Providing specialized care for your ear, hearing and balance needs through advanced treatment and technology

The Ohio State University Wexner Medical Center Hearing and Balance program encompasses the Divisions of Otology/Neurotology, Audiology and Balance Disorders, who work hand-in-hand to provide the best hearing and balance care available in central Ohio, as well as the nation. 

The Division of Otology, Neurotology and Cranial Base Surgery, in partnership with the Audiology and Balance Disorders programs, specialize in the medical and surgical management of a broad range of diseases and disorders of the ear and skull base. With three fellowship trained neurotologists, nine full-time audiologists, the most comprehensive vestibular (balance) testing facility in the area and a broad knowledge of auditory devices with a special focus on cochlear implants, The Ohio State University Wexner Medical Center is the most complete source for ear care in Ohio.

Our neurotologists often work closely with other Ohio State physicians in complex cases of the cranial base that require the resources of other specialties, such as oncology, neurology and neurosurgery.

Our Services

Conditions

Accoustic neuroma and other cranial base tumor

An acoustic neuroma is a benign tumor that develops on the nerve that connects the ear to the brain. The tumor usually grows slowly. As it grows, it presses against the hearing and balance nerves. At first, you may have no symptoms or mild symptoms. They can include:

  • Loss of hearing on one side
  • Ringing in ears
  • Dizziness and balance problems

The tumor can also eventually cause numbness or paralysis of the face. If it grows large enough, it can press against the brain, becoming life-threatening. Acoustic neuroma can be difficult to diagnose, because the symptoms are similar to those of middle ear problems. Ear exams, hearing tests and scans can help diagnose this condition. If the tumor stays small, you may only need to have it checked regularly. If you do need treatment, surgery and radiation are options.

NIH: National Institute of Deafness and Communication Disorders 


Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is a common inner ear disorder that affects balance.  

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Cerebrospinal fluid leaks through the ear

If the membrane that surrounds the brain and spinal cord tears or punctures, cerebrospinal fluid (CSF) contained by the membrane can leak through your ears.

Causes of CSF leak include:

  • Brain, skull or spinal surgeries
  • Injury or trauma to the head
  • Insertion of epidural anesthetic or pain medication
  • Spinal tap (lumbar puncture)

Headache is the most common symptom. Depending on the cause, many leaks can heal without treatment in a matter of days. However, if there is infection, fever and/or change in mental status after brain or spinal cord surgery, or as a result of a lumbar puncture, it is considered a medical emergency that requires immediate attention and antibiotic treatment.  

Other serious complications include meningitis and brain swelling. If the leak does not heal on its own, surgery may be necessary to patch the site of the leak. 


Cholesteatomas

Growths, such as cysts, shed skin which builds up inside the middle ear, creating a condition called cholesteatoma.

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Chronic ear infection and inflammation

Chronic ear infection is more common in children than adults. It is marked by fluid, infection or swelling in back of the eardrum. Chronic ear infection keeps coming back or doesn’t heal and can cause lasting damage to the ear.

Signs your child has a chronic ear infection:

  • Ear pain and/or pressure
  • Irritability or crying more than usual
  • Fluid draining from the ear
  • Hearing problems or loss 
  • Low-grade fever

These symptoms can come and go or last a long time. Sometimes symptoms can be difficult to detect, which can delay treatment. Bacterial ear infection may be treated with antibiotics. Surgery may be needed to remove tissue that has gathered inside the ear or to correct other issues. Chronic ear infections in children may require that they have special small tubes inserted in their ears to relieve pressure and restore hearing. 


Cochlear hydrops

Cochlear hydrops is a form of Meniere’s disease that does not include dizziness as a symptom. It is believed to be excessive fluid pressure in the cochlea of the inner ear. Although Auditory Brainstem Response Test (ABR) and other tests may be performed, there is no specific test to diagnose this condition.

Symptoms include:

  • Clogged or fullness sensation in the ear
  • Distortion of sound and speech
  • Hearing fluctuations
  • Roaring sound in the ear
  • Sensitivity to high-frequency noise

Treatment consists of dietary changes and restrictions, including no alcohol, no caffeine and low salt. Diuretics may be prescribed if the response to the modified diet is good. 


Ear tumors

Ear tumors, called acoustic neuromas, are noncancerous growths that can develop on the nerve that connects the ear to the brain.

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Facial nerve diseases and paralysis

Certain diseases can lead to facial disorders. For example, a viral infection is believed to be the cause of Bell’s palsy, which is the most common type of facial paralysis. Nerve diseases, like trigeminal neuralgia, which usually creates chronic facial pain, spasms and trouble with eye or facial movement, can be caused by tumors or multiple sclerosis.

Treatment options include medicines, surgery and other techniques.

NIH: National Institute of Neurological Disorders and Stroke 


Hearing loss

Hearing loss is a common problem caused by many factors including heredity, noise exposure, and aging. Hearing is a complex sense involving both detection (the ear's ability to recognize sounds presence in the environment) and intelligibility (the brain's ability to interpret or understand those sounds). The types of hearing loss are conductive, sensorineural and mixed. 

Hearing loss affects about 20% of adults in the United States. At age 65, one out of three people has hearing loss. Hearing loss is a major public health issue that is the third most common physical condition after arthritis and heart disease.

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Labyrinthitis/Inner Ear Infection

An inner ear irritation and swelling of the inner ear from a virus or bacteria that leads to vertigo and loss of hearing is called labyrinthitis. It is commonly referred to as an inner ear infection. Your inner ear is located in an area that cannot be seen on physical exam, so a diagnosis is made by history and balance and hearing test results. 

Symptoms of labyrinthitis can include:

It can take a week to a few months to completely recover from labyrinthitis. Initial treatment might include a prescription or over the counter anti-dizzy medication that should be used only during the period where the symptoms are at their worst (typically the first 24 - 72 hours). A natural compensation process where your "good" ear will start working harder to make up for the "bad" ear begins the very first week. This compensation process will be delayed if anti-dizzy medications are taken longer than necessary. 

Patients are encouraged to move about as much as safely possible to encourage the compensation process. Sometimes patients need vestibular therapy with a specialized physical therapist to hasten the compensation process. Typically, the more active you are, the faster you get better. 

Even though the vertigo typically lasts one to three days, a patient can feel off balance for much longer in situations that challenge your balance system (e.g., eyes closed in the shower, walking in a darkened room, pivoting corners, quick head movements or trying to shop in large stores). Do not drive, work with heavy machinery or work at heights if you are experiencing dizziness. 

Meniere's disease

Meniere’s disease of the inner ear can cause severe dizziness, a roaring sound in your ears called tinnitus, hearing loss that comes and goes, and ear pressure or pain. 

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Neurofibromatosis type 2

Neurofibromatosis type 2 (NF2) is a genetic disorder of the nervous system that causes tumors to grow on nerves of the brain and spine. Usually the tumors are benign, but sometimes they can become cancerous. You can get neurofibromatosis from your parents, or it can happen because of a change in your genes. Once you have it, you can pass it along to your children.

NF2 symptoms often start in the teen years and can include:

  • Balance problems
  • Dark skin blotches
  • Facial muscle weakness
  • Headaches
  • Hearing loss
  • Premature cataracts
  • Ringing and noises in the ears
  • Vision problems

Counseling, ongoing evaluations, radiation and surgery may be part of a treatment plan.

NIH: National Institute of Neurological Disorders and Stroke 


Otosclerosis

Gradual hearing loss from abnormal bone growth in the middle ear is called otosclerosis. It is believed to be a genetic condition, but the cause is unknown. The reason for hearing loss is because the new bone growth prevents normal operation of the ear bones that usually vibrate when sound is detected. One or both ears can be affected. Symptoms can include ringing in the ears (tinnitus) and vertigo.

For young adults, this is the most common type of hearing loss in the middle ear. Caucasian females have the highest risk. Pregnancy and a family history of hearing loss increase the risk.

Calcium, fluoride and vitamin D may help to slow the hearing loss. Hearing aids can help manage hearing loss and relieve symptoms. Surgery to remove the affected part of the ear (stapedectomy) and substitute a replacement can cure hearing loss that is conductive.


Ototoxicity

Ototoxicity is poisoning of the cochlear nerve in the inner ear from drugs or chemicals.

The nerve itself and hair cells within the ear are damaged, often creating a loss of hearing and balance. Products as common as aspirin and quinine have been known to cause ototoxicity, which reverses once consumption of these products has ceased.

The severity of symptoms usually depends on the level of toxic exposure and can be temporary or permanent. They include:

  • Blurred vision
  • Constant or fluctuating tinnitus 
  • Headache
  • Hearing loss in one or both ears
  • Loss of balance
  • Nystagmus (eye jerking)
  • Vertigo 
  • Vomiting

Treatments to relieve symptoms include: ototoxicity monitoring and hearing aids. Cochlear implants have been successful in treating total hearing loss. 


Perilymph fistula

Inside the ear is a thin membrane that separates the middle ear from the fluid-filled space of the inner ear. A perilymph fistula (PLF) is a tear in the membrane that causes the fluid to leak into the middle ear.

PLF symptoms include:

  • Dizziness
  • Ear pressure
  • Inconsistent hearing
  • Motion sensitivity
  • Sound sensitivity
  • Sudden hearing loss
  • Vertigo 

PLF symptoms increase with pressure and elevation changes in airplanes and elevators and when mountain climbing, or as a result of lifting heavy objects or even just bending over, coughing and sneezing.

PLF is usually caused by a head injury and sometimes by a perforated eardrum, but even activities like being a passenger on a plane that is ascending or more likely descending; giving birth, scuba diving and weightlifting can cause PLF. 


Superior semicircular canal dehiscence syndrome (SSCD)

SSCD is an opening (dehiscence) in the bone located over the superior semicircular canal of the inner ear. This opening allows the fluid in the canal to be displaced by pressure and sound. SSCD is believed to be a developmental abnormality inherited at birth.

Some of SSCD symptoms can be brought on by coughing, loud noises, sneezing and straining and can include any or all of the following

  • Autophony (increased, sustained volume of your own voice)
  • Sound hypersensitivity
  • Conductive hearing loss
  • Vertigo 
  • Oscillopsia (the perception that still objects are moving)

Many patients are able to manage symptoms by avoiding the things that aggravate their condition, like loud noises. For others, surgical repair of the dehiscence (plugging of the canal with fibrous tissue) can be very beneficial. However, hearing loss can be a risk for those who have had prior SSCD surgery. 


Tinnitus/ringing in the ears or ear noises

Tinnitus can be ringing, roaring, clicking, hissing or buzzing sound in the ear and can cause trouble hearing, working and sleeping. 

Learn more

 


Vestibular neuronitis

Viral infection, or less commonly bacterial infection, can inflame the nerves connecting the inner ear to the brain, resulting in vestibular neuronitis.

Vestibular neuronitis is very similar to labyrinthititis, however, vestibular neuronitis typically does not cause hearing loss. The symptoms can vary in severity:

  • Dizziness to a violent spinning sensation (vertigo) 
  • Imbalance
  • Impaired concentration
  • Nausea
  • Vision problems
  • Vomiting

Medications help control nausea and dizziness. Antibiotics, antiviral drugs or steroids may also be prescribed. Rehabilitation exercises that retrain the brain to adjust to vestibular imbalance may also be necessary in long-term cases.

Chronic benign paroxysmal positional vertigo (BPPV) may also develop from the neuronitis.   


Vestibular schwannoma

A vestibular schwannoma is a benign tumor on the nerve that connects the ear to the brain. The slowly growing tumor gradually presses against the hearing and balance nerves. At first, you may have no symptoms. But the tumor can eventually cause numbness or paralysis of the face. If it grows large enough, it can press against the brain, becoming life-threatening.

Mild emerging symptoms can include:

  • Dizziness and balance problems
  • Loss of hearing on one side
  • Ringing in ears

Vestibular schwannoma can be difficult to diagnose, because the symptoms are similar to those of middle ear problems. Ear exams, hearing tests and scans can show if you have it. If the tumor stays small, you may only need to have it checked regularly. If you do need treatment, surgery and radiation are options.

NIH: National Institute of Deafness and Communication Disorders 


Surgical Treatments

BAHA/Osteointegrated devices

Bone conduction implants are bone anchored devices which use bone conduction to provide a better hearing solution for people with ear canal problems, people who cannot wear a hearing aid, or those who have single-sided hearing loss. The system attaches to a titanium implant, which is surgically placed in the bone behind the ear. The bone provides a sound pathway to the inner ear and does not require that sound go through the ear canal. Even if the ear canal is completely absent or the middle ear is not functioning, the bone conduction implant can help. Your physician and/or audiologist will recommend the best-suited device for your hearing loss.


Cochlear implants

A cochlear implant is a two part system that is different from a hearing aid because it bypasses the damaged cochlea and sends electrical sound signals directly to the auditory (hearing) nerve. The external part called the processor, looks much like a large behind-the-ear hearing aid, captures sound from the environment, processes the sound into digital information, and then sends this data to the electrode array that is surgically placed inside the cochlea.

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Cranial base surgery

With three fellowship-trained otologists/neurotologists, seven full-time audiologists, our own dedicated advanced auditory testing staff and advanced facilities, we provide exceptional care for conditions that require cranial base surgery.

Our “super specialist” neurotologists have extensive subspecialty experience in the care of patients with complex cranial base disorders. We are the only center in central Ohio that currently performs auditory brainstem implants. Our surgeons perform hundreds of procedures every year, from removing acoustic neuromas to implanting sophisticated hearing devices like cochlear implants and the BAHA system. 


Endolymphatic shunt

An endolymphatic shunt is used in a procedure for Meniere’s disease and certain hydrops conditions to relieve pressure in the ear. The shunt, which is usually a tube, is inserted into the endolymphatic sac in order to drain out excess fluid.  


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Mastoidectomy (removal of mastoid infections)

When cells in the hollow, air-filled spaces in the skull behind the ear get infected, mastoidectomy surgery is required to remove the infected cells. Ear infections that spread are usually the cause of infected mastoid air cells.

Mastoidectomy may also be used in the following:

  • Cholesteatoma
  • Chronic ear infection (otitis media)
  • Infections of the mastoid bone that don’t respond to antibiotics
  • Cochlear implant procedure

Some possible risks of mastoidectomy are:

  • Alteration of taste
  • Dizziness
  • Facial muscle weakness
  • Hearing loss 
  • Infection that recurs
  • Noises in the ear (tinnitus)

Middle ear exploration (tympanotomy)

Tympanotomy is exploratory surgery of the middle ear to help diagnose ear disorders. The procedure is basically the same as middle ear surgery, such as stapedectomy. The operation is performed using otomicroscopy along the auditory canal. Incisions to the canal allow access to the middle ear and the internal structures.

Middle fossa IAC decompression

Surgical removal of certain types of neuroma (a tumor or mass growing from a nerve) can cause complete deafness. It appears that middle fossa internal auditory canal (IAC) decompression can improve and even extend useful hearing. This also allows for a period of rehabilitation, which can be extremely beneficial. Tomography scans or magnetic resonance imaging is essential to follow-up treatment.


Middle fossa suspension semicircular canal dehiscence repair

Patients with severe suspension semicircular canal dehiscence (SSCD, an opening in the bone located over the superior semicircular canal of the inner ear) can benefit greatly from surgical repair. This involves plugging the canal with fascia (fibrous tissue) and securing the tissue with small bone chips. This procedure has proven effective in managing symptoms long-term. Hearing loss is the main risk of this procedure, however, patients who have not had prior SSCD surgery or stapedectomy surgical removal of a middle ear bone called the stapes) have a low risk.


Repair of cerebral spinal fluid (CSF) leak

If the membrane that surrounds the brain and spinal cord tears or punctures, cerebrospinal fluid (CSF) contained by the membrane can leak and cause infection and further complications, including brain swelling and meningitis. When surgery is required to stop cerebral spinal fluid leak, a skin graft of the patient’s own tissue is usually used to patch the site of the leak. The surgery is performed under a general anesthetic and a two-night hospital stay is usually required.


Stapedectomy

Gradual hearing loss from abnormal bone growth in the middle ear is called otosclerosis. It is believed to be a genetic condition but the cause is unknown. Surgery to remove specific bones in the middle ear (stapes) and replace them with a prosthesis can cure conductive hearing loss. A total replacement is called a stapedectomy. Sometimes only part of the stapes is removed and is called a stapedotomy. Pain and dizziness from the surgery usually go away within a few weeks.


Tube insertion

Fluid that builds up behind a child’s or an adult’s eardrum may cause some hearing loss. If the condition affects both ears and lasts more than three months, or if the condition affects only one ear and lasts more than six months, ear tube insertion may be performed. Recurring or chronic ear infections that don’t respond to other treatments are also reasons for ear tube insertion.

The procedure involves making a small surgical cut in the eardrum under a general anesthetic. The fluid is then removed. Then, a small tube is placed through the eardrum to allow airflow and equalize pressure on the eardrum.


Tympanoplasty

A bad ear infection, foreign object, prior surgery or trauma can cause damage to the eardrum requiring surgical repair. Tympanoplasty is a surgical technique that patches the eardrum with the patient’s own tissue taken from a muscle or vein. This procedure can take two to three hours and is usually done when the hole in the eardrum is large, if there’s excess tissue around the eardrum or if there’s chronic infection that does not respond to antibiotics.


Nonsurgical Treatments

Gentamicin injections

Gentamicin injections (“gent injections”) are used to chemically destroy the inner ear. Gentamicin is a strong antibiotic given through an IV that is used for patients who have life threatening infections. This antibiotic has a side effect known as ototoxicity (poisonous to the ear) but this side effect has been found to be helpful in Meniere’s patients when it is injected directly through the numbed eardrum and allowed to travel into the inner ear structures of the Meniere’s ear.

Some patients require numerous gent injections over a period of many weeks or months and frequently a severe attack occurs as a result of the inner ear “dying off," which is the intended goal of the treatment. The gent injections are intended only to control vertigo. They will not improve hearing, tinnitus or ear fullness. Gent injections are not recommended for all Meniere’s patients. If gent injections are recommended for your treatment, you should discuss the pros and cons with your physician.

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