Finding the Right Doctor for Sudden Hearing Loss and Other Ear Problems
© August 2004 (revised October 2008) by Neil Bauman, Ph.D.
Question: 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?—S. D.
Answer: 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
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 not a 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 and otology 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
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.