More than 28 million Americans (10% of the population) have some degree of hearing loss. In fact, one out of every four people aged 65 and older has hearing loss and 100% of children will experience a temporary hearing loss due to ear infections or fluid at least one time before age 18.

Dr. Kimmelman works closely with each patient to properly diagnose and treat mild, moderate and severe hearing and balance problems in adults and children with the most advanced surgical and medical therapies available.

How do our senses of hearing and balance work?
Hearing is the complex process by which vibrations of air molecules are transformed into the conscious appreciation of speech, music and the sounds of the natural world. Even before birth, the human ear is functional. Being able to communicate with spoken symbolic language is a distinguishing attribute of the human race.
Balance and equilibrium are provided by the vestibular organ within the inner ear. Balance and equilibrium allow us to stand erect and to walk, run, and move without falling.

Hearing
There are five components of the hearing mechanism:

Outer ear – serves as a collector of sound vibrations around us, and funnels the vibrations into the ear canal. It assists us in determining the direction and source of sound.

Middle ear – is an air filled space behind the eardrum that amplifies sound. The air enters from the nose through the Eustachian tube, which equalizes air pressure on both sides of the eardrum. This is why you might feel air pressure changing in your ears as you swallow and your ears pop in an airplane or elevator.

Inner ear – is a fluid filled set of chambers that hold the sensory organs for hearing and balance. The cochlea is the hearing part of the inner ear. The semicircular canals, the utricle and the saccule make up the balance part of the inner ear, which is called the labyrinth.

Acoustic nerve – carries nerve impulses from the cochlea to a relay station in the brain stem.

Brain auditory centers – deal with the processing of auditory information to allow the conscious appreciation of sound, music and speech.

Balance
The balance system works with the visual and skeletal systems (the muscles and joints and their sensors) to maintain orientation or balance. An organ in our inner ear – the labyrinth –responds to the pull of gravity and the motion of the head and neck. Additional information about orientation and movement comes from the visual (eyes) and musculoskeletal (bones and joints) systems to maintain the body's position. The brain uses information from these three systems to understand the body’s orientation and movement in three-dimensional space.

What are hearing and balance disorders?
Hearing loss may be sudden or gradual, mild to severe and temporary or permanent. Hearing loss can be present at birth or develop at any time during a person’s life.
Depending on the part of the ear that’s damaged, there are two main types of hearing loss: sensorineural and conductive.

Sensorineural hearing loss affects over 17 million Americans and is due to damage to the inner ear, acoustic nerve or the brain itself. It can be caused by excessive exposure to loud noise, use of ear-damaging or “ototoxic” drugs, infections like measles and meningitis, head injury, neurologic diseases, blood vessel disease, endocrine disorders or a birth or hereditary defect.

Conductive hearing loss occurs when there are reduced transmission sound vibrations from the outer and middle ear to the inner ear. Conductive hearing loss can result from a punctured eardrum, middle ear infections, ear wax (cerumen) blockage, head trauma, birth defects or heredity.

A balance disorder is a disturbance of the balance organ of the inner ear that causes an individual to feel unsteady, giddy, woozy or have a sensation of movement, spinning or floating. The causes of malfunctions of the labyrinth are similar to those causing sensorineural hearing loss, and in fact, hearing loss and balance disorders often occur together.

What causes hearing and balance disorders?
There are many reasons for hearing loss. Some people's hearing gradually gets worse as they get older. The National Institute on Deafness and other Communication Disorders (NIDCD) estimates that about 1 in 3 Americans will have age-related hearing loss by age 65-75. But, not all hearing loss is age related. When noise is too loud -- sometimes during just one, single event -- it can make a person hard of hearing. This is a particular problem for people who work in industries such as construction, farming, the airlines, lumber and manufacturing – and, of course, for rock musicians and some members of the armed forces. There are other causes of hearing loss, which include viral or bacterial infections, heart conditions, stroke, head injuries, tumors and some prescription medicines.
Countless conditions can cause balance disorders including infections (viral or bacterial), head injury, disorders of blood circulation affecting the inner ear or brain, certain medications, and aging may change our balance system and result in a balance problem. Individuals who have illnesses, brain disorders or injuries of the visual or skeletal systems, such as eye muscle imbalance and arthritis, may also experience balance difficulties. A conflict of signals to the brain about the sensation of movement can cause motion sickness (for instance, when an individual tries to read while riding in a car).

How are hearing and balance disorders diagnosed?
Dr. Kimmelman’s first step in this process is to obtain a complete history of the course of your hearing or balance impairment. How long have you had the problem? Was it sudden or slow in onset? Did you have a head injury, infection, operation or other medical event? Do any of your relatives have a similar problem? What medications have you been exposed to? Do you live or work in a noisy environment? What other medical conditions do you have or have you been treated for, such as diabetes, hypertension, high cholesterol, autoimmune diseases, cancer or stroke? What medications do you currently take or have taken in the past? The answers to these questions will allow Dr. Kimmelman to identify the type of medical condition(s) causing your problem.

After a thorough physical examination of the ears, nose, face, nervous system, neck and throat, Dr. Kimmelman will carefully test balance with a series of balance maneuvers that allow him to pinpoint the source of the problem. Hearing testing is also an important part of the evaluation as well, and this is performed in a soundproof booth by a highly trained and experienced audiologist. Specialized balance testing to determine which labyrinth is malfunctioning (ENG) and nerve conduction testing (ABR) may also be required. The kind of testing will vary based on the patient's symptoms and health status. Not all patients will require every test. In some cases Dr. Kimmelman will order more complex testing, such as MRI and CT scans, facial nerve excitability testing and specialized somatosensory balance tests.

Can hearing and balance disorders be treated?
The treatment that Dr. Kimmelman selects for you will depend on the type, cause and extent of your hearing loss. Hearing loss caused by medications (like aspirin or ibuprofen) often improves once the drug is stopped. If an ear infection is the cause of the hearing loss, it often clears on its own, but antibiotics may be needed. Surgery may be needed to treat some conditions or injuries to restore hearing. However, some forms of hearing loss are permanent and irreversible. In these cases, Dr. Kimmelman may recommend a hearing device. Hearing aids may not restore hearing to normal, but they can greatly improve hearing and quality of life.
For patients with profound deafness, Dr. Kimmelman may recommend a cochlear implant. This tiny surgically implanted electrical device is inserted into the cochlea of the inner ear to directly stimulate the hearing nerve. It can transport a person from a world of silence to one of normal communication.

There are various options for treating balance disorders. Dr. Kimmelman may determine that he needs to treat the disease or disorder that may be contributing to the balance problem, such as ear infection or nerve inflammation. Individual treatments may include special exercises, medications, physical therapy and surgery depending on the diagnosis. Dr. Kimmelman will thoroughly review the various options available to help you.