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Hard of hearing

There are two reasons for recent increase in the number of people hard of hearing. First, modern life style is surrounded by noise. Second, the number of patients with presbycusia has been increased by extension of lifespan and improvement of life standard and development of medicine.

Structure of ear and physiology
Ear is composed of three parts: external ear, middle ear, internal ear. External ear consists of auricle and external auditory meatus, and there is eardrum between external ear and middle ear. Waves of sound are gathered in auricle and vibrate eardrum through the external auditory meatus.

Middle ear consists of eardrum, atrium, auditory ossicles, and auditory tube. Atrium is the room with air, and auditory tube exists for eardrum to vibrate well by making pressures of atrium and outside equal. 

In the inner ear, three tiny bones called ossicles are connected each other and expand the movement of vibrated eardrum and pass it to the inner ear.

Unlike in the air in the middle ear, fluid passes vibration in the inner ear. The tube in the inner ear that functions to hear looks like snail tube is called snail, in which hair cells are arranged and pass the vibration of waves in the snail to auditory nerves. 

In other words, the wavelength of sound is delivered in this order: auricle -> auditory meatus -> snail (hair cell) ->auditory nerves -> brain. When the delivery process of the sound has problem, hard of hearing occurs.
Category of hard of hearing
1. Category according to impaired area

1) Conductive hard of hearing 

When the problem occurs in the process of the delivery of sound from external auditory to ear ossicles, it is called conductive hard of hearing. In this case, many cases are able to be improved and fixed through surgery or drug therapy.

2) Sensorineural deafness 

If there is a problem in snail and sensorineural hearing, it is called sensorineural deafness. This case is rarely recoverd because it is inoperable and nerve tissue is rarely regenerated.

2. Category according to time 

1) Congenital deafness 

Congenital deafness means the case when you cannot hear from the birth due to hereditary stamp, German measles in the early pregnancy, virus infection, maternal drug use, damage during delivery. In most cases, condutive hearing loss may occur by auditory ossicles deformity.

2) Acquired hearing loss

Acquired hearing loss in childhood from 4 to 15 years is caused by eustache, adenoid hyperplasia, nasopharyngitis, and otitis media.

In adulthood, repeated cold, acute infectious diseases, noise trauma, drug addiction, Meniere disease, labyrinthitis, and acoustic tumor. Presbyacusia is most common.


Chronic otitis media
The eardrum trembles when the sound is passed through ear canal. The vibration of eardrum is delivered to internal ear through auditory ossicles. Infection in this part is otitis media. When the sound passes through ear canal, the eardrum trembles.
The symption of otitis media
When the burst in eardrum does not get healed by inflammation, not only perforated eardrum but also ingured tissues are formed around ear ossicles, syrigmus and otorrhea occur.
The reason why impared hearing comes with otitis media
1. General treatment for middle ear disorder

In case of having perforated eardrum, you should not let water go into the ear canal. When you take shower or wash hair, cover up ear canal with cotton moistened with Vaseline.
You must absolutely avoid swimming. In case that you have otorrhea, Wipe the ear canal with a cotton swab to maintain the cleanliness and drug treatment should be combined. You can stop otorrhea by placing gauze or cotton on the outside of ear canal, but should not block the ear canal.

2. Drug treatment of middle ear disorder

If there is a problem in snail and sensorineural hearing, it is called sensorineural deafness. This case is rarely recoverd because it is inoperable and nerve tissue is rarely regenerated.

3. Surgical treatment

The purpose of chronic otitis media sugery is to remove the inflammation. The eardrum can be transplanted with skin, muscle fascia, cartilage, and the lost auditory ossicles scan be replaced with cartilage or artificial materials. The type of surgery can vary depending on how much the inflammation is expanded.
Otitis Media Surgery
1. General treatment for middle ear disorder
In case the inflammation is limited to ear drum and middle ear, he surgery can be done in 1 hour by administering local anesthesia. But in case the inflammation is severe, the surgey takes 2 hours due to general anesthesia. Depending on the state of ear, the surgery can be done through ear canal without making external wound, and sometimes the operation is done from behind of the ear.

In case that the operation is possible by local anesthesia , you can be discharged from the hospital on the same day, but 1 or 2 days are needed in the case you need general anesthesia. You can go back to normal life in a week. 4-6 weeks after surgery, the eardrum is regenerated completely, but longer treatment period may be needed depending on the type of surgery. In case of sectomy, the amount of secretions decreases.

In case of not severe inflammation, hearing ability recovery can be expected by one time surgery. But when the inflammation is severe, you may have surgery to remove inflammation first and have the surgery for hearing improvement. The second surgey for hearing improvement generally is done at least 6 months after the first surgery.

Also, 10% of otitis media patients need reoperation.
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