Hearing Loss

Hearing difficulties are a common problem that affects both the young and old. Infants and young children often don’t realize they are having a problem and it falls to the parents and other caregivers to raise suspicion. Adults may notice a sudden change, which can constitute a medical emergency, or a more gradual change over many months or years.

Sometimes the problem is simple such as ear wax or middle ear fluid from a head cold. At other times, there is damage to the inner ear. This can result from noise exposure, recurrent infections, certain medical conditions or hereditary factors, just to name a few.

Although an evaluation may start with a screening test at work or in the primary care doctor’s office, a visit to an ear, nose and throat specialist is where the most comprehensive testing can occur. After examination, a complete audiologic evaluation is performed. This will determine the nature of the hearing loss and guide further testing or treatment. In my practice, these tests are performed by highly trained audiologists with master’s degrees. Older children and adults are evaluated in a hearing booth where they are asked to respond to sounds and words the audiologist introduces. We test infants and young children with both involuntary measurements (otoacoustic emissions) and play testing.

Treatment may be as simple as improved techniques for listening, corrective surgery, or the use of hearing aids. Once the exact cause of the loss is determined, I can guide the patient. Although I do not dispense hearing aids, I can make a referral to highly skilled audiologists with state-of-the-art products.


Tinnitis is what patients often described as ringing, hissing, or a buzz in their ears. It may come on rapidly over days or weeks. The most common cause of tinnitus is hearing loss although this may not be appreciated by the patient. The reason is that the hearing loss often occurs at the high frequency range which is not used for hearing in everyday situations. Therefore, patients are unaware of the loss. Occasionally if the hearing loss is reversible, such as wax impaction or middle ear fluid, the tinnitus can be cured. It is not known exactly why people have tinnitus. A leading theory is that damaged hair cells in the inner ear are “leaking” input to the brain which interprets these distorted signals as the ringing. It is important to have an exam and audiologic testing to determine the cause of the tinnitus. Additional testing or imaging studies with MRI may be necessary to rule out any lesion or pressure on the acoustic nerve.

Unfortunately, for many people, there is no specific treatment for tinnitus beyond masking strategies to help cover up the annoying sound in the head. There are many products now sold on the Internet and in drugstores that make claims for treating tinnitus. These do not have any scientific validity and are typically a waste of money.


Dizziness can be a debilitating problem. The diagnosis can be complicated as there are many systems in our body that control our balance. Certainly, the inner ear helps us maintain an upright position and move without falling. Additional components to balance include eyesight, the balance parts of the brain, peripheral muscles, and joints. When there is a spinning type of dizziness, medically referred to as vertigo, an inner ear (vestibular) problem is suspected. As with other types of illnesses, the history provided by the patient is very important. The onset of symptoms, frequency of episodes, persistence of symptoms between acute episodes, as well as hearing loss, headaches, and tinnitus are all important aspects in diagnosing this problem.

The examination looks for clues as to the source of the imbalance. The vestibular (balance) part of the inner ear is connected to the hearing (cochlear) part of the ear. During the initial evaluation audiologic testing will be performed to look for weakness and imbalance between the two ears. Additional testing of the balance part of the inner ear (ENG/VNG) is utilized to help distinguish a brain source for the imbalance from an inner ear source. This test can help characterize the type of inner ear problem when this is the source. Common diagnoses include benign positional vertigo (which patients often call ‘crystals’), acute labyrinthitis, vestibular neuronitis, and Ménière’s disease. In select patients, imaging studies such as MRI and neurologic consultation may be indicated.

Depending on the diagnosis a variety of treatment modalities are possible. Medications to suppress dizziness symptoms or relieved excessive inner ear fluid may be prescribed. Sodium restriction can help when Ménière’s disease is diagnosed. Balance therapy can be prescribed for many vertigo problems with great success. Dr. Feld recommends Huntington Physical Therapy as a resource for vertigo and balance therapy.

The information posted on this page is provided as general, background information in the spirit of service to the reader. In no way should it be interpreted as medical advice. While the practice of Robert Feld, MD, LLC, attempts to convey accurate and current information on this site, this information may contain typographical errors, technical errors, or may at some point become out-of-date. You are advised to confirm the accuracy of any information presented on this site before relying on it in any way.

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When you make an appointment with Dr. Feld, you will see Dr. Feld, not a physician assistant or nurse practitioner.

(631) 673-6868