Otitis Media (Inflammation of the Middle Ear)

Located within the middle ear space is a tube called the Eustachian Tube. This tube extends from the middle ear space to a region in the back of the throat and nose. In its normal state, the Eustachian tube is closed. However, when a person swallows or yawns, the Eustachian tube is forced open in order to allow air to enter the middle ear space, thus equalizing the air pressure in the middle ear to that within the ear canal. If the Eustachian tube fails to open and close properly, pressure builds up in the middle ear space allowing the accumulation of fluid.

A child’s Eustachian tube is an essentially narrow, straight, short tube which is the perfect condition for fluids and germs to gather in the middle ear space and cause problems. As children grow into adult bodies, this tube begins to widen, lengthen, and slope down into the back of the throat and nose space. Think of a properly functioning storm drain, an adult Eustachian tube allows for the proper drainage of fluid so that a buildup of fluid and germs is less likely to occur, similar to rain water properly running down the drain.

In addition to being at an anatomical disadvantage, a child’s immune system is not fully developed until the age of 7 years. Therefore, their bodies are not as good at warding off infections as adults. Environmental factors may also increase the risk of OM such as the use of pacifiers or bottles, exposure to second-hand smoke, and attending group child-care facilities where germs are easily spread.

In treating middle ear infections the physician will consider whether or not to use a “wait and see” approach, antibiotics, pressure equalization tube insertion, or a combination of two or more of these approaches. When planning the treatment approach the physician will consider the type and severity of the ear infection, frequency and duration of the ear infections, the age of the child, speech/language delays or learning disorders, state of hearing sensitivity and medical risk factors.

Pressure equalization tubes, or PE tubes, are surgically inserted in the ear drums. They help to drain fluid from the middle ear and equalize the pressure in the ear. The procedure takes about 10 minutes and is performed under general anesthesia. Children are most commonly able to leave about an hour after surgery and feel no pain after discharge.

If otitis media goes untreated, and fluid is allowed to remain in the middle ear for longer than 6 weeks, it may become thick. This thick fluid or mucous can cause significant damage to the eardrum and the tiny bones within the middle ear thus impairing hearing. Following your physician’s medical treatment plan is the best way to assure maximum recovery and hearing abilities.

Research about OM is ongoing; your doctor can talk to you about the current findings.

Coastal Ear, Nose and Throat has been treating monmouth county and ocean county for ear infections for over a decade. Our practice offers audiologic/diagnostic hearing evaluations our doctors of audiology. So come visit our board certified physicians and let them help you treat your otitis media. If you like our blog please visit our facebook page and like us.

Please visit our website at www.coastalhearing.com under helpful links for more healthy hearing information.
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Dr. Suzanne McCorry is Director of Audiology at Coastal Ear, Nose and Throat in Neptune, NJ and can be contacted at 732-280-7855; sbmccorry@coastalhearing.com; http://www.coastalhearing.com

Meet Our Physician Assistant

Jaclyn Sylvia, our Physician Assistant, is committed to excellence in patient care. She received her bachelor’s degree in Health Services and Biology at Quinnipiac University in 2005. She continued on to obtain her Master’s degree in Health Science Physician Assistant at Quinnipiac University in 2007. She has been a practicing licensed medical professional working in otolaryngology and facial plastic surgery for over three years providing care for both adults and pediatric patients. She is also on the Board of Directors for the Society of Physician Assistants in Otolaryngology/Head and Neck Surgery as well as an active member of the American Academy of Physician Assistants in order to promote growth and development of Physician Assistants in the ENT field.

Coastal Ear, Nose and Throat: Telephone Use with Hearing Aids

Coastal Ear, Nose and Throat: Telephone Use with Hearing Aids

Telephone Use with Hearing Aids

Courtesy of Coastal Ear, Nose & Throat

During the holidays, we have the opportunity to spend time our family members and friends who we might not get to see often throughout the rest of the year. Why not enhance your daily communication with those close to you by improving hearing ability on the telephone? Understanding speech on the phone is a significant area of difficulty for the majority of individuals with hearing loss.
Our ability to understand speech is augmented by the cues provided by looking at someone’s face when they are talking and by binaural listening (hearing with two ears). Communication via the telephone can be extremely difficult due to the loss of visual cues and relying on only one ear. In the past, individuals with hearing aids may have experienced whistling when attempting to use the telephone in conjunction with their hearing aid. The technology available today allows for improved telephone communication.
Hearing aids can now come equipped with a telecoil to improve telephone use. The telecoil circuit allows for electromagnetic communication between the telephone and the hearing aid by positioning them appropriately close together – a program button can be provided on the hearing aid if an individual has difficulty with maintaining the position of the phone. How do you obtain the most optimal telecoil response with a hearing aid? Your landline phone should have at least a 100 milliamps per meter (mA/m) magnetic strength in order to achieve a good connection to the hearing aid telecoil. If your phone is not emitting a strong enough magnetic field, a magnet can be placed on the phone receiver. Cell phones should have a minimum of a M3/T3 rating. The M refers to use with the hearing aid microphone; whereas the T refers to the use with the hearing aid telecoil. The higher the rating, the better compatibility is with the hearing aid – M4/T4 provides the best compatibility.
Even more exciting … some of the hearing aid manufacturers have recently developed technology that allows the hearing aid to automatically send the telephone response to both hearing aids simultaneously to regain the binaural listening, which is lost with traditional telephone use. In addition, many hearing aids are Bluetooth compatible to allow for hands-free cell phone use without having to take out the hearing aids to use a hands-free Bluetooth device for the cell phone while driving.
Individuals with a more severe degree of hearing loss may require use of a captioned telephone or phone relay service. Captioned telephones have a visual display of every word that the person you are communicating with to improve your ability to understand speech on the phone. IP Relay Service is available for individuals who use American Sign Language as their primary means of communication to allow for telephone communication.

Remember to enjoy your holiday season and keep in touch with the ones you love!

Suzanne McCorry is Doctor of Audiology at Coastal Ear, Nose and Throat in Neptune, NJ, and can be contacted at 732-280-7855; sbmccorry@coastalhearing.com; http://www.coastalhearing.com

Breathing Easier with the Help of K. Hovnanian Childrens Hospital

Dr. Samuel Engel, MD, MPH

Ryan Dunckley, 3, of Whiting was a constant worry to his parents. Born with a congenital condition called laryngomalacia, Ryan had an underdeveloped voice box that lacked structural support.

But when he developed a strange breathing problem that wouldn't go away, his mother, Karen, grew concerned. "His breathing sounded like a motor boat, especially when he was exerting himself or sleeping at night," she says.

She videotaped the noises and brought him to Mary Mitskavich, MD, a board certified otolaryngologist affiliated with Jersey Shore University Medical Center.

Because the majority of children outgrow laryngomalacia by age 2, Dr. Mitskavich at first took a watchful approach. But Ryan was slow to crawl, walk, and talk, and his breathing became more labored. At the next appointment, Dr. Mitskavich, introduced her new colleague in the practice, Samuel Engel, MD, MPH a pediatric otolaryngologist at K. Hovnanian Children's Hospital at Jersey Shore University Medical Center.

Dr. Engel, who has a special interest in pediatric airway obstruction, recommended a sleep study to make sure Ryan's breathing was not stopping during sleep, which is an associated condition called sleep apnea. The study was done in an overnight sleep lab, close to Ryan's home in Brick, at Ocean Medical Center.

After determining that Ryan did not have sleep apnea, Dr. Engel recommended surgery known as supraglottoplasty to fix the breathing problem. "I endoscopically corrected the structure of his voice box, which had collapsed," Dr. Engel explains. "The entire surgery was performed transorally so there are no scars. At the same time, Ryan had his adenoids removed and ear tubes placed for recurrent ear infections."

Ryan spent one night in the hospital before going home. As a precaution, he stayed in the pediatric intensive care unit. "The nurses and staff there are so friendly," Karen recalls. "We weren't as severe a case as the other children in the unit that night, but we go the same care. I swear it was just about the next day when Ryan started running around at home. His life changed right there."

Ryan's follow-up care involves speech therapy, but he's "a big, happy, healthy kid," Karen says. "And I can't say enough about Dr. Engel. He is just such a nice guy and talks in a way you understand. He made Ryan very comfortable, too." -Ryan Younger

Toys on Santa's Naughty List

With the holidays upon us, you are probably wondering what gifts to give the little ones. How about the gift of hearing? Each day, a child's ears are bombarded with loud and possibly damaging sounds; why continue that assault by giving a loud toy?

For the last 12 years, Minnesota's Sight and Hearing Association and the University of Minnesota, have teamed up to purchase and test readily available toys for potentially dangerous sound levels. This year, 15 out of 19 tested toys were deemed loud enough to damage precious hearing in 15 minutes. The top offender? Iron Man Mobile Headquarters Action vehicle by Jada Toys, Inc., which came in at a whopping 119.5 dBA! You must realize that a lawn mower produces about 90 dBA of noise and anything over 100dBA poses hearing risk in 15 minutes. Second and third place offenders go to the Fischer Price Learning Letters Mailbox (113.9 dBA) and Sesame Street Help Along Sing a Song (112.1 dBA), respectively.

How do you know if a toy is too loud for children? Try it out. Hold a toy next to your ear and give it a go. If you find yourself flinching at the sound, it is too loud. Noises can be harmful at all ages. However, a child's ears are more fragile due to the smaller size of the ear canal and the increased sound pressure placed upon the eardrum.

Take the time to inspect the toys children already have. If the toys are too loud, control the volume by taking out the batteries and putting packing tape over the speaker to muffle sounds, replace toys with less noisy toys, or restrict use to outside play areas.

Remember to enjoy your holiday season and protect the ones you love!

Candice E. Ortiz, AuD, CCC-A, FAAA

Audiologist

Coastal Hearing and Balance Center

3700 Rt 33

Neptune, NJ 07753

http://www.coastalhearing.com/

Medications and Their Effect on Hearing

Medications that can damage the ear, resulting in hearing loss and/or balance disorders are considered ototoxic. (Mudd, Edmunds, Glatz, Campbell, & Rybak, 2008) Literally, ototoxic means “ear poison.” There are over 100 known ototoxic prescription and over-the-counter medications on the market today. (Mudd, Edmunds, Glatz, Campbell, & Rybak, 2008) These include, but are not limited to, medicines used to treat serious bacterial infections, cancers, and heart disease.
What are the Effects of Ototoxic Medications?
The first sign of ototoxicity is most often ringing in the ears (tinnitus). Permanent, high frequency hearing loss may also occur. Although uncommon, hearing loss as a result of ototoxic medications may be temporary. The hearing loss often remains unnoticed by a person until speech understanding is affected.
In addition to hearing loss, a person may also experience a loss of balance and the feeling of bouncing vision from the medication. These side effects are often temporary as the human body can learn to adapt to theses deficits. (Guthrie, 2008)
Who is affected by Ototoxic Medications?
Use of ototoxic medications can have serious affects on its users’ quality of life. Not being able to hear conversation, or perhaps always feeling dizzy, may cause a person to stop participating in their usual activities. Therefore, it is important that the pros and cons be weighed before the start of a treatment plan.
All people who take ototoxic medications should be aware of its side effects. However, there are those who are at greater risk than others. Infants who are born prematurely are at a greater risk of ototoxicity than adults when taking medications known as aminoglycosides, which treat serious bacterial infections. Children are also at a greater risk for ototoxicity when using cisplatin (a drug used to treat cancer). (Garcia, Martinez, Agusti, Mencia, & Asenjo, 2001)
The elderly, those with kidney disorders, people who already have hearing loss, those who have previously used ototoxic medications, those using multiple ototoxic medications at one time, and those who have genes linked to ototoxic weakness, are also at a higher risk for experiencing ototoxic effects than others. (Garcia et al., 2001; Mudd et al., 2008; Vasquez & Mattucci, 2003)
The “who” is not the only factor to consider when thinking of vulnerability to ototoxic medications. The “how”is also important. The way that medications are delivered can play a role in severity of ototoxic effects. For example, medications put directly into the blood stream by intravenous injection may be more severe than those applied by liquid drops on the eardrum. (Guthrie, 2008)
Can a person protect themselves against ototoxicity?
There is a lot of research being done to develop ways of protecting a person from ototoxic medications. Animal experimentation shows promising results. However, the extent that the animal study results extend to humans is unknown at this time and human studies have not yet been performed. Therefore no protective strategy has been formally approved. (Guthrie, 2008)
What should a person do if they are going to begin using an ototoxic medication?
Monitoring the hearing and balance systems are very important. By thorough monitoring, if a change occurs, adjustments can be made by the doctor to try to save as much hearing and/or balance as possible. Adjustments in treatment can include, but are not limited to, changing the dose, the schedule of treatment, a switch to a less ototoxic medication, or possibly stopping the treatment temporarily. (Vasquez & Mattucci, 2003)
Prior to starting the treatment plan, a baseline evaluation should be conducted which includes a conventional hearing test, high frequency hearing test, word recognition test, otoacoustic emission test, and an electronystagmography or videonystagmography test when possible. Throughout the course of treatment, weekly tests should be performed consisting of at least conventional and high frequency hearing tests and the otoacoustic emission test. Post-treatment tests should also be performed as reactions to the drugs make not take affect right away and cannot be predicted. (Vasquez & Mattucci, 2003)
What can be done when treatment has ended and a person has hearing loss and/or balance problems?
Unfortunately, even with careful monitoring, ototoxic effects may be unavoidable as the primary concern is the treatment of the disease which requires the drug in the first place. If a person is left with tinnitus, hearing loss, imbalance, and/or dizziness, an audiologist can work to develop a rehabilitation plan. This plan may include lessons on better hearing strategies, hearing aids, and/or balance therapy.
If you suspect that you may have, or had, problems related to ototoxic medications, please feel free to make an appointment with our team of physicians and audiologists at Coastal Ear, Nose and Throat.

Coastal Hearing and Balance Center

3700 Route 33

Neptune, NJ 07753

www.coastalhearing.com

(732) 280-7855