The ear is comprised of three main parts: the outer ear, middle ear, and inner ear. There are a wide variety of hearing-related issues which ENTs are commonly consulted on. These can include anything from ear wax and swimmer’s ear, to hearing loss, tinnitus and cochlear implants.
Hearing loss can occur for many reasons. Hearing loss may be genetic or due to medical problems, medications, trauma or environmental exposure. Overexposure to noise can cause permanent or temporary hearing loss. There has been increasing concern regarding the use of MP3 players in regards to hearing loss. Parents should also be aware that sound levels at rock concert can be damaging and that ear protection should be worn at any event where there is excessive noise.
Genetics often play an important role in hearing loss, particularly in the elderly. If an individual inherits genes that are defective, hearing loss, deafness or other health disorders may result. Hearing disorders may be inherited through autosomal dominant inheritance, autosomal recessive inheritance, X-linked inheritance, or mitochondrial inheritance.
If you have been experiencing hearing loss, you should be examined by an otolaryngologist and then you will likely have a hearing assessment from an audiologist. Hearing loss may be conductive in which case there is a problem with the ear canal, eardrum or the three bones connected to the eardrum. Sensorineural hearing loss, on the other hand, is caused by damage to the inner ear or auditory nerve due to aging, noise exposure, trauma, infection, illness or inheritance. Medical treatment or surgery can often help conductive hearing loss, but hearing aids are often needed for sensorineural hearing loss. Evaluation by a physician is first needed before obtaining hearing aids, and hearing aids should be custom-fitted to your ear and hearing needs.
Children with hearing loss are commonly referred to ENTs as they specialize in childhood hearing and ear problems. An ENT can help to determine if there is an underlying cause to the hearing loss and how it is best treated, whether with medication or surgery. There are a variety of treatments for hearing loss which may include eardrum ventilation tubes, hearing aids, cochlear implants, or surgery.
Hearing is commonly tested in infants soon after birth in the hospital or during their first month. Two types of tests are commonly used in infants and children. Otoacoustic emissions (OAE) uses a sponge earphone to detect whether or not the ear responds to sound correctly, while the auditory brain stem response (ABR) test measures the brain’s response to sound through electrodes which are placed on the head and ears. A newborn child with hearing loss may not awaken to loud noises, react to unexpected loud noises, turn toward your voice, or imitate sound.
There are a variety of factors which can lead to feelings of dizziness. Conditions like poor circulation, inner ear disease, certain medications, injury, infection, allergies, anxiety and neurological disease may cause an individual to feel lightheaded, unsteady, giddy or experience sensations of floating, vertigo or motion sickness. The sense of balance is affected by several parts of the nervous system. If the nervous system receives conflicting messages from the inner ear, eyes, the pressure receptors in the joints of the lower extremities and spine, or the muscle and joint sensory receptors, symptoms like dizziness and motion sickness may appear. Dizziness can be treated, but the underlying cause must first be identified.
Motion sickness is characterized by a feeling of nausea caused by motion. Some people experience motion sickness when riding on a boat, car, airplane or even a roller coaster. If you are prone to motion sickness, there are some things that you can do to improve your symptoms. Do not read when moving, sit in the front seat of the car and do not sit facing backward. You can also discuss taking medication with your doctor.
Otoplasty is a corrective surgery which “pins back” protruding ears. While these conditions do not affect the hearing, large or protruding ears can result in significant teasing for children. Otoplasty can be performed on children once the ears have reached full size which tends to occur around the age of five or six. During surgery, an incision is made in a well-concealed skin fold behind the ear. Through this incision, Dr. Rubinstein may remove skin and cartilage or trim and reshape cartilage. Permanent sutures are used to secure the cartilage in the new position. If necessary, the ear can also be reshaped, reduced in size, or made more symmetrical. Ear surgery can also improve ear deformities and torn earlobes.
Ear infections are not uncommon among children. Viral infections of the ear often resolve on their own while bacterial ear infections require treatment with antibiotics. In some cases, ear tubes may become necessary if ear infections or fluid in the middle ear become chronic and cause hearing loss or other problems.
Ear tubes (tympanostomy tubes, myringotomy tubes, ventilation tubes, pressure equalization tubes) are tiny cylinders which allow air into the middle ear when placed through the ear drum. Ear tubes may be placed on a short-term or long-term basis. The surgery to insert ear tubes is an outpatient procedure that takes just fifteen minutes or less to complete. Recovery is mild as there is little postoperative pain. After surgery, most patients find that their hearing loss is immediately resolved.
The most common type of ear infection is otitis media (OM) or middle ear infection. Either one or both ears may be affected. Ear infections may occur when the Eustachian tube becomes blocked due to cold, allergy or upper respiratory infection or the presence of bacteria or viruses. This can allow pus and mucus to build up behind the ear, resulting in the ear infection. While more common in children, ear infections can affect adults as well. There are a variety of symptoms which may include earache, hearing problems, ear drainage, fever, a feeling of fullness or pressure, nausea, vomiting, dizziness or loss of balance. Younger children may also exhibit ear pulling or scratching, crying or irritability.
Ear infections can be serious. In fact, they are the most common cause of hearing loss in children. Antibiotics are typically used to treat ear infections. If this is not effective, surgery may be required to place pressure equalizing tubes in the ears. Because ear infections commonly occur following viral infections like the flu and pneumonia, vaccinations can be an important part of managing ear infections.
Children in daycare have a greater exposure to germs, particularly upper respiratory tract viruses. For this reason, it’s estimated that children in daycare environments experience four times the incidence of otitis media than children not in daycare. For those whom daycare is a necessity, teaching children to wash their hands may help but illness unfortunately cannot be prevented.
Many individuals experience ear troubles from airplane travel. Rapid changes in air pressure may occur when flying and this may cause the ear to feel blocked. For comfort, the Eustachian tube must open frequently in order to equalize the changes in pressure. Fortunately, there are ways to unblock the ears and make flying more comfortable on the ears, particularly during take-off and landing. Swallowing triggers the muscles that are responsible for opening the Eustachian tube. Sucking on hard candies or chewing gum will make you swallow more. Yawning is also a good practice. If these are not effective, you can gently blow air out your nose while pinching the nostrils shut and this should unblock the ears. If your ears are still bothering you after landing, decongestants and nasal sprays can help. Babies and children are particularly vulnerable to blockages and sucking on a pacifier or drinking from a bottle can help.
In normal amounts, earwax is healthy as it has self-cleaning and anti-bacterial properties and helps to lubricate and protect the ear. Problems with earwax may occur if there is too little, too much or a blockage of ear wax. When there is too little or no earwax, the ears may feel dry and itchy. An earwax blockage may occur from probing the ear with a cotton-tipped applicator or other instrument that pushes the wax deeper. While healthy ear canals should never need to be cleaned, cleaning may become necessary if earwax accumulates and causes symptoms like earache, fullness in the ear, plugged ears, partial hearing loss, tinnitus, itching, odor, discharge or coughing. Ear blockages can be treated at home by placing a few drops of baby oil, mineral oil, glycerin or commercial drops in the ear. Irrigation or ear syringing can also be done at home with a commercial irrigation kit or at your doctor’s office. In addition, an ENT can manually remove excess earwax. This method is preferred if other methods have not been successful, for narrow ear canals, if the eardrum has a tube or perforation, or in individuals with a weakened immune system or diabetes. Cotton swabs and ear candles should not be used.
Autoimmune Inner Ear Disease, or AIED, is a rare inflammatory condition of the inner ear in which the body’s immune system mistakes cells in the inner ear for virus or bacteria and attacks those cells. Individuals with AIED may experience sudden hearing loss in one ear followed by progressive loss in the other ear; fullness in the ear; vertigo; and ringing, hissing or roaring sounds. AIED is often mistaken for otitis media until the second ear experiences hearing loss. Treatment may include steroids, prednisone, methotrexate, hearing aids, or cochlear implants.
Often referred to as “ringing in the ears”, tinnitus is a condition in which individuals hear noises such as ringing, roaring, clicking, humming or buzzing that is not attributed to an outside source. The main cause of tinnitus in younger people is exposure to loud noise, but tinnitus may also be associated with ear injury, wax build-up, certain medications, circulatory system problems, ear infections, and sinus infections.
While not uncommon in children, children generally do not complain of symptoms as they often believe symptoms to be normal. However, tinnitus can lead to psychological distress so it is important to have your child evaluated by your physician and an otolaryngologist if necessary. Most children who experience tinnitus outgrow the condition.
Swimmer’s Ear, also known as otitis external, is an infection of the outer ear structures caused by bacteria in water that gets trapped in the ear canal. Swimmer’s Ear may occur from swimming, bathing and showering. Temporary hearing loss can occur in severe cases.
A hole or rupture in the eardrum is known as a perforated eardrum. Symptoms may include decreased hearing, occasional discharge, and sometimes pain. Some perforations heal on their own while surgery is necessary in some cases.
Bacterial meningitis is most common in children with cochlear implants. Because of this, the Centers for Disease Control (CDC) recommends that children with cochlear implants receive pneumococcal vaccination. The CDC recommends these children receive the vaccination on the same schedule recommended for other at-risk groups. This schedule will vary with age and other factors and should be discussed with your physician.
Hyperacusis is a rare condition characterized by an increased sensitivity to normal sounds. This can be an uncomfortable and even painful condition as individuals have trouble tolerating everyday sounds like running tap water, rustling leaves, shuffling paper, driving a car, and so on. High frequency sounds can be especially bothersome. Hyperacusis may occur as a result of head injury, Lyme disease, ear damage, air bag deployment, viral infections of the inner ear or facial nerve, and temporomandibular joint disorder. Treatment may involve sound therapy to “retrain” the auditory processing center of the brain to tolerate everyday sounds. There is a strong connection between hyperacusis and tinnitus.
Otosclerosis is a condition in which abnormal bone growth occurs around the stapes bone, causing fixation of the bone. The stapes bone is one of the small bones of the middle ear and proper function of the ear requires that the stapes bone move freely. The primary symptom of otosclerosis is the slow progression of hearing loss. Other symptoms may include dizziness, problems with balance, and tinnitus. Otosclerosis can be diagnosed by an ENT. Treatment may include hearing aids, sodium fluoride, or surgery. Surgery to treat otosclerosis is called stapedectomy. During this procedure, hearing is restored or improved by removing part or all of the fixed stapes bone and placing a prosthetic device in its place.