Your ears and hearing or that of your child are special. The best opportunity to correct a hearing, balance, or chronic ear problem is to be sure it is treated properly the first time. There are many excellent general otolaryngologist, ear, nose and throat specialist, who often spend more time in their practice on other aspects of the specialty, than with your ear problem. They often have very busy practices and may not have the time to spend on your particular hearing, balance, or ear problem. In addition they may not be as knowledgeable or as comfortable with the anatomy of the ear, or problems that may be encountered during or after surgery. Working under a microscope in an area less that 3/8 of an inch in diameter, around the facial nerve, and the tiny bones of hearing, requires special skills. If you or your child requires ear surgery, some surgeons may perform multiple or staged operations to manage the problem. If the surgery is complicated or unsuccessful, revision surgery to correct the problem is often more complex.
Dr. Jay Farrior has limited his practice to surgery and diseases that affect the ear, hearing and balance. He has done extensive training in the anatomy and surgery of the ear. While some surgeons routinely plan multiple operations to correct a perforated eardrum or hearing loss, Dr. Farrior feels that it is in the patient’s best interest to perform a single operation to remove all disease and restore hearing. This allows you or your child to return to normal activities, work or school, as quickly as possible. He has studied the multitude of disorders that affect the ear, hearing and balance, and feels that treatment should be specific, and effectively restore function quickly, whenever possible.
Dr. Farrior has studied the multitude of disorders that affect the ear, hearing and balance, and feels that treatment should be specific, and effectively restore function quickly, whenever possible.
ENG ( electronystagmogram) is a test of inner ear balance function. It helps to determine if both balance organs are working properly. It can often detect abnormal response to movement.
Audiogram, hearing test, is useful since problems that affect balance also affect hearing. Special hearing tests are often used to better localize the problem these include. OAE (otoacoustic emissions) is a test of inner ear hair cell function. ECOG (electrococheography) can often detect fluid pressure changes in the ear. BERA (brainstem evoked response audiometry) evaluates nerve conduction from the ear to the brainstem, the switchboard of the brain.
MRI (magnetic resonance imaging) is a scan to evaluate for tumors along the nerve of hearing and balance, strokes and other problems of the brain.
Meniere’s is a special form of vertigo, with violent attacks of whirling that are often associated with nausea and vomiting. In addition there is fullness in the ear, fluctuation in hearing, and roaring tinnitus. These symptoms are thought to be caused by fluid retention in the inner ear. One of the primary causes of Meniere’s is salt, especially hidden salt, in foods. The salt is commonly eaten 20 – 36 hours before an attack. Allergy or immune reaction against the inner ear may also cause Meniere’s, more common with bilateral disease. A variation of Meniere’s is associated with migraine headaches. Meniere’s can cause loss of hearing and balance, in the involved ear. Treatment is directed towards eliminating the vertigo attacks and preserving hearing.
Medical treatment – Low salt diet, less than 2000 mg. sodium, caution on hidden salt. A diet history for 2 days before an attack is helpful; Diuretics are to reduce salt; and water medications to reduce vestibular response.
When medical treatment is not enough to eliminate the vertigo attacks, there are other procedures that can be used. Surgery to eliminate the vertigo attacks may not alter the natural course of the disease process.
BPPV is felt to be caused by displaced granules from the balance organ resting in one of the semicircular canals, usually the posterior canal. With movement of the head, such as turning, these shifts stimulate the balance receptor and cause vertigo. The attacks usually last for only a few moments. BPPV can occur spontaneously, or it may be caused by previous injury to the inner ear from Meniere's, labyrinthitis, trauma, or aging. Occasionally positional vertigo may be caused by central problems.
BPPV will usually respond to labyrinthine suppressants. Exercises to help move the granules out of the semicircular canal and to train the brain to ignore the abnormal signals are generally more effective in eliminating the vertigo. While laying flat, turn to the affected side until the vertigo begins, then turn to the opposite side until it stops and then back to the affected side. Repeat the exercise 5 -10 times until the vertigo subsides.
Sudden inflammation of the vestibular system or nerve may result in severe vertigo that usually lasts for 24-48 hours. It is felt that this may be due to a recent viral infection or in some cases a loss of blood flow to the inner ear. Labyrinthine sedation and supportive treatment is often required. After the initial attack has cleared there may still be residual weakness of the balance system or positional vertigo. Occasionally a lesion along the hearing and balance nerve or a central problem may present as labyrinthitis. Labyrinthitis can also be caused by an infected cyst or tumor in the middle ear or mastoid that extends to the inner ear.
Acoustic neuromas, schwannoma, are tumors that develop along the nerve of hearing and balance. As the tumor enlarges, it destroys the nerve and eventually enlarges to compress the brain. As the tumor grows it can cause mild episodes of vertigo as well as chronic imbalance. Removal of the tumor depends on a number of factors, including its size, growth, and the condition of the patient.
Motion sickness, car or sea sickness is caused by a mismatch of input between the eyes and stimulation of the balance organ. Progressive bifocal glasses causes a similar problem when the head is turned frequently. Removing one of the stimuli will often correct the problem. Labyrinthine suppressants are most commonly used for temporary relief.
The central nervous system can be affected by a number of factors which can cause balance problems. Balance and coordination can be affected by strokes, decreased blood flow to the brain and medications. It is also affected by other medical problems which may cause a reduced awareness of the position of the body or joints, such as diabetes, or joint replacement.
The most common vascular problem that causes dizziness is a drop in blood pressure when someone gets up quickly. High Blood pressure, irregular heart beat, narrowed blood vessels, as well as many medications can cause dizziness.
Stress or fear of having an attack of vertigo can cause one to hyperventilate. While this may not be a full panic attack, by just breathing a few extra times per minute, it can have the same affect. Often this causes dizziness, lightheaded, fainting, nausea, headaches, and shortness of breath, numbness and other symptoms. Being aware of hyperventilation and some medications may control the anxiety and hyperventilation.
Patulous eustachian tubes may cause fullness in the ear, echo with speaking, and a rocking imbalance. The symptoms usually get worse the longer one is up or standing, and are better in the morning. Patulous eustachian tubes are often associated with weight loss, dehydration, chronic illness, but it can be caused by a simple cold. There is a loss of soft tissue around the eustachian tube, as a result it is open more than normal allowing air to pass to the middle ear.
Treatment - in many patients these symptoms will clear spontaneously, once the weight is stable. Ventilating (PE) tubes may allow the air to escape and give some relief.
Visual, progressive bifocal glasses make it difficult for the eyes to fixate and may give false signals to the brain and inner ear.