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Welcome to Dr. Mark Severtson's question and answer forum! Each month, Dr. Severtson will respond to medical questions you have submitted relating to your hearing. We are open to your questions NOW!  Please use the website's Contact Us  or Post a comment links to send in your questions today! You can also email us directly at info@hearinglosskentucky.org. Next month, we will post Dr. Severtson's reponses . Please note that questions regarded as non-medical will be responded to by our Editor.

Your Question: If I have cochlear implant surgery, what is removed from the ear?  Does my ear drum etc. remain intact?  Will there be any residual hearing?

Doctor's Reply: Good question! Nothing is removed from the ear during cochlear implant surgery.  However, a traditional cochlear implant operation destroys one's residual hearing.  A "hybrid" cochlear implant is designed for patients with severe to profound high frequency hearing loss but have potentially "aidable" low frequency hearing loss.  If successful, those patients are able to use a traditional HA and the hybrid cochlear implant.  The hybrid implant is less destructive because it's stimulating electrode is physically shorter than its counterpart and, therefore, less damaging to the cochlea. The remaining structures of the ear including the ear drum and hearing bones are not affected by CI surgery. 

Your Question: A close relative of mine is planning to undergo surgery for a cochlear implant. I don’t think he has told or emphasized his health (physical and mental) issues enough to the doctor. I understand confidentiality issues; but, I am still very worried about him. What can I do?

Doctor's Reply: First and fore-most your concern sounds genuine and hopefully is appreciated by your family member. Medically I'd recommend that the patient see his or her internist/family physician prior to surgery for medical clearance as CI surgery typically require 2-3 hours of general anesthesia.  Additionally, he or she should undergo pre-admission testing (PAT) with the anesthesiologist prior to surgery in order to confirm medical candidacy. If red flags are seen the anesthesiologist will refer the patient for additional testing and medical evaluation (e.g. cardiac clearance, stress test etc.). Psychologically, it's essential that the patient understands the complexity of the post-surgical rehabilitation process and the absolute commitment that's required to maximize one's benefit following surgery.  These issues are discussed both by the surgeon and CI audiologist. A third party evaluation by a social worker or psychologist familiar with cochlear implants and the rehabilitative process can prove helpful in this regard. Good luck!

Your Question: What are the dangers and complications of cochlear implant surgery?

Doctor's Reply: Cochlear implant surgery like any operation carries the risk of bleeding and infection.  Ear surgery, in general, is not terribly bloody although there is a large vascular structure in the mastoid bone which becomes the jugular vein in the neck which is at risk of injury.  Infection with CI surgery is particularly damaging due to the presence of a foreign body in the wound - the implant itself.  Occasionally the implant must be removed temporarily to clear the infection.

CI surgery complications include an injury to facial nerve which can cause temporary or permanent, partial or complete facial paralysis.  Traumatic injuries sustained at surgery require immediate repair and often result in a permanent, partial facial weakness.  A much more common scenario is a delayed, partial facial paralysis caused by swelling of the nerve or the herpes zoster virus (i.e. Bells Palsy).   This delayed weakness is treated with high dose, tapering steroids and anti-viral medications.  It typically resolves completely after medical treatment. 

A second nerve at risk in ear surgery is the chorda tympani nerve.  It controls taste and if injured one will experience a change in his or her taste sensation lasting weeks to months.  It typically resolves spontaneously without treatment.  

Other less common complications include tympanic membrane perforation and CSF leak.  Both can heal spontaneously but may require additional surgery to repair.

Lastly, a CI is a mechanical device which can break or fail  The risk of mechanical failure is about 1% and requires a replacement operation.

Your Question: What is Otosclerosis and how is it best treated?

Doctor's Reply: Otosclerosis is a disease process which affects the hearing bones, most commonly the stapes. In advanced cases the cochlea or inner ear may be affected as well. It affects women more commonly than men and tends to run in families, although the exact genetics of this disease process has not been worked out completely. 
 
In otosclerosis, excess bone formation occurs at the base of the stapes which reduces its ability to vibrate efficiently.  A mechanical type of hearing loss results which is known as conductive hearing loss (CHL). CHL is less common than sensorineural hearing loss (SNHL) which is age related and often caused by noise exposure. 
 
Treatment options include observation, use of a hearing aid or surgery. Stapedectomy or stapedotomy is the surgical procedure for otosclerosis and is usually performed with a laser and done through the ear canal and under local or, more commonly, general anesthesia. In short, the stapes bone in excised with the laser and a small hole is made through it's base called the footplate. A prosthetic stapes bone is placed, thereby restoring normal mobility to the ossicles. 
 
Surgical results are quite good. Patients can expect a 90% success rate with an experienced stapes surgeon. Complications, although rare, do occur the most significant of which is a 1% risk of complete and permanent hearing loss in the surgical ear. 

Your Question: I have had a lifetime of severe sinus problems and allergies that have included surgeries for polyp removals. What impact has this had on my hearing and what can I do to reduce the impact?

Doctor's Reply: Chronic sinus infections and polyps negatively affect the Eustachian tube and its ability to ventilate the middle ear. A negative middle pressure can result which will limit the mobility of the ear drum and can cause a conductive hearing loss. This type of hearing loss is treatable and potentially reversible. Maximizing one's allergy treatment and aggressively treating one's sinus infections is the first step. Ear tubes may be placed if conservative medical treatment fails over time. 

Your Question: Because of arthritis, back and shoulder issues, I am going to need an MRI that is prevented because of my CI. I know this can be done but not sure of the process.
1. I assume an outpatient surgery would be required to remove the metal head piece.
2. Can this be done in one day—i.e. removed, MRI and replaced the same day?
3. If not, how soon can it be re-implanted?
4. What is the long term impact on my hearing from this process? I need to weigh hearing to pain.
5. How long is the recovery process.
In thinking about this, I read that MRIs and Mono Cautery was counter indicated. What is Mono Cautery?

Doctor's Reply: You are correct.  The CI's magnet must be removed prior to undergoing a MRI. Most modern implants have a removable magnet and that operation can be done under local anesthesia. It can replaced immediately after the MRI but the logistics of this scenario, of course, vary institution to institution and doctor to doctor. Regarding long term impact there is always of risk of implant damage with surgical manipulation, however, it is low.  Most patients don't experience any ill effects and can resume using there device within a week or two depending on how fast his or her incision heals.Lastly, unipolar cautery refers to an electrical instrument used in surgery to control bleeding and as a cutting tool.  Patients with CI should avoid its use during any surgery performed above the clavicle (collar bone).  Bipolar cautery, on the other hand, is safe even above the clavicle because the electrical current does not disseminate into the surrounding tissues.

Your Question: I have a serious wax build up that keeps clogging my ear mold. I have tried a number of over the counter solutions but they seem to cause the wax to become impacted. Can you suggest anything?

Doctor's Reply: Wax buildup especially in the setting of hearing aid use can be a difficult and frustrating problem. I am not a big fan of the over the counter products and they tend to dry out the ear canal skin making it more difficult for one's ear wax to migrate out the ear canal. This natural migration is why I don't like Q-tips. They block the wax migrating out effectively sopping up the ear canal. That said lubricating ear drops are much more effective. Preparations as simple as mineral or baby oil work well. Just use a couple of drops in each ear at bedtime and let the body do what it's designed to do. A more aggressive approach is to flush the ears with a dilute boric acid solution (3% works well). The recipe is a half cup of boric acid powder mixed in one gallon of distilled water. A bulb syringe works great as well.

Your Question: Can Meniere’s disease make you lose your hearing completely? Will tubes placed in the ears help with the fullness feeling?

Doctor's Reply: Meniere's Disease does have the ability to destroy one's hearing completely.  This outcome is, thankfully, the exception rather than the rule.  When it does happen it typically occurs in only one ear.  Adhering to a strict low salt diet and taking a diuretic medication will help one mitigate this risk.

Your Question: How do ear infections or antibiotics cause hearing loss?  What role does Ototoxicity play?

Doctor's Reply:  It depends on the type of infection your talking about.  Middle ear infections cause conductive hearing loss because the ear drum doesn't vibrate as efficiently as it could.  Inner ear infections are typically viral in nature.  A virus often will stimulate an inflammatory response which can, in turn, damage the cochlea's hair cells.  The same is true for "ototoxic" antibiotics.  These antibiotics can damage the cochlea's hair cells directly or by causing inflammation within the inner ear. 

Your Question: One of my friends had labyrinthectomy. The question is how long does it take for one to recover with therapy focusing on balance?  What is the success rate for these people?  If there has been a study on patients going through this, with adjustments made, are they able to function as close as possible?  Thank you!

Doctor's Reply: You are absolutely correct.  By far the best treatment for imbalance following labyrinthectomy is physical therapy or vestibular rehabilitation training (VRT). VRT is typically very effective in restoring one's balance back to their personal baseline.  Of course, its effectiveness depends on the patient's commitment to the therapy and its exercises as well as his/her general health and presence of comorbidities. I am a true believer in VRT and prescribe it at least once a week in my practice.

Your Question: What are the chances of not regaining hearing from a ruptured ear drum?

Doctor's Reply: In general, hearing can be divided into two parts: 'Conductive' hearing describes the vibratory function of the ear drum and ossicles.  Sensorineural hearing describes the function of the cochlea which is to convert the vibratory energy of sound into an electrical signal which is carried to the brain and brain stem by the auditory nerve.   A ruptured ear drum will impede the conductive component of hearing. The amount of hearing loss depends on the size and position of the perforation along with one's overall ear health.  Perforations often heal spontaneously so their associated conductive hearing loss often resolves simultaneously. In addition, perforations that do not heal spontaneously can be repaired surgically.  These operations are generally very successful in healing the perforation and improving one's conductive hearing loss

Your Question: Which is the best cochlear implant model currently available?  With all of the manufacturers’ hype, how do I choose? How do I get good information?

Doctor's Reply: There are 3 cochlear implant companies working in the industry at present.  Cochlear Corporation is Australian, Med El is Austrian and Advanced Bionics is American.  I have worked with all 3 devices. Surgically, the cochlear implant operation for all 3 devices is the same although insertion techniques (i.e. placing the device in the cochlea) vary slightly.  All 3 are user-friendly. Audiologically, device differences are greater.  As a rule of thumb I recommend that patients choose their device in concert with their CI audiologist.  He or she is best suited to match the patient's needs with the strengths of a particular device. 

Your Question: Could you please comment on a recently seen advertisement which stated something to the effect of “Ringing now, deafness later.”?

Doctor's Reply: This is a misleading advertising slogan and argues for taking a particular tinnitus medication in order to prevent tinnitus-associated hearing loss in the future.  BUNK!!  The truth is that the physiology of tinnitus is not terribly well understood.  It is true that tinnitus can be associated with hearing loss but it does not cause hearing loss.

Your Question: What should one do if he wakes up one day and seems to not hear out of one ear/both ears?  What is the time frame to see a doctor for help to retain some hearing in that ear? (I have always told members that this is an emergency room situation and that the earlier steroids are used the better.  However, members report going to the emergency room only to be told to see an ENT in the next week or so and no medications were given.)

Doctor's Reply: You are correct.  Sudden hearing loss is one of the few otologic emergencies.  The sooner one begins  medical treatment with steroids the better.  I agree that emergency rooms are not helpful in this situation.  Patients are better served seeing an ENT doc or an audiologist where a booth hearing test is available.  The type and amount of hearing loss should be determined prior to beginning medical treatment.

Your Question: My hearing aid itches so badly sometimes. I have been known to use Bobbie pins, paper clips and finger nails to ease them. To my knowledge I've never damaged anything, or have I?

Doctor's Reply: Scratching one’s ears is dangerous particularly with sharp objects. It can cause abrasions which can become infected resulting in an outer ear infection or “swimmer’s ear”. These infections are painful and often require at least topical antibiotics to treat successfully. Try ear canal lubricants like mineral or baby oil. I often prescribe a moisturizing oil called DermOtic for this condition.

Your Question:What causes my ears to itch and what can I do about it?

Doctor's Reply: Multiple conditions can cause one's ear to itch.   The aging process itself can cause the ears to itch due to age-related loss of skin moisture.  Less wax is produced and one's skin dries out causing ear skin irritation and pruritus.  Many other skin conditions can cause a local, itchy dermatitis of the ear canal.  External ear infections (aka Swimmer's Ear) can cause pair and itchiness as well.  The treatment for the dermatitis conditions is topical anti-inflammatory medications and moisturizers.  Topical antibiotics coupled with ear flushes and occasional systemic antibiotics is the treatment for Swimmer's Ear.

Your Question:What is Meniere’s  disease and how it is best treated.

Doctor's Reply: Meniere's Disease (MD) is an inner ear condition that causes a constellation of symptoms which include episodic vertigo (i.e. hallucination of movement), low frequency hearing loss, roaring tinnitus and ear pressure.  A MD "attack" is when all 4 symptoms occur simultaneously.  MD variants exist as well and describe patients who experience some but not all of the 4 classic symptoms. Pathologically MD is caused by fluid retention in the vestibular component of the inner ear and is treated with a strict, low salt diet and diuretic medications.  Anti-nausea and sedative medications are used to medically abort an acute attack.  80% of patients respond well to conservative medical and dietary therapy. Surgery is reserved for patients who have failed medical therapy and range from brain surgery to cut the vestibular nerve to an office procedure where Gentamycin, an ototoxic medication, is injected into the middle ear through the eardrum. Trans-mastoid labyrinthectomy and endolymphatic sac decompression operations are surgical options as well.

Your Question: If one has an eardrum that bursts, is there a probability of having a hearing loss in that ear?

Doctor's Reply: Yes definitely. The eardrum vibrates when stimulated by sound and transmits that energy through the hearing bones to the inner ear or cochlea. A ruptured ear drum will vibrate poorly and therefore cause hearing loss.

Your Question: Is it normal or common to have a sound like wind blowing that comes and goes with heartbeats or of eyes opening and closing? The feeling is as if there's pressure causing it.

Doctor's Reply: Any non-environmental noise in the ear is called tinnitus which is quite common and usually harmless. It can, however, be a symptom of something more dangerous like a tumor or vascular problem particularly when it is pulsatile (goes with the heartbeat). Take home point is that tinnitus, particularly if it's on one side only or pulsatile, should prompt one to see an ENT physician. 

Your Question: Can you tell us what causes tumors in the ears?

Doctor's Reply: Inner ear tumors of the balance, hearing or facial nerve are usually benign, occur randomly but in some cases are associated with genetic disorders. Middle ear tumors are also usually benign and occur randomly or are the result of chronic ear infections such as in the case of cholesteatomas.

Your Question: I have peripheral neuropathy (permanent nerve damage in lower legs) and a subsequent balance problem.  Is this connected to my moderate hearing loss?

Doctor's Reply: Both systems are at work here. Your neuropathy is most likely the dominant player but the inner ear does contribute to one's overall sense of balance or lack thereof.

Bottom line is that I would recommend physical therapy for the balance system which is known as Vestibular Rehabilitation (VRT).  Your primary care physician can order it for you. Frazier Rehab has a particularly good program in Louisville. 

Your Question: What is the best solution to prevent ear infections with hearing aids?

Doctor's Reply: 3% Boric Acid solution and 70% Isopropyl alcohol mixed 50:50 with distilled white vinegar work well with a bulb syringe. The boric acid solution if made by mixing 1/2 teaspoon of Boric Acid in 1 gallon of distilled water. 

Your Question: What percent of speech understanding does one have before cochlea implants are recommended?

Doctor's Reply: First and foremost audiologic and speech discrimination criteria for cochlear implantation vary by insurance carrier, sometimes radically, so each CI candidate is encouraged to check their individual policies.

FDA guidelines state that the implanted ear speech discrimination can be no better than 50% and the non implanted ear can be no better than 60% in the best aided conditions. 

Medicare guideline is more stringent and requires a speech discrimination score of 40% or less in BOTH ears in the best aided condition. 
Lastly, Medicare does not cover bilateral implants. 

Your Question: How do I get the free telephone for hard of hearing (HOH) people?

Editor's Reply:  The Kentucky Commission on the Deaf and Hard of Hearing (KCDHH) has a telephone program called the Telecommunication Assistance Program (TAP).   Through this program any resident of the state of KY can receive a free specialized phone. This can be an amplified phone, a caption phone, a cell phone, a TTY, or an I-pad.  In addition, some alerting devices can be obtained free.  Contact KCDHH ( 502-573-2604,  www.kcdhh.ky.gov) .  Be sure to read all of the material and follow all of the rules.  Understand only one phone item will be distributed every four years.  Choose your phone carefully.  Cell phone services are not unlimited.  There are age limitations for children.

One may also receive a free landline caption phone through two other companies:   CaptionCall  (https://www.captioncall.com/1-877-557-2227);  Clarity Clear Voice  (www.clarityproducts.com  800-426 -3738). Note that the CaptionCall phones and the Clarity Ensemble Caption Phone are FREE.  You may have to pay a temporary deposit and you will have to document your hearing loss.  Read the fine print.  These phones and the calls associated with them are free.   The KCDHH cell phone calls have a cost limitation.  Understand the programs.  One might choose the cell phone from KCDHH and a landline phone from CaptionCall or Clarity.  If you need further information talk to us at the HLAA meetings.  KCDHH will require you to document your hearing loss and your KY residency.  Caution:  Selecting a phone, I-Pad and giving it to someone else is not acceptable and can be tracked.

Dr. Severtson is a magna cum laude graduate of Yale University who earned his medical degree from Columbia University’s College of Physicians and Surgeons in 1992 and completed his residency training at Loyola University, Chicago, in 1997. He extended his training with an American Otologic Society approved fellowship in otology/neurotology through the Ear Foundation and Vanderbilt University in Nashville, Tennessee. He is board certified by the American Board of Otolaryngology and is also board certified in Neurotology.  Dr. Severtson concentrates his practice in the areas of otology and neurotology (medical and surgical disorders of the ear, balance system, and skull base). Dr. Severtson and his wife, a clinical psychologist, have two children. He enjoys golf and traveling to the Pacific Northwest. 

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