One of the most frequent deafness is caused by Otosclerosis, the most severe being Acoustic Neurinoma.
Otosclerosis is a disease that blocks the movement of the stapes, the smallest ossicle of the ear, producing a progressive deafness in general of both ears and that can become very disabling for the patient. The ideal solution is surgical, Stapedotomy or Stapedectomy, an intervention of microsurgery and laser with which a good hearing can be recovered between 95 and 99% of the cases, depending on the case. It is more frequent in women than in men and is accentuated by pregnancy. In some cases it can cause very profound hearing loss.
If the deafness is profound or total, or a child is born deaf, a good hearing recovery can be obtained with a Cochlear Implant which consists of an electronic implantation in the inner ear (cochlea) complemented with an external computerized processor similar to a hearing aid. In 1985 we performed for the first time in Spain a single-channel Cochlear Implant called House 3M.
Nowadays in Otorhinolaryngology the implants are more sophisticated and allow hearing recoveries in some cases close to normal. If the implanted child is a child born deaf, he/she will also require a process of phonoaudiological reeducation during the first years.
It is a quite frequent pathology and in many cases associated to a tympanic perforation or a cholesteatoma and can derive from catarrhal otitis, very frequent in children. In both cases, in addition to medical treatment to cure the infection, they may require surgical treatment to reconstruct the eardrum or the ossicles chain, allowing in many cases also a hearing recovery.
The implanted hearing aid
In some cases of deafness when the only solution is a hearing aid (sonotone), generally in so-called perceptual hearing loss caused by a lesion in the nerve or cochlea, it is also possible to surgically implant a specially designed hearing aid that is completely hidden under the skin, i.e. invisible. In addition to the cosmetic benefit, since it is not visible, it allows hearing in situations in which a normal hearing aid cannot be worn, i.e. when practicing water sports, in the shower, while sleeping, etc. This does require surgical implantation.
A very frequent pathology derived from the ear is otologic vertigo, sometimes called Ménière’s disease. In principle it should be treated medically or with vestibular rehabilitation but if it does not resolve there are totally reliable surgical options. Sometimes the injection of Gentamicin or Cortisone in the ear can help the patient to improve. If the improvement is partial, or it is required to completely eliminate the vertigo crises that are very disabling, the best solutions are surgical, one is the Labyrinthectomy, although it is indicated when vertigo is associated with a significant hearing loss.
Otologic vertigo is always accompanied by tinnitus and hearing loss, but if this is not very important, the ideal solution is vestibular neurectomy, that is, disconnecting the organ of balance inside the ear from the nerve centers, thus eliminating vertigo definitively and maintaining hearing in most cases.
Many facial paralysis have their origin in otological problems. It is a very unpleasant pathology aesthetically and can be caused by ear infections, trauma due to intense cold or tumors of the nerve itself or contiguous nerves, or viral origin. In some cases the treatment is medical, but if it does not resolve it may require surgical treatment (decompression or repair of the facial nerve) if the cause is a tumor of the nerve or a contiguous nerve, acoustic or vestibular. Extirpation will be necessary if the paralysis is important or has an intracranial growth. If the consequence is a definitive facial paralysis, there are nerve repair techniques with very good results.
In the field of otoneurology, this pathology is a generally benign tumor but potentially serious due to its location. It consists of the formation of a tumor from the hearing nerve in its intracranial pathway.
The clinical symptoms may begin with tinnitus, hearing loss, dizziness, generally less violent than in Mèniére’s vertigo. Early diagnosis is important and is confirmed by MRI, since if the tumor is small and in a young or middle-aged person, it can often be removed while preserving hearing.
If the tumor is diagnosed late and is larger in size (sometimes it may happen that the lack of clinical symptoms does not allow its early diagnosis) the solution will be surgical. It can also be treated with radiosurgery, although this does not remove the tumor and the patient will require radiological control for the rest of his life and in many cases he will finally have to be operated on, with a considerable increase in surgical risks. For this reason we recommend this option in very old people or in those whose general condition is too serious to undergo major surgery.
In any other case, the definitive solution is the complete removal of the tumor before it begins to cause nervous symptoms or brain damage.