The Hearing and Balance Center at Keck Medicine of USC in Los Angeles offers every aspect of care from diagnosis and treatment to assistive training and physical therapy for a variety of ear conditions. From ear infections to dizziness and complete hearing loss, our specialists develop customized treatments, both nonsurgical and surgical, to help improve communication and restore equilibrium to our patients’ lives.
With access to some of the latest semi-implantable and implantable technologies, such as the cochlear implant and the osseointegrated implant (The Baha System), we are able to help patients who do not benefit from traditional hearing aids because these specialized systems are able to access the hearing pathway and provide sound in a way that a hearing aid cannot. The ability to fit and tune a listening device for a patient’s particular need calls for advanced technology, but, more importantly, a high level of experience. Our leading audiologists optimally fit and tune devices to address a wide spectrum of types of hearing loss.
The center also has one of the most advanced balance rehabilitation programs in the world. When neurological or inner ear problems give rise to balance disorders, such as dizziness or disequilibrium, our physical therapists are skilled in diagnosing the source of the balance problem and can prescribe exercises that strengthen the core balance of patients, often reducing the need for surgery or heavy medication.
Our experts also offer a unique and comprehensive approach to treating children with hearing loss at the USC Caruso Family Center for Childhood Communication.
Offering a complete range of treatment options, we provide a tailored approach for our patients. We work closely with our neurosurgery, neurology, internal medicine and physical therapy departments to find the best options for each patient we see. Providing this truly personalized care begins with an accurate diagnosis. We use the results of a physical examination to inform the right combination of genetic and sophisticated electro-physiologic tests. This personalization allows us to design an approach specific to our patients’ needs and lifestyle.
We are driven by our respect for the power of human connection. As all stages of human development are highly reliant on social connections, the team strives to ensure that patients are able to communicate effectively with their families, friends and coworkers by offering them the latest in technological advancements generally unavailable elsewhere. This respect informs our philosophy of care; we stress open lines of communication across specialties to deliver the best patient experience possible.
Middle-ear infection is most common in young children. By age three, 80 percent of children have had at least one episode of otitis media and almost 50 percent of children have had three or more episodes. Patients experience a sense of fullness in the ear; decreased hearing; pain (severe pain indicates infection).
Our physicians check for bulging of eardrum or fluid visible behind the eardrum on examination with an otoscope. Sometimes drainage of pus or fluid from the canal, hearing loss, or tenderness of the mastoid bone can occur.
Otitis media is said to be chronic when, despite treatment, drainage of fluid or pus and hearing loss persists longer than 6 weeks. Chronic otitis media can take two forms: inactive and active.
- In the inactive form, symptoms include persistent drainage of cloudy fluid from a perforation usually in the center of the eardrum and muffling of hearing.
- In the active form, a skin cyst in the middle-ear space erodes and destroys the bone in the mastoid air cells and promotes the spread of infection to adjacent structures.
Patients may experience intermittent or persistent drainage of cloudy fluid or foul-smelling pus from the ear, or loss or reduction of hearing for longer than 6 weeks.
Our physicians check for perforation of the eardrum or a skin cyst – also called a cholesteatoma – within the eardrum or middle ear (visible on examination with an otoscope); conductive hearing loss; drainage of cloudy fluid or foul-smelling pus from the ear; or destruction of mastoid air cells as shown by x-rays (sometimes).
Our physicians check for perforation of the eardrum seen on examination with an otoscope; loss of mobility of the eardrum, which may be documented by a tympanogram.
Our physicians check for retracted eardrum, blood behind the eardrum, or perforation of the eardrum on examination with an otoscope.
Our physicians check for sensorineural hearing loss as determined by audiometric and tuning fork testing.
Chronic, usually occupational, noise trauma accounts for nearly 20 percent of all cases of impaired hearing. Chronic exposure to loud, intense noise – whether in an industrial or employment setting from firearms or heavy equipment – can damage the sensitive and delicate structure of hearing: the inner ear’s hair cells and the nerve fibers they contact. Patients may experience at first, loss of perception of high-frequency sounds (may include normally spoke voice tones, particularly the consonant sounds), and later loss of perception of low-frequency sounds.
Our physicians check for hearing loss verified by audiometric testing; nerve loss verified by tuning fork testing.
Infections caused by bacteria or viruses trigger the body’s immune response, in which immune cells destroy the infectious agent. In the process, certain substances such as histamine are released from cells. These substances produce inflammation, which involves pain, swelling, redness, and irritation of affect tissues. Unless the inflammation is treated, there is a risk that is can lead to long-term damage of tissues and structures in the ear, especially the blood vessels. The result is sensorineural hearing loss. Patients may experience increasing trouble with hearing in one or both ears, usually developing slowly but sometimes occurring rapidly; dizziness; possibly facial paralysis. Some patients experience flu-like symptoms (fever, malaise, loss of appetite, fatigue). Rash, joint pain, and other symptoms may develop depending on the nature of the underlying illness.
A number of devices are now commercially available to screen for middle-ear infection, however these devices are difficult to use. A child’s small ear canals are angled in such a way that the eardrum is difficult to see. Note that ear infection is best detected by looking for fever, fussiness, ear tugging, and loss of sleep and appetite, especially after a cold or sore throat.
Patients should return to the doctor if the pain worsens or fails to resolve; if muffling of hearing persists; if sudden blurring of vision, dizziness, or loss of balance develops; or if drainage of pus, fluid, or blood occurs. In children, muffled hearing may be indicated by delayed development of speech, particularly the ability to produce crisp-sounding consonants.
The active form always requires surgical treatment. The type of surgery depends on the extent to which the infection has spread or on the amount of destruction done by the growing cyst. These procedures can usually be performed as outpatient surgery followed by two to three days of moderate discomfort that can usually be adequately treated with prescription-strength pain medication. After surgery, most doctors will recommend that patients avoid heavy lifting, strenuous exercise, or any other activity that might increase the pressure in the middle ear for four to six weeks.
The Cochlea or Hearing Inner Ear
Between 40 and 70 percent of people recover functional hearing without treatment.
How sound is heard
- Sound waves that enter the external ear are amplified by the eardrum (tympanic membrane). Three small bones (incus, malleus, and stapes) transmit the sound vibrations to fluid in three tubes (cochlear duct, scala tympani, and scala vestibuli). Fluid motion is converted to the nerve impulses that travel along the cochlear nerve to the brain. Hair cells in the cochlea convert the motion of fluid in the inner ear into impulses.
The Basics: The Eardrum, Middle Ear, and Mastoid
The eardrum is a cone-shaped, thin membrane located at the end of the external canal. The middle-ear chamber, an air space that lies behind the eardrum, contains the ossicles, three tiny bones involved in hearing: the hammer, also called the malleus; the stirrup, also called the stapes; and the anvil, also called the incus. The hammer is connected to the eardrum; the stirrup-shaped bone is connected to the inner ear; and the anvil connects the hammer to the stirrup. They form a bony chain that conducts sound waves from the eardrum to the hearing portion of the inner ear, amplifying the sound by a factor of almost 30. The lining of the middle-ear chamber is similar to the tissue lining the nose and produces a mucus-like fluid; normally, the fluid drains from the middle ear down the eustachin tube into the back of the throat. Blockage of the eustachian tube can cause fluid to build up and become infected. This tube also provides a means to equalize the pressure in the middle-ear chamber with that of the external environment. For example, ear popping, which often happens when flying in an airplane, is due to pressure changes mediated by the eustachian tube. The chamber also communicates with the mastoids, a bony cavity behind the ear perforated throughout with air chambers.
To examine the eardrum, the doctor uses an otoscope.
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