World Class Treatment In Your Hometown
Dr. Bruce MacDonald
Education & Training:
Dalhousie University Medical School (Halifax, Canada)
Otolaryngology – Head & Neck Surgery
Dalhousie University Medical School (Halifax, Canada)
University of Pittsburgh Department of Otolaryngology
American Board of Otolaryngology – Head & Neck Surgery
Conditions I Treat:
Hearing loss is exceptionally common. You can have hearing loss from nerve damage (sensorineural hearing loss) or from issues with the eardrum and ear bones conducting sound to your hearing nerve (conductive hearing loss). Sensorineural hearing loss is often treated with hearing aids at early levels and cochlear implants at more advanced levels. Conductive hearing loss can often be treated with outpatient surgery, depending on the reason for the loss.
Eardrum perforations are exceptionally common. When they don’t heal on their own, drain, or cause hearing loss a surgical procedure is often required to fix the eardrum. Often this can be performed with a new technique and small camera that eliminates the need for any external incision or downtime from work or school.
Cholesteatomas are skin cysts that become trapped behind the eardrum. They cause drainage and hearing loss. Over long periods of time they can often erode the hearing bones and cause worsening of hearing loss.
Sometimes the hearing bones can stiffen over time, causing hearing loss because the vibrations of sound aren’t efficiently conducted to the hearing nerve.
Cerebrospinal Fluid Leak
Sometimes patients can develop small holes in the lining of bone between the ear and the brain. While the cause is often unknown, we believe that small amounts of increased pressure sustained over years can gradually cause the bone to wear down. Sometimes portions of the brain can protrude into the ear with the spinal fluid leak, which we call an encephalocele.
Acoustic Neuroma/Vestibular Schwannoma
Acoustic neuromas are benign tumors that arise from the nerves that connect the ear to the brain stem. They are often found in patients with hearing loss in one ear. They most commonly come from the balance nerves and are therefore also known as vestibular schwannomas. These tumors are commonly observed and no treatment is needed unless they grow, cause significant symptoms, or are causing brain compression. If treatment is needed, both surgery and radiation are possible options, depending on the specific tumor.
Skull Base Tumors
In addition to acoustic tumors, a variety of other tumors can form at the junction between the ear and the brain. These can cause different symptoms, which may include hearing loss, dizziness, facial weakness, facial numbness, and voice changes. This often depends on the type of tumor, the size of the tumor, and the structures it is compressing. Examples of these tumors and growths include: meningiomas, epidermoid tumors, gliomas, juvenile xanthogranulomas, hemangiopericytomas, endolymphatic sac tumors, and cholesterol granulomas.
Vertigo is the perception of motion that is not occurring. There are a variety of causes of vertigo. Identifying the cause of vertigo is the most important step as it greatly impacts the treatment. When vertigo comes from the inner ear an otologist can help with treatment and management. Common examples of this include benign paroxysmal positional vertigo (BPPV), Meniere’s disease, and vestibular neuronitis. When it is not associated with the ear often a neurologist is needed for treatment and management. Common reasons for this can include central vertigo, stroke, or migraine-associated vertigo.
Superior Semicircular Canal Dehiscence
One specific cause of vertigo is superior semicircular canal dehiscence. Some patients can have the bone over their balance organs get very thin over time. This can cause specific symptoms like hearing their own heartbeat, hearing loss, and significant dizziness with pressure changes. Patients can also have strange sensations like “hearing their eyes move.”
I specialize in neurotology, the division of otolaryngology dedicated to treating conditions involving the ears. Neurotologists provide medical and surgical care to individuals with ear infections, hearing loss, tinnitus (ringing in the ears), Bell’s palsy (facial drooping), dizziness and balance problems. We have a dedicated and skilled team of audiologists who provide the hearing tests required for accurate diagnosis. This includes special capabilities in testing children, even newborns. Electrodiagnostic testing is available for complicated cases. Vestibular testing is available for those suffering from vertigo, dizziness and imbalance with risk of falling. Facial nerve electrodiagnostic testing is used in the care of Bell’s palsy.
A large component of my practice involves care of chronic ear infections including cholesteatoma (a destructive skin cyst in the middle ear and mastoid). Middle ear surgery to improve hearing is done regularly, including stapedectomy for those with otosclerosis. We have an active cochlear implantation program for those with severe hearing loss who receive no benefit from hearing aids. This includes children with hearing loss from birth related to congenital malformation of the inner ear. Surgery is performed for some patients with facial nerve disorders, superior semicircular canal dehiscence, and intractable vertigo. Additionally, I collaborate with neurosurgeons and head and neck cancer surgeons in the surgical care of acoustic neuromas, cerebral spinal fluid leaks involving the ear, cancer of the ear and other uncommon conditions.
Medical care for sensorineural hearing loss related to age, noise exposure or other causes is provided. Investigation and care of patients with tinnitus is provided. Vertigo, dizziness and balance disorders including benign positional vertigo, Ménière’s disease and other causes are cared for.
I’m proud to work with resident surgeons/physicians, and medical students from the University of Tennessee Health Science Center on a daily basis. The physicians-in-training benefit from anticipating in the care of patients with a wide variety of otologic conditions, and the patients certainly benefit from this team approach and 24/7 access to emergency care. I’m interested in all aspects of otologic teaching and clinical research. I’m a quintessential “family man” and compete in Olympic style curling and target archery at the regional and national level.
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