ENT Disorders

Ear Disorders

There are many different types of ear disorders, some more common than others. For example, one of the most common causes of ear infections is bacteria or a virus. Hearing loss may be caused by several factors, including injury, aging, and birth defect, and can happen gradually over time. There are treatments available for hearing loss, but treatment will depend on the severity of the condition and other factors such as age and occupation. Consult an ENT doctor if you believe you’re experiencing any symptoms of an ear disorder.

Hearing loss

There are a variety of reasons you may be experiencing hearing loss. The most common cause is exposure to loud noise. This includes using power tools, attending rock concerts, or listening to music too loudly on your headphones. Other causes include:

  • Aging
  • Diabetes
  • Autoimmune disorder

Hearing loss may not mean permanent damage to your ears, but it does require medical attention for the problem that caused it. You should see an audiologist or otolaryngologist if you have hearing loss. They can diagnose the severity with testing.

There are many types of ear disorders where some are more common than others. One of our ear specialist will evaluate and tailor a plan fit for your needs.
There are many types of ear disorders where some are more common than others. One of our ear specialist will evaluate and tailor a plan fit for your needs.

Once diagnosed, you’ll devise a treatment plan with your ENT doctor. This may include reducing or eliminating exposure to loud noises, getting ear protection for loud places, or taking hearing aids if needed.

Extra Tip

You should consider changes you can make in your lifestyle, like quitting smoking and not using certain medications that may cause hearing loss.

Ear Infections

An ear infection is a bacterial or viral infection of the middle ear. There are two types of ear infections: otitis media and otitis externa (swimmer’s ear). Otitis media affects the eardrum and usually occurs after an upper respiratory infection. It can cause symptoms such as:

  • Decreased hearing
  • Fever
  • Pain
  • Drainage from the ear
  • Bad smell coming from the
  • Ear canal
  • Headaches
The treatment for this type of infection is antibiotics.
There are many types of ear disorders where some are more common than others. One of our ear specialist will evaluate and tailor a plan fit for your needs.
There are many types of ear disorders where some are more common than others. One of our ear specialist will evaluate and tailor a plan fit for your needs.
Otitis externa is an infection of a different part of your ear. It occurs when water gets trapped in your ear canal, and bacteria multiply, causing pain, redness, and swelling. Swimming in contaminated water or having a lot of wax buildup can cause an external ear infection. The symptoms are similar to those of an inner ear infection.

Extra Tip

Keep track of how often you get an ear infection so that if the pattern changes, it may be something more serious, like allergies or another medical condition.

Audiological Diagnostic Testing

Testing for ear disorders usually involves a hearing test and a full ear examination, which may include checking the skull bones to see if there is any damage or pressure on the middle ear. Tests may also involve looking at the eardrum and inspecting the throat to see if there are signs of allergies, infection, or other problems that could cause hearing loss.

If ear pain is associated with this disorder, obtaining X-rays of the ears may be necessary to diagnose what is causing the pain. An ENT specialist should perform these tests because they have been trained to perform them.

There are many types of ear disorders where some are more common than others. One of our ear specialist will evaluate and tailor a plan fit for your needs.
There are many types of ear disorders where some are more common than others. One of our ear specialist will evaluate and tailor a plan fit for your needs.

Getting tested for an ear disorder will help identify the problem so treatment can start as soon as possible. Your ENT doctor will likely want to do testing for your type of ear problem before recommending treatment.

Extra Tip

Many audiological diagnostic tests are performed in as little as 30 minutes.

Audiogram

An audiogram is a graph of the softest sound (pure tone) a person can hear in each ear at different frequencies. An audiogram can help determine if a person has hearing loss. The pattern of the hearing loss on an audiogram may help diagnose the cause of the hearing loss. For example, if there is only one steep dip in the sound level on either side at some frequency, there’s likely an obstruction in one or both ear canals.

ENTs will usually monitor for changes over time to see if treatment is needed. An audiologist evaluates a patient by taking a medical history and performing a general physical exam. The next step includes using specialized instruments to measure how well sounds are transmitted through the ears and middle ear to the inner ear and brain.

Extra Tip

Before audiograms, clean your ears of any wax buildup to ensure a clearer reading.

Tympanometry

This test records the sound waves produced when someone talks or has their ears blocked by putting plugs in them. It can detect changes in the middle ear and air-bone gaps. This test is done by placing a small tube in each ear canal and measuring the pressure at different frequencies. Tympanometry testing is usually painless, and most people tolerate it well, but some people experience discomfort during the test. If tympanometry shows an abnormality, additional tests may be needed to determine the cause of hearing loss.

ENT specialists use tympanometry to diagnose problems with the outer, middle, and inner ears, such as:

  • Eardrum perforation
  • Infection
  • Sudden sensorineural hearing loss (SSHL)
  • Other causes of hearing loss

The results from this test will help them identify potential causes for your specific symptoms.

Extra Tip

Before your test, avoid any unnecessary loud noises. Your ENT doctor will give instructions about what not to do before the test starts and what to do after it’s over.

Otoacoustic Emissions (OAE) Testing

Otoacoustic emissions are a noninvasive diagnostic test that measures the amount of sound energy produced by the inner ear. OAE testing can detect several ear disorders, including:

  • Sensorineural Hearing Loss (SNHL)
  • Peripheral Hearing Loss (PHL)
  • Conductive Hearing Loss (CHL)
  • Presbycusis

Otoacoustic emission testing is noninvasive and does not involve harmful radiation or drugs. The ear canal is gently cleaned before inserting a probe into it for each test; otherwise, there are no special requirements for ear cleaning. In most cases, children too young to cooperate can be tested in a quiet area, so they don’t have to sit still while wearing headphones.

Extra Tip

Otoacoustic emission tests should be performed on newborns because hearing loss can often present at birth.

Implantable Devices

Implantable hearing devices are options for individuals with specific, and usually more severe, patterns of hearing loss. These involve an outpatient surgical procedure .

Cochlear Implant

A cochlear implant is a device that provides sound to people who are severely or profoundly deaf. This device sends an electrical signal to the auditory nerve, which stimulates the brain’s ability to process sound and create an awareness of sounds in the environment. Cochlear implants are used as a treatment to help those suffering from sensorineural hearing loss, where there has been damage to the inner ear called the cochlea. 

Image courtesy of Cochlear Americas

Extra Tip

Bone conduction hearing aids are an option for people with hearing loss associated with outer or middle ear problems or those with profound hearing loss in one ear.

Bone Anchored Hearing Devices

Bone-anchored hearing devices are an alternative to traditional hearing aids that can be used with patients with conductive and mixed hearing loss. The device is surgically implanted in the bone behind the ear and transmits sound vibrations through the skull to the inner ear. In some cases, other benefits of this procedure include a natural sound quality and improved speech discrimination and cognitive function.

There are two main types of bone-anchored hearing devices:

  • Auditory osseointegrated implants
  • Malleable or wearable prostheses

Auditory osseointegrated implants involve making a small hole in your skull and anchoring the implant directly to your skull bone. Wearable devices usually have two main parts; a sound processor is worn behind or in front of your ear and a section containing hearing instruments that fit over your ear.

Extra Tip

Bone conduction hearing aids are an option for people with hearing loss associated with outer or middle ear problems or those with profound hearing loss in one ear.

Hearing Aids

If you suffer from a hearing disorder, hearing aids may help you hear better. Hearing aids are worn in or around the ears, amplifying sounds your ears cannot detect well enough. The amplified sound is sent directly into your ears through a tiny speaker so you can easily understand what is being said or heard. ENT doctors will usually recommend one of three types of hearing aid:
  • Behind-the-ear (BTE)
  • Canal-type (ITE)
  • Receiver-in-canal (RIC)
There are many types of ear disorders where some are more common than others. One of our ear specialist will evaluate and tailor a plan fit for your needs.
There are many types of ear disorders where some are more common than others. One of our ear specialist will evaluate and tailor a plan fit for your needs.
These models vary depending on which area of the ear needs more amplification. For example, BTEs work best for people with moderate to severe high-frequency hearing loss, while RICs work best for those with mild high-frequency loss.

OTC Hearing Aids FAQ

Extra Tip

Practice taking care of your hearing aids by regularly cleaning them and keeping them properly stored when not in use.

Vertigo

Vertigo is a sensation of movement while in a stationary position, sometimes associated with nausea and vomiting. It can be caused by a problem with the vestibular system, the balance organs located within the inner ear.
The most common l cause of vertigo is benign paroxysmal positional vertigo (BPPV). In BPPV, tiny particles called otoconia (small calcium “crystals”) become dislodged. With changes in head position the otoconia may shift, triggering brief bouts of room spinning dizziness. Physical therapy is the mainstay of treatment and is usually very successful.
There are many types of ear disorders where some are more common than others. One of our ear specialist will evaluate and tailor a plan fit for your needs.
There are many types of ear disorders where some are more common than others. One of our ear specialist will evaluate and tailor a plan fit for your needs.
Your physician will perform specific physical exam tests and may refer you for specialized balance testing at our Center for Vestibular and Balance Disorders

Extra Tip

Your physician my refer you to our fellowship-trained Otoneurologist, Dr Ramocki, for further evaluation.

Tinnitus

Tinnitus is the perception of sound in the ear or head not originating from an external source. Tinnitus is commonly referred to as ringing in the ear. People often experience tinnitus as a high-pitched tone, and some report it sounds like rushing water, hissing, pulsating, or chirping. Tinnitus can be intermittent or continuous, pulsatile or non-pulsatile and may vary in intensity depending on day-to-day activities.
Tinnitus can be a short-term condition lasting for days or weeks, but for many people, it becomes chronic and intrusive. .
There are many types of ear disorders where some are more common than others. One of our ear specialist will evaluate and tailor a plan fit for your needs.
There are many types of ear disorders where some are more common than others. One of our ear specialist will evaluate and tailor a plan fit for your needs.
The hearing test can help reveal any possible causes for tinnitus, such as noise trauma or age-related hearing loss that could have been caused by years of exposure to loud noises.

Extra Tip

Consider using a white noise (a fan, air-conditioner, humidifier or white noise machine) to mask the noise from tinnitus if you are having trouble falling asleep at night.

Otology, Neurotology and Skull Base Surgery

Otology is that branch of ear, nose and throat surgery that deals specifically with the diagnosis, treatment and surgery of diseases of the ear. Neurotology is a division of Otology that not only deals with the ear but also those portions of the brain that are important for hearing and balance.
Neurotology bridges the gap between otology and neurosurgery. Skull base surgery is usually performed in conjunction with our neurosurgical colleagues.
There are many types of ear disorders where some are more common than others. One of our ear specialist will evaluate and tailor a plan fit for your needs.
university otolaryngology Brian Duff headshot
Dr. Brian Duff is the only physician in Rhode Island with fellowship training in Otology, Neurotology and Skull Base Surgery.
All areas of otology are represented in our practice including the treatment of hearing loss, otosclerosis; chronic otitis media (with and without cholesteatoma); tumors involving the external, middle, and inner ears, cerebrospinal fluid leaks, pulsatile tinnitus, acoustic neuromas, meningiomas and other skull base tumors.
Our practice specializes in hearing rehabilitation and surgical correction of certain types of hearing loss. Services we offer include hearing aids, pediatric and adult cochlear implants and bone-anchored hearing devices.

Conditions That Contribute to Ear Disorders

  • Ear Wax
  • Noise Exposure
  • Ear barotrauma
    (pressure-related injury with flights or
    diving)
Ear disorders can lead to temporary or permanent hearing loss. Other symptoms of an ear disorder may include ringing in the ears, vertigo, and dizziness.

Frequently asked questions

Have questions? We are here to help.

What is an Audiologist?
An audiologist is a licensed hearing professional who specializes in the diagnosis and treatment of hearing loss and balance disorders in adults and children. They have completed a Masters or Doctorate in the field of Audiology, as well as internships in their field of expertise.
How do I know if I need hearing aids?
Many people with hearing loss first notice they are asking their friends and family to repeat more frequently, or they feel everyone around them is mumbling. Getting your hearing evaluated is the first step to treatment. Your audiologist will test your hearing to help determine if you have hearing loss and if you can benefit from amplification.
How long will my hearing aid last?
The life of a hearing aid is about five to seven years. It is important to have regular appointments to ensure your hearing aid is functioning and programmed properly. Hearing aids also come with different warranties, typically two to three years, covering repair and loss replacement. Many hearing aids are still functioning well after seven years, while others may need re-programming, repair, or replacement.
How much does a hearing aid cost?
A hearing aid purchased from our practice can range anywhere from $1,200 to $7,000, depending on the level of technology you require. It is important to have a trained hearing professional assess your individual needs to ensure you receive the right level of technology for you personally. Hearing Aids are not ‘one size fits all’. This is why we recommend a Hearing Aid Evaluation with one of our Doctors of Audiology, so they can guide you towards what options would work best for you.
Does health insurance cover hearing aids?
Coverage for hearing aids varies based on insurance companies and plans. Understanding coverage, and how our practice’s participation or non-participation with your insurance will impact the cost to you, can be complex. We encourage you to speak with our dedicated audiology receptionist at 401-626-3748 for more information regarding your particular plan, and what your benefits may be. We also encourage you to reach out to your plan directly prior to visiting our office.
Why should I purchase my hearing aid from Univoto versus a big chain store at a discount? Why should I see an audiologist before getting an ‘OTC’ hearing aid?

An audiologist is a licensed, certified professional who specializes in helping patients with hearing loss. While OTC devices do not require a diagnostic hearing test, they do rely on the consumer to determine if they have perceived mild to moderate hearing loss. Many people are not able to accurately determine their degree of hearing loss. A diagnostic hearing test completed with an audiologist will provide accurate information on both the degree and type of hearing loss.

 

An audiologist can then help you determine if OTC or prescription hearing aids are right for your communication needs, or if you need a consultation with an otologist (ear physician). The hearing test can also be useful to self-fit an OTC device or to precisely program a prescription device. There is an overwhelming amount of information available on hearing technologies, and your audiologist can provide clarity and direction to ease you through the process to improved communication.

 

If you do decide to purchase your hearing aid with us, we offer servicing of the device and maintenance that would not be included in the purchase of an OTC device, as well as a warranty for repairs and device malfunction, which many patients find of value when making such a large purchase. Please reach out to our dedicated audiology receptionist at 401-626-3748 for more information.

Why was I not told there would be a cost for diagnostic testing?
We certainly appreciate how confusing insurance benefits can be for the average patient to make heads or tails of. Understanding your benefits can be a daunting and frustrating task! The challenge that we deal with as providers is that there are hundreds of insurance plans out there and each plan is unique to that person’s arrangement with the payer plan. Unfortunately, it would take an army to be able to check each individual patient’s benefits prior to providing care, and so we ask that patients be proactive about understanding their benefits prior to visiting our office. If you have a copay, deductible or coinsurance, please be aware that in most cases, diagnostic testing will be applied as an out of pocket cost to you directly. If you have questions about your benefits, or about how services were applied to your responsibility, please check with your plan directly, and/or your HR representative.
Do you participate with my insurance?

Univoto participates with the following plans: Aetna, BlueCross BlueShield of RI, Cigna, Medicare, Neighborhood Health Plan of RI, Tricare, Tufts Health Plan, United Health Plan, Harvard, Coventry (First Health), Humana Senior Plans.

 

Please note that Tufts Health Plan and Harvard become Point32Health, and merge, as of January 2024.

 

Also, keep in mind that there are some plans that look like a Cigna plan that actually go through a third-party benefit administrator such as ‘MultiPlan’. We are not in network with those plans. We recommend verifying with your insurance company directly that we are in network. Provide them our Tax ID 05-0319479, and the practice name ‘University Otolaryngology’, and they should be able to verify our participation.

Are hearing tests covered by insurance?
Yes, the majority of health insurances cover hearing testing. CPT billing codes we use when billing for diagnostic testing are 92557 (comprehensive audiogram), 92567 (tympanometry). Other codes may also be billed depending on the specific diagnostic needs of each patient.
Why is there a copay for a hearing test?
Many patients get confused when they receive a bill for a copay for a hearing test, as their insurance company tells them that they get one free ‘routine’ hearing test per year. The key there is the term ‘routine’. A ‘routine’ hearing test is essentially a screening hearing test to determine your baseline of hearing. This would have been performed at a primary care physician’s office, or by a screening service (an example of this would be hearing screenings that are done by a pediatric center such as a school). Univoto are a team of specialists that treat hearing disorders. If you see one of our providers, it is because you currently have, or have had a history of hearing loss or another ear disorder, and therefore our hearing tests are not ‘routine’, but rather ‘diagnostic’ in nature. Some payers, such as BlueCross BlueShield, do assign a copay to diagnostic hearing tests. We recommend that you reach out to your insurance plan and ask if you have a responsibility towards ‘diagnostic’ hearing tests, prior to your visit, if you are concerned about that potential cost.
How much will OTC hearing aids cost?
It is thought that OTC hearing aids will cost average $1,000 per pair. Any mention of OTC hearing aid costs are a best guess and will be determined by the manufacturers.
How will I know if OTC hearing aids will work for me?

The best way to know if OTC hearing aids will work for you is to see an audiologist for a comprehensive hearing evaluation. This evaluation will show you the degree of hearing loss and the part of the ear—outer, middle, or

 

inner—that is causing your hearing loss. This information, taken together, will help you decide whether an OTC hearing aid is your best choice or if your needs would be better addressed by a prescription hearing aid.

Who can wear OTC hearing aids?

OTC hearing aids will work if you have a mild to moderate hearing loss. They are not effective for a moderate to severe degree of hearing loss. You must be 18 years or older to wear OTC hearing aids. Children should never wear them.

 

You must consult a medical provider before buying an OTC hearing aid if you have any of the following medical conditions:

 

  • ear deformity
  • fluid, pus, or blood coming from the ear
  • hearing loss or ringing (tinnitus) that occurs in only one ear or that is noticeably different in one ear
  • pain or discomfort in the ear
  • history of excessive earwax or feeling that something is in the ear
  • pain or discomfort in the ear
  • sudden, quickly worsening, or fluctuating hearing loss
  • vertigo or severe dizziness
Who can help me pick an OTC hearing aid?

Many places may sell OTC hearing aids: your local pharmacy, big-box stores such as Walmart, or online providers. You will make the decision about what you buy, just like any other item on the shelf. You may be able to ask store staff for help; however, these staff members likely do not have specialized training in hearing loss and hearing technology programming. It is important to read all information on the box before buying a device. You may not be able to return the hearing aids once you buy them.

 

Audiologists have extensive training in ear, hearing, and balance disorders and have either a doctoral or master’s degree. They can explain your hearing loss and help you consider the hearing aid that is best for you. Some audiologists will help you with basic maintenance of your OTC hearing aid for a service fee.

Why should I see an audiologist even if I choose an OTC hearing aid?

An audiologist is the expert in hearing health care—–they can help you find a device and supply tips for you and your individual hearing needs. They will also be able to check your hearing over time to see if it remains stable or worsens. Regular check-ins are important: they reveal whether your chosen hearing aid (OTC or prescription) is

 

providing enough sound to meet your hearing needs—– or whether you and your audiologist should discuss other options. The common goal between you as the patient and the audiologist as the provider is to help you create a plan and a path toward improved hearing.

How do I find an audiologist in my area?
The American Speech-Language-Hearing Association (ASHA) has a national directory that can help you find an audiologist in your area. Visit https://www.asha.org/profind/ or email ASHA Audiology Practices at udiology@asha.org
The American Speech-Language-Hearing Association (ASHA) has a national directory that can help you find an audiologist in your area. Visit https://www.asha.org/profind/ or email ASHA Audiology Practices at udiology@asha.org

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