Diseases may affect the EAR alone or as part of a more generalised condition. The disease may affect the outer, middle or inner ear or a combination of these.
of the ear includes inspection of the external ear. An auriscope is used to examine the external ear canal and the ear drum. If a more detailed inspection is required, a microscope may be used to improve illumination and magnification.
are performed to identify the presence of DEAFNESS. The examiner tests whether the vibrating forkis audible at the meatus, and then the foot of the fork is placed on the mastoid bone of the ear to discover at which of the two sites the patient can hear the vibrations for the longest time. This can help to differentiate between conductive (canal/drum/ossicles) and nerve deafness.
are carried out to determine the level of hearing. An audiometer is used to deliver a series of short tones of varying frequency to the ear, either through a pair of headphones or via a sound transducer applied directly to the skull. The volume of the sound is gradually reduced until it is no longer heard and this represents the threshold of hearing.
Auriscope positioned in external auditory meatus of left ear for viewing ear drum.
The following are some of the chief symptoms of ear disease:
(see DEAFNESS).
is most commonly due to acute inflammation of the middle ear. Pain is sometimes felt in the ear when it actually comes from the tonsils or from carious teeth (see TEETH, DISORDERS OF). The treatment will depend on the underlying cause but may include antibiotics and painkillers.
is ringing in the ear, which often accompanies deafness but is sometimes the only symptom of ear disease. Even healthy people sometimes experience tinnitus, particularly if put in soundproofed surroundings. It may be described as hissing, buzzing, the sound of the sea, or of bells. It may occur in almost any form of ear disease, but is particularly troublesome in nerve deafness due to ageing and in noise-induced deafness.
Sometimes it results from general diseases such as ANAEMIA, high blood pressure and arterial disease, in which cases it is often synchronous with the pulse. It may also be caused by drugs such as QUININE, salicylates (SALICYLIC ACID and its salts, for example, ASPIRIN) and certain ANTIBIOTICS. Treatment of any underlying ear disorder or systemic disease, including DEPRESSION, may reduce or even cure the tinnitus, but unfortunately in many cases the noises persist. Management involves explanation of the mechanism and reassurance that tinnitus does not signify brain disease or an impending STROKE. Tinnitus maskers – which look like hearing aids – have long been used with a suitably pitched sound helping to ‘mask’ the condition.
(cerumen) is produced by specialised glands in the outer part of the ear canal only. Impacted wax within the ear canal can cause deafness, tinnitus and sometimes disturbance of balance. Wax can be softened with olive oil, 5-per-cent bicarbonate of soda or commercially prepared drops, and it will gradually liquefy and ‘remove itself’. If this is ineffective, syringing by a doctor or nurse will usually remove the wax but sometimes it is necessary for a specialist (otologist) to remove it manually with instruments. Syringing should not be done if perforation of the tympanic membrane (eardrum) is suspected.
such as peas, beads or buttons may be inserted into the external ear canal, especially by infants. Live insects may also be trapped in the external canal causing intense irritation and noise, and in such cases spirit drops are first instilled into the ear to kill the insect. Except in foreign bodies of vegetable origin, where swelling and pain may occur, syringing may be used to remove most of them, but sometimes removal by a specialist using suitable instrumentation and an operating microscope is required.
may be a diffuse inflammation or a boil (furuncle) occurring in the outer ear canal. The pinna is usually tender on movement (unlike acute otitis media – see below) and a discharge may be present. Initially treatment might be offered using magnesium sulphate paste or glycerine and 10-per-cent ichthammol. Topical antibiotic drops can be used and occasionally antibiotics by mouth are recommended. Analgesics and locally applied warmth help relieve the pain.
producing pain and discharge, can be caused by ECZEMA, seborrheic DERMATITIS or PSORIASIS. Hair lotions and cosmetic preparations may trigger local allergic reactions in the external ear, or irritation may be the result of swimming or the use of dirty towels. Careful cleaning of the ear by an ENT (Ear, Nose & Throat) surgeon and topical antibiotic or antifungal agents – along with removal of any precipitating cause – are the usual treatments.
of the ear can arise in the skin of the auricle, often as a result of exposure to sunlight, and can be benign or malignant. Within the ear canal itself, the commonest tumours are benign outgrowths from the surrounding bone, believed to occur in swimmers as a result of repeated exposure to cold water. Polyps may result from chronic infection of the ear canal and drum, particularly in the presence of a perforation. These polyps are soft and may be large enough to fill the ear canal, but may shrink considerably after treatment of the associated infection.
infection of the middle ear, usually occurs as a result of infection spreading up the Eustachian tubes from the nose, throat or sinuses but may also be caused by swimming and diving where water and infected secretions are forced up the Eustachian tube into the middle ear. Pain, throbbing or sharp in character, may be intense. The condition is accompanied by deafness, fever and often TINNITUS.
In infants, crying may be the only sign that something is wrong – although this is usually accompanied by rubbing or pulling at the ear. Examination usually shows redness, and sometimes bulging, of the ear drum. There may be a DISCHARGE if the ear drum has perforated as a result of the pressure created in the middle ear by the accumulated PUS. Discharge is usually accompanied by an immediate reduction in pain.
Pain relief is necessary and an antibiotic may be prescribed. Rarely, it may be necessary to perform a myringotomy, or incision of the ear drum, to drain pus from the middle ear.
or glue ear, is the most common inflammatory condition of the middle ear in children, with one in four pre-school children having an episode at some time or another. There is persistent sticky fluid in the middle ear which causes a conductive-type deafness. It may be associated with enlarged ADENOIDS, which impair the function of the Eustachian tube. If the hearing impairment is persistent and causes problems, drainage of the fluid, along with antibiotic treatment, may be needed – possibly in conjunction with removal of the adenoids. The insertion of ‘grommets’ (ventilation or tympanostomy tubes) was for a time standard treatment, but while hearing is often restored, there may be no long-term gain and even a risk of damage to the tympanic membrane, so the operation is performed very much less than in the past and hearing aids prescribed instead.
The signs of this condition include swelling and tenderness of the skin behind the ear, redness and swelling inside the ear, pain in the side of the head, high fever, and a discharge from the ear. Antibiotics, usually given intravenously, are necessary, with surgery if there is no improvement. This involves draining any pus from the middle ear and mastoid, and removing diseased lining and bone from the mastoid.
is a common IDIOPATHIC disorder of ENDOLYMPH control in the semicircular canals, with episodes of VERTIGO deafness and tinnitus. The cause is unknown and usually one ear only is affected at first, but in 50 per cent of cases, the opposite ear is eventually affected. The onset of dizziness is often sudden and lasts for up to 24 hours. The hearing loss is temporary in the early stages, but with each attack there may be a progressive nerve deafness. Nausea and vomiting often occur. Treatment during the attacks includes rest and drugs to control sickness. Vasodilator drugs such as betahistine hydrochloride may be helpful. Surgical treatment is sometimes required if crippling attacks of dizziness persist despite these measures.
A disorder of the middle ear that results in progressive deafness. Often running in families, otosclerosis affects about one person in 200. An overgrowth of bone fixes the stapes (the innermost bone of the middle ear) and stops sound vibrations from being transmitted to the inner ear. The result is conductive deafness. The disorder usually affects both ears. Those affected tend to talk quietly and deafness increases over a 10–15 year period. Tinnitus often occurs, and occasionally vertigo.
Abnormal hearing tests point to the diagnosis; the deafness may be partially overcome with a hearing aid but surgery is eventually needed. This involves replacing the stapes bone with a synthetic substitute (stapedectomy). (See also OTIC BAROTRAUMA.)