Our Services

At Carolina Ear & Hearing Clinic, PC, we provide high-quality, personalized care for ear-related problems and disorders

Types of Care

We offer diagnosis and treatment of ear-related issues and disorders across all ages
Surgical
Medical Neurotology
For information about hearing loss and audiological services, please visit our audiology page

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Autoimmune Hearing Loss


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Noise-Induced Hearing Loss


Exposure to loud noise damages the delicate receptor cells of the inner ear (called hair cells). High frequency noise loss and tinnitus may result. Both the length of exposure and the intensity of sound are important. The amount of sound exposure we receive over a lifetime is cumulative. Protection of hearing should be taught to school age children in order to reduce the chance of hearing impairment later in life. Programs through the Let Them Hear Foundation aim to provide this type of public education. Protective devices such as earplugs, ear muffs, or musician’s plugs (these customized devices require an ear canal impression and are made in such a way that no sound or intelligibility distortion occurs during use) are critical to hearing preservation in some work and social environments. Importantly, individuals who find themselves in these environments should have routine hearing testing to detect early changes due to noise induced hearing damage. In some instances, hearing damaged by noise exposure may be reversed with medications. In some cases, hearing aids will augment those portions of the speech spectrum where injury has occurred to make speech much more intelligible.




Acoustic Neuroma/Skull Base Surgery


Acoustic Neuroma

  • An acoustic neuroma, also called a vestibular schwannoma, is a benign primary intracranial tumor of the myelin-forming cells of the vestibulocochlear nerve (CN VIII). (Neuroma is derived from Greek, meaning "nerve tumor".) The term "acoustic" is a misnomer, as the tumor never arises from the acoustic (or cochlear) division of the vestibulocochlear nerve. The correct medical term is vestibular schwannoma, because it involves the vestibular portion of the 8th cranial nerve and it arises from Schwann cells, which are responsible for the myelin sheath in the peripheral nervous system. Approximately 3,000 cases are diagnosed each year in the United States with a prevalence of about 1 in 100,000 worldwide. Incidence peaks in the fifth and sixth decades and both sexes are affected equally.
Skull Based Surgery
  • Since tumors of the skull base sit underneath the brain, it can be difficult during surgery to get to the tumor in order to remove it. Traditional techniques used to approach tumors of the brain itself can be used to approach skull base tumors, but these often require significant force to retract the patient’s brain out of the way. This may lead to unwanted injury to otherwise normal brain tissue.The basic concept of skull base surgery is to approach the tumor from underneath or from the side by removing specific areas of skull base bone. Thus, the tumor can be exposed with little to no brain retraction. Skull base procedures, for example, may be designed to traverse the bone containing the ear (trans-temporal/trans-petrosal/retrosigmoid approaches), low on the temple beneath the brain (middle fossa approach), around the eye (trans-orbital/orbital-zygomatic/craniofacial approaches), through the nose or paranasal sinuses (trans-sphenoidal/trans-ethmoidal/trans-facial approaches), or from the neck (trans-cervical). Fundamentally, these are minimally-invasive techniques designed to maximize tumor removal while preserving neurological function to the greatest extent possible.




Sudden Hearing Loss


Sudden hearing loss is a medial urgency and should be evaluated for treatment within 24-48 hours. Usually occurring "out of the blue" for the patient, sudden loss may be caused by viral infection, breaks of delicate structures within the inner ear, trauma (a blow to the ear, airline flight for example), an interruption in the blood supply of the cochlea, brain tumors, and many more rare causes. Prompt evaluation and treatment increases the chance of restoring hearing. Complete medical work-up is important to rule out serious causes. CEHC Physicians may use an audiogram, auditory brainstem response, electrocochleography, stacked band derived auditory brainstem response, CT scan or MR imaging to define the cause of the disorder. In up to 70% of cases, treatment produces a partial or full return of hearing status. Early initiation of medical therapy increases the chance of hearing return.




Wax Removal


Earwax, also known by the medical term cerumen, is a yellowish, waxy substance secreted in the ear canal of humans and many other mammals. It plays an important role in the human ear canal, assisting in cleaning and lubrication, and also provides some protection from bacteria, fungi, and insects. Excess or impacted cerumen can press against the eardrum and/or occlude the external auditory canal and impair hearing. Excessive cerumen may impede the passage of sound in the ear canal, causing conductive hearing loss. It is also estimated to be the cause of 60–80% of hearing aid faults. As mentioned above, movement of the jaw helps the ears' natural cleaning process, so chewing gum and talking can both help. If this is insufficient, the most common method of cerumen removal by general practitioners is syringing with warm water (used by 95% of GPs). A curette method is more likely to be used by otolaryngologists when the ear canal is partially occluded and the material is not adhering to the skin of the ear canal. Cotton swabs, on the other hand, might just push the earwax further into the ear canal.




Swimmer's Ear


Otitis externa ("swimmer's ear") is an inflammation of the outer ear and ear canal. Along with otitis media, external otitis is one of the two human conditions commonly called "earache". It also occurs in many other species. Inflammation of the skin of the ear canal is the essence of this disorder. The inflammation can be secondary to dermatitis (eczema) only, with no microbial infection, or it can be caused by active bacterial or fungal infection. In either case, but more often with infection, the ear canal skin swells and may become painful and/or tender to touch. Chronic otitis externa is a low-grade disease, usually non-microbial and purely on the basis of chronic dermatitis or irritation from "cleaning" the canal, often with cotton swabs. It can be thought of as chronic dermatitis of the ear canal skin and may or may not be painful. There may only be seepage, mild swelling, or itching. In contrast to the chronic otitis externa, acute otitis externa is predominantly a microbial infection, occurs rather suddenly, rapidly worsens, and becomes very painful and alarming. The ear canal has an abundant nerve supply, so the pain is often severe enough to interfere with sleep. Wax in the ear can combine with the swelling of the canal skin and any associated pus to block the canal and dampen hearing to varying degrees, creating a temporary conductive hearing loss. In more severe or untreated cases, the infection can spread to the soft tissues of the face that surround the adjacent parotid gland and the jaw joint, making chewing painful. In its mildest forms, external otitis is so common that some ear nose and throat physicians have suggested that most people will have at least a brief episode at some point in life. While a small percentage of people seem to have an innate tendency toward chronic external otitis, most people can avoid external otitis altogether once they understand the mechanisms of the disease.




Bell's Palsy


Bell's Palsy is a paralysis of the facia nerve resulting in inability to control facial muscles in the affected side. Several conditions can cause a facial paralysis, e.g. brain tumor, stroke, and Lyme disease. However, if no specific cause can be identified, the condition is known Bell's Palsy. Named after Scottish anatomist Charles Bell, who first described it, Bell's palsy is the most common acute mononeuropathy (disease involving only one nerve), and is the most common cause of acute facial nerve paralysis. Bell's Palsy is defined as an idiopathic unilateral facial nerve paralysis, usually self-limiting. The trademark is rapid onset of partial or complete palsy, usually in a single day. It is thought that an inflammatory condition leads to swelling of the facial nerve (nervus facialis). The nerve travels through the skull in a narrow bone canal beneath the ear. Nerve swelling and compression in the narrow bone canal are thought to lead to nerve inhibition, damage or death. No readily identifiable cause for Bell palsy has been found, but clinical and experimental evidence suggests herpes simplex type 1 infection may play a role. Doctors may prescribe anti-inflammatory and anti-viral drugs. Early treatment is necessary for the drug therapy to have effect. The effect of treatment is still controversial. Most people recover spontaneously and achieve near-normal functions. Many show signs of improvement as early as 10 days after the onset, even without treatment. Protect the eye. Often the eye in the affected side cannot be closed. The eye must be protected from drying up, or the cornea may be permanently damaged resulting in impaired vision.




Chronic Middle Ear Fluid


Normal hearing requires air on either side of an intact eardrum (tympanic membrane). Allergies, infections, or undetermined factors can cause a chronic condition in which the middle ear fills with fluid. As the fluid remains in place, the middle ear lining removes water from it producing a thick mucous that may reach the point of a "glue ear". While a child may respond to sounds normally with fluid in the middle ear, the high frequency sounds are filtered producing a distorted signal as the sound reaches the brain. Children will reproduce what they hear with their own speech. Consequently, chronic middle ear fluid may produce speech abnormalities. Recent information makes it clear that a clear middle ear is necessary for the brain to develop understanding of spoken language in background noise. An abnormality of this brain function is known as a Central Auditory Processing Disorder. In the first twelve years of life, this system is developing actively and steadily. A normal system is critical to hearing in noise such as classroom performance or the workplace. It is normal for fluid to remain for up to several weeks following an ear infection. If fluid persists longer than 3 months, however, it is unlikely to clear without intervention. Medical treatment aimed at fluid alleviation is frequently first line therapy. Fluid that will not clear is treated with tympanostomy tubes which results in rapid return of the ear to normal status. In most situations, the fluid does not recur after the tubes extrudes from the ear or is removed.




Bone Anchored Hearing Aid (BAHA)


Indications for Surgery:

  • Bone conduction hearing loss, single sided deafness (SSD), and congenital atresia.
Anesthesia:
  • General
Surgical Time:
  • 15 minutes
Hospital Admission:
  • Outpatient
Surgical Procedure:
  • The titanium implant is placed during a short surgical procedure and over time naturally integrates with the skull bone. For hearing, the sound processor transmits sound vibrations through the external abutment to the titanium implant.
Miscellaneous:
  • BAHA is used to help people with chronic ear infections, congenital external auditory canal atresia and single sided deafness who cannot benefit from conventional hearing aids. The system is surgically implanted and allows sound to be conducted through the bone rather than via the middle ear - a process known as direct bone conduction.




Cochlear Implant Surgery


What is it?

  • A cochlear implant (CI) is an implantable medical device designed to provide sound detection and speech recognition for individuals with a severe to profound hearing loss. In contrast to a hearing aid, a cochlear implant bypasses the damaged part of the ear by providing electrical stimulation to the surviving auditory nerve fibers in the cochlea.
Cochlear Implant Candidacy for Adults
  • To be considered a candidate for a cochlear implant, an adult must meet the following criteria:
    • 18 years of age or older
    • Bilateral severe to profound sensorineural hearing loss
    • Limited benefit from appropriately fitted hearing aids
    • No medical contraindication for surgery (i.e. CT scan)
    • Desire to improve hearing, realistic expectations and be committed to participating in a follow-up program
Cochlear Implant Candidacy for Children
  • The cochlear implant consists of two basic parts, the processor and the implant. The processor is worn outside the body over the ear and the implant is surgically placed in the ear. To be considered a candidate for a cochlear implant, a child must meet the following criteria:
    • 12 months of age or older
    • Bilateral profound sensorineural hearing loss for children under age 2 years
    • Bilateral severe to profound sensorineural hearing loss for children over age 2 years
    • Limited benefit with appropriately fit amplification
    • Lack of progress in auditory development
    • No medical contraindications for surgery (i.e. CT scan)
    • Desire to improve hearing, realistic expectations and be committed to participating in a follow-up program
How Cochlear Implants Work
  • Sounds are picked up by the microphones on the speech processor
  • The speech processor then filters, analyzes and digitizes the sounds into coded signals
  • The coded signals are then sent from the processor to the transmitting coil
  • The transmitting coil then sends the coded signal as FM radio signals to the cochlear implant under the skin
  • The cochlear implant delivers the appropriate electrical energy to the array of electrodes that in turn stimulates the remaining auditory nerve fibers in the cochlea
  • The auditory nerve then sends this signal to the brain for interpretation




Endolymphatic Mastoid Shunt


Surgical Procedure:

  • Endolymphatic Mastoid Shunt
Indications for Surgery:
  • Meniere’s Disease unresponsive to conservative medical management
Anesthesia:
  • General
Surgical Time:
  • 40 minutes
Hospital Admission:
  • No
Surgical Procedure:
  • A mastoidectomy is performed exposing the endolymphatic sac (a small structure attached to the inner ear that is responsible for fluid balance). A incision is created into the structure and a shunt is inserted allowing drainage of fluid when inner ear pressure is elevated. As the inner ear contains only a few drops of fluid, resorption of the fluid occurs in the mastoid cavity.




Exostosis/Osteoma Removal


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Facial Reanimation


Facial nerve paralysis is a devastating injury that can result in blindness, oral incontinence and social handicaps. The muscles of the face are exquisitely designed for both voluntary and involuntary expression. The facial nerve emerges from the brainstem via the internal auditory canal and exits the brain through the stylomastoid foremen. At this point, the nerve travels a short distance to the pes where it divides into five motor branches--the temporal, zygomatic, buccal, mandibular and cervical branches. The nerve is responsible for orchestrating an intimately designed facial musculature system. The facial musculature is capable of maintaining tone as well as expressing both voluntary and involuntary emotions.




Glomus Tumor Surgery


Surgical Procedure:

  • Glomus Tumor Resection
Indications for Surgery:
  • Glomus tumor of the middle ear, facial nerve canal, or Jugular Bulb
Anesthesia:
  • General
Surgical Time:
  • 1 - 6 hours
Hospital Admission:
  • 1 - 3 days, some outpatient
Surgical Procedure:
  • Access to the tumor is tailored to its size and location. Deeply situated larger tumors require more extensive approaches. Removal of affected structures such as jugular vein may be necessary to completely resect the growth. Re-positioning of normal structures to be retained (such as the Facial Nerve) may be needed for tumor access. Tumors may extend intra-cranially and required an approach combining an opening into the brain cavity (called a craniotomy) for safe, and complete removal.
Miscellaneous:
  • As glomus tumors arise from cells that may make chemical substances released into the bloodstream (such as adrenaline), testing is performed prior to tumor removal to identify those tumors that secrete substances which must be provided for in order to accomplish safe resection.




Hilger Nerve Testing


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Implantable Hearing Devices


Surgical Procedure:

  • Implantable Hearing Devices
Indications for Surgery:
  • Sensorineural Hearing Loss (Nerve Deafness)
Anesthesia:
  • General or local depending on the device
Surgical Time:
  • 1 - 1.5 hours
Hospital Admission:
  • Outpatient
Surgical Procedure:
  • A mastoidectomy is performed in order to attach the portion of the implantable hearing device to the middle ear bone structures. These devices transmit sound energy to the inner ear by coupling devices to the middle ear bones.
Miscellaneous:
  • Implantable hearing devices are used for patients who have trouble using a traditional hearing aid. Patients experience clearer sound with an open ear canal.




Medical Treatment of Meniere's Disease


Meniere’s disease is present when a triad of symptoms exists: fluctuating hearing loss, episodic tinnitus (correlated to attacks), and episodic vertigo (a sense of spinning or motion) accompanied in many instances with nausea and vomiting. It can be one of the most difficult disorders to live with and requires treatment at specialized centers. Thorough medical evaluation is mandatory to identify, treat, or rule out associated diseases or more threatening medical conditions (brain tumors, for example, may masquerade as Meniere’s Disease). Diagnostic evaluation includes and audiogram and potentially a video-infrared electronystagmogram, electrocochleography, posturography, stacked band derived auditory brainstem response, and various radiology imaging studies such as an MRI or CT scan. Contrary to what many patients have been told, Meniere’s Disease is treatable with over 90% of patients seen at CEHC achieving significant or complete relief of symptoms. A three-tiered treatment strategy is utilized with the goal of finding the easiest, most effective treatment for an individual patient. First level therapy may include a combination or dietary and/or lifestyle modification (a low salt diet is used in most patients, for example), diuretic therapy to reduce fluid pressure in the inner ear – the cause of the disorder, treatment of exacerbating medical conditions (such as treatment of environmental allergies, migraines, chronic medical conditions, middle ear conditions and many others), and vestibular suppressant therapy using medications. Approximately 65% of patients respond favorably to first line therapy and need no further treatment. In the remainder of patients, Second line therapy is chosen from three alternatives: Endolymphatic Mastoid Shunt, Intra-tympanic Gentamycin therapy, or the Meniett Device. Less than 5% of patients proceed to third-tier therapy which includes an ablative procedure such as removal of the inner ear balance system (called Labyrinthectomy) which takes away the hearing in the affected ear or to division of the balance nerve which preserves the hearing in the affected ear in most cases (Vestibular Neurectomy). Please see the attached diagram for comparison of second and third tier therapies.




Meniere's Disease Surgery


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Microvascular Decompression for Trigeminal Neuralgia and Hemifacial Spasm


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Otosclerosis / Stapes Surgery


Treatment of otosclerosis relies on two primary options: hearing aids and a surgery called a stapedectomy. Hearing aids are usually very effective early in the course of the disease, but eventually a stapedectomy may be required for definitive treatment. Early attempts at hearing restoration via the simple freeing the stapes from its sclerotic attachments to the oval window were met with temporary improvement in hearing, but the conductive hearing loss would almost always recur. A stapedectomy consists of removing a portion of the sclerotic stapes footplate and replacing it with an implant that is secured to the incus. This procedure restores continuity of ossicular movement and allows transmission of sound waves from the eardrum to the inner ear. A modern variant of this surgery called a stapedotomy, is performed by drilling a small hole in the stapes footplate with a micro-drill or a laser, and the insertion of a piston-like prothesis. The success rate of either a stapedotomy or a stapedectomy depends greatly on the skill and the familiarity with the procedure of the surgeon. Other less successful treatment includes fluoride administration, which theoretically becomes incorporated into bone and inhibits otosclerotic progression. This treatment cannot reverse conductive hearing loss, but may slow the progression of both the conductive and sensorineural components of the disease process. Recently, some success has been reported with bisphosphonate medications, which stimulate bone-deposition without stimulating bony destruction.




Surgery for Superior Canal Dehiscence Syndrome


Superior canal dehiscence syndrome (SCD) results from an opening (dehiscence) in the bone overlying the superior (uppermost) semicircular canal within the inner ear. With this dehiscence, the fluid in the membranous superior canal (which is located within the tubular cavity of the bony canal) can be displaced by sound and pressure stimuli. There are normally only two points of increased compliance (yielding to pressure) in the inner ear: the oval window, through which sound energy is transmitted into the inner ear via the stapes bone; and the round window, through which sound energy is dissipated from the inner ear after traveling around the cochlea. SCD creates a third mobile window into the inner ear. Signs and symptoms of SCD result from the physiological consequences of this third window. Vestibular and/or auditory signs and symptoms can occur in SCD. Vertigo and oscillopsia (the apparent motion of objects that are known to be stationary) evoked by loud noises and/or by maneuvers that change middle-ear or intracranial pressure (such as coughing, sneezing, or straining). Persons with SCD may experience a feeling of constant disequilibrium and imbalance, and may perceive that objects are moving in time with their pulse (pulsatile oscillopsia). Auditory manifestations of SCD may include autophony (increased resonance of one’s own voice), hypersensitivity to bone-conducted sounds, and an apparent conductive hearing loss revealed on audiometry. The diagnosis of SCD is made based upon characteristic symptoms, specific findings on clinical examination, CT imaging, and findings on vestibular evoked myogenic potentials (VEMP) testing. The diagnosis should never be made exclusively on the basis of CT findings. For many patients, avoidance of provocative stimuli such as loud noises may be sufficient treatment. For those patients who are debilitated by their symptoms, surgical plugging of the superior canal can be very beneficial in alleviating or substantially reducing the symptoms and signs.




Surgical Repair of Cerebral Spinal Fluid Leaks


Surgical Procedure:

  • Cerebrospinal Fluid Leak Closure
Indications for Surgery:
  • Leakage of fluid from around the brain into the ear or surrounding structures (trauma, post-surgery, or spontaneous causes)
Anesthesia:
  • General
Surgical Time:
  • 1 – 5 hours
Hospital Admission:
  • 1 - 4 days
Surgical Procedure:
  • A combination of approaches tailored to the individual site of leakage. Frequently access from above and below the leak is necessary using a mastoid approach and a middle fossa approach. In many situations tissue is used to repair the leak, but bone replacement cements are necessary.
Miscellaneous:
  • Cerebrospinal fluid leakage places the patient at risk for meningitis and needs urgent attention.




Surgical Treatment of Chronic Ear Infections and Cholesteatoma Surgery


A cholesteatoma is a skin growth that occurs in an abnormal location, the middle ear behind the eardrum. It is usually due to repeated infection, which causes an ingrowth of the skin of the eardrum. Cholesteatomas often take the form of a cyst or pouch that sheds layers of old skin that builds up inside the ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth. A cholesteatoma usually occurs because of poor eustachian tube function as well as infection in the middle ear. The eustachian tube conveys air from the back of the nose into the middle ear to equalize ear pressure ("clear the ears"). When the eustachian tubes work poorly perhaps due to allergy, a cold or sinusitis, the air in the middle ear is absorbed by the body, and a partial vacuum results in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas weakened by previous infections. This sac often becomes a cholesteatoma. A rare congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common. An examination by an otolaryngologist-head and neck surgeon can confirm the presence of a cholesteatoma. Initial treatment may consist of a careful cleaning of the ear, antibiotics, and ear drops. Therapy aims to stop drainage in the ear by controlling the infection. The extent or growth characteristics of a cholesteatoma must also be evaluated. Large or complicated cholesteatomas usually require surgical treatment to protect the patient from serious complications. Hearing and balance tests, x-rays of the mastoid (the skull bone next to the ear), and CAT scans (3-D x-rays) of the mastoid may be necessary. These tests are performed to determine the hearing level remaining in the ear and the extent of destruction the cholesteatoma has caused. Surgery is performed under general anesthesia in most cases. The primary purpose of the surgery is to remove the cholesteatoma and infection and achieve an infection-free, dry ear. Hearing preservation or restoration is the second goal of surgery. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required. Reconstruction of the middle ear is not always possible in one operation; and therefore, a second operation may be performed six to twelve months later. The second operation will attempt to restore hearing and, at the same time, inspect the middle ear space and mastoid for residual cholesteatoma.




Surgical Treatment of Facial Nerve Disorders


Surgical Procedure:

  • Facial Nerve Surgery
Indications for Surgery:
  • Tumors, Infection, Trauma of the Facial Nerve; Facial Paralysis
Anesthesia:
  • General
Surgical Time:
  • 1 - 4 hours
Hospital Admission:
  • 1 – 3 days, occasional outpatient
Surgical Procedure:
  • Access to the long and curved course of the facial nerve is provided by Middle Fossa Approach, Transmastoid Approach or approach to the nerve outside the temporal bone in the tissue of the upper neck under the ear.
Miscellaneous:
  • Therapeutic interventions may include removal of the boney covering of the nerve (decompression), removal of tumors, and grafting of the facial nerve with a donor nerve (sensory branch to the ear) from the neck which allows the nerve to re-grow to the facial muscles achieving movement of the face.




Temporal Bone Fractures/Trauma


Temporal bone trauma usually is the sequela of blunt head injury. Damage to the temporal bone typically requires the application of great force and may cause fracture, hemorrhage, nerve trauma, vascular damage, or disruption of the middle or inner ear structures. Associated intracranial injuries, such as extra-axial hemorrhage, shear (or diffuse axonal injury), and brain contusion, are common. Potential complications of temporal bone fracture include infection (meningitis), hearing loss, facial (and other cranial) nerve injury, cerebrospinal fluid (CSF) leak/otorrhea, and perilymphatic fistula. Early identification of temporal bone trauma is essential to managing the injury and avoiding complications. Historically, temporal bone fractures were diagnosed clinically, with imaging playing a minor role in initial evaluation. After the advent of computed tomography (CT) scanning, the high contrast and spatial resolution of this modality provided detailed images of fractures and their complications. For excellent patient education resources, visit eMedicine's Back, Ribs, Neck, and Head Center. Also, see eMedicine's patient education article Facial Fracture.




Treatment of Acute Otitis Media


Treatment of acute otitis media is controversial. Much of the controversy centers around the difficulty of distinguishing viral infection from bacterial infection and the fact that viral infection can progress to bacterial infection at any time. Primary care providers, such as general practitioners and pediatricians, often have a monocular otoscope and perhaps a tympanometer as their only diagnostic tools, which makes this distinction difficult, especially if the canal is small and there is wax in the ear that obscures a clear view of the eardrum. Also, an upset child's crying can cause the eardrum to look inflamed due to causing distention of the small blood vessels on it, mimicking the redness associated with otitis media. Because of a tradition of inappropriate prescribing of antibiotics for viral acute otitis media, their use has recently been condemned by many primary care practitioners for most cases of acute otitis media. Ear specialists tend to disagree with this philosophy and promote efforts to distinguish between viral and bacterial infection, so as to optimize treatment results by giving antibiotics only for bacterial infection. Acute bacterial otitis media can cause pain that leads to sleepless nights for both children and parents, can cause eardrum perforations, not all of which heal, and can spread to cause mastoiditis and/or meningitis, brain abscess, and even death if a severe infection goes untreated long enough. High fever can occur and can cause febrile seizures. Appropriate antibiotic administration prevents most such complications. On the other hand, it is generally agreed that acute otitis media that is purely viral will usually resolve without antibiotic treatment, although associated persistent middle ear effusions may require medical intervention. Many guidelines now suggest deferring the start of antibiotics for 1 to 3 days. This results in 2 out of 3 children avoiding the need to start antibiotics, and no adverse effect on longterm outcomes for those whose treatment is deferred. First line antibiotic treatment, if warranted, is Amoxicillin. If the bacteria is resistant, then Augmentin or another penicillin derivative plus beta lactamase inhibitor is second line. In chronic cases or with effusions present for months, surgery is sometimes performed to insert a grommet (called a "tympanostomy tube") into the eardrum to allow air to pass through into the middle ear, and thus release any pressure buildup and help clear excess fluid within. Prior to the invention of antibiotics, severe acute otits media was mainly remedied surgically by Myringotomy. An outpatient procedure, it consists of making a small incision in the tympanic membrane to relieve pressure build-up. For chronic cases (glue ear), it is possible to use the Valsalva maneuver to reestablish middle ear ventilation, although repeated use of the Valsalva maneuver can cause infected matter to enter the eye cavity and cause conjunctivitis.




Treatment of Age-Related Hearing Loss


The Carolina Ear and Hearing Clinic is the premier site for evaluation and treatment of hearing loss. Two types of hearing impairment are encountered and are identified with an audiogram and Physician visit. The first, sensorineural hearing loss, or nerve hearing loss, involves a reduction in function of the hearing nerve receptor cells (called hair cells for the small projections seen along their surface) of the inner ear in the cochlea. Many causes of sensorineural hearing loss exist and can be identified by a CEHC MD. Secondly, dysfunction of the sound collecting system of the middle ear (the eardrum and the three middle ear bones: the malleus, the incus, and the stapes) may be causative. Frequently, problems with the middle ear system may be addressed with surgery. In some instances, both types of hearing loss exist. As a first step, it is our goal to reverse hearing impairment as much as possible and / or to avoid ongoing damage. SNHL may be addressed in our integral hearing device centers or with implantable hearing devices. CEHC offers the world’s finest hearing aids from the world’s finest Audiologists with a broad range of price and options. Hearing devices have improved dramatically over the last decade and we encourage you to give us the chance to help you. Many surgical procedures currently used around the world for hearing impairment were pioneered by CEHC Surgeon’s. Problems with the eardrum perforation, middle ear bones, cholesteatoma, fluid and chronic infection among others frequently produce hearing impairment. Thousands of patients have had their hearing restored with delicate surgical procedures through the Institute. In a large fraction of patients, the surgical procedure is a revision of a previous surgery that resulted in less than the desired outcome. Many times, damage done by previous disease or surgery can be reconstructed and reversed. In extreme cases, little to no residual hearing exists producing severe hearing impairment or deafness. Through the Let Them Hear Foundation, CEHC provides a miraculous technology that allows restoration of functional sound to deaf patients known as cochlear implants. Cochlear implants have advanced amazingly in the last 5 years, and many patients who previously were not candidates for implantation are receiving devices.





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© 2007 Carolina Ear and Hearing Clinic.

The information contained in this website is intended to provide general information and patient education on certain topics only and are not intended to and do not offer healthcare/medical advice. This information should not be considered complete and should not be used in place of a visit, consultation, or advice from your physician. If you have, or suspect you have, a health problem you should never disregard medical advice or delay seeking medical attention because of something you have read on this website. If you have questions about a medical condition or seek advice, see your healthcare professional.