Hearing and Balance Disorders

Hearing Loss

Hearing loss is a common condition that affects patients of all ages, from infancy to adulthood. Hearing loss can result from bacterial and viral infections, environmental and work-related noise exposure, genetics, medication toxicity or trauma. Hearing loss is divided into two categories: conductive and sensorineural.

Conductive Hearing Loss

The eardrum (tympanic membrane) and the ossicles (ear bones) work together to conduct and amplify sound to the inner ear. When these components fail to function properly, hearing loss occurs. Ear infections are a frequent cause of conductive hearing loss. While acute ear infections can cause temporary hearing loss, chronic ear disease may result in permanent damage. Cholesteatoma is a common cause of conductive hearing loss. Rare but serious complications of untreated chronic ear disease include deafness, vertigo, facial nerve paralysis, meningitis and spinal fluid leakage.

Sensorineural Hearing Loss

Sensorineural hearing loss arises from damage to either the cochlea (in the inner ear) or the auditory nerve. There are a wide variety of causes, including genetic or familial hearing loss, noise-induced hearing loss, Meniere’s disease, ototoxicity from certain medications and infections (such as meningitis), head trauma and certain brain tumors.


Tinnitus, a ringing, chirping or buzzing sensation in the ears, is a common symptom of ear damage. Once biological causes have been ruled out, strategies to alleviate the discomfort and nuisance associated with these sounds can include masking devices, hearing aides and tinnitus biofeedback. These treatments are available through the UC Division of Audiology.

Diagnostic Testing and Treatment for Hearing and Balance Disorder

ABR – Auditory Brainstem Response

The Auditory Brainstem Response (ABR) is an objective test used to identify neurological abnormalities of the auditory nerve and auditory pathway to the brainstem or to estimate hearing sensitivity.

Electrodes are placed on the patient’s forehead and behind the ears. Earphones are placed in the ears, and a click stimulus is sounded. The patient does not respond, but remains seated in a recliner as relaxed as possible. The electrodes measure the electrical activity from the auditory pathway to the brain. As the responses are recorded, they are analyzed by a computer and translated into a waveform pattern. The different peaks on the waveform provide information about the time it takes various structures of the auditory pathway to respond to the stimulus. This information can help in identifying potential causes of hearing loss or sensitivity.

ECoG – Electrocochleography

The electrocochleography (ECoG) test is an objective measure of the electrical potentials generated in the inner ear as a result of sound stimulation. Electrodes are placed on the patient’s forehead and in the ear canal. An earphone is placed in the ear canal along with the electrode, and a click stimulus is sounded. The patient does not respond to the sound, but remains seated in a recliner and as relaxed as possible.

As the responses are recorded, they are analyzed by a computer and translated into a waveform pattern. The amplitude ratio of the different peaks provides information that will help determine whether the cochlea (inner ear) has an excessive amount of fluid pressure. Excessive fluid pressure can cause a feeling of aural fullness (ear pressure), dizziness, tinnitus (noises in the ear), and/or hearing loss. These symptoms may be the result of certain inner ear pathologies such as Meniere’s disease or endolymphatic hydrops.

Hearing Loss Rehabilitation

Treatment options for hearing loss include medical treatment of acute infections; stabilization of certain disease processes such as Meniere’s disease; reconstructive surgery to rebuild the tympanic membrane or the ossicular chain; and hearing amplification or direct neural stimulation. Bone Anchored Hearing Aid (BAHA) implantable hearing devices are an option for patients with single-sided deafness and those who are unable to wear hearing aids because of prior surgery. Cochlear implantation is now a routine treatment option for patients with profound hearing loss, including congenital deafness, in both ears. The safety and success of cochlear implants has led to broader criteria for use, from infants as young as six to twelve months old to elderly patients in their 80s and 90s.

Hearing aids can’t help everyone with hearing loss, but they can improve hearing for many people. The components of a hearing aid include:

  • A microphone to gather in the sounds around you
  • An amplifier to make sounds louder
  • An earpiece to transmit sounds to your ear
  • A battery to power the device

The louder sounds help stimulate nerve cells in the cochlea so that you can hear better. Getting used to a hearing aid takes time. The sound you hear is different because it’s amplified. You may need to try more than one device to find one that works well for you. Most states have laws requiring a trial period before you buy a hearing aid, making it easier for you to decide if the hearing aid helps.

Hearing aids come in a variety of sizes, shapes and styles. Some hearing aids rest behind your ear with a small tube delivering the amplified sound to the ear canal. Other styles fit in your outer ear or within your ear canal

Balance Disorders

Vestibular Rehabilitation

Vestibular rehabilitation can offer relief of symptoms for persons suffering from an inner ear disorder. Vestibular rehabilitation is an exercise program designed by specially trained therapists to help people compensate for a loss or imbalance within the vestibular system.

The program may include balance activities and/or eye or head movement exercises. The balance activities help people maximize the use of the remaining vestibular function, their sight, and the sensation in their feet to keep their balance. When there is an imbalance in the vestibular system, a person may also experience dizziness because the reflexes that help with eye movement have been changed. The eye exercises help the brain relearn these reflexes. Because each patient’s symptoms and needs are different, it is very important to design a program to meet individual needs.

Fall prevention is a very important part of vestibular rehabilitation. Even if testing shows that someone suffering from imbalance does not have a vestibular disorder, he or she may be referred to vestibular rehabilitation for fall prevention. Conditions other than vestibular disorders which may cause imbalance are poor eyesight, poor sensation in the feet or weak leg muscles. A balance aid such as a walking stick may be all that is needed to help people maintain their balance and prevent injuries from falling. Patients may also be referred to an occupational therapist to discuss home safety and assistive devices. The goal is to prevent patients from falling and keep them independent and safe.

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