Hearing & Balance


A cholesteatoma is a benign skin growth that grows in the middle ear or on the bone deep in the inner ear called the petrous apex. These growths can form as a result of eardrum perforation, infection or direct trauma, a birth defect or an improperly functioning Eustachian tube. The Eustachian tube carries air from the back of the nose into the middle ear to equalize pressure. When the passage does not work properly, the air does not flow and is absorbed by the body, creating a vacuum. This is the most common cause of a cholesteatoma.

Cholesteatoma can result in fluid leaking from the ear, increased pressure in the ear and eventually hearing loss. Dizziness and muscle weakness in the face can also occur. If the growth gets big enough, it can break the bones in the middle ear.

An examination by an ear, nose and throat specialist can confirm the diagnosis of a cholesteatoma. Treatment usually involves a gentle but thorough cleansing of the ear, antibiotics and ear drops. Treating the symptoms helps keep the infection to a minimum and hopefully prevents growth. Larger cholesteatoma may require surgical treatment to remove the growth and eliminate the infection. Surgery is also done to preserve or restore hearing. The surgery is usually performed under general anesthesia and recovery usually takes a week or two.

Eustachian Tube Dysfunction

Ear pain is often caused by Eustachian tube dysfunction (ETD). The Eustachian tubes drain fluid from the middle ear, but if it builds up it may cause pain or hearing loss. ETD is likely to occur due to a cold or allergy that causes the tube to be swollen shut.

This condition may resolve on its own or with a little help by yawning, swallowing or chewing. If it does not improve in a few days or you have significant discomfort, your doctor may recommend taking a decongestant, antihistamine or nasal corticosteroid to promote an opening of the Eustachian tubes. In severe cases, surgery may be required to encourage drainage.

Eardrum Perforation

Eardrum perforation is a hole in the eardrum that is most often caused by a middle ear infection. It can also be caused by a sudden change in pressure caused by a loud noise, flying in an airplane or an object placed in the ear. If an object penetrates the eardrum, it can also sometimes fracture the small bones called ossicles within the inner ear.

Eardrum perforation causes severe pain and can also result in bleeding from the ear and hearing loss. The hearing loss can be severe if the ossicles are broken. A perforation is diagnosed by a doctor simply looking in the ear with a special instrument called an otoscope. A hearing test is also sometimes performed to verify hearing loss.

The most important treatment for a perforated eardrum is keeping the ear completely dry. Keeping water away from the ear usually allows it to heal by itself. Other treatment options include antibiotics and ear drops if the ear is infected. For rare cases when the ear does not heal within 2 months, surgery may be performed to repair the eardrum. This surgery, called tympanoplasty, can help heal severe injuries with hearing loss as well. Tissue from the back of the ear is placed underneath the remaining eardrum to provide closure. See Dr. Cohen immediately if you think you have a perforated eardrum.

Ear Wax

Ear wax, also known as cerumen, is a natural substance produced to protect the ear from damage and infections. It is produced in the ear canal and normally accumulates and then dries up and falls out of the canal. It rids the ear of dust or sand particles and repels water, which can cause infections. Without ear wax, our ears would be dry, itchy and unprotected.

Ear wax is made up of various different materials depending on materials found in the canal. The wax can be soft and almost liquid or firm and solid. It can consist of skin cells, bacteria and water. The production and clearing of ear wax is natural and self-sufficient, so cleaning should never be needed. However, ear wax tends to accumulate in the ear canal for a number of reasons. The ear canal may narrow from an infection, the wax may not be as soft or too much wax may have been produced. If an extreme amount of wax builds up, it may need to be cleaned, or lavaged, by Dr. Cohen. Ear drops may also be prescribed to soften the wax and allow it to be cleared out.

For more information about Hearing & Balance, contact our office at 818-609-0600 to schedule an appointment.

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