Audiometry is the electronic testing of hearing ability. You will sit in a special room wearing earphones and be asked to respond when you hear a noise through the earphones. These tests can measure your hearing levels as well as other aspects of hearing such as the ability to recognise speech against background noise. It is possible to do your own accurate hearing assessment if you have an iphone and apple ear buds, using the free Mimi app from the app store. This can be really useful in emergency situations although the app does not do speech testing or tympanometry. Tympanometry uses sound and air pressure to check middle ear function. A small, soft probe is placed in your ear for a few seconds and a computer measures your ears response to sounds and pressure emitted through the probe. This test is often carried out in young children to assess for glue ear. Otoacoustic emissions are tiny sounds made by a normally functioning ear, which are detectable with a small soft tip probe in the ear. These are very useful to help assess hearing in young children.

This is inflammation or infection of your middle ear (the space behind your eardrum) and is often associated with a build-up of fluid in your middle ear. Acute Otitis Media For the most complete information, please click on the link below, which will take you to my website. Acute otitis media is usually caused by a temporary malfunction of the Eustachian tube, usually following an acute viral upper respiratory tract infection (such as a cold or the 'Flu). The Eustachian tube connects the middle ear to the nose and allows air to enter the middle ear, thus making middle ear pressure the same as air pressure outside the head. Acute otitis media results in an infection in the middle ear causing pain, fever and a red, bulging eardrum (the thin, transparent membrane between the outer ear canal and the middle ear). This condition is usually seen in young children, but can also be seen in adults. The treatment may be pain relief and/or antibiotics. If there are repeated episodes, surgical insertion of grommets into the eardrums may be required. Grommets are tiny ventilation tubes that allow normal airflow into the middle ear until the Eustachian tube begins to work normally. The operation is done under general anaesthesia (your child is asleep) and takes 10-15 minutes. This procedure can be performed under local anaesthetic in adults. Most grommets fall out naturally after six to eighteen months, by which time the Eustachian tubes are often working properly. Otitis Media with Effusion (Glue Ear) Like acute otitis media, glue ear is usually the result of a temporary malfunction of the Eustachian tube and may either follow an episode of acute otitis media or occur on its own. The condition is usually seen in children. Fluid is present in the middle ear and the ear is not usually painful, the ear drum is not red and bulging and there is no fever. Glue ear may lead to hearing loss, which can result in speech delays, and balance problems. Treatment usually involves a hearing test followed by observation for a period of weeks or months if the hearing is not affected too much. If the hearing is reduced on the hearing test, grommets are usually recommended. Chronic Otitis Media If the Eustachian tube is blocked repeatedly over a period of several years, there may be changes to the tissues of the middle ear such as deformity of the ear drum and damage to the bones of the ear. These changes may result in hearing problems, balance problems, and persistent discharge from the ear. If such long term damage has occurred, an operation called a mastoidectomy may be required. This involves making an incision (cut) behind your ear, drilling through the mastoid bone and removing, and possibly repairing, damaged tissues. For further information about otitis media please click here.

When the growth of one of the tiny bones in your middle ear, the stapes, changes from hard to soft and spongy, it leads to the condition called otosclerosis. As this abnormal growth develops, the stapes becomes more rigid or fixed in position. The stapes needs to be able to vibrate to allow sound vibrations to pass through to the inner ear. When the stapes is not vibrating as well as it should, gradual hearing loss can occur. Otosclerosis may occur in one or both ears and may sometimes be associated with ringing/clicking/buzzing noises in your ear (tinnitus). The condition will be diagnosed by examination of your ear after an assessment of the history of the hearing loss, examination and hearing testing. Sometimes a CT scan of the ear may be needed. Otosclerosis most often develops during teenage and early adult years and it tends to run in families. The condition can become worse during pregnancy. Treatment There are several different approaches to treating otosclerosis. Hearing aids work very well for many people with otosclerosis. A surgical option is a surgical procedure called stapedectomy is also available. This is a microsurgical procedure (microscopic lenses are used to help the surgeon see the tiny structures involved) usually performed through the ear canal. A small cut (incision) is made in the ear canal near the eardrum and the eardrum is lifted, exposing the middle ear and its bones. Part of the stapes bone is removed using a laser, and an artificial prosthesis inserted to help transmit sound into the inner ear. The eardrum is then folded back into position. The surgery is most often performed under general anaesthetic (you sleep through it). You will be advised not to fly, blow your nose or allow any water to get into your ear for about four weeks after the operation. For further information about otosclerosis please click here.

Hearing loss can be divided into two types: conductive hearing loss (caused by some sort of mechanical problem in the external or middle ear) or sensorineural hearing loss (caused by disorders of the inner ear, hearing nerve or associated brain structures). Conductive hearing loss is often reversible and can be due to: blockage of the ear by e.g. wax, inflammation, infections or middle ear fluid poor sound conduction because of e.g. holes or scarring in the eardrum or the bones of the middle ear (ossicles) becoming fixed and rigid. Sensorineural hearing loss is generally not reversible and can be caused by: genetic make-up (this could include congenital conditions i.e. those you are born with, or late-onset hearing loss) head injury tumours infections certain medications exposure to loud noises the aging process (a significant hearing loss is experienced by about one third of people aged over 70 years). Some of the signs you might notice that indicate you have a hearing loss include: having to turn up the volume on the TV or radio finding it hard to hear someone you are talking with finding it hard to hear in a group situation where there is background noise e.g. in a restaurant having to ask people to repeat themselves you find people's speech is unclear - they are mumbling Hearing loss can be partial (you can still hear some things) or complete (you hear nothing) and may occur in one or both ears. Treatment Treatments for hearing loss range from the removal of wax in the ear canal to complex surgery, depending on the cause of the loss. One of the most common treatments for hearing loss is the use of a hearing aid. The type of aid you get depends on the cause of your hearing loss and how bad it is, as well as what your preferences are in terms of comfort, appearance and lifestyle. For information about bone anchored hearing aids please click here. If your hearing loss is severe to profound, you may be suitable for a surgical procedure known as a cochlear implant. In this procedure, a small cut (incision) is made behind your ear and a device is implanted that can bypass the damaged parts of your ear. The surgery usually takes 2-3 hours and is performed under general anaesthesia (you sleep through it). You may be able to go home the same day or have to spend one night in hospital. For further information about cochlear implants please click here.

This is a slow-growing, benign (non-cancerous) overgrowth of tissue on the nerves that affect your hearing and balance. When the neuroma is small, there may either be no symptoms or you may have a slight hearing loss or mild tinnitus (ringing/clicking/buzzing noises in your ear). As the neuroma grows and exerts pressure on the nerves, there will be a more noticeable loss of hearing, more tinnitus and problems with balance. The condition is diagnosed using hearing tests and MRI scans. Acoustic neuromas are usually found only in one ear and generally occur in people over 40 years of age. Treatment If the neuroma is small and not causing significant problems, you may not require any treatment but the growth and effects of the neuroma will be monitored regularly. If treatment is being considered, surgery to remove the growth is usually recommended. For some, radiotherapy may be an option. For larger neuromas that are causing significant problems, surgical treatment may be suggested. Depending on the size of the neuroma, there are several different types of operation that can be performed. Whatever surgical approach is used, it will be performed under general anaesthetic (you will sleep through it) and you will probably remain in hospital for about one week.

Prominent ears may cause children significant psychological distress. Prominent ears are readily improved with a usually straightforward surgical procedure. Cuts (incisions) are made behind the ears through which the cartilage in the ear can be reshaped. Usually, fine dissolving stitches are used to hold the newly shaped tissues in place. For further information about surgery for prominent ears please click here.

In the facial bones surrounding your nose, there are four pairs of hollow air spaces known as sinuses or sinus cavities. These sinuses all open into your nose, allowing air to move into and out of the sinus and mucous to drain into the nose and the back of your throat. If the passage between the nose and sinus becomes swollen and blocked, then air and mucous can become trapped in the sinus cavity causing inflammation of the sinus membranes or linings. This is known as sinusitis. Sinusitis can be: acute - usually a bacterial (or sometimes viral) infection in the sinuses that follows a cold, or an allergic reaction. chronic - a long term condition that lasts for more than 3 weeks and may or may not be caused by an infection. Sinusitis can be a recurrent condition which means it may occur every time you get a cold. Symptoms of sinusitis include: facial pain or pressure nasal congestion (blocking) nasal discharge headaches fever. Treatment for bacterial sinusitis is antibiotics and for non-infective sinusitis may include steroid nasal sprays and nasal washes. If this treatment is unsuccessful, surgery may be considered. This is usually performed endoscopically; a tiny camera attached to a tube (endoscope) is inserted into your nose. Very small instruments can be passed through the endoscope and used to remove abnormal or obstructive tissue thus restoring movement of air and mucous between the nose and the sinus.

Snoring is the harsh rattling noise made by some people when they sleep. Snoring occurs when the flow of air through the back of the mouth and nose becomes partially blocked and structures such as the tongue, soft palate (the back part of the roof of the mouth) and uvula (the tag that hangs at the back of the mouth) strike each other and vibrate. Causes of snoring include: nasal polyps; a bend in the nasal septum (the partition running down the middle of the nose), large tonsils or adenoids, obesity, smoking, excess alcohol. Surgical treatment of snoring involves the removal of excess loose tissue in the throat or soft palate. For the management of snoring in children please see www.ear.co.nz - the section on tonsils.

When snoring is interrupted by episodes of totally obstructed breathing, it is known as obstructive sleep apnoea. The obstruction is caused by the relaxation of muscles that support the soft tissues at the back of the throat such as the uvula, soft palate, tongue and tonsils. These tissues then collapse and momentarily block the airway. Episodes may last 20 seconds or more and may occur hundreds of times per night. While you are not breathing, the levels of oxygen in your blood drop which causes your blood pressure to go up and adds strain to your cardiovascular system. In addition, you are likely to feel overly tired during the day and your work, driving and overall performance may be affected. The usual treatment for OSA is to wear a nasal mask that delivers pressurised air to keep the airways open while you sleep. This treatment is known as Continuous Positive Airway Pressure (CPAP).

Rhinitis is the inflammation of the lining of the nose (nasal mucosa). The most common symptoms are a blocked, runny and itchy nose. Rhinitis can be: allergic – either seasonal (hay fever) caused by pollen allergies or perennial caused by e.g. house dust mite, pets. infectious – e.g. the common cold non-allergic, non-infectious – caused by irritants such as smoke, fumes, food additives In the case of allergic rhinitis, the specific allergen (the thing that you are allergic to) may be identified by skin prick tests. This involves placing a drop of the allergen on your skin and then scratching your skin through the drop. If you are allergic, your skin will become red and swollen at the site. Treatment of allergic rhinitis involves avoiding the allergen if possible, but if not possible then corticosteroid nasal sprays and antihistamines are the usual medications prescribed. In order to help the ability to breathe through the nose, sometimes a reduction in the size of the "inferior turbinates" may be recommended. The inferior turbinates are humidifying tissues in the nose, which often swell in response to allergies.

Your tonsils are the oval-shaped lumps of tissue that lie on both sides of the back of the throat. Sometimes tonsils can become inflamed (red and swollen with white patches on them) as the result of a bacterial or viral infection; this is known as tonsillitis. If you have tonsillitis, you will have a very sore throat and maybe swollen glands on the side of your neck, a fever, headache or changes to your voice. In some cases, pus can be seen on the tonsils. Tonsillitis mostly occurs in young children and can be a recurrent condition (it keeps coming back). If the tonsillitis is caused by bacteria, antibiotics will be prescribed. If the tonsillitis is caused by a virus, treatment will usually consist of medications to relieve symptoms such as a pain killer. If tonsillitis occurs often over a period of two or more years, then surgical removal of the tonsils (tonsillectomy) may be considered. For further information about tonsillitis please click here.

A myringoplasty is an operation to repair a hole in the ear drum ("perforated ear drum"). For further information about this procedure please click here.

Microtia means "small ear". Atresia means "not formed" - in this situation applying to the ear canal. For further information about this condition, please click here.

A cholesteatoma is a skin growth that occurs in an abnormal location inside the middle ear behind the eardrum. Ear canal skin "sheds" just like the skin in any other part of the body; cholesteatomas often take the form of a cyst or pouch lined by ear canal skin. This collects the layers of shed old skin and builds up inside the ear. Over time the cholesteatoma can increase in size or become infected and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare, but can result from continued cholesteatoma growth. For further information on this condition, please click here.

Deafness is most commonly due to malformation of or damage to the hearing organ of the inner ear and its tiny hair cells, which detect sound waves. This may occur during development in the womb, or at any stage in the first few years of life. Much less common causes of deafness involve abnormalities of the ear canal, ear drum or hearing bones. For further information about deafness in children please click here.

Dr Brown is one of the most experienced Exostosis/Surfers Ear surgeons in New Zealand and has excellent and consistent operating results, including protection and maintenance of the hearing. He consults with and operates on patients from all over New Zealand. Exostoses are smooth, bony bulges or knobs in the ear canal which are initially symptom free, but progressive growth causes water trapping in the ear which may lead to painful and difficult to treat ear canal infections. They are caused by cold water and air entering the ear canal which is protected by only a very thin layer of skin over the bone which grows with cumulative exposure to the cold. As this is a progressive condition, the time until symptoms develop depends on cumulative time spent swimming, surfing, windsurfing, water skiing and kite surfing. Typically, this affects men in their 30s onwards and because of our long coastline and relatively cool water, is very common in New Zealand. People may present with difficulty clearing water from the ear, often having to resort to shaking the head or hopping. Water trapping predisposes to ear canal infections which may be very slow to settle as the ear canal is narrowed further by inflammation in the canal skin, making it even more difficult to clear infected debris. Usually temporary hearing loss and/or ringing in the ears may result until the infection settles. In the non-infected state, one may see multiple smooth, pale prominences in the canal. Treatment is generally by prevention. This involves using ear plugs for all cold water sports. “Blue tac” works well, but "Surf Ears" ( bought online) or “Doc’s Pro Plugs” (available from audiology clinics) generally allow one to hear better while wearing them. Audiologists can also custom make ear plugs. Neoprene hoods or “ear wraps” (also available from audiology clinics) are also both protective and may prevent loss of ear plugs. Alcohol ear drops are good to use after water exposure. These help displace moisture and evaporate quickly, leaving a slightly acidic protective residue. A good alternative, if you are travelling and forget to take alcohol drops with you, is vodka or gin! Otitis externa is treated with antibiotic steroid drops, and may also require the ear/s to be suctioned free of debris. Generally “Sofradex” antibiotic drops are a good first line, but if the bacterium pseudomonas is suspected (because of its green tinged discharge, odour, history of recent swimming pool use or because of a swab result) Ciproxin HC drops or ciloxan would be a good choice. When is surgery needed? Surgical treatment is necessary when the exostoses are symptomatic with water trapping or ear infections are not easily manageable with ear drops and or ear plugs. If the exostoses are large and if on-going cold water exposure is anticipated, surgical treatment may also be recommended. Many surfers don’t like wearing ear plugs and should have large exostoses removed before too many problems begin. Surgery is a safe and effective treatment for exostoses and involves elevating the ear canal skin off the exostoses and then drilling them away. The skin is then replaced and held in place with a dressing while it heals. Operations are performed on a day stay basis and are tailored to the individual. We can do minimally invasive "chisel" removal down through the ear canal for moderate size exostoses, and for severe exostoses a discrete cosmetic incision is made tucked into the crease behind the ear and a combination of chisel and micro drill is used. Discomfort is mild afterwards, and the ear needs to be protected from water from 4-12 weeks ( depending on the procedure best suited). After exostosis surgery, all should use ear protection from the cold to minimise the risk of the exostoses re growing. Dr Brown can do telehealth/video consultations for you if you live away from Auckland and have good quality photos of your ear canals taken by an audiologist or your GP, and a diagnostic hearing test. Consultations and surgery are usually both covered by health insurance. For more information Click here