What is dizziness?

Dizziness is a condition in which the patient’s ability to orient him or herself in space is altered. This condition can lead to symptoms of vertigo (spinning or abnormal sense of motion), imbalance, or sense of lightheadedness. This can occur as a result of inner ear, brain or a combination of these and other disorders. Dr. Lieberman will work with you to determine the best possible solution for your balance problems.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo or dizziness. Symptoms consist of brief episodes of spinning, lasting less than 30 seconds, that occur when an individual lies down in bed, sits up from bed, rolls over in bed or tilts the head forward or backward.

How is benign paroxysmal positional vertigo diagnosed?

If the condition is not resolving spontaneously, treatment can include a procedure called an Epley maneuver to reposition the otoliths within the inner ear. The calcium deposits are repositioned in the inner ear through a series of head movements. This allows the otoliths to settle into an inert position in the inner ear. Occasionally the Epley maneuver may need to be repeated in order to be fully effective.
Although BPPV is a benign condition, other types of vertigo can represent more serious underlying inner ear or neurological conditions. All vertigo should be evaluated by Dr. Lieberman to differentiate between benign and more serious causes of dizziness.


Tinnitus (Abnormal Sensation of Sound)

What is tinnitus?

Tinnitus is an abnormal sensation of sound when there is no actual physical cause. The most common causes of hearing loss and tinnitus in adults are noise exposure and age-related loss (presbycusis). In some cases, tinnitus can occur without significant hearing loss, due to head injury or other factors. Tinnitus can arise from neck and jaw muscle tension and occasionally from side effects of certain medications. The unrelenting noise can cause the individual significant mental anguish. The severity of tinnitus often decreases over time but in some cases may remain permanently bothersome.

How is tinnitus evaluated?

Patients with tinnitus undergo a full ear, nose and throat evaluation in addition to testing such as an audiogram. Further studies such as MRI or CT scan may be ordered in certain cases.

What treatment is available?

Since the majority patients with tinnitus have hearing loss as the cause, the most effective treatment for the tinnitus is to reduce or eliminate the hearing loss. In some cases, surgery can restore hearing. In most cases, however, the hearing loss is not surgically correctable, so a hearing aid is the most effective treatment. Most patients with tinnitus tend to find the condition more bothersome in a very quiet situation such as when trying to fall asleep. The trick is to not be in a silent environment. “Masking” is the technique of covering up tinnitus with background noise (e.g. TV, radio, fan, sound machine, etc.) to make it less apparent and is often quite effective. There are numerous other treatments that are often offered by various facilities, but unfortunately, they are not usually of much help.



What is earwax and why do we have it?

Excessive earwax, or cerumen, is not a glamorous topic, but it is one of the most common reasons for a trip to the ear, nose and throat doctor. Wax impacted in the ear canal most commonly leads to ear blockage and hearing loss, but can also cause pain, and sometimes contribute to infection and dizziness. Removing the wax impaction generally leads to rapid relief of these symptoms.

Specialized glands in the skin of the outer half of the ear canal secrete wax into the ear canal. The wax serves a number of functions. Among these are lubrication of the skin of the canal, assisting in cleaning foreign debris from the ear canal, and protection against invasion of the skin by bacteria and fungi. The skin of the ear canal migrates slowly outward, dragging wax and any adherent particles toward the ear opening. When this mechanism is functioning as intended, the ear canal should be “self-cleaning.”

How does a wax impaction develop?

Wax becomes impacted in the ear for a variety of reasons. Probably the most common cause is the habit of using Q-tips to try to clean the ears. This is an extremely common routine for many people, but has the tendency to create the opposite and unintended effect of actually pushing earwax deeper into the ear canal, where it builds up and becomes impacted. Wax buildup also occurs more commonly when hearing aids or earplugs are used, since these also may interfere with wax migrating out of the ear canal. Sometimes, the consistency of a particular individual’s wax, or the condition of the ear canal skin may promote wax buildup.

How do you “clean” the ears?

Most individuals are best off leaving the ears alone, rather than taking routine steps to “clean” the ears. Since the ears are designed to be “self-cleaning”, avoiding Q-tips and other similar objects goes a long way toward avoiding the tendency of these objects to tamp down the wax against the eardrum. The most expeditious way to deal with excessive or impacted earwax is to see your ENT doctor to have it taken care of. There are three basic ways to remove the earwax…curettage (debridement with a tiny metal loop), suctioning and irrigation.

“Over the counter” wax removal drops can be tried, but are frequently ineffective and often result in ear infections.