Allergy is diagnosed by history and physical examination and confirmed by allergy testing. We do this allergy testing by skin testing on the arms or by tests done on blood drawn from your arm. Inhalant allergies can cause multiple symptoms but will mainly affect the respiratory system. Persistent and recurrent “colds”. “hay fever”, and “sinus” are examples of allergic symptoms. Any substance that can be inhaled or absorbed into the body may provoke allergic reactions. The most common inhalant allergens that trigger symptoms are pollens, molds and environmental agents such as animal dander and dust mites.
Allergy treatment is based on avoidance of offending allergens through environmental control, medications to control symptoms, and immunotherapy (allergy shots). If immunotherapy is recommended, a solution is mixed specifically for you based on your allergy testing results and will be administered in your arm. The need for allergy medication may decrease or disappear as immunotherapy is advanced. Allergy injections are usually given three to five years, but some patients require immunotherapy indefinitely
Bone-anchored hearing aids use a surgically implanted abutment to transmit sound by direct conduction through bone to the inner ear, bypassing the external auditory canal and middle ear. A titanium prosthesis is surgically embedded into the skull with a small abutment exposed outside the skin. A sound processor sits on this abutment and transmits sound vibrations to the titanium implant. The implant vibrates the skull and inner ear, which stimulate the nerve fibers of the inner ear, allowing hearing. The surgery is often performed under local anesthesia and as an outpatient procedure.
A cochlear implant is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing in both ears. Cochlear implants bypass the normal hearing process; they have a sound processor that resides on the outside of the skin (and generally worn behind the ear) which contains microphones, electronics, battery, and a coil which transmits a signal to the implant. The implant has a coil to receive signals, electronics, and an array of electrodes which is placed into the cochlea, which stimulate the cochlear nerve. The procedure is done under general anesthesia.
A relatively new approach to inner ear disease which allows the exposure of either cortisone or an antibiotic to the inner ear by placing the substance in the middle ear space and allowing it to diffuse to the inner ear through the natural membrane called the round window. This is done in refractory cases of Meniere’s disease and in some cases of sudden or progressive hearing loss or in refractory vertigo, which is a spinning type of dizziness.
An operation that requires drilling out the bone just behind and above the ear canal for exposure and removal of disease in the mastoid cavity. In some cases, the ear canal wall is removed resulting in a larger than normal ear canal for the sake of prevention of further mastoid disease. In most cases, however, the canal wall can be preserved and the surgery done through incision behind the ear.
Myringotomy tubes are placed in the ears of children who either have recurring ear infections, or persistent fluid build-up behind the eardrums. The procedure is done in the operating room with the child asleep. The child can resume normal activities the next day. The amount of time the tube stays in varies depending on the type of tube used, and the patient.
Most typically, this is done in conjunction with tympanoplasty for the treatment of chronic ear disease. One or more bones of hearing may have become eroded or stiffened. The faulty portion of the hearing mechanism is replaced with a prosthesis with or without additional tissue from the patient’s own body.
Removal of Tumors of the Temporal Bone
Rarely benign and malignant tumors can develop in the bone housing the ear and require removal and repair of the defect the tumor has caused. In some cases, a neoplasm is found just beyond the temporal bone between the brain and the bone, such as an acoustic neuroma, which requires removal by the joint effort of the neurosurgeon and the otologist.
Repair of Inner Ear Fistula
In some cases of head injury, significant strain or more rarely, with relatively simple stresses to the ear, if there is some type of congenital weakness of the ear, a leak of fluid can develop coming from the inner ear into the middle ear. These lesions can be repaired by exploring the middle ear and sealing the leaks.
In this procedure, the third bone of hearing called the stapes which has become stiffened by either hereditary, congenital or inflammatory processes is removed and replaced by a prosthesis to restore the hearing mechanism.
Tonsillectomy is done for problems such as chronic infection, tonsil enlargement causing symptoms, and obstructive sleep apnea. The tonsils are removed under general anesthesia, and this is usually done as outpatient surgery. The patient can generally return to school or work after one week. In children, the adenoids are frequently removed as well.