EAR PROBLEMS

Deafness

Ear Anatomy

The ear is a copmplex organ which can be divided into 3 areas: the outer ear comprising the pinna and ear canal; the middle ear containing the 3 bones of hearing (malleus, incus and stapes), and the inner ear comprising the cochlea and balance organs (semicircular canals, utricle and saccule). (see diagram)

Abnormalities in any of these areas can lead to problems with hearing.

1. Helix
2. Antihelix
3. Tympanic membrane (eardrum)
4. External auditory meatus
5. Lobule
6. Middle ear
7. Round window
8. Eustachian tube
9. Stapes footplate covering oval window
10. Cochlear and vestibular nerves
11. Cochlea
12. Lateral semicircular canal
13. Superior semicircular canal
14. Rear semicircular canal
15. Stapes
16. Incus
17. Malleus

Outer Ear Problems

Ear Wax

Ear wax is not a disease it is a natural product of the outer ear canal and has a protective function in the outer ear. Some people produce more wax than others, nevertheless in the majority of people who leave their ears alone and dont clean them the wax naturally falls out as it is designed to do. Problems occur when people obsessively try and clean the ear canal with cotton buds (Q tips), this is not necessary and can lead to impaction of wax further into the ear where the natural process of extruding wax cannot work.

If the ear has become blocked then a short course of olive oil drops or drops that actually dissolve the wax will in most cases clear the obstruction. Occasionally the ear is still blocked and the wax will need to be syringed out or removed by an ENT surgeon. For patients with recurrent problems with wax I recommend the use once or twice a week of olive oil drops on a more permanent basis to try and stop the obstruction. (PS it does not need to be extra virgin)

Otitis Externa

This is a condition which is characterised by inflammation of the ear canal. It comes in various guises with varying levels of severity.

The mildest form starts as an itch in the ear canal and is similar to eczema on the rest of the body and responds to the same treatment as eczema. Occasionally the inflammation worsens and the ear canal starts to become full of debris (dead skin flakes and fluid secreted by the ear canal). At this stage the patient may notice a small discharge and may have a hearing loss. Finally the ear canal itself can swell and become acutley infected. This stage is extremely painfull (almost as bad as child birth, well from a mans' perspective anyway), and the infection can spread to affect the whole ear and even the skin of the face of the neck.

The best treatment for otitis externa is to avoid it. The best way to avoid it is to avoid getting the ear canals wet, especially in swimming pools of uncertain hygiene. If you are prone to this condition then you should avoid all water entering the ears. I find the easiest way is with a small ball of cotton wool smeared in vaseline. Also, never clean the ears with cotton buds (Q tips).

In the mild form of disease a short course of simple steroid drops suffices, however, once the ear is full of debris then this really needs to be removed ideally by suction under microscope control. Once this has happened then the drops are effective.

Once the condition has progressed to the more severe forms then treatment is usually required at the local ENT department. Here they will microsuction any debris, place wicks soaked in antibiotic and steroid drops, or occassionally a tar impregnated dressing. Finall patients are sometimes admitted for intravenous antibiotics and pain control.

Middle Ear Causes

Glue ear (serous otitis media)

This is the commonest cause for deafness in children but can also occur in adults. Basically the eustachian tube has for some reason stopped equalising the pressure in the middle ear and the ear in reponse secretes a fluid into the middle ear space. This can cause a hearing loss which is usually mild to moderate in nature.

In most cases the glue ear only is present for a few weeks or months and clears by itself. However, as in all conditions some patients have persistent problems and may require treatment.

Children with persistent glue ear should be followed up, however, if their hearing is not significantly affected then as long as their school is made aware of the diagnosis they can ensure that the child is nearer to the teacher. This is useful as children with only mild hearing losses can have worsening of their hearing if they get a cold or flu like illness. If the childs hearing loss is more severe and or the child is getting recurrent ear infections then an intervention may be needed. The options for simple hearing loss are either grommet insertion as a day case or hearing aids. The latter option has become more and more viable recently. Often the biggest barrier is the parents concerns that their child be stigmatised as handicapped, along with an ENT surgeons desire to produce n instant cure with an operation. Grommets are a safe procedure, however, they can occasionally weaken an ear drum which can lead to problems in the future. The difficulty is that leaving the ear with a retracted drum may also cause further problems with the ear drum and bones of hearing. It is often a difficult decision which route to take. However, children adapt extremely quikly to using hearing aids, in primary school it is uncommon for children to be bullied regarding the aids and finally they are usually a temporary measure and can be used when the heraring is at its worst.