How The Ear Works:
The ears are paired sensory organs comprising the auditory system, involved in the detection of sound, and the vestibular system, involved with maintaining body balance/ equilibrium. The ear has three main parts: the outer, middle and inner ear. The outer ear opens into the ear canal.  The eardrum separates the ear canal from the middle ear. Small bones in the middle ear help transfer sound to the inner ear. The inner ear contains the auditory (hearing) nerve, which leads to the brain.

Any source of sound sends vibrations or sound waves into the air. These funnel through the ear opening, down the ear, canal, and strike your eardrum, causing it to vibrate. The vibrations are passed to the small bones of the middle ear, which transmit them to the hearing nerve in the inner ear. Here, the vibrations become nerve impulses and go directly to the brain, which interprets the impulses as sound (music, voice, a car horn, etc.).

Evaluation of Ear-Related Problems
A complete otologic examination by an ear, nose and throat (ENT) physician can determine what type of hearing impairment may exist, its possible causes, and treatment options.

Common Forms of Hearing Loss

Conductive Hearing Loss
Hearing loss can be conductive or sensorineural in nature. Conductive hearing loss occurs when excessive earwax or a disease or disorder, such as damage to the eardrum or middle ear bones due to infection or otosclerosis1, impedes the ability of either our middle or outer ear to transmit sound to the inner ear.  Medication and/or surgical reconstruction techniques often can correct mechanical functions of the eardrum or ossicular chain. Blockage of the outer ear canal also can result in hearing loss. In such cases, an ENT physician often can provide treatment to improve hearing.

Sensorineural Hearing Loss 
Sensorineural hearing loss is nerve-based.  It occurs when either the microscopic hair cells of the inner ear or nerve fibers, which transmit signals to the brain, are damaged or compromised.  In most cases, this type of hearing loss is permanent and irreversible.

Mixed Hearing Loss
Sometimes people can have a combination of conductive and sensorineural impairment, commonly referred to as a mixed hearing loss.   Multiple disorders or a single disease, such as otosclerosis that can spread to both middle and inner ear structures, can result in a type of mixed hearing loss.

Tinnitus
Hearing loss is one of many different health factors that can be associated with tinnitus, a symptom usually identified as a ringing or roaring sensation in the ear. Approximately 80% of patients with hearing loss report experiencing tinnitus. While some degree of head noise is a normal occurrence in everyone, it can be debilitating for some people. In the latter case, a licensed physician should be consulted to check for a serious medical condition. Audiologists and other trained professionals can offer devices and techniques to help manage or minimize debilitating tinnitus,  and patients sometimes get relief through stress control,  ample rest, exercise,  and avoidance of caffeine and other dietary stimulants.

Evaluation of Hearing
A periodic hearing test by a licensed audiologist or physician is the best way to monitor personal hearing health. If you are exposed to high levels of sound on a daily basis (e.g., in your work or recreation), you should schedule a hearing test at least once a year. A hearing health professional can help identify changes in hearing ability and provide consultation and recommendations*.

Pure Tone Threshold Tests
The traditional hearing test that takes place in a quiet booth and introduces the listener to a series of individual tones at varying frequencies and volumes. This standard test typically measures hearing ability from the 250 to 8000 hertz (Hz) frequency range.

Speech Audiometry
Commonly used to assess a person's abilities to hear and understand the spoken word under quiet conditions.

Tympanometry
Tympanometry is a measure of the stiffness of the eardrum and thus evaluate middle ear function. This test can be helpful in detecting fluid in the middle ear, negative middle ear pressure, disruption of the ossicles, tympanic membrane perforation, and otosclerosis.

To perform the test, a soft probe is placed into the ear canal and a small amount of pressure is applied. The instrument then measures movement of the tympanic membrane (eardrum) in responses to the pressure changes.

Otoacoustic Emissions (OAE)
This test measures the functionality of the outer hair cells and is sensitive in the detection of subtle damage to the inner ear.

Auditory Brainstem Response (ABR) Audiometry
This is a screening test to monitor for hearing loss or deafness, especially notable for its use with newborn infants. It is a method employed to assess the functions of the ears, cranial nerves, and various brain functions of the lower part of the auditory system, prior to the child developing to the point of describing a possible hearing problem.

Protection & Care for the Ear
Ear Hygiene – Tips to Safe Cleaning

What is ear wax?
Your external ear naturally produces oil and sheds skin tissue. Ear wax is the mixture of your body's natural skin oils and dead tissue.  Some people produce more of it than others.  While ear wax helps protect the delicate lining of your ear canal, excessive build-up over time may lead to blockage, hearing loss and the attraction of dirt, resulting in poor ear hygiene.

• Use clean hands to insert and remove earplugs.
• Clean your outer ear by gently washing it with a washcloth and warm water.
• Safely remove excess ear wax using over-the-counter ear wax removal solutions.
• Never use a cotton swab inside your ear canal.   A cotton swab can actually damage the tissue lining of your ear canal or puncture your ear drum (tympanic membrane).  It can also dry and irritate the ear canal, creating an itching sensation for some people.   Cotton swab usage inside the ear canal may actually plunge the ear wax deep into the canal, making it more difficult to remove without the help of a physician. In severe cases, the wax may form a plug that may reduce your ability to hear. This wax plug may also adhere to the ear drum.
• Limit your exposure to sounds that exceed 85 decibels (dB) ex: sound of busy city traffic). Noise-induced hearing loss  (NIHL)  is  a  leading  cause  of  permanent ensorineural hearing loss, yet it can be prevented with proper education and listening habits.
• Visit your ear, nose, throat (ENT) or otology physician for more extensive ear wax removal treatments or if you are experiencing ear pain, inflammation,  blockage or hearing loss.

Just a Reminder . . .
Some types of hearing loss may be signs of a serious medical condition. If you notice a sudden change in your hearing or an onset of asymmetrical or unilateral hearing loss (hearing loss in one ear), you should have an evaluation by an ear specialist – an otolaryngologist (ENT), otologist or neurotologist.

References :
www.hei.org
www.dizziness-and-balance.com
www.dangerousdecibels.org
TMC Hearing & Dizziness Unit

Note: This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment. If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.

The Medical City offers a roster of competent ENT Specialists who may assess and treat people with hearing loss. 

For any inquiries please call:

THE HEARING AND DIZZINESS UNIT
Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6251

CENTER FOR PATIENT PARTNERSHIP
Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6444