Audiology (Ears)

Vestibular Schwannoma

A vestibular schwannoma (also known as acoustic neuroma, acoustic neurinoma, or acoustic neurilemoma) is a benign, usually slow-growing tumor that develops from the balance and hearing nerves supplying the inner ear.

The tumor comes from an overproduction of Schwann cells–the cells that normally wrap around nerve fibers like onion skin to help support and insulate nerves. As the vestibular schwannoma grows, it presses against the hearing and balance nerves, usually causing:

  • Unilateral (one-sided) or asymmetric hearing loss
  • Tinnitus – ringing in the ear
  • Dizziness/loss of balance

As the tumor grows, it can interfere with the face sensation nerve (the trigeminal nerve), causing facial numbness. Vestibular schwannomas can also press on the facial nerve (for the muscles of the face) causing facial weakness or paralysis on the side of the tumor. If the tumor becomes large, it will eventually press against nearby brain structures (such as the brainstem and the cerebellum), becoming life-threatening.

Unilateral vestibular schwannomas affect only one ear. They account for approximately 8 percent of all tumors inside the skull; one out of every 100,000 individuals per year develops a vestibular schwannoma. Symptoms may develop at any age but usually occur between the ages of 30 and 60 years. Unilateral vestibular schwannomas are not hereditary.

Bilateral vestibular schwannomas affect both hearing nerves and are usually associated with a genetic disorder called neurofibromatosis type 2 (NF 2). Half of affected individuals have inherited the disorder from an affected parent and half seem to have a mutation for the first time in their family. Each child of an affected parent has a 50 percent chance of inheriting the disorder. Unlike those with a unilateral vestibular schwannoma, individuals with NF2 usually develop symptoms in their teens or early adulthood. In addition, patients with NF2 usually develop multiple brain and spinal cord related tumors. They also can develop tumors of the nerves important for swallowing, speech, eye and facial movement, and facial sensation.

Scientists believe that both unilateral and bilateral vestibular schwannomas form following the loss of the function of a gene on chromosome 22, which produces a protein that controls the growth of Schwann cells.

Early diagnosis of a vestibular schwannoma is key to preventing its serious consequences. There are three options for managing a vestibular schwannoma:

  1. Surgical removal
  2. Radiation
  3. Monitoring

Typically, the tumor is surgically removed (excised). The exact type of operation done depends on the size of the tumor and the level of hearing in the affected ear. If the tumor is very small, hearing may be saved and accompanying symptoms may improve. As the tumor grows larger, surgical removal is more complicated because the tumor may have damaged the nerves that control facial movement, hearing, and balance and may also have affected other nerves and structures of the brain.

Swimmers Ear

Swimmer’s ear (otitis externa) is an inflammation and infection of the ear canal. It occurs when the protective film that covers the ear canal (lipid layer) is removed. This causes the ear canal to look red and swollen. The ear canal may be narrower than normal and is tender when the outside of the ear is gently pulled up and back.

Swimmer’s ear may develop when water, sand, dirt, or other debris gets into the ear canal. Since it often occurs when excess water enters the ear canal, a common name for this inflammation is “swimmer’s ear”. If you have had swimmer’s ear in the past, you are more likely to get it again.

A rare but serious infection called malignant external otitis can develop if bacteria invade the bones inside the ear canal and spread to the base of the skull. Not many people get this infection — it is mainly seen in older adults who also have diabetes, people who have HIV, and children who have impaired immune systems — but it can be fatal. Symptoms include ear pain with sudden facial paralysis, hoarseness, and throat pain. Antibiotics are used to treat this infection.

Other causes of inflammation or infection of the ear canal include:

  • Allergies
  • Bony over growths in the ear canal called exostoses
  • Bubble baths, soaps, and shampoos
  • Cleaning the ear canal harshly or with a sharp object
  • Headphones inserted into the ear
  • Scratching the ear canal with a cotton swab, bobby pin, fingernail, or other sharp object
  • Skin problems, such as eczema, psoriasis, or seborrhea
  • Sweating

Swimmer’s ear is more likely if you have a very narrow or hairy ear canal, live in a warm, humid climate, have impacted earwax, or have had a head injury that also injured your ear.

Symptoms can include:

  • Itching
  • Pain
  • A feeling of fullness in the ear
  • Your ear canal may be swollen
  • You may have moderate to severe pain, drainage, or hearing loss

Unlike a middle ear infection, the pain is worse when you chew, press on the “tag” in front of the ear, or wiggle your earlobe.

Symptoms often get better or go away with home treatment.

  • Gently rinse the ear using a bulb syringe and warm saline solution or a half-and-half solution of white vinegar and warm water. Make sure the flushing solution is body temperature. Inserting cool or hot fluids in the ear may cause dizziness.
  • If your ear is itchy, try non-prescription swimmer’s eardrops, such as Star-Otic. Use them before and after swimming or getting your ears wet.
  • To ease ear pain, apply a warm face cloth or a heating pad set on low. There may be some drainage when the heat melts earwax. Do not use a heating pad on a child.
  • Do not use ear candles. They have no proven benefit in the removal of earwax or other objects in the ear and can cause serious injury.

See your doctor if:

  • Ear pain persists or gets worse
  • The ear canal, the opening to the ear canal, the external ear, or the skin around the external ear becomes swollen, red, or very painful
  • Drainage from the ear that does not appear to be earwax develops
  • Drainage from the ear that smells bad develops
  • Dizziness or unsteadiness develops
  • Ear discomfort lasts for longer than 1 week
  • Symptoms become more severe or frequent

Middle Ear Infection

The middle ear is the small part of your ear behind your eardrum. It can get infected when germs from the nose and throat are trapped there.

A small tube connects your ear to your throat. A cold can cause this tube to swell. When the tube swells enough to become blocked, it can trap fluid inside your ear. This makes it a perfect place for germs to grow and cause an infection. Ear infections happen mostly to young children because their tubes are smaller and get blocked more easily.

The main symptom is an earache. It can be mild, or it can hurt a lot. Babies and young children may be fussy. They may pull at their ears and cry. They may have trouble sleeping. They may also have a fever.

You may see thick, yellow fluid coming from their ears. This happens when the infection has caused the eardrum to burst and the fluid flows out. This is not serious and usually makes the pain go away. The eardrum usually heals on its own.

When fluid builds up but does not get infected, children often say that their ears just feel plugged. They may have trouble hearing, but their hearing usually returns to normal after the fluid is gone. It may take weeks for the fluid to drain away.

To help prevent ear infections:

  • Do not smoke. Ear infections happen more often to children who are around cigarette smoke. Even the fumes from tobacco smoke on your hair and clothes can affect them
  • Handwashing
  • Having your child immunized
  • Make sure your child does not go to sleep while sucking on a bottle
  • Try to limit the use of group child care

Most ear infections go away on their own. You can treat your child at home with an over-the-counter pain reliever like acetaminophen (such as Tylenol), a warm face cloth or heating pad on the ear, and rest. Do not give ASA to anyone younger than 20. Your doctor may give you eardrops that can help your child’s pain.

Your doctor can give your child antibiotics, but ear infections often get better without them. Whether you use them will depend on how old your child is and how bad the infection is.

Sometimes after an infection, a child cannot hear well for a while. Call your doctor if this lasts for 3 to 4 months.

Minor surgery to put tubes in the ears may help if your child has hearing problems or repeat infections.

Cochlear Implants

The cochlear implant is a medical prosthesis (small electronic device) that is placed in the inner ear that can help improve the hearing of people with severe, irreversible hearing loss. Although a cochlear implant does not restore normal hearing, it can allow a person to hear and understand more speech than was possible with a hearing aid.

For a child, this could mean an opportunity to develop listening and speech skills and the potential to attend school with hearing peers. For adults, a cochlear implant could reduce social isolation and improve communication.

The implant system has three primary parts:

  • Microphone and Transmitter — The headpiece and transmitter is about the size of a quarter and is worn above the ear to pick up sounds. These sounds are sent to a speech processor.
  • Speech Processor — A speech processor is worn externally, either on a belt like a pager or behind the ear like a large hearing aid, to convert sound into a digital code that is transmitted to an implanted stimulator.
  • Implanted Stimulator — The implanted stimulator is a small component placed under the skin behind the ear. It receives a digital code from the speech processor and sends it to the auditory or hearing nerve. The brain interprets this signal and it is recognized as sound.

The small headpiece and transmitter is held in place by a magnet coupled the implanted stimulator, under the skin.

Your audiologist will determine if you or your child is a candidate for a cochlear implant. Patients are selected based on medical and hearing histories and test results as well as findings and recommendations from a psychological interview.

Evaluation generally takes two days. Your audiologist will discuss in detail the components of the cochlear implant device, its functions, benefits and limitations as well as the surgical process. The evaluation, which differs slightly for children and adults, includes the following:

  • Medical Evaluation — Conducted by the implant surgeon who will take your medical history, examine your ears and explain the surgical process to you.
  • CT Scan — This computerized tomography (CT) scan produces a two-dimensional X-ray of your inner ear. It allows the surgeon to evaluate the ear’s internal structure, recommend which ear to implant and may provide information as to the cause of deafness.
  • Audiological Evaluation — This evaluation involves a hearing test to confirm the type and degree of your hearing loss, hearing aid evaluation to assess the benefit provided by a hearing aid and aided speech recognition testing to determine if a hearing aid might provide greater benefit than an implant.
  • Psychological Screening — This screening is conducted by psychologists to assess your feelings about hearing loss and the cochlear implant, such as your reasons for seeking the implant and your expectations.
  • Cochlear Implant Counseling — At this time, you will find out if you qualify for an implant, based on the results of the entire evaluation. If you qualify, possible benefits and limitations will be explained and you will be provided with information to select your device.
  • School Visit — For a child, the purpose of the school visit is to establish an ongoing relationship with his or her school, teacher and therapists prior to implant surgery and to provide in-service training to the professionals working with your child to ensure mutual support and shared goals.