Ear Surgery - Coastal Ear Nose & Throat

1. KnowAllAboutEarSurgery Diseases of the ear can affect hearing and balance and lead to significant functional problems for patients suffering from ear disease.ThephysiciansandaudiologistsatCoastalEar,Noseand Throatunderstandthecomplexstructureandfunctionoftheear and can evaluate, diagnose and treat your ear problem using state-of-the-art technology including surgical and non-surgical management depending on the severity and nature of your problem. OurfellowshiptrainedNeurotologist,Dr.J.SethMcAfee,aswell asanexperiencedstaff,areequippedtohandlethemostdifficult caseswithbothmedicalandsurgicalmanagement.

2. TypesofHearingLoss SensorineuralHearingLoss Sensorineuralhearingloss,alsoknownas“nerveloss,”isaresultof damagetothemicroscopichaircellswithintheinnerearand/ortothe nerveofhearing.Thisdamagecanbeduetogenetics,advancingage, ornoiseexposure.Ifyouareworriedabouthearingloss,callustoget an appointment with one of the doctors at any three locations: Neptune,HolmdelorManahawkin,NewJersey. Approximately 90% of hearing losses are sensorineural. In fact, most peoplewhowearhearingaidshavesensorineuralhearingloss.Inmost cases,thesetypesofhearinglossarepermanentandcannotbetreated by medication or surgery. Hearing aids are thus the primary mode of treatment.Incasesofsevereorprofoundcases,cochlearimplantsmay beaconsideration. Cont....

3. TypesofHearingLoss ConductiveHearingLoss Aconductivehearinglossoccurswhensoundisnotabletoreachahealthyinner earadequately.Thiscanbedueto: a blockage in the ear canal such as wax fluidinthetypicallydrymiddleearspace poormovementofthebones(ossicles)locatedinthemiddleear conditionswherepeoplehavemalformedorabsentearcanalsand/orpinnae (thevisibleportionoftheearonthesideofthehead) Conductivehearinglossaccountsfor5-10%ofhearinglossesandaregenerally treatedbymedicationorsurgery. MixedHearingLoss Mixedhearinglossisacombinationofbothsensorineural(“nerveloss”)andconductivehearinglosseswhichoccur simultaneously.Surgery,hearingaidsandassistivelisteningdevicesarealltreatmentoptions.

4. CochlearImplants Howdocochlearimplantswork? Cochlear implants bypass damaged hair cells and convert speech and environmentalsoundsintoelectricalsignalsandsendthesesignalstothe hearingnerve. The implant consists of a small electronic device, which is surgically implantedundertheskinbehindtheearandanexternalspeechprocessor, which is usually worn on a belt or in a pocket. A microphone is also worn outsidethebodyasaheadpiecebehindtheeartocaptureincomingsound. Thespeechprocessortranslatesthesoundintodistictiveelectricalsignals. These 'codes' travel up a thin cable to the headpiece and are transmitted acrosstheskinviaradiowavestotheimplantedelectrodesinthecochlea. The electrodes’ signals stimulate the auditory nerve fibers to send informationtothebrainwhereitisinterpretedasmeaningfulsound

5. Whatcausesswimmer’sear? Acommonsourceoftheinfectionisincreasedmoisturetrappedintheearcanal,bathing,orshowering, increasedhumidityorlivinginwarmmoistclimatesmayalsocontributetothiscommoninfection.When wateristrappedintheearcanal.Bacteriathatnormallyinhabittheskinandearcanalmultiply,causing infectionandirritationoftheearcanal.Iftheinfectiongetsworseitmayaffectotherareasoftheear. Swimmer’searneedstobetreatedtoreducepainandeliminateanyeffectitmayhaveonyourhearing.

6. Surfer'sEar CoastalEar,NoseandThroatcanprovidereliefofsymptomsfrom surfer’s ear through a minimally-invasive procedure, performed within the comfort of our own surgery center. Dr. McAfee, our fellowship trained neurotologist, is the only surgeon in the tri- stateareathatusesaminimallyinvasiveproceduretoremovethe painful bone growths that often develop with repeated bouts of ear exposure to cold water and wind. With the use of surgical osteotomes, bony growths are removed through the ear canal withoutneedforadrillorincisionbehindtheear.Thisprocedure maypermanentlycorrectcommoneffectsofsurfer’sear,resulting in: Hearing restoration Eliminationofwatertrapping Eliminationofrecurringearinfection. Otherbenefitsofthisminimallyinvasiveprocedure: Noovernighthospitalstay More rapid healing and recovery for a quicker return to water sports Onlymilddiscomfort,whichcanbetreatedwithover-the-counterpain relievers

7. Meniere'sDisease WhatisMeniere'sdisease? Meniere's disease also called idiopathic endolymphatic hydrops,isadisorderoftheinnerear.Althoughthecause is unknown, it probably results from an abnormality in thefluidsoftheinnerear.Meniere'sdiseaseisoneofthe most common causes of dizziness originating in the innerear.Inmostcasesonlyoneearisinvolved,butboth earsmaybeaffectedinabout15percentofpatients. Ménière’sdiseasetypicallystartsbetweentheagesof20 and 50 years. Men and women are affected in equal numbers.

8. InnerEarDisorders Theearsareamazingorgansthatcanreceiveanddecipherawiderange ofsound.Therearebasicallythreesectionstotheear:outer,middle,and inner. They all work together to create hearing. Sound waves enter through the outer ear. When they reach the middle ear, they cause the eardrum to vibrate. Those vibrations are further transmitted through three tiny bones in your middle ear to your inner ear. The inner then is responsible for the nerve impulses that are sent to your brain, which decodesthemasthevarioussounds.Inadditiontoitsauditoryrole,the innerearalsocontrolsbalance.

9. BenignParoxysmalPositionalVertigo BenignParoxysmalPositionalVertigo,alsoknownasBPPV,isacommonformofvertigo,a balancedisordercausedbyinnerearissues.PatientswhosufferfromBPPVmayhavebrief periods of vertigo that come and go. Although BPPV is not a life-threatening condition, it shouldbeevaluatedbyadoctortoensurepropertreatment. CausesofBPPV BPPV is caused by a problem with the inner ear. The inner ear contains tiny particles of calciumthatstimulatenervecellsandhelptomaintainbalance.Whentheseparticlesshiftor aredisrupted,vertigomayoccur.BPPVmaybecausedbyaninfectionorinflammationofthe earthatcausesthecalciumparticlestoshift,resultinginbalanceproblemsandvertigo. SymptomsofBPPV Patients with BPPV experience a sensation of tilting or spinning, although neither is actually occurring. In some cases, the vertigo may be brought on by a tilt or turn of the head. These symptomsmaylastforafewminutesatatime,andareusuallymild.Additionalsymptomsmay Nausea Dizziness Vomiting Difficultystandingorwalking include:

10. Whatcausestinnitus? Mosttinnituscomesfromdamagetothemicroscopicendingsofthehearingnerveintheinnerear.Thehealthofthese nerve endings is important for acute hearing, and injury to them brings on hearing loss and often tinnitus. If you are older,advancingageisgenerallyaccompaniedbyacertainamountofhearingnerveimpairmentandtinnitus.Ifyouare younger,exposuretoloudnoiseisprobablytheleadingcauseoftinnitus,andoftendamageshearingaswell. Therearemanycausesfor“subjectivetinnitus,”thenoiseonlyyoucanhear.Somecausesarenot serious(asmallplugofwaxintheearcanalmightcausetemporarytinnitus).Tinnituscanalsobe asymptomofstiffeningofthemiddleearbones(otosclerosis). Tinnitusmayalsobecausedbyallergy,highorlowbloodpressure(bloodcirculationproblems),a tumor, diabetes, thyroid problems, injury to the head or neck, and a variety of other causes including medications such as anti-inflammatories, antibiotics, sedatives, antidepressants, and aspirin.Ifyoutakeaspirinandyourearsring,talktoyourdoctoraboutdosageinrelationtoyour size. Treatmentwillbequitedifferentineachcaseoftinnitus.Itisimportanttoseeanotolaryngologist toinvestigatethecauseofyourtinnitussothatthebesttreatmentcanbedetermined.

11. DizzinessandMotionSickness Feeling unsteady or dizzy can happen due to poor circulation, vertigo, injury, infection, allergies, or neurological disease. Dizziness is treatable but it is importantforyourdoctortohelp you determinethecauseso that the correct treatment is used. While each person will be affected differently, symptoms that warrant a visit to the doctor include a high fever, severe headache, convulsions or ongoing vomiting, chest pain, heart palpitations, shortness of breath, inability to move an arm or leg, a change in vision orspeech, orhearing loss.

12. Tympanoplasty Tympanoplastyisreconstructivesurgeryfortorn tympanicmembranes(eardrums) or ossicles(middleear bones).Eardrumtearsmayresultfromchronicinfection or, lesscommonly,fromtraumatotheeardrum. Tympanoplastycan alsohelp torestorehearing,treat certain types of deafness, and prevent middle ear infections. Tympanoplasty can be performed through the ear canal or through an incision behind the ear. Tympanic membrane graftingmayberequiredin whichagraftistaken from tissueundertheskin aroundtheeartoreconstructthe eardrum.Theprocedureisperformed on an outpatient basisunder local orgeneralanesthetic.

13. OssicularReconstrution Ossicular reconstruction is performed to repair the bones of the middle ear thatareusedforhearing.Themiddleearbones maybecome damagedfrom infection orfromchronicretraction oftheeardrum.Thisprocedure often accompaniestympanoplasty(surgicalreconstructionoftheeardrum). The need for ossicular reconstruction is sometimes known prior to tympanoplasty surgery, but even when identified during surgery, ossicular reconstruction can usually be performed while reconstructing the eardrum. Tympanoplasty with ossicular reconstruction typically requires an overnight stayatthehospital.

14. Myringoplasty Myringoplastyisthe nameofthesurgicalprocedurethatisusedtorepaira holeintheeardrum.When thisprocedureis combinedwithaproceduretoclearthemiddleearofdisease andfurtherrepairtheeardrum,itiscalledtympanoplasty. Myringoplastyisusuallyperformedas an outpatientprocedureorwithoneovernightstay.Inmostcasesthepatientisunder generalanestheticwhilethesurgeryisperformed. Acutis made behindtheear,orinsomecasesa small cutis made infrontoftheear.Tissuefromtheareawherethecutis madeisusuallyusedtorepairandcovertheholeintheeardrum. Repairingtheeardrumcanimprovehearing,keep theeardry,reducepain,andpreventinfection.

15. CauliflowerEar(AuricularHematoma) Howdoyougetacauliflowerear? Cauliflower ear is characterized by thickened, fibrotic scarring of the ear, giving it a cauliflower-esque appearance. Cauliflower ear is an acquired deformity(meaning you weren’t born withit) oftheouterearthatisusually caused by blunt trauma to the ear. The ear is not well protected against blunt trauma. When it is struck by a punch or kick, for instance, the blood supply to the skin and cartilage is disrupted, often forming a pocket of blood(auricularhematoma).Ifthebloodis notevacuatedordrainedin a timely fashion, a fibrous, solid material results, causing scarring and deformity of the ear known as cauliflower ear. Although it rarely impairs hearing, the cosmetic deformity is quite difficult to repair if not addressed immediately after the injury occurs. You can get cauliflower ear in other ways such as accidents, physical altercations, and even an infected ear lobe caused by piercing. This last example can lead to infection in the cartilage, whichcan resultin cauliflowerear.

16. WhatisCerebrospinalFluidLeaks Cerebrospinal fluid (CSF) surrounds the brain and spine, and is encased in a membrane known as the dura. Sometimes, a CSF leak develops from a defect in the dura, allowing fluid to leak from the nose or ear. CSF leaks can be caused by headinjuries,varioussurgeries,orspontaneouslyfromhighpressureinsidethe skull. SymptomsofCerebrospinalFluidLeaks Symptoms of a CSF leak include a watery, clear discharge from the nose or ear, and a headache that is more painful when standing upright than when lying down.Ifaccompaniedbynausea,photosensitivityandastiffneck,an infection may be present. If a CSF leak is not repaired, serious and potentially fatal complications,includingmeningitisorswellingofthebrain,mayarise DiagnosisofCerebrospinalFluidLeaks Diagnosis is usually based on the patient’s history of injury combined with a focusedphysicalexamination.Necessaryworkupmayincludetestingoffluid samples,aswell asvarioustypesofimaging,toincludeCTandMRI.

17. WhatisaCholesteatoma? An abnormal skin growth in the middle ear behind the eardrum is called cholesteatoma. Repeated infections and/or and a tear or retraction of the eardrumcancausetheskintotoughenandformanexpandingsac. Cholesteatomas often devolop as cysts or pouches that shed layers of old skin, which build up inside the middle ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss,dizziness,andfacialmuscleparalysisarerare,butcanresultfromcontinued cholesteatomagrowth. SymptomsandDangers Initially,theearmaydrainfluidwithafoulodor.Asthecholesteatomapouchorsacenlarges,itcancauseafeelingof fullness or pressure in the ear, along with hearing loss. An ache behind or in the ear, especially at night, may cause significant discomfort. Dizziness, or muscle weakness on one side of the face (the side of the infected ear) can also occur.Anyorallofthesesymptomsaregoodreasonstoseekmedicalevaluation. An ear cholesteatoma can be dangerous and should never be ignored. Bone erosion can cause the infection to spread intothesurroundingareas,includingtheinnerearand brain.Ifuntreated,deafness,brainabscess,meningitis,and, rarely,deathcanoccur.

18. WhatareEarmolds? Custom earmolds are made to specifically fit the size and shape of your individualear,whichprovidesforamorecomfortablefitcomparedtomany over-the-counter options. The tighter, more accurate fit provides for a betterseal to protectagainst noiseexposureortokeep wateroutoftheear. Anaudiologisttakesimpressionsofeachearusingasiliconematerial;these impressions are then sent out to an earmold manufacturer who will make the molds specific for each order. Earmolds are available in various materials and colors. For children, it is recommended that they use earmolds attached to their hearing aids. Since their ears are constantly growing and changing in size and shape, the audiologist will need to monitorthefitoftheearmoldsatregularfollow-upappointments.

19. Whatisearcanalstenosis (atresia)? Sometimesachildcanbebornwithoutanexternalearcanal.This iscalledaural atresia.In othercases,thechildhasa narrowedear canal, where the eardrum can still be viewed but the canal is narrower than normal. This condition is called ear canal stenosis. Theseconditionscanaffectoneorbothears. Patients with atresia and no ear canal have hearing loss. The same is oftentrue ofearcanal stenosis,althoughattimeshearingcanbe normal depending on the severity of the stenosis. In both conditions, the inner ears and auditory nerves are generally normal. In the cases of hearing loss, surgery to either create or widen the ear canal is necessary. This surgery is referred to as canaloplasty oratresiaplasty.

20. WhatIsOtitisMedia? Otitismediameansinflammationofthemiddleear.Theinflammationoccursasaresultof a middle ear infection. It can occur in one or both ears. Otitis media is the most frequent diagnosis recorded for children who visit physicians for illness. It is also the most common causeofhearinglossinchildren. Althoughotitismediaismostcommoninyoungchildren, italsoaffectsadultsoccasionally.Itoccursmostcommonly inthewinterandearlyspring months.WhatAreTheSymptomsOfOtitisMedia? Ininfantsandtoddlers,be onthelookoutforanyofthefollowingsymptoms: Pullingorscratchingattheear,especiallyifaccompaniedbythefollowing... Hearingproblemsorcrying,irritabilityorfever Vomiting Eardrainage Earache Feelingoffullnessorpressure Hearingproblems Dizzinessorlossofbalance Nauseaand/orvomiting Eardrainage Fever

21. KnowAboutEarwax Goodintentionstokeepearscleanmayberiskingtheabilityto hear.Theearisadelicateandintricatearea,includingtheskin oftheearcanal andtheeardrum.Therefore,special care should be given to this part of the body. Start by discontinuing theuseofcotton-tippedapplicatorsandthehabitof probing theears. WhatcanIdotopreventexcessive earwax? There are no proven ways to prevent cerumen impaction, but not insertingcotton-tippedswabsorotherobjectsin theearcanal is stronglyadvised.Ifyouare pronetorepeatedwaximpaction or usehearingaids,considerseeingyourdoctorevery6to12months foracheckup androutine preventivecleaning.

22. WhatisaVestibular Schwannoma? Avestibularschwannoma,sometimesreferredtoasacousticneuroma,isa benign tumor found on the vestibularcochlear nerve, the nerve that connects the ear to the brain. This nerve is behind the ear, right under the brain.Thistypeoftumoristypicallyveryslow-growing,anditmay press against the nerves controlling hearing and balance as it grows. An acoustic neuromaisan uncommon causeofhearing loss.Ifthetumorremains small, many patients will remain asymptomatic. However, if it enlarges enough to exert serious pressure on the brain, it may become life- threatening.

23. ContactUs CoastalEar,Noseand Throat - Neptune Address:3700Route33Neptune,NJ07753 (732)280-7855(main) (732)280-7815 CoastalEar,NoseandThroat - Manahawkin Address:1301Route72 Unit 340 Manahawkin,NJ08050 (609)978-0590 (732)280-7815 CoastalEar,NoseandThroat - Holmdel Address:100Commons Way #210 Holmdel,NJ07733 (732)280-7855 (732)-280-7815 To Know MoreAbout Ear Surgery,VisitUs: https://coastalearnoseandthroat.com/services/ear-surgery/