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Otology (Ear Disorders)

Ear wax
You cannot prevent ear wax, it is there to prevent bacteria from dirt and germs entering your inner ear. Some people naturally have more wax than others or it may be as a result of hairy or narrow ear canals, age (wax gets harder) or because of use of hearing aids or ear plugs which may push wax further in. Ear wax should usually fall out on its own without the need for intervention but if it doesn’t, it can cause blockage of the ear giving rise to symptoms which include earache, hearing loss, itchiness, dizziness, tinnitus and infection of the ear.

Balance disorders

There are a variety of reasons that can give rise to problems with balance but it may be as a result of vertigo, which is a condition giving rise to the sensation of the surroundings moving in relation to the patient, or the patient moving in relation to the surroundings. Vertigo is a condition which is directly linked to the inner ear and the majority of those that suffer from it as a result of inner ear complications, will recover without treatment in time.
Sometimes, dizzy spells can occur for extended periods of time which less common. Meniere’s Disease or endolymphatic hydrops can be a cause of severe vertigo attacks. These kind of attacks are usually also linked to vomiting, the sufferer is often aware of the onset of an attack due to a sudden loss in hearing, sensation of fullness in the ear and/or tinnitus.
Severe vertigo lasting days to weeks may be a result of inner ear infection (labrynthitis) or inflammation of the balance nerve (vestibular neuronitis).

 

Tinnitus

Tinnitus is the sensation of noise, often ringing, hissing, whistling or buzzing, in one or both ears, inside the head or in a person’s immediate environment. In some people, the sound is constant, for others it is constantly changing and can even take the form of musical sounds or indistinct speech. Tinnitus may be experienced in conjunction with a hearing loss, dizziness, pain, aversion to loud noises and a feeling of the ears being blocked. In some cases, tinnitus is a result of ear damage but equally, people with normal ears and hearing can be affected. For some people, tinnitus is attributable to a sound which is real, generated inside the body by the flow of blood or muscular activity.

Ear infections

Ear infections which usually give rise to symptoms including pain or earache, discharge from the ear which may be smelly or blood-stained, hearing loss, dizziness and tinnitus (noises). In children the only clues of ear infection may be tugging of the ear and/or fever.
Outer ear infections (otitis externa) are very common and refer to infection of the skin of the ear canal, they can be extremely painful and cause disturbed sleep. Outer ear infections are common in people who suffer from other skin conditions such as eczema, psoriasis and dermatitis but also in people who swim regularly or who have narrow ear canals.
Middle ear infections (otitis media). Infection of the middle ear is very common, particularly in children, with symptoms including severe earache, fever and associated hearing loss. If the eardrum bursts releasing pus, the pain in the ear will generally ease with the eardrum generally repairing itself once infection subsides and hearing returning to normal. If infection is frequent, problems may occur long term as a result of damage to the eardrum, or loss of hearing resultant from fluid behind the eardrum, also known as glue ear. Chronic or persistent middle ear infection can be more serious, often associated with smelly ear discharge and deafness, but rarely pain. Less frequent but significant symptoms are tinnitus, facial weakness and dizziness and in such cases treatment will usually involve surgery to remove infection from the middle ear and mastoid bone, ignoring such symptoms can be dangerous. The mastoid bone surrounds the ear, acute infection of it is known as mastoiditis and these days is much less common however it does still occur, especially in very young children. Mastoiditis must be treated urgently with antibiotics.
Inner ear infections are less common and usually caused by viruses, occasionally as a result of secondary bacterial infection. Symptoms of inner ear infection are dizziness and sudden loss of hearing. The most common cause of inner ear infection is probably the common cold virus however other viruses such as mumps, measles and herpes can also be a cause for sudden hearing loss.
The majority of ear infections are treated with antibiotics prescribed by your GP, but in some cases referral to a specialist may be required.

Chronic suppurative otitis media

Middle ear infections (otitis media). Infection of the middle ear is very common, particularly in children, with symptoms including severe earache, fever and associated hearing loss. If the eardrum bursts releasing pus, the pain in the ear will generally ease with the eardrum generally repairing itself once infection subsides and hearing returning to normal. If infection is frequent, problems may occur long term as a result of damage to the eardrum, or loss of hearing resultant from fluid behind the eardrum, also known as glue ear. Chronic or persistent middle ear infection can be more serious, often associated with smelly ear discharge and deafness, but rarely pain. Less frequent but significant symptoms are tinnitus, facial weakness and dizziness and in such cases treatment will usually involve surgery to remove infection from the middle ear and mastoid bone, ignoring such symptoms can be dangerous. The mastoid bone surrounds the ear, acute infection of it is known as mastoiditis and these days is much less common however it does still occur, especially in very young children. Mastoiditis must be treated urgently with antibiotics.

Hearing problems

How the ear works
Sound enters and travels along the ear canal to the ear drum, causing it to vibrate which in turn causes the ossicles (little bones) to vibrate. The ossicles bridge the gap between the ear drum and the cochlea (inner ear/hearing organ). The vibration of the ossicles causes the fluid inside the cochlea to move. This causes hair cells within the cochlear to vibrate resulting in an electrical signal that stimulates the nerve endings. These signals are then transmitted to the brain where it is perceived as sound.
What causes hearing loss?
Hearing loss is common and can affect people of any age, it is estimated that 16% of UK adults have some form of hearing loss. Half of the over 75 population is thought to be affected by hearing loss, and children are the next most commonly affected group. Any form of hearing loss can make normal communication with others a struggle.
A range of conditions which affect the outer, middle or inner ear that can result in deafness or hearing loss. Types of deafness can be categorised according to where in the ear the problem occurs. There are two types of hearing loss; one is known as conductive hearing loss and is due to problems with the transmission of sound through either the outer ear (ear canal, eardrum) or the middle ear (hearing bones/ossicles) to the cochlea (hearing organ), and the other is known as sensorineural hearing loss which is due to problems with the cochlea itself and the auditory (hearing) nerve that connects the cochlea to the brain.

 

Conductive Hearing Loss

When sound waves are not reaching the ear drum, perhaps due to wax blocking the ear canal, or the vibrating mechanisms of the ear drum or ossicles not working correctly as a result of current or previous infections, conductive hearing loss occurs due to sound waves not being converted into movements by the ear drum and the ossicles. Conductive hearing loss can be caused for a number of reasons including blockages caused by ear wax, previous or current infections, build-up of fluid, trauma or fixation of the small bones (ossicles) of the middle ear (ostosclerosis). Damaged ossicles as a result of infection can result in conductive hearing loss, one such condition is called cholesteatoma whereby infected skin has grown around the ossicles restricting movement and connections, another such condition is otosclerosis where the stapes bone becoming attached to the surrounding bone, which stops the transmission of sound. Conductive hearing loss can usually be treated and hearing corrected or improved.

Sensorineural Hearing Loss

There are many causes of this type of hearing loss. Problems with the inner ear or with the nerve that carries signal from the inner ear to the brain, result in sensorineural hearing loss. Problems are most commonly resultant from old age (presbyacusis), as a result of loss of sound sensing cells in the cochlea (hair cells), both ears are normally affected to the same degree and it is often associated with tinnitus. Other conditions that affect the inner ear are viral infections, trauma, side effects from certain medications and congenital causes. Excessive noise exposure (industrial noise damage or exposure to excessively loud music) can also cause sensorineural hearing loss). Some inner ear problems are reversible but as a rule, the hearing loss caused by the problem is permanent. In rare cases, the hearing loss may be caused by a tumour impacting on the hearing nerve of the brain.

Sensorineural hearing loss gives rise to difficulties in hearing conversations properly, particularly where there is background noise with frequent complaints being the sounds of a conversation but discrimination of what is being said is not possible. Feelings of frustration and isolation are common. It is not uncommon for people to have problems discriminating speech in their 30s, particularly from regular exposure to loud noise for example from nightclubs.

There is no complete cure for sensorineural hearing loss however, hearing aids can amplify or increase sounds being sent to the middle ear which will partially overcome the hearing loss.

If you experience sudden hearing loss you should seek medical advice immediately, treatment for sudden deafness sometimes requires fast treatment.

Deafness

Hearing loss

Neurotology

Neurotology is the study and treatment of neurological disorders of the ear, the term used to describe the treatment of inner ear conditions, or hearing or balance disorders. Otology generally refers to treatment of middle ear disease and conductive hearing loss.

Otoneurology

Otitis Media (glue ear)

Middle ear infections (otitis media). Infection of the middle ear is very common, particularly in children, with symptoms including severe earache, fever and associated hearing loss. If the eardrum bursts releasing pus, the pain in the ear will generally ease with the eardrum generally repairing itself once infection subsides and hearing returning to normal. If infection is frequent, problems may occur long term as a result of damage to the eardrum, or loss of hearing resultant from fluid behind the eardrum, also known as glue ear. Chronic or persistent middle ear infection can be more serious, often associated with smelly ear discharge and deafness, but rarely pain. Less frequent but significant symptoms are tinnitus, facial weakness and dizziness and in such cases treatment will usually involve surgery to remove infection from the middle ear and mastoid bone, ignoring such symptoms can be dangerous. The mastoid bone surrounds the ear, acute infection of it is known as mastoiditis and these days is much less common however it does still occur, especially in very young children. Mastoiditis must be treated urgently with antibiotics.

 

Dizziness

Fainting attacks, heart problems, thyroid problems and brain problems can all result in feelings of light-headedness and general imbalance.