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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Dizzy After Hard Hit Near Left Ear, Ringing Sound, Took Antibiotics. Advised Middle Ear Exploration To Check Loss. Necessary ?

I got hit really hard near my left ear and jaw with a much heavier person than me with his right hand. I felt dizzy for couple of seconds and after that I was fine. This happened 2 months ago. After a couple of days slow ringing sound started and I consulted an ENT doctor. He clean my ear and said there was a little injury and gave some antibiotics for 5 days and he said everything will be fine. Immediately after consulting the doctor I traveled to USA due to my job. But my ringing in the ears did not stop and I felt like little hearing loss at low frequencies or bass sounds. So I went to a doctor today in USA, and he told that the eardrum is fine and conducted some hearing tests. He said the results are not normal in both left and right ears. But the left ear, where I got the hit, he said it is not able to recognize certain low frequency sounds. He said he needs to do a "Middle Ear Exploration" surgery to make sure if there is any problem like fracture in the bone near the inner ear (he said something like inner ear fistula), and if so correct it. I am little scared. I just wanted to know if this injury, if there is really any fracture or so in inner ear, will heal on its own? Do I really need to undergo this surgery or exploration? Will my ringing sound go away on its own? It is really frustrating while in office or home because it is so silent and I can't concentrate much.
Fri, 23 Aug 2013
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Otolaryngologist / ENT Specialist 's  Response
Hi,

Thank you for your query.

1. The benefit of any exploratory tympanotomy must outweigh the risk of worsening the hearing or tinnitus (ringing sound in the ear).

2. An HRCT (High Resolution CT) and an MRI study of the Temporal Bones will demonstrate any ossicular discontinuity without opening the ear surgically.

3. A conductive hearing loss of more than 60 dB will be seen with complete ossicular discontinuity. Hearing loss will be more in the higher frequencies. A tympanogram may show a hypermobile ear drum.

4. An incomplete ossicular discontinuity may cause a fluctuating hearing loss.

5. Treatment should be conservative, however, any ossicular fracture is unlikely to heal. There will usually be union by fibrosis and there may also be bone necrosis if the delicate blood supply to the distal part of the ossicle bone is destroyed.

6. In the event that a surgery is planned, the ossicular chain may have to be replaced, resulting in some amount of hearing loss as the lever ratio of the ossicles cannot be replaced with conventional techniques.

7. The management of tinnitus depends upon its severity on a scale of 1 to 10.
Regards.
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Dizzy After Hard Hit Near Left Ear, Ringing Sound, Took Antibiotics. Advised Middle Ear Exploration To Check Loss. Necessary ?

Hi, Thank you for your query. 1. The benefit of any exploratory tympanotomy must outweigh the risk of worsening the hearing or tinnitus (ringing sound in the ear). 2. An HRCT (High Resolution CT) and an MRI study of the Temporal Bones will demonstrate any ossicular discontinuity without opening the ear surgically. 3. A conductive hearing loss of more than 60 dB will be seen with complete ossicular discontinuity. Hearing loss will be more in the higher frequencies. A tympanogram may show a hypermobile ear drum. 4. An incomplete ossicular discontinuity may cause a fluctuating hearing loss. 5. Treatment should be conservative, however, any ossicular fracture is unlikely to heal. There will usually be union by fibrosis and there may also be bone necrosis if the delicate blood supply to the distal part of the ossicle bone is destroyed. 6. In the event that a surgery is planned, the ossicular chain may have to be replaced, resulting in some amount of hearing loss as the lever ratio of the ossicles cannot be replaced with conventional techniques. 7. The management of tinnitus depends upon its severity on a scale of 1 to 10. Regards.