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04.02.2014

Loss of hearing in one ear with ringing, ear ringing noise - Review

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An acute attack of Meniere’s disease is generally believed to result from fluctuating pressure of the fluid within the inner ear. Abnormally enlarged fluid pathways into the ear, such as the vestibular aqueduct or cochlear aqueduct, may also be associated with Meniere’s-like symptoms, but recent evidence is against a relationship between the cochlear aqueduct and Meniere’s disease.
Meniere’s disease can cause hair cell death, as well as mechanical changes to the ear. Mechanical disruption of the inner ear is also likely, with dilation of the utricle and saccule of the ear being a well-known pathological finding.
Hearing tests often begin with showing a fluctuating low-frequency sensorineural hearing loss.
Between attacks, medication may be prescribed to help regulate the fluid pressure in your inner ear, thereby reducing the severity and frequency of the Meniere’s episodes. The purpose of treatment between attacks is to prevent or reduce the number of episodes, and to decrease the chances of further hearing loss. The Meniett device, manufactured by Medtronic (R), is a noninvasive treatment option that works by sending small pulses of pressure into the ear canal. In extremely severe cases, treatments that deaden the inner ear such as gentamicin injections or surgery may be considered. Another operation, called a labyrinthectomy, is recommended in persons who have lost all usable hearing or in whom vestibular nerve section is considered too dangerous. For bilateral Meniere’s disease, when the patient is incapacitated and it cannot be determined which ear is causing the dizziness, intramuscular streptomycin (1 gm twice a day) can be given on an outpatient basis until the first sign of ototoxicity develops. Surgical treatments have not been shown to preserve hearing to any greater extent than medical treatments (Sismanis, 2010). Your inner ear fluid is influenced by certain substances in your blood and other body fluids. People with certain balance disorders must control the amount of salt and sugar that is added to food. The American Hearing Research Foundation is a non-profit foundation that funds research into hearing loss and balance disorders related to the inner ear, and to educating the public about these health issues. Otosclerosis —An abnormal overgrowth of one or more bones in the middle ear prevents the small bones from moving normally. Meniere's disease — This typically causes dizziness, hearing loss, ringing in the ears (tinnitus) and a sensation of fullness or stuffiness in one or both ears. Drugs — Many prescription and nonprescription medications can damage the ear and cause hearing loss. If you have sudden, severe hearing loss, you will notice immediately that your ability to hear has decreased dramatically or disappeared totally in the affected ear. Wear protective earplugs or earmuffs if you are often exposed to loud noise at work or during recreational activities. Drug-induced hearing loss — Stopping the problem medication may reverse hearing loss or prevent it from getting worse. Sudden sensorineural hearing loss — When the cause is unknown, this condition is usually treated with steroids. If you do have sudden sensorineural hearing loss, treatment with steroids within the first 2 weeks of the symptoms provides the best chance that some of the hearing may return. The gold standard treatment for sudden deafness, if caught within two weeks of the onset of the symptoms, is high-dose steroids, taken by mouth. Evidence now suggests that injection of medication into the middle ear, using a relatively painless and quick procedure in the clinic, is also effective in treating sudden sensorineural hearing loss without the side effects that can be seen when taking high-dose steroids by mouth.
This study will compare high dose oral steroids with intratympanic, or middle-ear injections of a special formulation of steroid medication for the treatment of sudden sensorineural hearing loss. This Sudden Sensorineural Hearing Loss Multicenter Treatment Trial is the first prospective, randomized clinical trial to compare these two different treatment options. If you have any questions about Sudden Sensorineural Hearing Loss and treatment, please feel free to call Dr. Watch this slideshow tour through the ear, helping you understand the causes of ear infections and how they are diagnosed and treated.
View an illustration of ear anatomy and learn about the outer, middle and internal sections that make up the ear and their functions.
Learn Eustachian tube problems like clearing the ears when flying, or suffering infection and incurring an ear infection.
Watch this slideshow on Tinnitus (ringing in the ears) and learn causes, symptoms, relief remedies, treatments and prevention tips. Read about swimmer's ear (external otitis or otitis externa), an infection of the skin covering the outer ear.


Meniere’s disease is a disorder of the inner ear that causes episodes of vertigo, ringing in the ears (tinnitus), a feeling of fullness or pressure in the ear, and fluctuating hearing loss. A low-frequency sensorineural pattern is commonly found initially, but as time goes on, it usually changes into either a flat loss or a peaked pattern (click here for more information about hearing testing). Meniere’s patients who have associated migraines are reported to have an earlier age of disease onset and a higher rate of family history, suggesting a genetic component (Cha, 2007). In a review of literature, Ciuman (2009) stated that the endolymphatic sac in those with enlarged vestibular aqueduct was thin, whereas it was fibrous in those with Meniere’s. It is most often attributed to viral infections of the inner ear, head injury, a hereditary predisposition, and allergy.
The differential diagnosis is broad and includes perilymph fistula, recurrent labyrinthitis, migraine, congenital ear malformations of many kinds, syphilis, tumors, Multiple Sclerosis, etc. Over years, this gradually progresses to a “peaked” pattern with both low- and high-tone reduction, and finally a “flat” pattern, typically 50 db loss (110 db would be completely deaf). This is an important part of treatment for virtually all patients with Meniere’s disease. A permanent tinnitus (ringing in the ears) or a progressive hearing loss may be the consequence of long-term Meniere’s disease. It is thought that this reduces symptoms of Meniere’s disease by eliminating excess endolymphatic fluid within the ear. In a normal inner ear, the fluid is maintained at a constant volume and contains specific concentrations of sodium, potassium, chloride and other electrolytes. This fluctuation causes the symptoms of hydrops (pressure or fullness in the ears), tinnitus (ringing in the ears), hearing loss, dizziness and imbalance.
For instance, when you eat foods that are high in salt or sugar, your blood level concentration of salt or sugar increases, and this, in turn, will affect the concentration of substances in your inner ear.
High salt intake results in fluctuations in the inner ear fluid pressure and may increase your symptoms. The nicotine present in cigarettes constricts blood vessels and can decrease the blood supply to the inner ear, making your symptoms worse.
In spite of this concentration of effort by the medical community, Meniere’s disease remains a chronic, incurable disorder that causes progressive disability to both hearing and balance. Long-term disability of class A patients with Meniere’s disease after treatment with interlymphatic gentamycin. HLA-DRB1*1101 allele may be associated with bilateral Meniere’s disease in southern European population. Illness behavior, personality traits, anxiety and depression in patients with Meniere’s disease.
Dexamethasone inner ear perfusion for the treatment of Meniere’s disease: A prospective, randomized double-blind crossover trial.
The most common reversible causes are severe buildup of earwax in the ear canal and acute infections of the external ear or middle ear. A vibrating tuning fork is placed in the middle of your forehead to help diagnose one-sided hearing loss.
Your doctor may recommend a hearing aid or an implant to improve your ability to communicate with others. A typical patient loses his or her hearing in one ear over a period of one to several days, associated with a feeling of fullness in the ear, and often tinnitus, or ringing of the involved ear.
Occasionally, the patient may report an upper respiratory infection (cold symptoms) prior to the onset of the hearing loss.
The symptoms of decreased hearing and fullness of the ear are often diagnosed as a middle ear infection (otitis media) and so the referral to an audiologist or otolaryngologist (ENT specialist) is made too late.
The diagnosis can only be made by specialized hearing testing in a sound-proof chamber by an audiologist. In Figure 1, the area of the ear affected is the entire labyrinth, which includes both the semicircular canals and the cochlea.
This mechanical disruption and distortion of normal inner ear structures may result in the gradual onset of a chronic unsteadiness, even when patients are not having attacks. The process of diagnosis usually includes hearing testing (audiometry), an ENG test, several blood tests (ANA, FTA), and an MRI scan of the head. While some people have hearing that fluctuates like this without any further symptoms of dizziness or tinnitus, in most cases, this does not progress to Meniere’s disease (Schaaf et al, 2001). While very effective, this procedure, especially the hearing-sparing variant, is presently generally felt to be of much higher risk than gentamicin injection. This treatment however damages the inner ear and causes bilateral vestibular paresis, which has its own set of symptoms and disability.


Limiting or eliminating your use of caffeine and alcohol will also help to reduce symptoms of dizziness and ringing in the ears. Try to anticipate fluid loss which will occur with exercise or heat, and replace these fluids before they are lost. With their assistance, you’ll find that modifying your eating habits can help you control the symptoms of your balance disorder. Auditory and vestibular hair cell stereocilia: relationship between functionality and inner ear disease. Long-term effects of the Meniett device in Japanese patients with Meniere’s disease and delayed endolymphatic hydrops reported by the Middle Ear Pressure Treatment Research Group of Japan. Intratympani gentamicin treatment of patients with Meniere’s disease with normal hearing.
Noise-induced hearing loss can happen because of a single brief burst of an extremely loud sound. Acoustic neuroma often causes dizziness and equilibrium problems in addition to gradual hearing loss. Or it can result from a Q-tip that ruptures the eardrum during an attempt to clean the ear canal. Your doctor will want to know if you have been exposed to loud noises, trauma of the ear or head, or ear infections. He or she will check for middle-ear problems by measuring your eardrum's ability to reflect sounds.
A hearing aid amplifies sounds electronically and is effective for many people with age-related hearing loss. Pure-tone thresholds, speech discrimination scores, acoustic reflex testing, and distortion product otoacoustic emission testing, the parts of a complete audiometric evaluation, are performed to confirm the diagnosis of a sudden sensorineural hearing loss. Vestibular (motion sensing) hair cells seem more resilient but there is also a slow decline in the caloric response in the diseased ear over roughly 15 years (Stahle et al, 1991). The periodic dilation and shrinkage of the utricle is also a reasonable explanation for periodic attacks of another inner ear disorder, BPPV. A recent study examined the relationship between hearing fluctuation and vertigo attacks (Neill et al., 2010). Injections of gentamicin are given through the ear drum, through a small hole or through a small tube. One recent study did conclude a higher success rate than gentamicin injection (Derebery et al., 2010). We are particularly interested in projects that might lead to method of stopping progression of hearing loss and the disabling attacks of dizziness. Your doctor will want to rule out the possibility that medications may be causing your hearing loss. Hearing aids today are very small, so small that other people often do not notice you are wearing them. This comprehensive testing by an audiologist will ensure that the loss is nerve-related, and not due to fluid, infection, or a perforation, or hole in the ear drum. This is a very disabling symptom as it occurs without warning and can result in severe injury. Silverstein suggested that 75% of persons destined to become bilateral do so within five years. One way for this to happen is when the drainage system, called the endolymphatic duct or sac is blocked. The studies concluded that hearing fluctuation often occurs indepentantly of vertiginous episodes.
It is typically harder to hear high-pitched tones (women's voices, violins) than low-pitched ones (men's voices, bass guitar). MRI scan of the brain, with gadolinium contrast, is also performed to exclude the presence of a cerebellopontine angle tumor, such as a vestibular schwannoma (acoustic neuroma). As the sac is the immune organ of the ear, this idea makes sense if one is attempting to immunosuppress the ear. The majority of people with Meniere’s disease are over 40 years of age, with equal distribution between males and females.



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