Hearing and Deafness

Hearing problems are extremely common.

Chronic otitis media ("Glue ear")

“Glue ear” is a common cause of hearing loss in children. This may cause speech delay, language problems and even behavioural issues (children often feel isolated or frustrated). In many respects the hearing level is not too dissimilar to being under water. The hearing must be tested and the presence of fluid confirmed by tympanometry.

Removing the "glue" in addition to grommet insertion allows air to re-enter the middle ear to restore hearing. This is performed under general anaesthesia. The grommets usually fall out after 18 months in this age group.

Adults with a persistent middle fluid ear should undergo examination of the postnasal space under general anaesthesia. A biopsy should be taken from the Fossa of Rosenmüller, just medial to the Eustachian tube, to exclude the rare possibility of a tumour obstructing the Eustachian tube orifice.

Sudden hearing loss


The cause of sudden inner ear hearing loss is usually unknown. Causes include labyrinthine viral infection, labyrinthine vascular compromise, intracochlear membrane ruptures, and immune-mediated inner ear disease. Appropriate blood tests, an MRI scan and serial audiograms are performed. If sudden sensorineural hearing loss is bilateral, admission is required. Consideration must be given to treatment with acyclovir and oral steroids.

Tympanic membrane perforation (hole in the ear drum)

Infection, pressure changes or direct trauma to the ear canal may result in a hole in the ear drum. If this does not heal of its own accord, patients may suffer from recurrent ear infections or a hearing loss, and surgical closure may be required (tympanoplasty).

This operation is performed under a general anaesthetic. A cut is made behind the ear and a graft taken. This is then placed under the ear drum. Packing is inserted into the ear and left in place for several weeks until the ear has healed.

Cholesteatoma

This uncommon condition occurs because skin tissue enters the middle ear and slowly expands. It usually becomes recurrently infected and the ear may weep.

As the cholesteatoma grows, it can eat through the bones of hearing causing deafness, and enter the inner ear causing hearing loss and vertigo. It may also damage the facial nerve resulting in a facial droop. In some cases the infection may spread into the brain and cause meningitis or a brain abscess. This may result in death.

Most patients require mastoid surgery, to drill open the bone and remove the disease. My current approach involves drilling open the mastoid bone and reconstructing the hearing mechanism in the majority of patients. Although historically patients undergoing mastoid surgery had little or no functional hearing, this approach leaves many patients with good functional hearing.

Age related hearing loss (presbyacusis)

As we age our hearing gradually declines. This is because the hair cells that detect sound within the inner ear gradually die away. Patients first have difficulty in noisy environments and then later in even quiet environments.

For most patients a hearing aid is useful. Some patients may require an implant (e.g. cochlear implant) if the hearing is very poor.

Bone anchored hearing aids

If a patient is unable to use a hearing aid, perhaps due to recurrent ear infections, a bone anchored hearing aid may be useful. This involves screwing a titanium stud behind the ear and attaching a special hearing aid to this. This has transformed the lives of many patients.