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Otology
The Otology Service at the Massachusetts Eye and Ear Infirmary is dedicated to the evaluation and treatment of a wide variety of
disorders of the ear and related structures. In conjunction with the Audiology Department, the Jenks Vestibular Diagnostic
Laboratory, Department of Radiology, the Cochlear Implant Program, Hearing Aid Center and dedicated operating rooms of the Infirmary,
the Otology Service can provide a full range of services for disorders of the ear.
Anatomy of the Ear
To understand the variety of disorders that may affect the ear and its
related structures, it is important to understand the basic anatomy
of the ear
- External Ear
- The external ear
consists of the auricle and external ear canal. Its function is to
collect sound and transmit it to the eardrum (tympanic membrane)
which separates the external ear from the middle ear.
- Middle Ear
- The middle ear is an air space behind the eardrum which is physically
continuous with the mastoid air space behind the ear and with the
nose via the eustachian tube. Contained in the middle ear are the
ossicles, or middle ear bones. The malleus, incus and stapes bones
conduct sound from the eardrum to the inner ear. In addition,
because of their structure they also provide a modest amplifier
effect.
- Inner Ear and Internal Auditory Canal
- The inner ear consists of an auditory (or hearing) portion and a
vestibular (balance) portion. The auditory inner ear consists of
the cochlea which transforms the mechanical energy of sound into
electrical energy which is transmitted through the auditory nerve
to the brain. The balance portion of the inner ear includes
specialized receptors that are sensitive to rotation (the
semicircular canals) and receptors sensitive to gravitational force
(utricle and saccule). These receptors also act as transformers of
mechanical energy into an electrical signal which is transmitted
via the vestibular nerve through the internal auditory canal to the
brain.
- Other structures Located Near the External, Middle and Inner Ear
- The anatomy of the ear is closely related to a number of structures,
including the temporomandibular joint (jaw joint), parotid salivary
gland, the facial nerve which provide motion to the muscles of the
face, carotid artery, jugular vein and associated cranial nerves
which pass from the inside of the skull to the neck.
Disorders of the Ear
There are a variety of disorders for which evaluation, treatment, and
rehabilitation are offered by the Otology Service. Examples include
the following:
- Hearing Loss
- At birth the prevalence of significant hearing loss is approximately 1
in 3,000 whereas by the age of 70 years the prevalence has
increased to approximately 1 in 3 individuals. There are a variety
of causes of hearing loss. Major subgroups include conductive
hearing losses due to disorders of the external and middle ear
and sensorineural hearing losses due to disorders of the
inner ear, auditory nerve and associated brain
structures.
- Patients with hearing loss may complain of fullness,
pressure in their ears and at times a ringing noise (tinnitus).
- Conductive Hearing Loss
- Any interference with the transmission of sound through the external
ear canal, eardrum, middle ear or ossicles may produce a conductive
hearing loss. This includes a wide variety of disorders including
occlusion of the ear canal from wax, inflammatory closure of the
external ear canal, new bone growth in the ear canal, perforations
or scarring of the eardrum, fluid or other disorders of the middle
ear, or fixation of the ossicles due to trauma, previous infection
or otosclerosis.
- Sensorineural Hearing Loss
- There are a wide variety of disorders that may cause a sensorineural
hearing loss. Among the most common are genetic disorders resulting
either in congenital (present at birth) hearing loss or late onset
progressive loss, hearing loss due to ototoxic drugs, hearing loss
due to infections or immune disorders, tumors of the inner ear or
auditory nerve or other neurologic diseases. Sensorineural hearing
loss may be present at birth, may occur later in life either
suddenly, (such as sudden sensorineural hearing loss), or may
progress slowly or rapidly.
- Treatment of Hearing Loss
- Today there are a wide variety of treatment and rehabilitative modalities
available for hearing loss. For example, most of the causes of
conductive hearing loss can be eliminated to restore normal or near
normal hearing by a variety of means including medications or
surgery.
- In contrast to the medical situation 20 years ago there is an
increasing list of causes of sensorineural hearing loss that may be
controlled or even reversed. This includes such disorders as sudden
idiopathic deafness, or immune mediated sensorineural hearing loss.
For patients with irreversible sensorineural loss at handicapping
levels, rehabilitative services including a wide variety of hearing
aids and other listening devices. For individuals who are
profoundly deaf and for whom a hearing aid is of no use, some may
benefit from a cochlear implantation which is a device placed in
the inner ear to bypass its damaged segments.
- Balance Disorders (Click hereto access the Jenks
Vestibular Diagnostic Laboratory)
- Our sense of balance results from the integration of information from
the inner ear, eye, and sense organs in our limbs, muscles, and
skin. There is a long list of disorders which are known to affect
the inner ear and which may produce chronic or episodic disorders
of balance. Examples of such disorders include Meniere's disease,
benign positional vertigo, degenerative disorders of the balance
system, and toxic or traumatic causes of vestibular disturbance.
After proper diagnosis, balance disorders may be treated by a wide
variety of medical, surgical and rehabilitative techniques.
- Facial nerve disorders
- The facial nerve reaches the muscles of the face through the internal
auditory canal, mastoid and middle ear. Disorders of the facial
nerve may cause weakness and paralysis of the face, an inability to
close the eye, or abnormal twitching or distortion of the face.
Because of its long course through the ear, many disorders of the
ear may affect the facial nerve. This includes such disorders as
infections of the middle ear, injury, tumors of the inner ear,
middle ear or mastoid. After proper diagnosis, there are a variety
of medical and surgical treatments that may reverse or at least
improve the deformity and dysfunction caused by facial nerve
disorders.
- Infections of the Ear
- Infections of the ear are a relatively common problem.
They may occur anywhere in the ear including the external canal
(swimmer's ear), the middle ear and mastoid, or in the bone
surrounding these structures. Infections of the middle ear and
mastoid are particularly common in childhood following upper
respiratory infections. Swimmer's ear as the name implies is
particularly common in the summer months. Chronic infections of the
middle ear and mastoid may result in significant damage to the
hearing and balance mechanisms and facial nerve and at times can
spread beyond the ear to surrounding structures including the
brain.
- Tumors of the Ear (Click here to access Cranial Base
Center information)
- There are a number of tumors that can affect the external, middle, and
inner ear. Examples include both benign and malignant lesions of
the skin of the auricle and external auditory canal, middle ear and
mastoid, acoustic neuromas that commonly produce a progressive
hearing loss and balance problems in one or both ears, and
glomus tumors which arise in blood vessel structures in the
middle ear or adjacent skull base. After proper diagnosis, there
are a variety of medical and surgical treatments to control such
tumors.
- Congenital Disorders
- Malformation of the external ear, ear canal, middle ear
and its contained ossicles or inner ear may occur during prenatal
development. Some congenital disorders, particularly those of the
auricle and external and middle ear may be surgically
reconstructed. For other disorders, specialized hearing aids or
cochlear implants may be helpful in rehabilitation.
Diagnostic Process
As might be imagined given the wide variety of disorders that may affect the
ear and related structures, the evaluation must be individualized.
In addition to a thorough ear and head and neck examination, the
physician may request a number of adjunctive diagnostic procedures
such as audiogram (hearing test) auditory evoked response testing,
imaging of the ear including CT or MR scan, balance testing,
testing of the facial nerve all of which are available at the
Infirmary.
Medical Staff
Otology and Neurotology
Joseph B. Nadol, Jr., M.D., Director Appointments: 617-573-3632
Robert Levine, M.D. Appointments: 617-573-3708
Richard F. Lewis, M.D. Appointments: 617-573-3501
Michael J. McKenna, M.D. Appointments: 617-573-3672
Saumil N. Merchant, M.D. Appointments: 617-573-3503
Steven D. Rauch, M.D. Appointments: 617-573-3644
Jennifer Smullen, M.D. Appointments: 617-573-4102
Patient Education
Special Clinics
content updated: 8/02/07
