Hearing Loss and Fluid in the Ear

Q: Will a hearing aid help me with hearing loss caused by fluid in the ear?

A. If you’re talking about fluid-in-middle-ear-cavity, either ear or both ears, I’d be sending you to an Ear, Nose and Throat (ENT) doctor for a medical evaluation before we fit any hearing system on you. Have you had an ENT evaluation recently or ever to discuss your fluid in the ear?

Yes, chronic middle ear fluid or middle ear infections can cause permanent degradation of the ossicular chain (hammer, anvil, stirrup). This creates a “conductive” hearing loss. Again, I’d want an ENT to look at the case. Surgical interventions might be possible; you should at least know about them.

fluid in the ear
If you are dealing with fluid in the ear, it is best to see an ENT professional.
If we’re talking fluid-in-ear-canal, I would want to know the source. Typically, it’s either a hole in the ear drum (fluid coming from the middle ear) or it is an infection in the ear canal. Once again, I’d be sending you to an ENT evaluation.

A proper hearing test and audiogram would show “air conduction” AND “bone conduction” thresholds. Hence, we would know what segment of your loss is “conductive” and what segment is “sensorineural.” This is a critical thing to know. If there is a 15 dB gap between “air” and “bone,” I would be sending you to an ENT evaluation.

If you’ve had a full ENT evaluation in the past and can explain to me your pathology and that medical interventions were not an option you wanted or were not possible, then I might fit you with a hearing system. Even so, I’d suggest we send your clinic record with me to your ENT to be a part of your medical file.

I’d want to see a “tympanogram” on your ears. This is where we measure the “compliance” of your TM (tympanic membrane, aka “ear drum”) under increasing air pressures. Not every retail hearing clinic has or does tympanometery. Basically, a tymp-reading gives me a confirmation of what is really going on in your middle-ear-cavity. It confirms the presence of a middle-ear pathology. If there truly IS a middle-ear pathology, it confirms that, indeed, you need an ENT evaluation.

Some patients “feel like” they have fluid in the middle ear when the truth is they don’t. The “tymp” tells the tale. The “air/bone gap” I mentioned earlier tells a similar tale. Either way, when we get an “abnormal” reading (via tymp or air/bone gap) it should result in an ENT evaluation.

In most U.S. states, our licensure requires us to make such an ENT referral when certain conditions are identified. “Fluid” and “air/bone gap” are within those parameters. We call them “red flag” conditions.
Speaking frankly, some providers in the industry can be, shall we say, hesitant to make ENT referrals. Most ENTs have a staff-audiologist who also sells hearing aids. So, when I (a local provider) make a referral to an ENT, there is a chance the ENT’s audiologist will “poach” the patient and sell the new hearing system instead of me. Smart providers, like me, build a strong relationship with a few ENTs where they gladly evaluate the patient without “poaching.”

Now the truth is, every local provider should always make the referral – regardless of a possible “poach” – when conditions warrant a referral. This is how I train providers in our company. “Do the right thing, always.” When we live up to the highest standards of personal and professional ethics, I believe we build our local practice. It’s a long-term view. Call it “karma” if you will. Or, “what goes around, comes around.” Or, for the spiritually-minded, “God will not be mocked. Do the right thing, always.” Do not necessarily call me altruistic. What I am saying is truly good business. Do the right thing, always. Leave the results to God.

Did I mention that I think you might ought to go to an ENT about that fluid in the ear? 🙂