Ear Problems

Common Outer Ear Problems

A number of problems can obstruct the sound waves on their way to the inner ear. Problems of the outer and middle ear generally do not cause permanent damage and often can be overcome with self-treatments. The most common problems are earwax buildup, foreign objects lodged in the canal, a ruptured eardrum, or an infection that can cause a buildup of fluid in the middle ear.

Earwax Blockage
Skin lining the outer portion of the ear canal contains glands that produce a waxy substance called cerumen which is more commonly known as earwax. Cerumen is a normal protectant of the ear.

Its job is to defend against harm, trapping dust and other foreign objects before they can reach the more delicate tympanic membrane (eardrum). Wax also helps inhibits the growth of bacteria.

Normally, earwax migrates to the external edge of the ear canal and falls away or is wiped off. However, sometimes more wax is produced than the ear can expel, causing it to accumulate in the ear canal.

Generally, excessive earwax does not lead to hearing loss because it does not completely block the passageway. But many people insist on inserting a variety of objects into the ear canal on the assumption that they are cleaning the ear when in fact, they are introducing more potentially harmful microorganisms as well as risking damage to the delicate tissues and membrane.

This action also pushes the wax farther into the passageway and impacting it. Impacted wax can reduce hearing by blocking airborne sound vibrations in the ear canal. Blockage can also induce earaches and tinnitus (noise like ringing, buzzing, or roaring in the ear).

Home Treatment: If necessary, earwax removal can be done at home or may require a physician. The easiest step in home care is to purchase an ear-cleaning kit and follow the instructions.

However, softening the earwax with a few drops of olive oil twice a day for several days will also work. When the wax is softened, fill a bowl with warm filtered water. (Water any hotter or colder than body temperature may cause dizziness during the procedure.)

Hold the head upright and grasp the top of the ear, pulling upward. With the other hand, gently squirt water into the ear canal using a three-ounce rubber bulb syringe.

Tilt the head to the side and allow the water to drain into another bowl. This may need to be repeated several times before all the wax falls out. Dry the outer ear carefully and, using an eyedropper, insert a few drops of alcohol-vinegar preparation (half rubbing alcohol, half white vinegar) to help dry out the middle ear.

A few drops of hemp seed oil or coconut oil also works well since both have natural antimicrobial properties.

CAUTION: If there is a history of a ruptured eardrum or ear surgery, do not flush the ears unless your doctor has given permission to do so.

Foreign Objects
Occasionally, an object or an insect can become stuck in the ear. It may tickle, hurt, or give a feeling that the ear is plugged.

Most can be removed without medical intervention; but if something is pushed too far into the ear, it may rupture the eardrum. If the object is clearly visible to an observer, it may be grasped with a pair of sterilized tweezers; but, if not, medical help should be contacted.

If an insect is involved, it will instinctively crawl up rather than down. Therefore, if it is still alive, tilt the ear upward and place a few drops of oil into the ear. The oil will suffocate the critter so it can be washed out.

Sometimes shining a flashlight into the ear will cause the insect to instinctively crawl towards the light, where it can be removed.

Swimmer’s Ear
Otitis externa (swimmer’s ear) is an infection of the ear canal and the result of persistent moisture in the ear. As its name suggests, it most commonly occurs after frequent swimming, but it can result in combination with a mild injury to the skin in the ear canal.

Such an injury can also occur from scraping the ear canal when trying to remove ear wax. Hair spray and dyes may also cause similar ear infections.

Treatment: Pain or itching in the ear, a swollen ear canal, and pus draining from the ear are all symptoms of an outer ear infection. Temporary hearing loss may occur if swelling or pus blocks the canal.

For mild pain without drainage, do the following:

• Place a warm heating pad on the ear – but do not lie on it.
• Keep the ear canal as dry as possible by placing a few drops of 50% rubbing alcohol-vinegar solution in the ear after showering or swimming. The alcohol will help dry the skin while the vinegar helps prevent bacterial or fungal growth.
• A few drops of coconut oil with a drop of tea tree oil or oregano oil on a cotton ball and placed in the ear overnight will often kill any micro-organism that might be causing an infection to start and will take care of the resulting pain. This is particularly effective and inexpensive.
• If the pain does not subside, medical help should be sought.

WARNING: In a few people, particularly those with diabetes or a weakened immune system, swimmer’s ear may lead to infections of the bones and cartilage at the base of the skull (malignant otitis externa). Such a complication is life-threatening and usually requires prolonged care under a team of specialists including an otologist, endocrinologist, and an infectious disease specialist.

Common Middle Ear Problems

A variety of problems can affect the middle ear, including infections, cysts, tumors, and abnormal bone growths. These problems are frequently associated with hearing loss caused by a disturbance of either the eardrum or the tiny bones in the middle ear (malleus, incus, and stapes). Often, hearing can be restored with medical or surgical treatment; but if the problem extends to the inner ear, permanent hearing loss may occur.

Middle Ear Infections
An inflammation or infection of the middle ear is known as otitis media. This condition is often associated with a cold, sore throat, or other respiratory infection that blocks the eustachian tube.

A blocked tube prevents the middle ear from being properly ventilated, causing the inflammation and an accumulation of fluids such as pus and mucus. Bacteria from the nose and throat may travel through the lining of the Eustachian tube and infect the middle ear.

Otitis media can occur at any age but is more common in children, partly because of the shape of the Eustachian tube, which is shorter and more horizontal than that of an adult. A more horizontal orientation means fluid is less likely to drain and more likely to accumulate.

While fluid accumulation is not necessarily a problem, it is an ideal breeding ground for microorganisms that cause infections. Although the accepted course of treatment has been repeated doses of antibiotics, this is now proving not to be the best course of action.

Sometimes fluid accumulation in the middle ear can reach a point where it obstructs the movement of the eardrum and the ossicles, causing conductive hearing loss. Too much fluid can also cause the eardrum to rupture. Pain results as the infection worsens, and is just one of several symptoms.

Others include dizziness, loss of balance, nausea, vomiting, ear drainage, and fever. At times, pus and mucus may persist even after the infection has passed, causing recurring episodes of infection and persistent hearing loss.

Food allergies, especially to wheat and dairy products, can be the cause of recurring middle ear infections and eliminating these from the diet is particularly effective for children – despite the parents’ initial reluctance to withhold them.

There are nutritional suggestions that can improve hearing and help reduce the incidents of infection.

Chronic Ear Infection
Persistent middle ear infection is known as chronic otitis media and may occur as a complication of an acute case of otitis media. Sometimes a low-level infection will continue long after an acute episode, leaving the ear more vulnerable to future infections.

The signs and symptoms of a chronic ear infection are often milder than those of an acute episode, but they can be more dangerous than an acute episode.

If the Eustachian tube is consistently blocked, the tissues of the middle ear gradually thicken and become inflamed. The mucus that is normally secreted also thickens. A vacuum created in the middle ear by the blocked tube can deform or rupture the eardrum.

As these changes occur, the structures of the middle and inner ear slowly deteriorate, causing permanent damage and hearing impairment. Infection can also spread to the bone behind the ear (mastoid process) and even to the brain.

Usually medication is given which will clear up the problem. However, when this fails to work, an incision may be made in the eardrum to relieve pressure and help drain the fluid. Healing should occur in about a week and sometimes before all the fluid has drained out. To prevent this, the doctor may temporarily place a tiny ventilation tube into the incision.

If significant damage has been done to the eardrum and ossicles, more extensive surgery may be required to remove infection tissue and repair these structures. This procedure is known as tympanomastoidectomy.

Eardrum Problems
The tympanic membrane is a resilient, yet fragile structure subject to constant use and abuse. Two common problems are a ruptured eardrum and barotrauma. Both can result in hearing loss mostly caused by a disruption or distortion of the eardrum and prevents it from vibrating properly. Usually the loss is temporary.

• Ruptured Eardrum
  This means that a tear or a perforation has occurred in the membrane as a result of an infection or a trauma. Chronic infections can also wear down the eardrum, creating a perforation on the surface. A blow to the head can also cause a perforation. Symptoms include an earache, partial hearing loss, tinnitus, and slight bleeding or discharge from the ear. In some cases, the ossicles in the middle ear may be damaged, resulting in more severe hearing loss. Usually, a ruptured eardrum heals by itself but larger ruptures may cause recurring infections.
• Barotrauma
  It is also known as ‘airplane ear’ because it results from a disparity between air pressure in the atmosphere and the air pressure in the middle ear. As the name suggests, this disparity of atmospheric pressure can occur during air flights or deep-sea dives. It can also happen when the Eustachian tube becomes blocked or fails to deliver air properly to the middle ear. An example of this would be when there is nasal congestion from an allergy or infection. Normally, the Eustachian tube that connects the middle ear to the back of the nose and upper throat allows air to flow in and out of the middle ear during swallowing or yawning. This type of movement helps maintain equal air pressure on both sides of the eardrum. A more serious problem may occur if the air pressure change is extreme or blocked, causing the small blood vessels in the middle ear to rupture and bleed.Generally, barotrauma is not a serious condition and requires no treatment. There are little techniques to help avoid the problem or relieve it as soon as it happens. Taking a decongestant before flying or scuba diving is sometimes helpful (but be aware of the side effects of such medications, especially drowsiness if scuba diving). Sucking on a lozenge or chewing gum during a flight is a well-known remedy. Pilots have a method that works well for them: pinch the nostrils shut, inhale, and swallow. The pop in the ears is a sign that the air has gone through the eustachian tube to the middle ear. On occasion, if the condition persists, a physician may have to make a tiny incision in the eardrum to equalize air pressure and remove fluid from the middle ear. This procedure is known as myringotomy.

Common Inner Ear Problems

Sensorineural hearing loss involves damage to the inner ear, the auditory nerve, or the brain. For example, when some of the hair cells of the organ of Corti are damaged or other changes take place in the cochlea or to the auditory nerve, the electrical impulses are not transmitted as efficiently, resulting in hearing loss. Sensorineural damage is often permanent and the hearing loss irreversible. However, with the use of hearing aids and other assistive hearing devices and techniques, it is still possible to communicate effectively, even with a hearing impairment.

Presbycusis
The most common form of sensorineural hearing loss is that associated with aging. This is known as presbycusis. As a person ages, the hair cells within the cochlea gradually wear out, causing a sensitivity loss to sound. Some adults may lose very little hearing as they age while others lose considerably more because of hair cell loss.

Viral Infections
Such infections as measles and mumps are the major causes of hearing loss in children. The measles virus usually attacks cells lining the lungs and back of the throat. The mumps virus typically affects the parotid glands – one of three types of salivary glands – between the ear and the jaw. From these areas in the head, either infection can easily spread to the inner ear and destroy hair cells and nerve endings in the cochlea. Viruses may also travel through the bloodstream to the cochlea. Such other viral infections, as influenza, chickenpox, and mononucleosis, may also lead to hearing loss.

Labyrinthitis
This is an inflammation of the inner ear that affects the cochlea and the vestibular labyrinth. The cochlea is vital to hearing and the vestibular labyrinth plays a role in balance and eye movement. If an inflammation affects only the vestibular labyrinth, it is known as vestibular neuronitis. The exact cause is unknown but often follows a bacterial ear infection or an upper respiratory viral illness. It may also occur after a blow to the head or it may occur with no associated illness or trauma.

Signs and symptoms of labyrinthitis include dizziness, hearing loss, tinnitus, nausea, vomiting, and involuntary movements of the eyes. All of the hearing in the affected ear may be lost. To keep the condition from becoming worse, it is sometimes helpful to sit as still as possible and avoid sudden changes in position. Most of the time, the inflammation goes away on its own in a few weeks. If the underlying problem is bacterial, antibiotics may be prescribed.

Presbycusis
This refers to age-related hearing loss. According to a survey conducted for the Centers for Disease Control and Prevention and the National Center for Health Statistics, about 30% of Americans 65 or older have hearing loss, whereas only about 3% under the age of 45 have hearing loss.

Because there is much variation in how people age, its effects on the human body cannot be precise. Typically, some of the hair cells in the cochlea may be lost during the aging process. In addition, nerves may become a little slower at transmitting messages to and from the brain and the brain may not be as quick to interpret sounds.

Initially, there is a loss of sensitivity to sounds with a higher frequency or pitch. This is because damage to the hair cells often occurs first at a location where high-frequency sounds are generally processed. At the same time, the ability to hear sounds with a low frequency may remain intact. Some sounds may even seem too loud.

Presbycusis is sometimes accompanied by a ringing or buzzing in the ears, a condition known as tinnitus. The condition also makes it hard to hold a conversation in an area with background noise, as a busy store. Presbycusis tends to run in families, which means genetics may be involved and the onset of hearing loss can be earlier in some families than in others.

Noise
This is another cause of sensorineural hearing loss because it can damage the inner ear. For many older adults, hearing loss is the result of a combination of aging and noise exposure over a period of years. The cumulative effect of a lifetime of noise can gradually affect the ability to hear. Noise-induced hearing loss may come as a result of a sudden explosion of sound or through gradual, prolonged exposure. If a sudden explosion of noise happens, hearing loss is noticed right away and may last a short or long time. However, with prolonged exposure, hearing loss may be so gradual and painless that it is hardly noticed until too late. Although noise-induced hearing loss cannot be restored, it can be prevented through the use of hearing protection devices.

Other Factors
Some drugs known to be harmful to the hearing mechanism are said to be ototoxic. Other causes include disease, trauma, and genetic disorders.

Other Problems Related to Hearing

Acoustic Neuroma (Vestibular Schwannoma)
This is a slow-growing, benign tumor on the 8th cranial nerve, which consists of the auditory and vestibular nerves twined together. The tumor develops as a result of overproduction of Schwann cells that cover and insulate the nerves. What stimulates these cells to overproduce is not known. The tumor usually develops at the point where the nerves exit the bony canal and enter the brain cavity.

Because an acoustic neuroma affects both the auditory and vestibular nerves, hearing loss in one ear, tinnitus and dizziness are common signs and symptoms. As the tumor grows, it can affect other nerves, especially the facial nerve, causing facial numbness and weakness or paralysis. It may also eventually press against nearby brain structures and become life-threatening.

Usually removed surgically, the tumor may also be treated with radiation therapy. To remove an acoustic neuroma surgically, the surgeon will make an incision behind or above the ear and remove a segment of the skull about the size of a silver dollar to get at the tumor. Once the tumor is removed, the bony segment or a permanent acrylic patch is used to cover the opening in the skull to prevent infection and protect the brain.

If the tumor is small, it can be removed without injuring the auditory nerve and hearing will be preserved. The larger the tumor, however, the greater are the risk that facial nerves and hearing will be affected.

Radiation treatment, called gamma-knife radiation, involves shrinking or stabalizing small or medium-sized tumors. This is a closed-skull procedure that requires the use of a machine that treats the tumors with highly focused radiation beams. The main benefit is that the skull is not opened, thus reducing the chances of infection. As a result, recovery time is shorter. A serious drawback is that it offers less certainty of long-term tumor control.

Autoimmune Inner Ear Disease (AIED)
This occurs when the body’s immune system mistakes normal cells in the inner ear for a virus, bacteria, or other pathogen and begins attacking it, producing an inflammatory reaction in the inner ear which can lead to problems with both hearing and balance. AIED is rare, accounting for less than 1% of all cases of hearing loss.

Signs and symptoms include:

• hearing loss that usually begins in one ear and moves to the other;
• tinnitus;
• a feeling that the ear is plugged;
• dizziness.

Because these signs and symptoms are similar to those of other ear disorders, diagnosis is difficult since it is often associated with other autoimmune disorders of the body including:

• ankylosing spondylitis (a disease that affects the spine);
• Sjögren’s syndrome (a dry eye syndrome);
• Cogan’s syndrome (affects both eyes and ears);
• ulcerative colitis (affects the intestinal tract);
• Wegener’s granulomatosis (inflames blood vessels);
• rheumatoid arthritis (inflames the joints);
• scleroderma (hardens and scars the skin and other connective tissue);
• systemic lupus erythematosus (SLE) and Behcet’s syndrome (both affecting multiple systems of the body).

Cholesteatoma
This is a growth of normal skin tissue in the wrong place. It often occurs when skin from the ear canal grows through a hole in the eardrum and extends into the cavity of the middle ear. It may also happen when a blocked eustachian tube creates a vacuum in the middle ear, drawing the membrane of the eardrum inward to form a pocket.

Old skin cells caught in the eardrum pocket contribute to the formation of a cholesteatoma. Occasionally, during fetal development, skin cells become trapped behind the eardrum so that a baby may be born with congenital cholesteatoma. This type may grow quickly.

Signs and symptoms include pus draining from the ear, hearing loss, ear pain or numbness, headaches, dizziness, and weakness of the facial muscles. The degree of hearing loss depends on where the tissue grows. Frequently, it encroaches on the ossicles, impeding the sound vibrations and causing significant conductive hearing loss.

The development of a cholesteatoma can erode bone, which makes this a potentially serious condition. It may invade the mastoid bone behind the ear and if left untreated, a cholesteatoma will continue to grow. This will eventually destroy the bony structures of the middle and inner ear, damaging the cochlea and the vestibular labyrinth and resulting in sensorineural hearing loss along with balance problems. Uncontrolled growths can also damage the facial nerve and in severe cases, may penetrate the brain causing an infection.

A cholesteatoma is removed surgically, generally in one operation if the growth is small. However, larger or more advanced cholesteatoma may require a series of operations to correct any damage to the bones of the middle ear, including the possibility of rebuilding them. If all of the growth is not removed, it will grow back. In severe cases, a radical mastoidectomy may be necessary.

This leaves a cavity that can be cleaned out periodically, but does not restore damaged bones or lost hearing. Attempts to reconstruct the ossicular bones with an artificial replacement (prosthesis) or cartilage is done during a modified radical mastoidectomy.

Congenital Hearing Problems
These exist from birth. They can be hereditary in nature or may have developed in the womb or during the birthing process. It is estimated that genetic factors are responsible for more than 50% of all incidents of congenital hearing loss.

A child whose hearing loss may be inherited usually has parents who each carry a recessive gene for hearing loss (autosomal recessive hearing loss). This gene is not expressed in the parents, who may have normal hearing, but is expressed in a child who inherits both recessive genes.

To date, more than 15 genes have been identified that cause recessive hearing loss not related to any other illness.

Often, congenital hearing loss is part of a collection of symptoms (syndrome) caused by such genetic defect, as Down syndrome, Usher’s syndrome, Treacher Collins syndrome, Crouzon’s disease, and Alport’s syndrome.

Congenital hearing problems are typically sensorineural and such factors that may cause hearing loss in an infant include:

• such infection present in the mother as rubella, cytomegalovirus, herpes, or syphilis;
• premature birth;
• a lack of oxygen during or shortly after birth;
• blood incompatibilities between the mother and child;
• diabetes in the mother;
• fetal alcohol syndrome;
• abnormal development of ear, face, or neck structures.

Most newborns are screened for hearing loss before they leave the hospital. It is important to continue monitoring the child’s hearing since a hearing impairment that goes unnoticed will significantly interfere with speech and language development, socialization, and learning.

Cysts and Tumors
These may develop in the middle ear or surrounding tissues, as the temporal bone of the skull, although these types of growth are less common. Most middle ear tumors are benign but some, as squamous cell carcinoma, are malignant and capable of spreading to other parts of the body (metastasize). Benign tumors usually grow slowly, whereas malignant ones tend to grow at a faster rate.

A sensation of the affected ear being plugged may indicate a tumor. But, so can hearing loss or tinnitus (noise in the ears), drainage from the ear, facial paralysis, dizziness, and loss of balance. In which case, a doctor must be consulted. A CT scan or MRI can help determine if a tumor is present.

Tumors of the ear are usually surgically removed; a delicate and complex procedure that may involve removing some, or all parts of the ear, depending on the nature and size of the tumor. Needless to say, this can result in permanent hearing loss as well as the function in the nerves leading to the face and shoulder. Radiation may be used as a primary treatment or in combination with surgery.

The more common tumors include:

• Glomus tympanicum and Glomus jugulare consist of masses of cells that can grow in the middle ear, interfering with vibration of the ossicles and leading to significant hearing loss. Often a glomus tumor will cause a pulsing sound in the ear that accompanies each heartbeat. Most are benign, but in rare instances, they can spread to the lymph nodes in the neck and become a more serious problem.
• Squamous cell carcinoma is a malignant tumor. While malignant tumors of the ear are rare, of those that do occur, squamous cell carcinoma is the most common. This type of tumor usually develops in skin cells of the pinna and ear canal or in the middle ear and mastoid. Their cause is not known, but it has been associated with chronic inflammations of the ear. Ear pain, periodic draining of fluid from the ear, and extended periods of bleeding from the ear are signs and symptoms of squamous cell carcinoma. This type of cancer is fatal if left untreated.

Medications
They can cause hearing loss, tinnitus, and balance problems. Medications, and other chemicals, can also aggravate an existing inner ear or hearing problem. Such medications are considered ototoxic and their effects can range from mild to severe, depending on the dose, length of time on the medication, as well as such factors as heredity.

Hearing problems caused by some ototoxic drugs usually go away when the medication is discontinued. Those drugs known to cause permanent hearing loss are given only when there is no other alternative for treating a life-threatening disease.

There are more than 920 drugs and chemicals considered to be ototoxic (harmful to the ear). Some of these include:

• salicylates (e.g., Aspirin and other NSAIDs);
• quinine;
• loop diuretics;
• amino-glycoside antibiotics (mycins);
• anticancer drugs (Carboplatin and Cisplatin)

Environmental chemicals may also have the same effect. These include:

• lead;
• manganese;
• n-butyl alcohol;
• toluene

Other substances can be equally to blame for causing hearing loss. One of the more common is Aspartame.

Some signs and symptoms of ototoxic reactions to medications include:

• onset of tinnitus or worsening of existing tinnitus;
• a feeling of plugged ear(s);
• loss of hearing or worsening of existing hearing loss;
• dizziness that is sometimes accompanied by nausea.

Some sites that list ototoxic medications:

• Dr. Timothy Hain
• Vestibular Disorders Association

• Center for Hearing and Communication

Book:

• Bauman, Neil G. Ototoxic Drugs Exposed. 2004.

Ossicular Chain Disruption
This can be the result of a traumatic head injury that displaces or breaks the small bones of the middle ear. These bones (the hammer, anvil, and stirrup) are referred to as the ossicular chain. The most common site of displacement from a trauma is at the joint where the anvil connects to the stirrup and frequently, the anvil itself is partially broken.

The disruption of the ossicular chain causes a breakdown in the passage of sound waves from the eardrum to the inner ear, resulting in significant hearing loss. Surgery involves a procedure called ossiculoplasty, which attempts to rebuild the displaced ossicles or to replace them either with a prosthesis or with small pieces of bone or cartilage.

Because ossicles are so small, the operation is very delicate and not all of the hearing may be restored. If head trauma has caused damage to the cochlea, resulting in sensorineural hearing loss, a hearing aid may be the best option as surgery will not resolve cochlear damage.

Although complications are rare, some of the risks involved may be:

• total deafness in the affected ear;
• tinnitus;
• dizziness and loss of balance;
• damage to the facial nerves, resulting in changes to the sense of taste or facial paralysis on the affected side.

Otosclerosis
This develops when an abnormal growth of spongy bone forms at the entrance to the inner ear (oval window). Because of this growth, the stirrup (stapes) gradually becomes fixed to the oval window and loses its ability to vibrate. In some cases, the cochlea of the inner ear becomes involved, causing greater hearing loss.

Otosclerosis is the most frequent cause of the middle ear hearing loss in young adults. It is twice as common in women as men and affects whites more often than people of other races. Signs and symptoms usually appear between the ages of 15 and 35. The development of the disease is slow and can affect one or both ears. In women with otosclerosis, the rate of hearing loss may increase during pregnancy.

An increasing amount of evidence suggests that genetic defects may predispose a person to the disease, since about half have a family history of the disease. Other recent studies indicate that the measles virus may also be a contributing factor.

Treatment generally consists of hearing aids if the hearing loss remains mild to moderate. Surgery is another option used to remove the fixed stirrup from the ear and insert a tiny wire or prosthesis made of platinum, titanium, teflon, or stainless steel – a procedure known as a stapedotomy.

The prosthesis can help most people with otosclerosis, but in a few cases it may cause total loss of hearing. The prosthesis may also become displaced, a growth of spongy bone may recur over the oval window, or the incus (to which the prothesis is attached) may erode. If the disease continues to progress after surgery, the ability of the prosthesis to function may be greatly reduced.

Perilymph Fistula
This is the medical term for a tear in the membrane covering either the oval window or round window, which are situated between the middle ear and the inner ear. It most commonly results from trauma to the head, but may also be caused by rapid changes in atmospheric pressure (scuba diving or airplane maneuvers) and extreme exertion (weightlifting or childbirth).

Signs and symptoms of a perilymph fistula include vertigo, imbalance, nausea, and vomiting. A fistula may also lead to tinnitus and hearing loss. Bed rest and avoiding sudden movements often allow the rupture to heal on its own otherwise, surgery is required.

Superior Semicircular Canal Dehiscence (SSCD)
This is similar to perilymph fistula in that both involve an abnormal opening in the inner ear. With SSCD the abnormal opening is at the top of one of the semicircular canals of the vestibular labyrinth, where there is a lack of bone covering the canal. The primary symptom associated with SSCD is dizziness when straining. Treatment may involve surgery.

Sudden Sensorineural Hearing Loss (SSNHL)
This is a medical emergency and may be caused by a viral inner ear infection, an abrupt loss of blood flow to the cochlea, a tear in the membrane within the cochlea, or from an acoustic neuroma. Most times, the cause is unknown. Sudden deafness may not always come as a result of a loud noise. It may come all at once or within only a few days, a condition known as sudden sensorineural hearing loss (SSNHL). When this happens, a popping sound is noticed, or it may be detected upon awakening or try to use the impaired ear. SSNHL is almost always confined to one ear and dizziness or tinnitus may also accompany the hearing loss. More common in young or middle-aged adults, about 4,000 new cases occur each year in the US.