Ear disorders are characterized by improper function of a person's ear. The ear is important because it sends messages to the brain that allow a person to hear sounds and sense their balance. As a result, patients with ear disorders may be unable to hear sounds properly, or they may feel dizzy.
The ear is divided into three parts: the outer, middle, and inner ear. Sound waves enter the outer ear and hit the eardrum. This causes the eardrum to vibrate. Behind the eardrum, in the middle ear, are three tiny bones: the malleus, incus, and stapes. When the eardrum vibrates, it signals these bones to transmit the vibrations to the hearing organ, called the cochlea, in the inner ear. Inside the cochlea, there are thousands of hair-like nerve endings, called cilia. When the cochlea vibrates, it causes the tiny cilia to move. The auditory nerves translate the vibrations and send them to the brain, where they are interpreted as sound.
The middle ear is normally filled with air. It is connected to the back of the nose by the Eustachian tube. This tube is normally closed. However, sometimes (e.g. when a person yawns or swallows) it opens to let air into the middle ear and drain out any fluid. These tubes equalize pressure on either side of the middle ear.
If any part of the ear is damaged, infected, or not properly developed, it may result in an ear disorder. Some of the most common types of ear disorders include ear infections, glue ear, hearing loss and deafness, Meniere's disease, phonological disorders, and tinnitus (ringing in the ears).
Articulation disorders, auditory dysfunction, chronic cochleovestibular disorders, cochlear, deaf, deafness, ear infection, earache, ENT specialist, Eustachian tube, Eustachian tubes, glue ear, hearing loss, iodine deficiency, phonological disorders, presbycusis, tinnitus, ringing in the ears, sign language.
Overview: An ear infection occurs when a cold, allergy, or upper respiratory infection leads to the accumulation of pus, inflammation, and mucus behind the eardrum, blocking the Eustachian tube. This tube connects the middle ear to the back of the nose.
More fluid may collect and push against the eardrum, causing pain and sometimes a temporary or, in severe cases, a permanent loss of hearing.
Acute ear infections usually clear up after one to two weeks of treatment. Sometimes, ear infections last longer and become chronic (long-term). After an infection, fluid may stay in the middle ear. This may lead to more infections and hearing loss.
Although ear infections are most common in young children, they may also affect adults.
Causes: Ear infections can start with a bacterial or viral infection. In such cases,
the middle and/or outer structures of the ear become inflamed from the infection. Fluid may also build up behind the eardrum.
Bacteria cause about 65-75% of all ear infections. The most common types of these bacteria are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Viruses that may lead to ear infections include the respiratory syncytial virus (RSV), the most frequent type found, followed by influenza (flu) viruses.
Ear infections also may be associated with problems, such as swelling in the Eustachian tubes, the narrow passageways that connect the middle ear to the throat. Normally, these tubes equalize pressure inside and outside the ear. A child's Eustachian tubes are narrower and shorter than an adult's. This makes it easier for fluid to get trapped in the middle ear when the Eustachian tubes dysfunction or become blocked during a cold. It also provides a perfect breeding ground for infections. Also, just as the mucus in the nose becomes thicker and harder to expel, fluid inside the ear may also become thick and difficult to drain.
Another factor that contributes to ear infections is swelling of the small clumps of glandular tissue at the back of the nose (called adenoids). These are tissues located in the upper throat near where the Eustachian tubes connect. Adenoids contain lymphocytes, white blood cells that normally fight against infections. Sometimes the adenoids become infected or enlarged, blocking the Eustachian tubes. Infection in the adenoids may also spread to the Eustachian tubes, causing ear infections.
Children also do not have fully developed immune systems, so it is easier for them to develop many illnesses, including ear infections.
Symptoms: Ear infections are often difficult to detect in children because many children affected by this disorder do not yet have sufficient speech and language skills to tell someone what is bothering them. Common signs to look for include unusual irritability, difficulty sleeping, tugging or pulling at one or both ears, earache, fever, fluid draining from the ear, loss of balance, and unresponsiveness to quiet sounds or other signs of hearing difficulty. These signs may include sitting too close to the television or being inattentive. Fluid buildup in the middle ear also blocks sound, which can lead to temporary hearing loss.
If the pressure from the fluid buildup is high enough, it may cause the eardrum to rupture, resulting in drainage of fluid from the ear, which may include blood and thick, yellow pus. This releases the pressure behind the eardrum, usually relieving pain.
If there is fluid in the middle ear, it may feel similar to a sensation of ear fullness or "popping." The fluid behind the eardrum may block sound, so mild temporary hearing loss can happen, although it may not be obvious.
Possible complications include short- or long-term hearing loss, ruptured ear drum, and inflammation of the rounded protrusion of bone just behind the ear, called the mastoid bone. When the mastoid bone swells, it is commonly called mastoiditis.
Diagnosis: Ear infections are usually diagnosed after a medical history, physical exam, and ear exam. If a middle ear infection is suspected, a healthcare provider will use an instrument, called a pneumatic otoscope, to look at the eardrum for signs of redness, bulging, or fluid behind the eardrum.
Reflectometry is used if the ear exam with a pneumatic otoscope does not indicate that fluid is behind the eardrum. The tip of a small handheld instrument is placed in the ear canal. This instrument sends off a sound. How the eardrum reacts to the sound tells the doctor if fluid is present.
Tympanocentesis is performed when fluid stays behind the eardrum (chronic otitis media with effusion) or if an infection continues despite treatment with antibiotics. Tympanocentesis can remove the fluid. The doctor uses a needle to pierce the eardrum and suck out the fluid. A sample is usually tested for bacterial or viral growth. These tests reveal what kind of bacteria or virus is causing the infection and what medication is best for treatment. Patients may receive pain relievers or sedatives before the procedure.
Treatment: Ear infections can be treated several ways. The best treatment option for a patient depends on several factors, including the person's age, medical history, level of pain, and the type of ear infection. Most ear infections go away without treatment in just a few days, and antibiotics will not help an infection caused by a virus. About 80% of children with acute otitis media recover without antibiotics, according to the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).
If a patient (adult or child) is uncomfortable, the doctor may recommend an over-the-counter (OTC) pain reliever, such as acetaminophen (Tylenol® or Tempra®) or ibuprofen (Advil® or Motrin®). It is important to read the labels closely on these medications and give the proper dosage, especially in children and infants.
Ear drops are commonly used in both adults and children to relieve pain and inflammation. If fluid is not draining from the ear or ear tubes, prescription eardrops containing a local anesthetic (numbing agents) and anti-inflammatory drugs may be an option. Examples include benzocaine (Americaine Otic® or Otocain®) and antipyrine/benzocaine (Auralgan®, Auroto®, or Otocalm®). Ear drops containing neomycin and polymixin B (both antibiotics) are available for infections. These medications are also available as solutions and suspensions to treat a rupture.
If the individual is younger than six months or has two or more ear infections within 30 days or fluid remains behind the eardrum (chronic otitis media with effusion), the doctor may recommend an antibiotic. The AAP and the AAFP recommend the use of high doses and short courses of amoxicillin (Amoxil®, Trimox®) or amoxicillin combined with clavulanate potassium (Augmentin®) in individuals (including children) with otitis media. Erythromycin antibiotics (Eryped® or Erytab®) may also be used.
If fluid in the individual's ear is affecting his or her hearing or recurrent ear infections do not respond to antibiotics, surgery may be needed. The most common surgery for ear infections is a myringotomy. During this procedure, which requires general anesthesia, a surgeon inserts a small drainage tube through the eardrum. This helps drain the fluid and equalize the pressure between the middle ear and outer ear. Hearing should improve immediately. If the ear infections continue after age four, the surgeon may recommend removing the adenoids.
Prevention: Ear infections are more common in children who are exposed to cigarette smoke in the home. Even fumes from tobacco smoke on the hair and clothes may affect the child.
Breastfeeding a baby helps improve immunity and resistance to infections. This is because a mother's breast milk contains important proteins that improve a baby's developing immune system. The baby should be breastfed in an upright position to prevent the possibility of acquiring infections.
Individuals should talk to their doctors about recommended vaccinations. Although there is currently no vaccine for infections, many immunizations can prevent illnesses that may progress to ear infections.
Practicing good hygiene may also help reduce the risk of acquiring infections.
Overview: Glue ear occurs when the middle ear fills with a thick fluid that resembles glue. Different kinds of fluid may build up behind the eardrum, which ranges from yellow to white in color. The fluid weakens the vibrations of the eardrum, which may cause a patient to hear sounds quieter than they really are. One or both ears may be affected.
Although glue ear can affect anyone, it is most common in young children.
This condition usually goes away without treatment, and hearing returns to normal after several weeks to months. In some cases, the condition may come back in the future. However, as children grow older, glue ear becomes less common. It is considered rare in children who are older than eight years old. This is because the Eustachian tube widens with age, allowing the middle ear to drain properly.
Causes: The cause of glue ear is poorly understood. Experts believe it occurs when the Eustachian tube does not work properly. For instance, if the tube is blocked, does not open properly, or is too narrow, the amount of fluid and air in the middle ear is not regulated. Air in the middle ear may pass into the nearby cells if it is not replaced by air coming up the Eustachian tube. This may result in a vacuum-like effect in the middle ear, causing fluid to enter the middle ear from the nearby cells.
Some cases of glue ear develop after a child has a cold, illness, or ear infection that causes the body to make extra mucus. In such cases, the mucus builds up inside the middle ear and does not drain down the Eustachian tubes.
Symptoms: Symptoms typically last a few weeks, although sometimes they may persist for a few months. The main symptom of glue ear is dulled hearing. This temporary hearing loss is usually mild, but the severity can vary from day to day in the same person. Hearing loss is generally worst when the fluid is very thick. Older children may be able to communicate that they are having trouble hearing, while younger children may be unresponsive to normal sounds. Some children may experience a mild earache from time to time.
Because the thick fluid in the ear provides a good environment for bacteria to grow, children with glue ear have an increased risk of developing ear infections. Therefore, if a child experiences any of these symptoms, he/she should be taken to a doctor for a checkup.
Diagnosis: If glue ear is suspected, the child's doctor may recommend an ear, nose, and throat (ENT) specialist. A procedure called an otoscopy may be performed to determine if the child has glue ear. During the procedure, a doctor uses an instrument called an otoscope to look inside the ear drum. The doctor may see signs of trapped fluid and poor movement of the eardrum, which indicate glue ear.
A hearing test may also be performed. There are many different types of hearing tests available. During most tests, a child wears headphones and responds to different sounds.
Treatment: When a patient is diagnosed with glue ear, doctors typically wait to see if the condition improves on its own before starting treatment. The length of time a doctor might advise a patient to wait varies from weeks to several months.
If the condition does not improve on its own, a balloon treatment may be recommended. During the procedure, a child uses the nose to blow up a special type of balloon. This process, called autoinflation, increases the pressure in the nose, which may help open up the Eustachian tube and allows the fluid to drain. This procedure is repeated several times until the fluid is drained. Although this procedure does not cause any side effects, it is not effective in all cases.
If glue ear is persistent or severe, a minor operation may be recommended. During surgery, a small cut is made in the eardrum and fluid is drained. Then a ventilation tube is inserted into the ear. This tube (called a grommet) allows air to enter the middle ear. Hearing improves immediately. Grommets fall out of the ear as the eardrum grows (usually six to 12 months after surgery). Once the grommet falls out, the small hole in the eardrum heals quickly. In some cases, the small clumps of glandular tissue at the back of nose (called adenoids) may be removed.
Prevention: Because the cause of glue ear remains unclear, there is no way to prevent the condition. However, children who are breastfed and live in homes free of cigarette smoke may have a decreased risk of developing glue ear.
hearing loss and deafness
Overview: Hearing problems may be present at birth or may occur later in life. Hearing loss may be mild, resulting in difficulties with conversation, or as severe as complete hearing loss (deafness). Depending on the cause, one or both ears may be affected.
Causes: Experts believe that a person's biological makeup and long-term exposure to loud noises are the main factors that contribute to hearing loss. Frequent exposure to loud noises may damage the cochlea (ear organ), which can ultimately result in hearing loss. If hearing loss is caused by damage to the ears, the condition cannot be reversed. Sudden hearing loss might be caused by trauma to the ears or problems with blood circulation. If hearing loss occurs gradually, it may be caused by factors, such as aging, infections, tumors, or other diseases. It is normal for hearing, especially the ability to hear high-pitched tones, to decline with age.
Earwax buildup is a common cause of temporary hearing loss. Once the earwax is removed, hearing returns to normal.
Symptoms: The severity of symptoms varies among patients. Some patients may hear dulled sounds, while others may not be able to hear at all. Common symptoms include hearing muffled qualities of sounds, difficulty understanding people when they talk (especially when there is background noise), frequently asking others to repeat things and speak louder, needing to turn up the volume of the television or radio, and withdrawal from conversations. Babies with hearing loss may be unresponsive or less responsive than normal to sounds.
Diagnosis: If hearing loss is suspected, a doctor may recommend a specialized doctor, called an audiologist. The audiologists will ask questions about the patient's medical history and perform a hearing test called an audiogram to determine the severity of hearing loss. During an audiogram, the patient wears headphones and is exposed to various sounds that have different pitches and frequencies. The patient is asked to identify each time a sound is heard. The audiologist may also say various words to evaluate the patient's hearing ability.
Treatment: If earwax buildup is causing symptoms, a doctor will remove the extra earwax. First, the doctor places a few drops of baby oil, glycerin, or mineral oil into the patient's ears to loosen the wax. Warm water is then squirted into the ear. The patient then tilts the head and the water and wax drains out. This process may need to be repeated several times. Alternatively, a doctor may scoop out the wax with a small instrument called a curette. A suction device may also be used to remove loosened wax from the ears.
Individuals who experience hearing loss due to aging may benefit from hearing aids. These battery-operated devices are available in three basic styles: behind-the-ear aids, in-the-ear aids, and canal hearing aids. Patients should talk to their healthcare providers to determine the type of hearing aid that is best for them. A behind-the-ear device is used for mild to profound hearing loss. The device has a hard plastic case that is worn behind the ear and connected to a plastic ear mold that fits inside the outer ear. In-the-ear hearing aids fit completely inside the outer ear, and they are used for mild to severe hearing loss. Canal hearing aids are smaller hearing aids that fit inside the patient's hearing canal. They are used for mild to moderately severe hearing loss.
If hearing loss is severe, patients may benefit from cochlear implants. These electronic devices are surgically implanted inside of the ears. Unlike a hearing aid, which amplifies sound, a cochlear implant makes up for damaged parts of the inner ear.
Individuals who are deaf are often able to communicate with others by using sign language. It is best to begin teaching signs at a young age. A child's pediatrician can recommend programs that teach sign language.
Prevention: Some types of hearing loss can be prevented. People who are exposed to loud noises on a regular basis, such as construction workers, should wear protective ear muffs or earplugs. This helps prevent the eardrums from becoming damaged. Do not listen to loud music, especially when wearing headphones. Regularly remove earwax buildup to prevent temporary hearing loss. Do not use cotton balls or Q-tips to clean the ears because they may damage the ear. Regular hearing tests are also recommended. If hearing loss is diagnosed early, people can take steps to prevent further damage.
Overview: Sometimes hearing loss may lead to articulation disorders. Articulation disorders occur when an individual has difficulty pronouncing certain consonants or vowels correctly (such as the letters "s" and "r"). As a result, certain words are mispronounced. Patients with these disorders will omit, replace, or distort the sounds of vowels or consonants that they have difficulty pronouncing. A common type of phonological disorder is a lisp.
Causes: In many cases, the cause for phonological disorders is unknown. However, most of the time phonological disorders are not an immediate cause for concern. Phonological disorders are common in young children, but most of these children are able to pronounce words correctly by the age of five. Patients with phonological disorders who are older than five years old should visit their doctors. Sometimes phonological disorders are caused by hearing loss. Other potential causes include brain damage, brain disorders, or physical handicaps (such as a cleft palate or cerebral palsy). In other cases, the condition may be caused by poor coordination of muscles in the mouth or dental problems.
Symptoms: Patients with phonological disorders have difficulty pronouncing certain vowels or consonants. Patients may leave out certain sounds in words. For instance, they may say "at" instead of "hat." Patients may replace sounds that are difficult to pronounce with others. For instance, the letter "r" is often replaced with the letter "w." These patients may say "wunning" instead of "running." Finally, some patients may make distorted sounds when they try to pronounce certain words. A distorted sound may whistle, the air may come out the sides of the mouth causing a "slushy" sound or lateral lisp, or the tongue may thrust between the teeth causing a frontal lisp. Most children with phonological disorders are able to overcome this disorder without treatment by the age of five.
Diagnosis: Phonological disorders are common among young children. However, patients who are older than five years of age and have symptoms of the condition should visit their doctors. A speech pathologist will evaluate the patient for characteristic symptoms of phonological disorders. If hearing loss is the suspected cause of an articulation disorder, an audiogram (hearing test) will be performed.
Treatment: If hearing loss is causing articulation disorders, a doctor may recommend hearing aids or cochlear implants. Improving the person's hearing increases the effectiveness of speech-language therapy, which is considered the primary treatment for articulation disorders.
Speech-language pathologists, also called speech therapists or speech-language professionals (SLPs), evaluate, diagnose, treat, and help to prevent speech, language, communication, swallowing, and other related disorders. These professionals have been educated in the study of human communication. SLPs have earned Master's degrees and state certification/licensure in the field. They are also certified in clinical competency from the American Speech-Hearing Association.
During speech-language therapy, a qualified SLP works with the patient on a one-to-one basis, in a small group, or directly in a classroom to overcome speech disorders. Programs are tailored to the patient's individual needs. On average, patients receive five or more hours of therapy per week for three months to several years.
Speech pathologists use a variety of exercises to improve the patient's communication skills. Exercises typically start off simple and become more complex as therapy continues. For instance, the therapist may ask the patient to name objects, tell stories, or explain the purpose of an object.
The therapist may also help patients learn how to cope with some of their symptoms. For instance, the therapist may teach the patient to over-articulate words that are hard to pronounce or to pause before saying big words.
Speech pathologists help patients improve their stronger communication skills in order to enhance those that are weaker. For instance, the therapist may teach the patient how to improve their skills with gestures or body language.
Oftentimes, family members participate in therapy, serving as communication partners. This allows patients to practice their communication skills in a comfortable and supportive environment. This type of group therapy may include role playing, which allows patients to practice their language in social situations.
Prevention: Hearing loss increases an individual's risk of developing phonological disorders. Therefore, infants who are at risk of developing hearing loss should have their hearing tested. It is important that patients with speech disorders receive immediate treatment. Early diagnosis and treatment has been shown to increase an individual's long-term prognosis.
tinnitus (ringing in the ears)
Overview: Tinnitus is a medical term for ringing in the ears. Tinnitus is a common condition that affects millions of people. For some, symptoms may occur intermittently and they may only be mildly annoying. Others may have more serious symptoms that are persistent and cause people to seek medical help.
Tinnitus can affect anyone, but it is most common among elderly people. However, it is becoming increasingly common among young people who are frequently exposed to loud noises, such as music.
Tinnitus is a symptom of an underlying condition, such as age-related hearing loss or ear injury. Although the noise may be irritating, it is rarely a sign of a serious health problem.
Causes: Tinnitus occurs when the delicate hairs inside the ears (called cilia) become damaged. Normally, these hairs vibrate, which triggers nerve cells to send signals to the brain. These signals are then interpreted as sound. In patients with tinnitus, these hairs are bent or broken, and they move randomly because they are irritated. As a result, the person hears a ringing sound.
In most cases, the hairs become damaged as a result of age-related hearing loss (also called presbycusis), a condition that usually begins around the age of 60.
Long-term exposure to loud noises, such as chain saws, portable music devices, or construction equipment, may also damage the hairs.
Sometimes a medication may cause tinnitus. For instance, high doses of aspirin and some antibiotics have been shown to cause tinnitus. In such cases, symptoms of tinnitus often go away once the medication is stopped.
A head or neck injury may also damage the inner ear and cause tinnitus.
Some types of blood vessel disorders may cause a type of tinnitus, called pulsatile tinnitus. For instance, atherosclerosis (hardening of the blood vessels), high blood pressure, and narrowing of a carotid artery or jugular vein may lead to tinnitus.
Less commonly, tinnitus may be a symptom of a tumor in the neck or head.
Symptoms: People with tinnitus hear sounds, such as ringing, whistling, or buzzing, when no external sound is present. The pitch and volume of the sound varies among patients. For some, the noise may be subtle. However, for others, the noise may make it difficult to concentrate or hear properly. The sound may occur temporarily and last for a few days to weeks. In other cases, the sound may be permanent and continuous. One or both ears may be affected.
Diagnosis: A doctor first takes a detailed medical history and performs a physical examination. It is important for patients to tell their doctors if they are taking any medications, herbs, or supplements because these could be the cause the condition. If tinnitus is suspected, a doctor may recommend an ear, nose, and throat (ENT) specialist.
An ENT specialist will examine the inside of the ear to determine if the inner ear is damaged. The doctor will also put a stethoscope up to the patient's ear to see if he/she can hear the abnormal noise as well. If only the patient can hear the noise, it is called subjective tinnitus. If the doctor is able to hear the noise as well, the condition is caused by a vascular disorder, and it is called pulsatile tinnitus. In such cases, the noise that the patient (and doctor) hears is turbulent blood flow in the patient's blood vessels.
Treatment: Treatment of tinnitus depends on the cause. If a medication is the suspected cause of symptoms, a doctor may recommend a different dose or type of medicine. However, patients should not stop taking their medications or change dosages without first talking with their doctors.
If tinnitus is caused by an underlying medical condition, symptoms may improve once treatment is started. For instance, patients with tinnitus that is caused by high blood pressure may experience an improvement in symptoms after they start taking blood pressure-lowering drugs.
If tinnitus is caused by age-related hearing loss, there are no treatment options to reduce the noise. Instead, a doctor may recommend lifestyle changes to help manage the symptoms. For instance, nicotine, caffeine, tonic water, alcohol, or high doses of aspirin should be avoided or limited because they may worsen symptoms of tinnitus. These substances reduce blood flow to the structures of the ear, which may aggravate symptoms. Listening to a quiet background noise, such as a fan or low-volume music, may help mask the noise in the ears. Patients are encouraged to manage their stress because stress may constrict blood vessels and reduce blood circulation, which may subsequently worsen symptoms of tinnitus. Simple relaxation techniques may help reduce stress. Because fatigue may also worsen symptoms, patients are encouraged to get plenty of rest.
Several medications have been suggested as possible treatment options for patients with tinnitus, but their effectiveness is unclear. Some doctors have prescribed tricyclic antidepressants, such as nortriptyline or amitriptyline, but they have had varying affects. For some patients, side effects of these medications may not be worth the potential benefit. Side effects may include dry mouth, blurred vision, and constipation.
New evidence suggests that the migraine medication gabapentin (Neurontin®) and acamprosate (Campral®), a drug used to treat alcoholism, may help relieve symptoms of tinnitus. However, until additional studies are performed, it is unclear if these are effective treatment options.
Prevention: People who are exposed to loud noises on a regular basis, such as construction workers, should wear protective ear muffs or earplugs. This helps prevent the inner ear from becoming damaged. Do not listen to loud music, especially when wearing headphones.