Treating neurological disorders of the ear

Another major advancement in the treatment being provided by the ENT Unit of the Anuradhapura Hospital is neurotology – the treatment of neurological disorders of the ear.

“Neurotology involves the inner ear and its neural connections located at the base of the skull. Under neurotology services, ENT Surgeons along with Neurologists and Audiologists work together to diagnose and manage ‘balance’ and ‘hearing’ disorders,” says Consultant ENT Surgeon Dr. Daminda Dumingoarachchi.

The record of the Anuradhapura ENT Unit is impressive in other spheres as well. Being provided equipment to expand its audiology service by adding neonatal hearing screening, the audiology laboratory has been able to clear the long waiting lists by reducing the screening time from 45 minutes per child to five minutes. It has plans to implement a universal hearing screening programme at the hospital, next year.

Meanwhile, under the ‘balance’ service, the unit provides physiotherapists with training in vestibular rehabilitation.

However, Dr. Dumingoarachchi laments that the unit is facing major issues with regard to space availability for audiology and vestibular assessment.

Currently, the Sunday Times sees, balance assessment being performed in a temporary, partitioned area in the ENT clinic corridor. What the unit needs urgently is a separate audio-vestibular laboratory attached to the ENT clinic to accommodate neonates, mothers and patients with balance and hearing disorders. “We need only an additional room close to the ENT clinic, along with a nurse and a second audiology technician,” he says.

Pointing out that the unit has the potential to implement cochlear implant surgery for the benefit of children in the North Central Province next year, Dr. Dumingoarachchi adds that what they also need is adequate operating-theatre time and more Anaesthetists.

The ‘usual’ and ‘objective’ hearing (audiological) tests performed at the unit include:

– Seated in a sound-proof room, the patient wears ear-phones through which are delivered tones at different pitches and levels. The patient is requested to press a button whenever he/she hears the tones and the response is recorded to determine his/her hearing. Tympanometry – A small ear-piece is used to cause pressure and play a sound in the ear canal. This test can determine whether there are any problems in the middle ear. The same test may be used to check out acoustic reflexes, the reflex of middle-ear muscles to pressure and loud sound. A sound is given out and the cochlear (hearing) and cochlear-nerve functions as well as the brainstem function are checked out. These tests include Otoacoustic Emissions (OAEs) as a screening and a diagnostic test; Electrocochleography (ECoG); Auditory BrainStem Response (ABR) as a screening and a diagnostic test; and Auditory Steady State Response (ASSR).

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