Our Program

Hearing-and-Balance

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.

Our Approach

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.

Conditions

The mucous membrane lining the middle-ear space, like that of the nasal chamber, produces fluid. Normally, the fluid drains from the middle ear down the estachian tube into the back of the nasopharynx, the area where the nose and throat meet. Viral infections of the upper respiratory tract (for example, a cold) can result in increased production of mucus from the middle ear lining and swelling of the estachian tube, a combination that allows fluid to build up in the middle-ear chamber. Fluid in the chamber dampens vibration of the eardrum and movement of the middle-ear bones, leading to a temporary decrease in or loss of hearing.

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.

Chronic Otitis Media, Cholesteatoma, and Mastoiditis
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).

Rupture of the eardrum may be caused by any pressure against the membrane. The pressure could come from direct puncture by an object such as a cotton-tipped applicator, stick, hairpin, or foreign object; a forceful stream of water; or a blast of air pressure against the eardrum, such as might occur from a hard blow against the ear. Symptoms – including hearing loss, ringing in the ears, pain, and bleeding – may begin immediately following the perforation. Patients may experience hearing loss, tinnitus (ringing in the ears), pain, and bleeding.

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.

Proper function of the ear requires that the air pressure within the middle ear is equal to that of the surrounding atmosphere. Sudden changes in pressure can either put outward traction on the eardrum or cause it to collapse. In either event, the result can be pain and diminished or muffled hearing. Any pressure change can damage the eardrum; most commonly it occurs with descents when flying or scuba diving. Patients may experience sudden fullness, pain, and decreased hearing in one or both ears.

Our physicians check for retracted eardrum, blood behind the eardrum, or perforation of the eardrum on examination with an otoscope.

In otosclerosis, abnormal growth of sponge-like bone occurs in the vicinity of the inner ear. This bony tissue gradually fixes the stirrup (one of the bones involved in hearing), limiting and finally preventing its motion. Since the motion of the bone is essential for efficient transmission of vibrations to the inner ear, the result is progressive hearing loss (the rate is low) at which hearing is lost. The disorder, which usually affects both ears, occurs more commonly in adults in their 20s and 30s is the most common cause of hearing loss in young adults regardless of family history. The disorder may extend to affect inner-ear function, producing a combined conductive and nerve hearing loss. Patients may experience progressive hearing loss, often accelerating during pregnancy.
The inner ear, also called the cochlea, is the shaped like the shell of a snail. It is lined with thousands of specialized hair cells that are connected to thousands of nerve fibers. The pressure waves that have been intensified by the bones of the middle ear are carried into a chamber filled with fluid called the endolymph, making the hair cells that line the inner ear vibrate. These vibrations produce nerve impulses that are carried to the hearing centers of the brain. Sensorineural hearing loss due to disorders of sensory mechanism of the inner ear is covered in this section.
A certain degree of hearing loss, beginning first in the high-pitched range, is nearly universal among the elderly. It is likely that it results from a combination of genetic vulnerability, the effects of diseases such as hypertension (high blood pressure), and non-occupational noise exposure. It represents the most common cause of deafness in the United States. Of people age 65 to 75, 1 in 4 people and nearly half of those over age 75 experiences some hearing difficulty. The majority of these people do not complain of deafness; rather, their family members are the first ones to notice. The cause of age-related hearing loss is not clearly understood. Patients may experience progressive hearing loss. The ability to hear, first, high frequency sounds and then conversational speech is affected.

Our physicians check for sensorineural hearing loss as determined by audiometric and tuning fork testing.

Traumatic (Occupational and Noise) Hearing Loss
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.

Inflammatory Causes of Hearing Loss
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.

Treatments

Prompt resolution of pain occurs in almost all cases once antibiotic treatment has begun. Fever (if present) should resolve in 48 hours. Restoration of hearing results from drainage or reabsorption of middle-ear fluid, healing, and when the eardrum returns to its normal shape and position. A hearing test is often advised to assess the slight possibility of long-term (permanent) effects on hearing.

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.

In the inactive form of the disorder, extending the course of treatment with antibiotic medication may be sufficient to resolve the problem. If fluid accumulation does not improve, surgical treatment may be necessary. The surgery is usually a simple myringotomy and placement of PE tubes.

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.

If the perforation is small, it may heal on its own in several weeks. Larger holes may require myringoplsty. Hearing loss usually resolves completely after either spontaneous healing or myringoplasty and within a few months the appearance of the eardrum should return to normal.
In many cases, decongestant nasal sprays or tablets may relieve symptoms. Occasionally, myringotomy may be necessary if there is bleeding behind the eardrum. If a perforation occurs, a small myringotomy will usually heal uneventfully; larger ones may require a graft.
The best treatment for otosclerosis is surgery, either with a procedure called a stapedotomy, which bypasses the stirrup by making a small opening in the inner ear, or with a stapedectomy, which involves removal of the stirrup and replacement with an artificial bone. The surgery usually can be performed under local anesthesia and is typically done in the operating room of a hospital. Hearing is usually regained quickly.

The Cochlea or Hearing Inner Ear

The usual treatment is a prescription for a hearing aid after an evaluation by audiologist (hearing specialist) for audiometric testing.
There is no treatment to reverse sensorineural hearing loss; however, a hearing aid may help. There is no reversal of this problem once it occurs but management strategies (use of amplification, auditory training) can be of immense benefit.
Steroid drugs can relieve symptoms of inflammation. If a bacterial infection is found to be the cause, treatment also calls for the use of antibiotics. Depending on the type of underlying autoimmune disease involved, anti-inflammatory medications, steroids, or other methods may be used in treatment. Hospitalization may be required and in many causes use of steroids must continue indefinitely.
Between 40 and 70 percent of people recover functional hearing without treatment.

Patient Information

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.

Our Physicians

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Practicing Locations

Keck Hospital of USC
USC Healthcare Center 4

Specializing In

Otolaryngology

Additional Team Members

Ki-Young Portillo
Aline Tran