Sudden Sensorineural hearing loss
Sudden deafness can occur within no time in an otherwise normal hearing patient. It also comes with ear fullness, ringing sensation and sometimes giddiness. If patient comes within 24 hours, hearing tests has to be done. We also suggest MRI of brain and with special emphasis on hearing nerve to rule out any etiology in brain and other lesions compressing auditory nerve . If MRI is normal (in most cases) with profound (ie severe) hearing loss is confirmed in Pure tone audiogram -intravenous and intra tympanic steroids have to be started immediately. Most of the cases show minimum improvement of 50% or more, if treatment was started within 24hours. If severe or profound hearing loss sets in permanently – patient has got only one option i.e hearing aid and if doesn’t help in worse cases a cochlear implant.
Pure tone audiometry showing left ear sensori neural hearing loss
Tinnitus is the perception of noise or ringing in the ears. Tinnitus effects 1 out of 5 people. It is not a symptom actually but it’s a sign of underlying condition. It can be seen in hearing loss( age related, sudden deafness), fluid in middle ear( SOM), injury to ear(physical trauma, noise induced). Patients coming to us with tinnitus will be tested and based on the etiology we advice necessary treatment . Treatment can include oral as well as intratympanic injections. Its prognosis is solely based on its duration of onset and how early a patient gets treatment. If medical management doesn’t completely reduce or nil response-we suggest tinnitus masker devices.
Facial nerve palsy
Facial nerve is the nerve which controls muscles of face. Facial nerve paralysis is characterized by unilateral facial weakness, with other symptoms including loss of taste, hyperacusis and decreased salivation and tear secretion. Other signs may be linked to the cause of the paralysis, such as vesicles in the ear, which may occur if the facial palsy is due to shingles. Most commonly it is idiopathic ( no reason) also known as Bells palsy. Other causes are trauma, infection, paralysis, tumors. Treatment of facial nerve palsy depends on the cause. It is usually treated with steroids. If medical treatment fails- we suggest facial nerve decompression surgery as early as possible.
Decompressed nerve -white arrow area showing location of compressed nerve
Otitis externa is infection of external ear. It can be localized(boil) or diffuse. It is usually caused by local bacteria when the patient tries to clean his ears on his own. Patient complains of severe pain with ear discharge. It has to treated with antibiotics and anti-inflammatory drugs. In diabetic patients extra care has to be taken as they are more prone to infection and delayed wound healing. If it gets infected with pseudomonas in diabetics it is known as malignant otitis externa which has to be treated aggressively as it can cause facial nerve paralysis.
It is a type of external otitis but caused by fungal organisms. Most common organisms causing fungal otitis externa are Aspergillus niger and candidal sp. In aspergillus cases black fungal spores can be seen on otoscopy and in candidal infection whitish discharge can be seen. It has to be treated with antibiotics, anti histamines and local antifungal cream or drops.
A preauricular sinus is a common congenital malformation characterized by small pit infront of the ear. It is formed due to failure of fusion of membranes(hillocks of his) during development of baby. It is usually asymptomatic but once it gets infected it is better to excise. During surgery sinus tract has to be excised fully including part of cartilage where the sinus tract is attached.