Common Outer Ear Problems
A number of problems can obstruct the sound waves on their way to the inner ear. Problems of the outer and middle ear generally do not cause permanent damage and often can be overcome with self-treatments. The most common problems are earwax buildup, foreign objects lodged in the canal, a ruptured eardrum, or an infection that can cause a buildup of fluid in the middle ear. Earwax Blockage
Skin lining the outer portion of the ear canal contains glands that produce a waxy substance called cerumen which is more commonly known as earwax. Cerumen is a normal protectant of the ear. Its job is to defend against harm, trapping dust and other foreign objects before they can reach the more delicate tympanic membrane (eardrum). Wax also helps inhibits the growth of bacteria. Normally, earwax migrates to the external edge of the ear canal and falls away or is wiped off. However, sometimes more wax is produced than the ear can expel, causing it to accumulate in the ear canal. Generally, excessive earwax does not lead to hearing loss because it does not completely block the passageway. But many people insist on inserting a variety of objects into the ear canal on the assumption that they are cleaning the ear when in fact, they are introducing more potentially harmful microorganisms as well as risking damage to the delicate tissues and membrane. This action also pushes the wax farther into the passageway and impacting it. Impacted wax can reduce hearing by blocking airborne sound vibrations in the ear canal. Blockage can also induce earaches and tinnitus (noise like ringing, buzzing, or roaring in the ear). Foreign Objects-Occasionally, an object or an insect can become stuck in the ear. It may tickle, hurt, or give a feeling that the ear is plugged. Most can be removed without medical intervention; but if something is pushed too far into the ear, it may rupture the eardrum. If the object is clearly visible to an observer, it may be grasped with a pair of sterilized tweezers; but, if not, medical help should be contacted. If an insect is involved, it will instinctively crawl up rather than down. Therefore, if it is still alive, tilt the ear upward and place a few drops of oil into the ear. The oil will suffocate the critter so it can be washed out. Sometimes shining a flashlight into the ear will cause the insect to instinctively crawl towards the light, where it can be removed. Swimmer’s Ear
Otitis externa (swimmer’s ear) is an infection of the ear canal and the result of persistent moisture in the ear. As its name suggests, it most commonly occurs after frequent swimming, but it can result in combination with a mild injury to the skin in the ear canal. Such an injury can also occur from scraping the ear canal when trying to remove ear wax. Hair spray and dyes may also cause similar ear infections.
Common Middle Ear Problems
A variety of problems can affect the middle ear, including infections, cysts, tumors, and abnormal bone growths. These problems are frequently associated with hearing loss caused by a disturbance of either the eardrum or the tiny bones in the middle ear (malleus, incus, and stapes). Often, hearing can be restored with medical or surgical treatment; but if the problem extends to the inner ear, permanent hearing loss may occur. Middle Ear Infections
An inflammation or infection of the middle ear is known as otitis media. This condition is often associated with a cold, sore throat, or other respiratory infection that blocks the eustachian tube. A blocked tube prevents the middle ear from being properly ventilated, causing the inflammation and an accumulation of fluids such as pus and mucus. Bacteria from the nose and throat may travel through the lining of the Eustachian tube and infect the middle ear. Otitis media can occur at any age but is more common in children, partly because of the shape of the Eustachian tube, which is shorter and more horizontal than that of an adult. A more horizontal orientation means fluid is less likely to drain and more likely to accumulate. While fluid accumulation is not necessarily a problem, it is an ideal breeding ground for microorganisms that cause infections. Although the accepted course of treatment has been repeated doses of antibiotics, this is now proving not to be the best course of action. Sometimes fluid accumulation in the middle ear can reach a point where it obstructs the movement of the eardrum and the ossicles, causing conductive hearing loss. Too much fluid can also cause the eardrum to rupture. Pain results as the infection worsens, and is just one of several symptoms. Others include dizziness, loss of balance, nausea, vomiting, ear drainage, and fever. At times, pus and mucus may persist even after the infection has passed, causing recurring episodes of infection and persistent hearing loss. Food allergies, especially to wheat and dairy products, can be the cause of recurring middle ear infections. Chronic Ear Infection
Persistent middle ear infection is known as chronic otitis media and may occur as a complication of an acute case of otitis media. Sometimes a low-level infection will continue long after an acute episode, leaving the ear more vulnerable to future infections. The signs and symptoms of a chronic ear infection are often milder than those of an acute episode, but they can be more dangerous than an acute episode. If the Eustachian tube is consistently blocked, the tissues of the middle ear gradually thicken and become inflamed. The mucus that is normally secreted also thickens. A vacuum created in the middle ear by the blocked tube can deform or rupture the eardrum. As these changes occur, the structures of the middle and inner ear slowly deteriorate, causing permanent damage and hearing impairment. Infection can also spread to the bone behind the ear (mastoid process) and even to the brain. Usually medication is given which will clear up the problem. However, when this fails to work, an incision may be made in the eardrum to relieve pressure and help drain the fluid. Healing should occur in about a week and sometimes before all the fluid has drained out. To prevent this, the doctor may temporarily place a tiny ventilation tube into the incision. If significant damage has been done to the eardrum and ossicles, more extensive surgery may be required to remove infection tissue and repair these structures. This procedure is known as tympanomastoidectomy. Eardrum Problems
The tympanic membrane is a resilient, yet fragile structure subject to constant use and abuse. Two common problems are a ruptured eardrum and barotrauma. Both can result in hearing loss mostly caused by a disruption or distortion of the eardrum and prevents it from vibrating properly. Usually the loss is temporary.
- Ruptured Eardrum
This means that a tear or a perforation has occurred in the membrane as a result of an infection or a trauma. Chronic infections can also wear down the eardrum, creating a perforation on the surface. A blow to the head can also cause a perforation. Symptoms include an earache, partial hearing loss, tinnitus, and slight bleeding or discharge from the ear. In some cases, the ossicles in the middle ear may be damaged, resulting in more severe hearing loss. Usually, a ruptured eardrum heals by itself but larger ruptures may cause recurring infections.
- Barotrauma
It is also known as “airplane ear” because it results from a disparity between air pressure in the atmosphere and the air pressure in the middle ear. As the name suggests, this disparity of atmospheric pressure can occur during air flights or deep-sea dives. It can also happen when the Eustachian tube becomes blocked or fails to deliver air properly to the middle ear. An example of this would be when there is nasal congestion from an allergy or infection.
Normally, the Eustachian tube that connects the middle ear to the back of the nose and upper throat allows air to flow in and out of the middle ear during swallowing or yawning. This type of movement helps maintain equal air pressure on both sides of the eardrum. A more serious problem may occur if the air pressure change is extreme or blocked, causing the small blood vessels in the middle ear to rupture and bleed. Generally, barotrauma is not a serious condition and requires no treatment. There are little techniques to help avoid the problem or relieve it as soon as it happens. Taking a decongestant before flying or scuba diving is sometimes helpful (but be aware of the side effects of such medications, especially drowsiness if scuba diving). Sucking on a lozenge or chewing gum during a flight is a well-known remedy. Pilots have a method that works well for them: pinch the nostrils shut, inhale, and swallow. The pop in the ears is a sign that the air has gone through the eustachian tube to the middle ear. On occasion, if the condition persists, a physician may have to make a tiny incision in the eardrum to equalize air pressure and remove fluid from the middle ear. This procedure is known as myringotomy.
Common Inner Ear Problems
Sensorineural hearing loss involves damage to the inner ear, the auditory nerve, or the brain. For example, when some of the hair cells of the organ of Corti are damaged or other changes take place in the cochlea or to the auditory nerve, the electrical impulses are not transmitted as efficiently, resulting in hearing loss. Sensorineural damage is often permanent and the hearing loss irreversible. However, with the use of hearing aids and other assistive hearing devices and techniques, it is still possible to communicate effectively, even with a hearing impairment. Presbycusis-The most common form of sensorineural hearing loss is that associated with aging. This is known as presbycusis. As a person ages, the hair cells within the cochlea gradually wear out, causing a sensitivity loss to sound. Some adults may lose very little hearing as they age while others lose considerably more because of hair cell loss. Viral Infections-Such infections as measles and mumps are the major causes of hearing loss in children. The measles virus usually attacks cells lining the lungs and back of the throat. The mumps virus typically affects the parotid glands – one of three types of salivary glands – between the ear and the jaw. From these areas in the head, either infection can easily spread to the inner ear and destroy hair cells and nerve endings in the cochlea. Viruses may also travel through the bloodstream to the cochlea. Such other viral infections, as influenza, chickenpox, and mononucleosis, may also lead to hearing loss. Labyrinthitis-This is an inflammation of the inner ear that affects the cochlea and the vestibular labyrinth. The cochlea is vital to hearing and the vestibular labyrinth plays a role in balance and eye movement. If an inflammation affects only the vestibular labyrinth, it is known as vestibular neuronitis. The exact cause is unknown but often follows a bacterial ear infection or an upper respiratory viral illness. It may also occur after a blow to the head or it may occur with no associated illness or trauma. Signs and symptoms of labyrinthitis include dizziness, hearing loss, tinnitus, nausea, vomiting, and involuntary movements of the eyes. All of the hearing in the affected ear may be lost. To keep the condition from becoming worse, it is sometimes helpful to sit as still as possible and avoid sudden changes in position. Most of the time, the inflammation goes away on its own in a few weeks. If the underlying problem is bacterial, antibiotics may be prescribed. Presbycusis-This refers to age-related hearing loss. According to a survey conducted for the Centers for Disease Control and Prevention and the National Center for Health Statistics, about 30% of Americans 65 or older have hearing loss, whereas only about 3% under the age of 45 have hearing loss. Because there is much variation in how people age, its effects on the human body cannot be precise. Typically, some of the hair cells in the cochlea may be lost during the aging process. In addition, nerves may become a little slower at transmitting messages to and from the brain and the brain may not be as quick to interpret sounds. Initially, there is a loss of sensitivity to sounds with a higher frequency or pitch. This is because damage to the hair cells often occurs first at a location where high-frequency sounds are generally processed. At the same time, the ability to hear sounds with a low frequency may remain intact. Some sounds may even seem too loud. Presbycusis is sometimes accompanied by a ringing or buzzing in the ears, a condition known as tinnitus. The condition also makes it hard to hold a conversation in an area with background noise, as a busy store. Presbycusis tends to run in families, which means genetics may be involved and the onset of hearing loss can be earlier in some families than in others. Noise-This is another cause of sensorineural hearing loss because it can damage the inner ear. For many older adults, hearing loss is the result of a combination of aging and noise exposure over a period of years. The cumulative effect of a lifetime of noise can gradually affect the ability to hear. Noise-induced hearing loss may come as a result of a sudden explosion of sound or through gradual, prolonged exposure. If a sudden explosion of noise happens, hearing loss is noticed right away and may last a short or long time. However, with prolonged exposure, hearing loss may be so gradual and painless that it is hardly noticed until too late. Although noise-induced hearing loss cannot be restored, it can be prevented through the use of hearing protection devices. Other Factors
Some drugs known to be harmful to the hearing mechanism are said to be ototoxic. Other causes include disease, trauma, and genetic disorders.