Q: My son had tubes when he was 1 year old, they came out, but one of the holes didn't heal. My doctor suggested we not correct the problem immediately. He's now almost four and still the hole has not closed. What should we do? Will he have hearing loss from that hole in his ear? And what procedure do they do to correct it?

Moderator: Dr. MacDonald says the reason to delay is to ensure that he's outgrown the tendency to ear infections. The best way to know that is to monitor the other ear, the one without a hole. Now that he's about four, if he's had no infections on the other side for approximately a year, it's reasonable to repair that hole. some doctors would suggest waiting until he was a little older.

Dr. MacDonald: It depends on the size of the hole and which part of the eardrum it is. If it's small and in the location where a tube is usually placed, there's probably no hearing loss from it. If it's larger and there is some hearing loss, repairing the hold would probably normalize the hearing.

Q: The Doctor said that most hearing problems can be helped, if sorted correctly, does he mean by hearing aids? My 3 year old was born with a moderate severe hearing loss and her school is worried that her speech is not coming along good enough. She has had aids since she was 6 months old.

Dr. MacDonald: Congenital nerve hearing loss can be helped by hearing aids. With properly functioning hearing aids, and some speech therapy, her speech should be coming along well. If there's any concern about her speech, the first thing to do is recheck her hearing levels and be sure the hearing aids are functioning properly. If both of those are ok, some speech therapy can help her catch up.

Q: The hole is large. Does that affect his balance and coordination now?

Dr. MacDonald: If there is an infection with drainage in that ear, it's common to have some balance difficulties. Otherwise you would not expect significant balance problems. It's easy to test the hearing and know whether it's affected by the size of that hole.

Q: Hi I wanted to ask about speech problems with children. My son's ENT said my son has a cyst on his vocal cords this is causing his voice to be very hoarse. His teacher and I have noticed recently that this problem is getting worse what can be done to correct this and how dangerous can it be.

Dr. MacDonald: Most vocal cord nodules are caused by voice overuse or abuse. They're often called singer's nodules, and a change in voice use or sometimes speech therapy is the best way to treat those individuals. There are other causes of bumps or lumps on the vocal cords which are more worrisome, but your doctor would be able to advise you best.

Q: We just had her aids checked and she's been getting Speech Therapy since she was 6 months old. Her school is recommending that she leaves the oral program to go sign language. When does a cochlear implant come into play?

Dr. MacDonald: A cochlear implant is designed for patients with profound hearing loss in both ears. If your child's hearing loss is in the moderate range, then the cochlear implant is not for her. If she's having trouble in the normal school system, it may be beneficial to go to a school for hearing-impaired children. With moderate hearing loss, you would ordinarily expect that the child could catch up and be mainstreamed. Sign language usually would not be the best choice for someone with moderate hearing loss.

Q: I am a 44 year old female with slight hearing loss in 1 ear, what can I do?

Dr. MacDonald: hearing loss on one side should always be investigated by an ear doctor. The common causes of hearing loss generally affect both ears to the same degree. You should ask for a referral and be evaluated by an ear doctor and have your hearing tested.

Q: What causes ringing in the ears?

Dr. MacDonald: Nerve ending damage in the inner ear causes hearing loss and ringing. The ringing occurs because the damaged nerve endings generate a nerve impulse without any sound entering the ear. The part of the brain involved in hearing recognizes that as ringing, which is called tinnitus. The way to sort it out is to be evaluated by an ear doctor and have the hearing tested to decide on the best way to care for you.

Q: She's in a hearing impaired program they are the one recommending that she goes to a sign language program. Thank you for your help.

Dr. MacDonald: It sounds as if the hearing loss is worse than moderately severe. Sometimes the hearing deteriorates over the years in children with such problems. Perhaps she is in the hearing range which would benefit from considering a cochlear implant if you want aural communication.

Q: Thank you so much! I will have her retested.

Q: Should I be worried about my young child using headphones for the computer and/or CD player?

Dr. MacDonald: If you can hear the music when your child is wearing the headphones, it's probably too loud. Noise-induced hearing loss is most common in adults who work with machinery, but the personal CD and tape players with headphones certainly can damage the hearing in children. The nerve damage from recurrent noise exposure will last throughout life.

Q: I heard that you shouldn't clean your ears with a q-tip. Is that true?

Dr. MacDonald: Cotton swabs tend to remove most of the wax but push a small amount in deeper than its normal position. That small amount of wax can build up to cause major problems. Occasionally, you can bump the ear drum, causing a perforation with hearing loss using a cotton swab. I have seen patients who have had total, irreversible nerve hearing loss with chronic balance problems from a cotton swab injury.

Q: My husband has wax buildup. What can he do about it? Does that cause hearing problems?

Dr. MacDonald: wax buildup seldom causes hearing problems but when it does, it usually occurs suddenly and is quite distressing. If the wax is almost sealing the ear canal, a bit of moisture from washing or showering can suddenly close the ear. Wax can usually be removed with a wax removal kit at any drugstore. If necessary, you can use a wax kit 3-4 times a year to prevent buildup again.

Q: Occasionally my ears stop up for no reason, and then later it goes away. Do you know why they would do that?

Dr. MacDonald: The Eustachian tube maintains an air pocket behind the ear drum. It may not always function perfectly. During a head cold or an airplane flight, the air pressure behind the drum may differ from the room's air pressure with the sensations you describe. Severe Eustachian tube problems are the mechanism for most recurring middle ear infections.

Q: I had my ears pierced 20 years ago. One of the holes is stretched further than the other. Is there anything I can do to correct this?

Dr. MacDonald: Heavy earrings or pulling by young children are the common causes of this problem. If you stop using that piercing and the stretched hole is still obvious, you can have a small cosmetic operation to close it. You can have the ear pierced again later. Piercing the ear through the cartilage portion is very unwise. An infection of the cartilage portion of the ear can damage the entire outer ear within days.

Q: Hi Dr.Macdonald, good job with todays topic!

Dr. MacDonald: Thanks.

Q: How often you should have your hearing tested?

Dr. MacDonald: All newborns should have their hearing tested before leaving the hospital. Children with speech or learning concerns should all have their hearing tested. Adults with no concerns about their hearing don't necessarily need to have their hearing tested. People with known hearing loss generally have their hearing tested on a regular basis every year or two. Anyone with a sudden loss of hearing should be evaluated and tested on an emergency basis.

Q: Can scar tissue be removed from your eardrum?

Dr. MacDonald: Scar tissue usually occurs after past ear infections. After surgery, the ear drum often looks abnormal and may have a bit of scarring. Scar tissue doesn't necessarily cause hearing loss or other problems. If it does, the ear drum can be repaired surgically.

Q: I had tubes as a child that didn't fall out and were removed in the Dr's office. He stated I had a 10% hearing loss. does this relate to my ear canal being abnormal?

Dr. MacDonald: Without seeing the hearing test and examining the ear, it's not possible to answer that question. Your physician should be able to help you with that question.

Dr. MacDonald: Thanks for your questions. If you have hearing problems, you should consult your physician. If you need specialized care, he may refer you to our office, which can be reached at 347-8220. We have an office in Germantown and in the Medical Center.

Moderator: Dr. Bruce MacDonald: Thanks for participating today.