The Need for Comprehensive Otolaryngologists

Fact: Roughly 30 million Americans suffer from some sort of hearing loss. And an even larger population suffers from other types of hearing disorders such as tinnitus.

Fact: Roughly 25% of all Americans over the age of 65 suffer some significant hearing loss.

Fact: In spite of popular belief, hearing loss is not a natural part of the aging process. Hearing loss related to age represents an accumulation of ototoxic exposures or experiences, compounded by genetic predisposition.

Common Complaints Related to the Auditory System

Patients seen by otolaryngologists commonly complain of one or more of a distinct set of symptoms. These include tinnitus, hearing loss, otalgia, otorrhea and vertigo, described briefly below:


  • tinnitus refers to a sound that appears to be coming from one or both ears. It is not related to an external stimulus, but rather generated internally. Approximately 1 in 5 Americans has tinnitus, though not all would say they “suffer” from tinnitus. Approximately 83% of people with tinnitus hear ringing constantly, without intermission. Approximately 75% of people with tinnitus habituate to it and are not bothered by it.
  • The number one cause of tinnitus is loud noise. Other causes include stress/anxiety, high or low blood pressure, medications including antibiotics, antidepressants and aspirin, tumors, diabetes, thyroid problems, sinus and respiratory infections, ear wax buildup, head trauma, and likely numerous additional unknown causes.
  • Tinnitus can be categorized as “pulsatile” (vessel related) or “non-pulsatile” and “objective” (due to blood vessel or muscle spasms) or “subjective” which offers clues to its pathogenesis.
  • Most tinnitus appears to be a consequence of hearing loss and the pitch of the tinnitus is related to the frequency of the hearing loss. In younger people, tinnitus is most commonly associated with noise exposure.
  • Tinnitus is more prevalent in the adult population, but can be the first sign of hearing loss in children.
  • Tinnitus may be generated from more than one part of the auditory system, though most commonly it is associated with damage to nerve endings at the hair cell. Functional MRI imaging studies have identified portions of the central auditory pathway (Inferior Colliculus) that appear to generate tinnitus.
  • Treatments for tinnitus include masking devices, hearing aids which amplify background noise, concentration and relaxation exercises, magnetic stimulation and biofeedbacktraining.


  • A significant portion of the American population suffers from some sort of hearing loss.
  • Hearing Loss represents a very generalized complaint that may arise due to chronic noise exposure, acute noise exposure, genetic predisposition, and ototoxicity, or any combination of these.
  • Combined exposures can result in “synergistic” levels of hearing loss, even when neither individual exposure would cause a loss.  This is a documented problem for factory and field workers exposed to solvents and pesticides in the presence of loud equipment.


  • In adults, most ear pain (otalgia) is not otogenic, but commonly associated with disorders affecting the larynx, pharynx and tonsils, as well as the muscles of mastication (chewing) and temporomandibular joint (TMJ) problems associated with teeth clenching/grinding and orthodontic treatments.
  • Many of the more important otologic diseases such as cholesteatoma, chronic otitis media, Meniere’s disease and tumors are not associated with ear pain.
  • Most otogenic pain is caused by infection—most commonly external otitis and acute otitis media, both of which can be excruciatingly painful.
  • Not uncommonly, cerumen impaction can result in ear pain.


  • Otorrhea is fluid drainage from the ear.
  • This is almost always due to infection with the rare exception of a cerebrospinal fluid (CSF) leak.
  • Painless drainage usually signifies chronic otitis media, possibly due to a cholesteatoma.
  • Acute otitis media resulting in TM perforation and drainage is almost always painful.


  • Dizziness has many causes, many of which are unrelated to the temporal bone and ear. Complaints of being light-headed, giddy or faint are not likely to represent inner ear problems. Dizziness is often associated with any feeling of unease or disorientation,  This should not be confused with vertigo.
  • Vertigo arising from the vestibular system presents clinically as an “illusion of motion” when no motion is actually present. A patient with vertigo often reports the room is spinning or they are spinning.
  • Patient history, including age, visual difficulties, diabetes, stroke and medication usage are extremely useful in diagnosis the cause of vertigo.