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Otology and Balance Disorders

The ear performs two entirely separate jobs — hearing and balance — and problems with either can be disabling in ways that are difficult for others to see. Hearing loss isolates people socially long before they describe it as a problem. Dizziness is frightening and often dismissed for years before the cause is identified.

Both are worth assessing properly. Many causes are readily treatable, and even those that are not can usually be managed to a point where they no longer dominate daily life.

CONDITIONS COMMONLY SEEN

Hearing and the ear

  • Hearing loss — gradual or sudden, in one or both ears
  • Sudden sensorineural hearing loss — a medical emergency (see below)
  • Tinnitus — ringing, buzzing or hissing in the ears
  • Ear infections, acute and chronic
  • Perforated eardrum
  • Chronic ear discharge and cholesteatoma
  • Otosclerosis
  • Ear wax obstruction
  • Eustachian tube dysfunction — pressure, popping and blockage, often worse with flying or diving

Balance

  • Benign Paroxysmal Positional Vertigo (BPPV) — brief, intense spinning triggered by head movement or turning in bed
  • Ménière’s disease — episodic vertigo with fluctuating hearing loss and tinnitus
  • Vestibular neuritis and labyrinthitis
  • Vestibular migraine
  • Unsteadiness and imbalance, particularly in older adults where falls risk becomes the central concern

ASSESSMENT

Assessment includes microscopic examination of the ear canal and eardrum, and formal hearing testing — pure tone audiometry to measure hearing thresholds and tympanometry to assess middle ear function and detect fluid.

Where dizziness is the presenting problem, specific balance examination is performed, including positional testing (the Dix-Hallpike manoeuvre) which can diagnose BPPV in clinic within minutes. Imaging is arranged where indicated.

TREATMENT

  • Medical treatment of ear infections and inflammatory conditions
  • Microsuction — precise, controlled removal of wax and debris under the microscope, which is considerably safer than syringing
  • Intratympanic injections — in cases of Sudden Sensorineural Hearing Loss and refractory Meniere’s disease
  • Repositioning manoeuvres for BPPV, which frequently resolve the vertigo in a single clinic visit
  • Vestibular rehabilitation for persistent imbalance
  • Endoscopic Eustachian Tube Balloon Dilatation – in persistent symptoms such as ear fullness / pressure and difficulty equalizing pressure during altitude changes
  • Grommet insertion for glue ear and Eustachian tube dysfunction
  • Eardrum repair (myringoplasty)
  • Hearing aid referral for hearing loss
  • Tinnitus management, including counselling and sound therapy

AN IMPORTANT WARNING

Sudden hearing loss in one ear, occurring over hours or a few days, is a medical emergency. Treatment is most effective when started within 72 hours and its effectiveness declines sharply after that. If this happens to you, seek assessment immediately rather than waiting for a routine appointment.

Request an appointment: +357 24 840840