by Neil Bauman, Ph.D.
© December, 2011
A person asked, “I woke up this morning completely deaf in one ear. I went to my primary care physician and he gave me some drops for my ear and told me to come back in two weeks if my hearing doesn’t come back. This doesn’t sound like he is treating my hearing loss as a medical emergency. What should I do?”
A lot of people ask the same questions: “What kind of a doctor should I go to when I experience sudden hearing loss?” and, “What is the most effective treatment?”
If you make the wrong choice and don’t get effective treatment immediately when you should, you may condemn yourself to a life of permanent hearing loss. Thus you need to take action to get the treatment you need, when you need it.
“Cry Wolf” or Die—Take Your Pick
Far too many people relate to me how they went to their family doctors and because their doctors did not recognize the emergency nature of their hearing losses, their doctors did not give them the immediate, effective treatment they really needed. Instead, their doctors often took a “wait and see” attitude. As a result, these patients ended up with permanent hearing loss. Don’t let this happen to you.
Sudden hearing loss can result from many different conditions. Some are medical emergencies and others are not—just like having a heart attack is a medical emergency and heartburn is not. The trick sometimes is telling which is which since heartburn can be one of the symptoms of a heart attack.
You may feel foolish calling an ambulance and being rushed to the hospital only to discover it was heartburn and not a heart attack. However, doctors and paramedics would rather you call them first—and find out later it wasn’t a medical emergency—instead of waiting to be sure, and die in the process.
The same holds true with your ears. Sudden hearing loss could be caused by something as simple as putting your hearing aid on and thereby pushing some wax further down your ear canal so it blocks sounds from reaching your eardrum. Voila! Instant deafness. This is nota medical emergency.
In contrast, you may wake up one morning with no hearing in one ear. Chances are this is a medical emergency and you should seek effective treatment now!
In a recent email to me, one lady wrote: “Doctors do not know how to treat sudden hearing loss. I wrote my primary care physician a letter about this and sent him your article with it entitled: Sudden Hearing Loss Is A Medical Emergency. When I went to see him, he was afraid to call it an emergency and get me an appointment with an ear specialist, as someone might think he was ‘crying wolf’ and thus wouldn’t believe him in the future if it was not a ‘real’ emergency.”
This is a valid and very real concern of doctors—especially primary care physicians who are not specifically trained in the specifics of ear problems.
What’s the answer? To my way of thinking, if doctors cannot find anything obvious causing the sudden hearing loss such as wax blocking the ear canal, they should treat it as a medical emergency. It’s that simple!
This is not “crying wolf.” This is being responsible and saying, “I’ve looked and can’t see any obvious reason for this sudden hearing loss, so I am sending my patient to you for your expert opinion. It may be nothing, or it may be serious—but I just can’t tell which and I don’t want to risk my patient’s hearing by wasting time.”
Since ear problems could be minor or very serious, both you and your doctors would be wise to err on the side of “medical emergency” until this is ruled out. The cavalier “wait and see” attitude of many doctors lets the precious minutes in your “golden hour” tick away without your ears receiving any effective treatment. When finally the serious nature of your hearing loss is recognized, often many days later, it is then far too late for treatment to do much good.
Which Doctor Should I Go To?
“Harold” wrote: “On July 23rd at noon, I was sitting in my office. I realized that I had suddenly lost the hearing in my right ear as I could not hear anything over the phone. That ear now feels blocked.”
Quickly! Which doctor should Harold go to? Do you know?
When it comes to diagnosing and treating ear problems, doctors basically have three levels of “ear expertise.” They are from least to most—primary care physicians (PCP), ear, nose & throat doctors (ENTs) and otologists/neurotologists. Each has their own niche.
1. Medical Doctors/Primary Care Physicians (MD/PCP)
Often your first contact with the medical community is with a standard Medical Doctor (MD), often called a Primary Care Physician (PCP), General Practitioner (GP) or Family Doctor. These doctors have no specialized training in treating ear problems. However, you often need to go to one of these doctors in order to get a referral to an ear specialist such as an ENT or otologist.
Family doctors normally treat ear conditions of the outer ear and ear canal such as removing ear wax or treating infections in the ear canal. For problems in the middle and inner ear, they should immediately refer you to the appropriate ear specialist.
2. Ears, Nose & Throat Doctors (ENT)
The middle level of “ear expertise” is the Ear, Nose & Throat doctor, commonly referred to as an ENT. The fancy term for these doctors is otolaryngologist (OH-toe-lar-ing-JOL-uh-jist) or sometimes by the tongue-twisting name of otorhinolaryngologist (OH-toe-RYE-noe-lar-ing-JOL-uh-jist). (When you break this name down, it is easier to understand and pronounce. Oto—ear, rhino—nose and larynx—throat). Sometimes these doctors are called EENTs (eyes, ears, nose and throat doctors).
ENTs are medical doctors that have taken further training and specialized in problems of the ears, nose and throat.
Despite the name, ENTs do not spend a lot of their time working with ears. One otologist told me that he estimated the average ENT only spent about 5% of his time with ears. Thus you cannot expect them to be experts on many kinds of ear problems.
ENTs generally specialize in problems of the middle ear—typically middle ear infections and medical problems of the middle ear. This may include surgical procedures for things like otosclerosis, or removing middle ear tumors such as cholesteatomas. They may also perform CI surgery.
3. Otologists (Neurotologists)
At the top of the pile is the otologist (oh-TOL-uh-jist) and neurotologist (NEU-roe-oh-TOL-uh-jist). Otologists and neurotologists are medical doctors who have trained as ENTs and then completed additional studies is the sub-specialty of otology (or neurotology). These are the real ear experts and are the doctors that know the most about inner ear problems.
If you experience sudden hearing loss and there is no obvious reason, these are the doctors that most likely will be able to help you. In fact, otologists/neurotologists are the only doctors (as a whole) that seem to recognize the true emergency nature of sudden hearing loss. Unfortunately, there are not very many otologists/neurotologists in the country.
Finding an Otologist (Neurotologist)
Since otologists are few and far between, finding an otologist or neurotologist near you may be difficult, especially if time is an important factor. If you live in the United States or Canada, probably the quickest and easiest way to find an otologist or neurotologist is to go to the website of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS). Here’s how to do it.
1. Go to http://www.entnet.org. In the center of the page is a box “Find an ENT By“.
In this box you have several options. Don’t make your search too stringent or you may not have many “hits.”
2. Leave doctor’s “Name” blank.
3. You can put in a distance from you within which you are willing to travel. I suggest 25 or 50 miles. Then put in your zip code. If you don’t get any/many results, try again, but this time leave the distance and zip code blank, and instead choose your “State/Province” (or a nearby state if you live near the border of two states).
4. Under “Specialty” select “Neurotology” then click “Go.” See how many entries come up. If there are too many, you may want to narrow your search. If too few, make your search even wider.
5. Do the same search again but this time select the specialty “Otology.”
Note: a good number of doctors are listed under both neurotology andotology so there aren’t as many choices as you might first think.
6. To learn more about any given doctor, in the resulting list click on the doctor’s name. This will bring up a new screen giving the address and phone number of the doctor, his specialties and his education/training record.
7. Finally, contact the doctor that interests you the most or is at a convenient location to you.
Note: This website only lists doctors that are members of the AAO-HNS. No doubt there are other otologists and other ear specialists that are not members. Therefore, they are not listed here. However, this website gives you a good place to start your search for an otologist or neurotologist.
Otologists are a rare breed. In case you are interested, there are only 9 neurotologists, and 15 otologists listed for the whole of Canada. In the USA, the figures are 242 and 403 respectively.
If you leave “-Select One-” as the specialty, you will get a listing of ENTs. Remember, otologists are, at the same time, ENTs. If you check their personal listings, you will find that some of them list otology as one of their specialties. There are only 37 ENTs listed for Canada, and 2,610 for the USA.
Sudden hearing loss can be serious. If there is any doubt in your mind about any treatment (or lack thereof) you have received from PCPs and ENTs, don’t delay. Contact an otologist/neurotologist as soon as possible.