Question
I've had 3 patients in the last 8 months who have consistently complained that their hearing aids brought about a constant urge to cough or clear their throat. I assumed it was from vagus nerve in the ear canal, but I even after I tapered and shortened the canals of the hearing aids to the point where there was only a small ''stump'' that did not make contact anywhere in the canal, they still complained. One of them gave up on wearing the hearing aids. Any insight?
Answer
There is no easy solution to the problem, assuming the physical attributes of the hearing aid have been addressed. While cleaning cerumen from the ear canal, many patients will cough or have an urge to cough. This occurs due to the nerve innervation in the external auditory canal which originates from a division of the Vagus Nerve (Arnold's Nerve). The other division lies in the posterior pharynx; and when the canal is stimulated, the reflexive response is a cough. Arnold's nerve is located inferiorly in the canal, along the tympanomastoid suture line. The external auditory canal also receives innervation from the Auriculotemporal branch of the Mandibular Nerve (5th cranial nerve), branches of the 9th cranial nerve, 7th cranial nerve, and from greater and lesser auricular branches of the upper cervical nerves.
Regarding medical and surgical solutions to this problem, the type and degree of hearing loss is an issue, as is the amount of difficulty the patient is dealing with, as is the patient's desire to solve the problem.
Topical anesthetic agents will create moisture in the canal and subsequently in the hearing aid or ear mold, so that is not an ideal option.
However, the ear canal can be injected with xylocaine inferiorly, and if this eliminates the cough one could consider a canalplasty. This would involve elevating the skin in the ear canal, circumferentially removing bone in the ear canal and returning the skin to the canal. This would take about 30 minutes in the operating room under general anesthesia. This procedure would disrupt the neural innervation to the canal and thus, solve the problem.
Another option, depending on the type and degree of hearing loss, is to consider an implantable middle ear hearing aid. CLICK HERE TO LEARN MORE ABOUT MIDDLE EAR IMPLANTS.
BIO: Douglas Beck, Au. D completed his fellowship at the House Ear Institute in Los Angeles, California in 1985. Dr. Beck worked at Loyola Medical Center of Chicago, IL, and was Director of Audiology at St. Louis University Medical Center in St. Louis, MO before starting a private practice in 1997. He left St. Louis in 2001 to become President and Editor-in-Chief of Audiology Online, Inc.
Wes Krueger MD is the Medical Director for Healthy Hearing.Dr. Krueger received his Medical Degree from the University of Texas Medical School at Houston, Texas. He then completed his Surgical Internship and Residency in Otolaryngology-Head and Neck Surgery at the University of Texas Affiliated Hospitals, Hermann Hospital and M.D. Anderson Hospital and Tumor Institute, in Houston,Texas. During this period of time, he also was a Research Project Investigator at M.D. Anderson Hospital and Tumor Institute, Section of Head and Neck Surgery. After finishing his residency, Dr. Krueger then completed a clinical fellowship in Otology/Neurotology/Skull Base Surgery, at the Otologic Medical Group and House Ear Institute, in Los Angeles,California. He presently is in private practice in San Antonio, Texas, where is practice is limited to Otology/Neurotology/Skull Base Surgery.
Dr. Krueger serves also as a Clinical Associate Professor, Division of Otolaryngology, at the University of Texas Medical School in San Antonio. He has many professional memberships and has been involved in numerous investigational research activities. He has served on the Editorial Review Panel for the Journal of Otolaryngology-Head and Neck Surgery and been the Instructor for numerous Otologic/Neurotologic Surgical Courses. Dr. Krueger has also published numerous papers in his specialty.