The clinical practice and research focus of Joseph T. Breen, M.D., centers on diseases of the ear and nearby structures of the skull base. Tumors, infections and altered anatomy of this area can be treated by delicate microsurgical procedures that can greatly improve quality of life.
Many of the important frontiers of research in ear surgery relate to diseases and symptoms caused by high cerebrospinal fluid pressure, also called intracranial hypertension. These conditions include cerebrospinal fluid leaks, encephaloceles, superior semicircular canal dehiscence, sigmoid sinus wall problems and pulsatile tinnitus. Dr. Breen seeks to better understand the mechanisms of and treatments for these conditions through novel imaging techniques and computational models.
- Pulsatile tinnitus. Several conditions can cause sounds generated by one's own heartbeat, also called pulsatile or pulse-synchronous tinnitus. Noise created by blood flow near the ear competes with other external sounds and can be distracting or distressing. Pulsatile tinnitus is often caused by irregular or uncovered blood vessels near the middle ear or mastoid. Pulsatile tinnitus caused by these vessels can be eliminated by surgery in some cases. Dr. Breen seeks to better understand mechanisms of how pulsatile tinnitus is generated, with the goal of developing more-effective and less invasive treatment options.
- Imaging of the temporal bone. As the quality and availability of CT and MRI scans continue to improve, surgeons have greater ability to diagnose diseases of the ear and temporal bone as well as predict findings at the time of surgery. Dr. Breen has researched and described novel uses of CT, MRI and ultrasound to better diagnose a variety of temporal bone pathologies, including cerebrospinal fluid leaks. One of his long-term research goals is to develop noninvasive means to measure intracranial pressure with MRI scans.
- Cochlear implantation. Cochlear implants can restore hearing and quality of life for many people who do not receive enough benefit from hearing aids. Every year brings technological improvements and more scientific evidence supporting the use of cochlear implants. Dr. Breen's research interests include the use of imaging and large clinical data sets to optimize hearing outcomes and better understand who can benefit most from cochlear implants.
Significance to patient care
Pulsatile tinnitus can be much more than an occasional annoyance for patients. While many causes of pulsatile tinnitus are benign, the symptom can signal some conditions that are a threat to function or even to life. The ability to accurately diagnose causes of pulsatile tinnitus can help ear surgeons offer treatments that improve their patients' quality of life.
Additionally, the mechanisms of how intracranial hypertension sometimes leads to pulsatile tinnitus are not well understood. Further investigation of these changes to blood flow around the ear and brain will hopefully lead to more-accurate and less invasive means to diagnose intracranial hypertension. Untreated intracranial hypertension doesn't cause symptoms for some, but for others it can lead to headaches or vision loss and can even be life-threatening in severe cases.