to travel to either Townsville or Brisbane for the definitive procedure.

For hearing impaired persons there are many disadvantages to conventional hearing aids such as discomfort, poor fitting, wax impaction, poor sound quality, lack of high frequency benefit, feedback or background noise amplification.

The advantages of an implantable device include reduction or elimination or occlusion effect (blockage) and feedback, improved comfort (particularly for swimmers) and improved sound by direct stimulation. The disadvantages for having an implantable device include cost, risks associated with undergoing a surgical procedure and potential to worsen residual hearing. These factors will be discussed with you in detail at your consultation. There are various implantable devices and a complete audiological assessment by a suitably qualified audiologist is recommended to determine the nature of your hearing loss and what is the best option for you. The cochlear implantation assessment process involves a full audiological assessment, CT scan and/or MRI scan with subsequent vestibular and balance assessment, psychological review and depending upon age, a geriatric assessment. The Brisbane or Townsville surgeon will review these reports and determine suitability for surgery. The post-operative audiological rehabilitation for candidates is long and exhaustive, particularly for those with longer periods of hearing deprivation.

Otosclerosis

Otosclerosis is defined by the Royal Australasian College of Surgeons as a hereditary disorder that causes progressive hearing loss which may occur in one or both ears. Often an audiologist will recommend you seek a referral to an ENT surgeon. The diagnosis of otosclerosis can be made following an audiogram and clinical examination by an ENT surgeon. Your ENT surgeon will require a detailed medical history including any health problems you may have had, and any medications you may be taking. The treatment of otoscelerosis may include watchful waiting, use of hearing aids or surgery, commonly in the form of a stapedectomy.

Eustachian Tube Dysfunction

Eustachian Tube Dysfunction is a condition where the pressure generated in the middle ear is not released properly to the nasal cavity. It is a very common condition. Typically it causes a feeling of fullness, pain with flying and a hearing loss. Audio entry and pressure testing pick can indicate this condition. Having a cold or flu makes it worse. Investigation includes examination of the back of the nose where the Eustachian tubes sit and the ear. Treatment includes ensuring the nasoendoscopy is as clear as possible and occasionally grommets or balloon tuboplasty. Your ENT surgeon will discuss the risks, benefits and alternatives to these procedures.

Patulous Eustachian Tube

Patulous Eustachian tube dysfunction is where the Eustachian tube remains completely or intermittently open, rather than being closed. Usually, the cause of patulous eustachian tube dysfunction is unknown. Commonly suffers report being able to hear their own voice or pulse or breathing loudly. Classically symptoms get better with a cold or flu. Symptoms may include a feeling of fullness in the ear, tinnitus, autophony, hearing loss or suprathreshold hearing. It is a very discomforting condition and can result in anxiety when breathing, especially when exercising. Medical treatment may involve weight loss/gain (if medically indicated), increasing fluid intake, nasal saline drops or irrigations to improve hydration of mucosa. If medical treatment is not successful, surgical treatment may include myringotomy with tympanostomy tube replacement or other less common procedures. Your ENT surgeon will discuss the risks, benefits and alternatives to these procedures.

Surgical ear procedures

• Myringoplasty is an operation to repair a perforation of the ear drum. A perforation may result in a constantly discharging ear, frequent ear infections, hearing loss, build-up of granulation tissue. It may also occur as a result of disease such as cholesteatoma. Myringoplasty will need to be performed under a general anaesthetic and may require an overnight stay in hospital. Each perforation is different and our surgeon will discuss in detail the surgery required. Commonly a tissue graft is harvested and is fixed to the ear drum. Your surgeon may also wish to explore the middle ear space to ensure there is no further underlying pathology. Your recovery will take 1-2 months. Up to 5% of grafts fail and further surgery may be required.

Personal care, dedicated to resolutions.

Mackay Ear, Nose and Throat Specialists work closely with sleep study facilities and can also help with snoring and breathing problems including sleep apnoea.

Post operative care is a critical component of Mackay Ear, Nose and Throat Specialists’ service and all procedures and surgeries are followed up personally by our Specialists until they are satisfied the problem has been resolved.

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