J. Walter Kutz, M.D. Answers Questions On: Otolaryngology

Otosclerosis is the most common cause of conductive hearing loss in patients without a history of ear infections or ear surgeries.

Typically patients with otosclerosis will have progressive hearing loss. When they come in, we’ll perform an audiogram that will show the conductive hearing loss with a normal otoscopic ear exam. Often patients will have a family history of otosclerosis.

If the conductive hearing loss is severe enough, some patients will elect to undergo a stapedectomy operation – an outpatient procedure in which the stapes bone is replaced. The outcomes are overall very good. A hearing aid would be another option for people with mild hearing loss or patients not wanting surgery.

Children who have severe to profound hearing loss in both ears but do not benefit from a hearing aid are excellent candidates. We try to implant these children as early as we can. Often we will implant them at one year of age. At that age, they’ll have a better chance of developing speech. If you implant after about three years of age, the prognosis for developing speech is more limited.

Some children with progressive hearing loss are also good candidates for a cochlear implant. They may be older and may have had some hearing when they were young. But that hearing has faded and now they are no longer able to use a hearing aid. Those kids can also benefit from a cochlear implant even though they are older than three years of age.

Adults who had hearing at some point but lost it for various reasons, and are not able to benefit from a hearing aid, are also good cochlear implant candidates.

The most common symptom of acoustic neuroma is hearing loss or ringing in one ear. However, with the widespread use of MRI for conditions like headaches, often acoustic neuromas will be found incidentally without any symptoms.

Treatment options vary depending on the size of the tumor, age of the patient, health condition of the patient, and hearing status. A lot of times for small tumors or tumors in older patients we’ll just monitor the situation with a series of MRIs.

For small tumors in patients with good hearing, we offer some surgical approaches to try to preserve the hearing.

In very large tumors, there are potentially life-threatening complications where you can have spinal fluid build up around the brain. Those tumors require surgical removal.

Select patients can be treated with Gamma Knife radiosurgery, a focused radiation therapy, which is very successful at stopping the tumors from growing. That’s generally reserved for growing tumors and tumors in older patients.

Often people think they have Meniere’s disease but they don’t. To have definite Meniere’s disease, you have to have two or more episodes of vertigo lasting more than 20 minutes and fluctuating hearing loss in one ear. You’ll also have ringing in the ear and fullness (a feeling of pressure) in that ear.

To treat Meniere’s disease, typically we start with dietary modifications, including a low-salt diet. If that doesn’t work, there are some medical treatments that are often very successful. Certain patients who don’t benefit from the medical treatment will move on to other treatments.

One treatment commonly used here at UT Southwestern is intratympanic steroid injections. That has about a 90 percent success rate at controlling vertigo episodes in patients in which medical management didn’t work. For patients who continue to have vertigo, we offer some surgical options.

Most of the problems we see are going to be advanced chronic ear infections, specifically large eardrum perforations or cholesteatoma.

Cholesteatoma is where the skin of the eardrum has grown into the middle ear and the mastoid. There’s really no medical treatment for a cholesteatoma, so it’s treated surgically.

Often we’ll do two surgeries, where the initial surgery will remove the cholesteatoma and repair the ear drum. In the second surgery we’ll make sure there’s no residual cholesteatoma and reconstruct the hearing bones.

One of the biggest things we see nowadays is the use of personal listening devices. Young kids, especially, will play the devices at a very loud level. Some recent research shows that there’s a higher instance of hearing loss in kids, probably due to this practice. One of the things parents can do is make sure they listen to the volume that kids are listening at and regulate it. 

There are also a lot of occupational hazards for adults. Fortunately, hearing protection is much more widespread, but still we see some need for improvement.

We’ve expanded the conditions with which we can treat with cochlear implants. Traditionally we only implanted people with profound bilateral hearing loss. With new electrode design and surgical techniques, we’re able to preserve the hearing in a significant number of patients. So we’re starting to place implants in patients with who still have some residual hearing. At UT Southwestern, we’re going to participate in clinical trials regarding hearing preservation with cochlear implants.

Implantable hearing aid technology is also an interesting field. With some of the new technology on the horizon, patients will benefit from an implantable hearing aid that currently exists but at a very costly price. I think there’s going to be expansion of implantable hearing aids to hopefully make this more widespread and affordable.