Ear Surgery - Coastal Ear Nose & Throat
                     Know All About Ear Surgery
Diseases of the ear can affect hearing and balance and lead to  
significant functional problems for patients suffering from ear  
disease. The physicians and audiologists at Coastal Ear, Nose 
and  Throat understand the complex structure and function of 
the ear  and can evaluate, diagnose and treat your ear problem 
using  state-of-the-art technology including surgical and non-
surgical  management depending on the severity and nature of 
your  problem.
Our fellowship trained Neurotologist, Dr. J. Seth McAfee, as 
well  as an experienced staff, are equipped to handle the most 
difficult  cases with both medical and surgical management.
Types of Hearing Loss
Sensorineural Hearing Loss
Sensorineural hearing loss, also known as “nerve loss,” is a result of  
damage to the microscopic hair cells within the inner ear and/or to 
the  nerve of hearing. This damage can be due to genetics, advancing 
age,  or noise exposure. If you are worried about hearing loss, call us 
to get  an appointment with one of the doctors at any three 
locations:  Neptune, Holmdel or Manahawkin, New Jersey.
Approximately 90% of hearing losses are sensorineural. In fact, most  
people who wear hearing aids have sensorineural hearing loss. In 
most  cases, these types of hearing loss are permanent and cannot be 
treated  by medication or surgery. Hearing aids are thus the primary 
mode of  treatment. In cases of severe or profound cases, cochlear 
implants may  be a consideration.
Cont....
Types of Hearing Loss
Conductive Hearing Loss
A conductive hearing loss occurs when sound is not able to reach a healthy 
inner  ear adequately. This can be due to:
a blockage in the ear canal such as wax  
fluid in the typically dry middle ear 
space
poor movement of the bones (ossicles) 
located in the middle ear
conditions where people have malformed or absent ear canals and/or 
pinnae  (the visible portion of the ear on the side of the head)
Conductive hearing loss accounts for 5-10% of hearing losses and are 
generally  treated by medication or surgery.
Mixed Hearing Loss
Mixed hearing loss is a combination of both sensorineural (“nerve loss”) and conductive hearing losses which 
occur  simultaneously. Surgery, hearing aids and assistive listening devices are all treatment options.
Cochlear Implants
How do cochlear implants work?
Cochlear implants bypass damaged hair cells and convert speech and  
environmental sounds into electrical signals and send these signals to 
the  hearing nerve.
The implant consists of a small electronic device, which is surgically  
implanted under the skin behind the ear and an external speech 
processor,  which is usually worn on a belt or in a pocket. A microphone 
is also worn  outside the body as a headpiece behind the ear to capture 
incoming sound.  The speech processor translates the sound into 
distictive electrical signals.  These 'codes' travel up a thin cable to the 
headpiece and are transmitted  across the skin via radio waves to the 
implanted electrodes in the cochlea.
The electrodes’ signals stimulate the auditory nerve fibers to send  
information to the brain where it is interpreted as meaningful 
sound
What causes swimmer’s ear?
A common source of the infection is increased moisture trapped in the ear canal, bathing, or 
showering,  increased humidity or living in warm moist climates may also contribute to this common 
infection. When  water is trapped in the ear canal. Bacteria that normally inhabit the skin and ear canal 
multiply, causing  infection and irritation of the ear canal. If the infection gets worse it may affect 
other areas of the ear.
Swimmer’s ear needs to be treated to reduce pain and eliminate any effect it may have on your hearing.
Surfer's Ear
Coastal Ear, Nose and Throat can provide relief of symptoms 
from  surfer’s ear through a minimally-invasive procedure, 
performed  within the comfort of our own surgery center. Dr. 
McAfee, our  fellowship trained neurotologist, is the only 
surgeon in the tri-  state area that uses a minimally invasive 
procedure to remove the  painful bone growths that often 
develop with repeated bouts of  ear exposure to cold water and 
wind. With the use of surgical  osteotomes, bony growths are 
removed through the ear canal  without need for a drill or 
incision behind the ear. This procedure  may permanently 
correct common effects of surfer’s ear, resulting  in:
Hearing restoration  Other benefits of this minimally invasive 
Elimination of water procedure:  No overnight hospital stay
trapping More rapid healing and recovery for a quicker return to water sports  
Elimination of recurring ear Only mild discomfort, which can be treated with over-the-counter 
infection. pain  relievers
Meniere's Disease
What is Meniere's disease?
Meniere's disease also called idiopathic endolymphatic  
hydrops, is a disorder of the inner ear. Although the 
cause  is unknown, it probably results from an 
abnormality in  the fluids of the inner ear. Meniere's 
disease is one of the 
 most common causes of dizziness originating in the  
inner ear. In most cases only one ear is involved, but 
both  ears may be affected in about 15 percent of 
patients.
Ménière’s disease typically starts between the ages of 
20  and 50 years. Men and women are affected in 
equal  numbers.
Inner Ear Disorders
The ears are amazing organs that can receive and decipher a wide 
range  of sound. There are basically three sections to the ear: outer, 
middle, and  inner. They all work together to create hearing. Sound 
waves enter  through the outer ear. When they reach the middle ear, 
they cause the  eardrum to vibrate. Those vibrations are further 
transmitted through  three tiny bones in your middle ear to your inner 
ear. The inner then is  responsible for the nerve impulses that are sent 
to your brain, which  decodes them as the various sounds. In addition 
to its auditory role, the  inner ear also controls balance.
Benign Paroxysmal Positional Vertigo
Benign Paroxysmal Positional Vertigo, also known as BPPV, is a common form of vertigo, 
a  balance disorder caused by inner ear issues. Patients who suffer from BPPV may have 
brief  periods of vertigo that come and go. Although BPPV is not a life-threatening 
condition, it  should be evaluated by a doctor to ensure proper treatment.
Causes of BPPV
BPPV is caused by a problem with the inner ear. The inner ear contains tiny particles of  
calcium that stimulate nerve cells and help to maintain balance. When these particles shift 
or  are disrupted, vertigo may occur. BPPV may be caused by an infection or inflammation 
of the  ear that causes the calcium particles to shift, resulting in balance problems and 
vertigo.
Symptoms of BPPV
Patients with BPPV experience a sensation of tilting or spinning, although neither is actually  
occurring. In some cases, the vertigo may be brought on by a tilt or turn of the head. These  
sinycmlupdtoems mNaayu lsaesat  f or a few minutes at a time, and are usually mild. Additional symptoms 
:may Dizziness 
 
Vomiting
Difficulty 
standing 
or 
walking
What causes tinnitus?
Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. The health of 
these  nerve endings is important for acute hearing, and injury to them brings on hearing loss and often tinnitus. If 
you are  older, advancing age is generally accompanied by a certain amount of hearing nerve impairment and 
tinnitus. If you are  younger, exposure to loud noise is probably the leading cause of tinnitus, and often damages 
hearing as well.
There are many causes for “subjective tinnitus,” the noise only you can hear. Some causes are 
not  serious (a small plug of wax in the ear canal might cause temporary tinnitus). Tinnitus can 
also be  a symptom of stiffening of the middle ear bones (otosclerosis).
Tinnitus may also be caused by allergy, high or low blood pressure (blood circulation problems), 
a  tumor, diabetes, thyroid problems, injury to the head or neck, and a variety of other causes  
including medications such as anti-inflammatories, antibiotics, sedatives, antidepressants, and 
 aspirin. If you take aspirin and your ears ring, talk to your doctor about dosage in relation to 
your  size.
Treatment will be quite different in each case of tinnitus. It is important to see an 
otolaryngologist  to investigate the cause of your tinnitus so that the best treatment can be 
determined.
Dizziness and Motion Sickness
Feeling unsteady or dizzy can happen due to poor  
circulation, vertigo, injury, infection, allergies, or  
neurological disease. Dizziness is treatable but it is  
important for your doctor to help you determine the cause 
so  that the correct treatment is used. While each person 
will be  affected differently, symptoms that warrant a visit 
to the  doctor include a high fever, severe headache, 
convulsions or  ongoing vomiting, chest pain, heart 
palpitations, shortness  of breath, inability to move an arm 
or leg, a change in vision  or speech, or hearing loss.
Tympanoplasty
Tympanoplasty is reconstructive surgery for torn  
tympanic membranes (eardrums) or ossicles 
(middle ear  bones). Eardrum tears may result from 
chronic infection  or, less commonly, from trauma 
to the eardrum.
Tympanoplasty can also help to restore hearing, 
treat  certain types of deafness, and prevent middle 
ear  infections.
Tympanoplasty can be performed through the ear canal 
or  through an incision behind the ear. Tympanic 
membrane  grafting may be required in which a graft 
is taken from  tissue under the skin around the ear to 
reconstruct the  eardrum. The procedure is 
performed on an outpatient  basis under local or 
general anesthetic.
Ossicular Reconstrution
Ossicular reconstruction is performed to repair the bones of the middle 
ear  that are used for hearing. The middle ear bones may become 
damaged from  infection or from chronic retraction of the eardrum. 
This procedure often  accompanies tympanoplasty (surgical 
reconstruction of the eardrum).
The need for ossicular reconstruction is sometimes known prior to  
tympanoplasty surgery, but even when identified during surgery, ossicular  
reconstruction can usually be performed while reconstructing the eardrum. 
 Tympanoplasty with ossicular reconstruction typically requires an 
overnight  stay at the hospital.
Myringoplasty
Myringoplasty is the name of the surgical procedure that is used to repair a hole in the eardrum. When this 
procedure is  combined with a procedure to clear the middle ear of disease and further repair the eardrum, it is 
called tympanoplasty.
Myringoplasty is usually performed as an outpatient procedure or with one overnight stay. In most cases the patient is 
under  general anesthetic while the surgery is performed.
A cut is made behind the ear, or in some cases a small cut is made in front of the ear. Tissue from the area where the 
cut is  made is usually used to repair and cover the hole in the eardrum.
Repairing the eardrum can improve hearing, keep the ear dry, reduce pain, and prevent infection.
Cauliflower Ear (Auricular Hematoma)
How do you get a cauliflower ear?
Cauliflower ear is characterized by thickened, fibrotic scarring of the ear,  
giving it a cauliflower-esque appearance. Cauliflower ear is an acquired  
deformity (meaning you weren’t born with it) of the outer ear that is 
usually  caused by blunt trauma to the ear. The ear is not well protected 
against  blunt trauma. When it is struck by a punch or kick, for instance, 
the blood  supply to the skin and cartilage is disrupted, often forming a 
pocket of  blood (auricular hematoma). If the blood is not evacuated 
or drained in a  timely fashion, a fibrous, solid material results, causing 
scarring and  deformity of the ear known as cauliflower ear. Although it 
rarely impairs  hearing, the cosmetic deformity is quite difficult to repair 
if not addressed  immediately after the injury occurs. You can get 
cauliflower ear in other  ways such as accidents, physical altercations, and 
even an infected ear lobe  caused by piercing. This last example can lead to 
infection in the cartilage,  which can result in cauliflower ear.
What is Cerebrospinal Fluid Leaks
Cerebrospinal fluid (CSF) surrounds the brain and spine, and is encased in a  
membrane known as the dura. Sometimes, a CSF leak develops from a defect 
in  the dura, allowing fluid to leak from the nose or ear. CSF leaks can be 
caused by  head injuries, various surgeries, or spontaneously from high 
pressure inside the  skull.
Symptoms of Cerebrospinal Fluid Leaks
Symptoms of a CSF leak include a watery, clear discharge from the nose or 
ear,  and a headache that is more painful when standing upright than when 
lying  down. If accompanied by nausea, photosensitivity and a stiff neck, an 
infection  may be present. If a CSF leak is not repaired, serious and potentially 
fatal  complications, including meningitis or swelling of the brain, may arise
Diagnosis of Cerebrospinal Fluid Leaks
Diagnosis is usually based on the patient’s history of injury combined with a 
 focused physical examination. Necessary workup may include testing of 
fluid  samples, as well as various types of imaging, to include CT and 
MRI.
What is a Cholesteatoma?
An abnormal skin growth in the middle ear behind the eardrum is 
called  cholesteatoma. Repeated infections and/or and a tear or 
retraction of the  eardrum can cause the skin to toughen and form an 
expanding sac.
Cholesteatomas often devolop as cysts or pouches that shed layers of old skin,  
which build up inside the middle ear. Over time, the cholesteatoma can increase  
in size 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.
Symptoms and Dangers
Initially, the ear may drain fluid with a foul odor. As the cholesteatoma pouch or sac enlarges, it can cause a 
feeling of  fullness or pressure in the ear, along with hearing loss. An ache behind or in the ear, especially at night, 
may cause  significant discomfort. Dizziness, or muscle weakness on one side of the face (the side of the infected 
ear) can also  occur. Any or all of these symptoms are good reasons to seek medical evaluation.
An ear cholesteatoma can be dangerous and should never be ignored. Bone erosion can cause the infection to 
spread  into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, 
meningitis, and,  rarely, death can occur.
What are Earmolds?
Custom earmolds are made to specifically fit the size and shape of your  
individual ear, which provides for a more comfortable fit compared to 
many  over-the-counter options. The tighter, more accurate fit provides 
for a  better seal to protect against noise exposure or to keep water out 
of the ear.
An audiologist takes impressions of each ear using a silicone material; 
these  impressions are then sent out to an earmold manufacturer who will 
make  the molds specific for each order. Earmolds are available in various  
materials and colors. For children, it is recommended that they use  
earmolds attached to their hearing aids. Since their ears are constantly  
growing and changing in size and shape, the audiologist will need to  
monitor the fit of the earmolds at regular follow-up appointments.
What is ear canal stenosis 
 (atresia)?
Sometimes a child can be born without an external ear canal. 
This  is called aural atresia. In other cases, the child has a 
narrowed ear  canal, where the eardrum can still be viewed but 
the canal is  narrower than normal. This condition is called ear 
canal stenosis.  These conditions can affect one or both ears.
Patients with atresia and no ear canal have hearing loss. The 
same  is often true of ear canal stenosis, although at times 
hearing can be  normal depending on the severity of the 
stenosis. In both  conditions, the inner ears and auditory nerves 
are generally  normal. In the cases of hearing loss, surgery to 
either create or  widen the ear canal is necessary. This surgery is 
referred to as  canaloplasty or atresiaplasty.
What Is Otitis Media?
Otitis media means inflammation of the middle ear. The inflammation occurs as a 
result of  a middle ear infection. It can occur in one or both ears. Otitis media is the most 
frequent  diagnosis recorded for children who visit physicians for illness. It is also the 
most common  cause of hearing loss in children. Although otitis media is most common 
in young children,  it also affects adults occasionally. It occurs most commonly in the 
winter and early spring
months. 
What Are The Symptoms Of Otitis Media?
In infants and toddlers, be on the lookout for any of the following symptoms:
Pulling or scratching at the ear, especially if accompanied by the 
following...  Hearing problems or crying, irritability or fever
Vomiting  
Ear 
drainage  
Earache
Feeling of fullness or 
pressure  Hearing problems
Dizziness or loss of 
balance  Nausea and/or 
vomiting  Ear drainage
Fever
Know About Earwax
Good intentions to keep ears clean may be risking the ability 
to  hear. The ear is a delicate and intricate area, including 
the skin  of the ear canal and the eardrum. Therefore, 
special care  should be given to this part of the body. Start by 
discontinuing  the use of cotton-tipped applicators and the 
habit of probing  the ears.
What can I do to prevent excessive 
 earwax?
There are no proven ways to prevent cerumen impaction, but not 
 inserting cotton-tipped swabs or other objects in the ear 
canal is  strongly advised. If you are prone to repeated wax 
impaction or  use hearing aids, consider seeing your doctor 
every 6 to 12 months  for a checkup and routine preventive 
cleaning.
What is a Vestibular 
 Schwannoma?
A vestibular schwannoma, sometimes referred to as acoustic neuroma, is 
a  benign tumor found on the vestibularcochlear nerve, the nerve that  
connects the ear to the brain. This nerve is behind the ear, right under the 
 brain. This type of tumor is typically very slow- growing, and it may 
press  against the nerves controlling hearing and balance as it grows. An 
acoustic  neuroma is an uncommon cause of hearing loss. If the 
tumor remains  small, many patients will remain asymptomatic. 
However, if it enlarges  enough to exert serious pressure on the brain, it 
may become life-  threatening.
Contact Us
Coastal Ear, Nose and Coastal Ear, Nose and Coastal Ear, Nose and 
Throat  - Neptune Throat  - Manahawkin Throat  - Holmdel
Address: 3700 Route Address: 1301 Route 72 Address: 100 
33 Neptune, NJ 07753 Unit 340 Commons
(732) 280-7855 (main) Manahawkin, NJ Way #210
(732) 280-7815 08050 Holmdel, NJ 07733
(609) 978-0590 (732) 280-7855
(732) 280-7815 (732)-280-7815
To Know More About Ear Surgery, Visit Us:
https://coastalearnoseandthroat.com/services/ear-
surgery/