Ear & Hearing

Ear & Hearing

A baby smiles as he hears his mother’s voice, a teenager sways  to the rhythm of her favorite music, a couple sits on the beach and is mesmerized by the soothing sounds of the ocean—all of these pleasures made possible by the ear. Diseases of the ear can affect either or both hearing and balance. Otolaryngologists are experts in the diagnosis and treatment of diseases of the ear.

How the Ear Works

The ear has three main parts: the outer, middle and inner ear. The outer ear (the part you can see) opens into the ear canal. The eardrum separates the ear canal from the middle ear. Small bones in the middle ear help transfer sound to the inner ear. The inner ear contains the auditory (hearing) nerve, which leads to the brain.

Any source of sound sends vibrations or sound waves into the air. These funnel through the ear opening, down the ear, canal, and strike your eardrum, causing it to vibrate. The vibrations are passed to the small bones of the middle ear, which transmit them to the hearing nerve in the inner ear. Here, the vibrations become nerve impulses and go directly to the brain, which interprets the impulses as sound (music, voice, a car horn, etc.

The outer ear collects sounds. The middle ear is a pea sized, air-filled cavity separated from the outer ear by the paper-thin eardrum. Attached to the eardrum are three tiny ear bones. When sound waves strike the eardrum, it vibrates and sets the bones in motion that transmit to the inner ear. The inner ear converts vibrations to electrical signals and sends these signals to the brain. It also helps maintain balance.

A healthy middle ear contains air at the same atmospheric pressure as outside of the ear, allowing free vibration. Air enters the middle ear through the narrow eustachian tube that connects the back of the nose to the ear. When you yawn and hear a pop, your eustachian tube has just sent a tiny air bubble to your middle ear to equalize the air pressure.

What is Otitis Media?

Otitis media means inflammation of the middle ear. The inflammation occurs as a result of a middle ear infection. It can occur in one or both ears. Otitis media is the most frequent diagnosis recorded for children who visit physicians for illness. It is also the most common cause of hearing loss in children.

Although otitis media is most common in young children, it also affects adults occasionally. It occurs most commonly in the winter and early spring months.

Ear Infections and Earache

Is It Serious?

Yes, it is serious because of the severe earache and hearing loss it can create. Hearing loss, especially in children, may impair learning capacity and even delay speech development. However, if it is treated promptly and effectively, hearing can almost always be restored to normal.

Otitis media is also serious because the infection can spread to nearby structures in the head, especially the mastoid. Thus, it is very important to recognize the symptoms (see list) of otitis media and to get immediate attention from your doctor.

What Causes Otitis Media?

Blockage of the eustachian tube during a cold, allergy, or upper respiratory infection and the presence of bacteria or viruses lead to the accumulation of fluid (a build-up of pus and mucus) behind the eardrum. This is the infection called acute otitis media. The build up of pressurized pus in the middle ear causes earache, swelling, and redness. Since the eardrum cannot vibrate properly, you or your child may have hearing problems.

Sometimes the eardrum ruptures, and pus drains out of the ear. But more commonly, the pus and mucus remain in the middle ear due to the swollen and inflamed eustachian tube. This is called middle ear effusion or serous otitis media. Often after the acute infection has passed, the effusion remains and becomes chronic, lasting for weeks, months, or even years. This condition makes one subject to frequent recurrences of the acute infection and may cause difficulty in hearing.

What Are the Symptoms?

In infants and toddlers look for pulling or scratching at the ear, especially if accompanied by the following

• hearing problems
  
• crying, irritability
  
• fever
  
• vomiting
  
• ear drainage

In young children, adolescents, and adults look for:

• earache
  
• feeling of fullness or pressure
  
• hearing problems
  
• dizziness, loss of balance
  
• nausea, vomiting
  
• ear drainage
  
• fever

Remember, without proper treatment, damage from an ear infection can cause chronic or permanent hearing loss.

What Will Happen at the Doctor’s Office?

During an examination, the doctor will use an instrument called an otoscope to assess the ear’s condition. With it, the doctor will perform an examination to check for redness in the ear and/or fluid behind the eardrum. With the gentle use of air pressure, the doctor can also see if the eardrum moves. If the eardrum doesn’t move and/or is red, an ear infection is probably present.

Two other tests may be performed for more information.

An audiogram tests if hearing loss has occurred by presenting tones at various pitches.

A tympanogram measures the air pressure in the middle ear to see how well the eustachian tube is working and how well the eardrum can move.

The Importance of Medication

The doctor may prescribe one or more medications. It is important that all the medication(s) be taken as directed and that any follow-up visits be kept. Often, antibiotics to fight the infection will make the earache go away rapidly, but the infection may need more time to clear up. So, be sure that the medication is taken for the full time your doctor has indicated. Other medications that your doctor may prescribe include an antihistamine (for allergies), a decongestant (especially with a cold), or both.

Sometimes the doctor may recommend a medication to reduce fever and/or pain. Analgesic ear drops can ease the pain of an earache. Call your doctor if you have any questions about you or your child’s medication or if symptoms do not clear.

What Other Treatment May Be Necessary?

Most of the time, otitis media clears up with proper medication and home treatment. In many cases, however, further treatment may be recommended by your physician. An operation, called a myringotomy may be recommended. This involves a small surgical incision (opening) into the eardrum to promote drainage of fluid and to relieve pain. The incision heals within a few days with practically no scarring or injury to the eardrum. In fact, the surgical opening can heal so fast that it often closes before the infection and the fluid are gone. A ventilation tube can be placed in the incision, preventing fluid accumulation and thus improving hearing.

The surgeon selects a ventilation tube for your child that will remain in place for as long as required for the middle ear infection to improve and for the eustachian tube to return to normal. This may require several weeks or months. During this time, you must keep water out of the ears because it could start an infection. Otherwise, the tube causes no trouble, and you will probably notice a remarkable improvement in hearing and a decrease in the frequency of ear infections.

Otitis media may recur as a result of chronically infected adenoids and tonsils. If this becomes a problem, your doctor may recommend removal of one or both. This can be done at the same time as ventilation tubes are inserted.

Allergies may also require treatment.

So, Remember . . .

Otitis media is generally not serious if it is promptly and properly treated. With the help of your physician, you and/or your child can feel and hear better very soon.

Be sure to follow the treatment plan, and see your physician until he/she tells you that the condition is fully cured.

Swimmer’s Ear

WARNING: If you already have an ear infection, or if you have ever had a perforated or otherwise injured eardrum, or ear surgery, you should consult an ear, nose, and throat specialist before you go swimming and before you use any type of ear drops. If you do not know if you have or ever had a perforated, punctured, ruptured, or otherwise injured eardrum, ask your ear doctor.

Causes

Swimmer’s ear is an infection of the outer ear structures. It typically occurs in swimmers, but the since the cause of the infection is water trapped in the ear canal, bathing or showering may also cause this common infection. When water is trapped in the ear canal, bacteria that normally inhabit the skin and ear canal multiply, causing infection and irritation of the ear canal. If the infection progresses it may involve the outer ear.

Signs and Symptoms

The most common symptoms of swimmer’s ear are mild to moderate pain that is aggravated by tugging on the auricle and an itchy ear. Other symptoms may include any of the following:

• Sensation that the ear is blocked or full
  
• Drainage
  
• Fever
  
• Decreased hearing
  
• Intense pain that may radiate to the neck, face, or side of the head
  
• The outer ear may appear to be pushed forward or away from the skull
  
• Swollen lymph nodes

Treatment

Treatment for the early stages of swimmer’s ear includes careful cleaning of the ear canal and eardrops that inhibit bacterial growth. Mild acid solutions such as boric or acetic acid are effective for early infections.

For more severe infections, if you do not have a perforated ear drum, ear cleaning may be helped by antibiotics. If the ear canal is swollen shut, a sponge or wick may be placed in the ear canal so that the antibiotic drops will be effective. Pain medication may also be prescribed. Follow-up appointments with your physician are very important to monitor progress of the infection, to repeat ear cleaning, and to replace the ear wick as needed. Your otolaryngologist has specialized equipment and expertise to effectively clean the ear canal and treat swimmer’s ear.

Prevention

A dry ear is unlikely to become infected, so it is important to keep the ears free of moisture after swimming or bathing. Removable earplugs, sometimes worn for hearing protection, can be used to keep moisture out of the ear canal. Q-tips should not be used for this purpose, because they may pack material deeper into the ear canal, remove protective earwax, and irritate the thin skin of the ear canal creating the perfect environment for infection.

The safest way to dry your ears is with a hair dryer. If you do not have a perforated eardrum, rubbing alcohol or a 50:50 mixture of alcohol and vinegar used as eardrops will evaporate excess water and keep your ears dry.

Before using any drops in the ear, it is important to verify that you do not have a perforated eardrum. Check with your otolaryngologist if you have ever had a perforated, punctured, or injured eardrum, or if you have had ear surgery.

People with itchy ears, flaky or scaly ears, or extensive earwax are more likely to develop swimmer’s ear. If so, it may be helpful to have your ears cleaned periodically by an otolaryngologist.

Why do ears itch?

An itchy ear is a maddening symptom. Sometimes it is caused by a fungus or allergy, but more often it is a chronic dermatitis (skin inflammation) of the ear canal.

One type is seborrheia dermatitis, a condition similar to dandruff in the scalp; the wax is dry, flaky, and abundant. Some patients with this problem will do well to decrease their intake of foods that aggravate it, such as greasy foods, carbohydrates (sugar and starches), and chocolate.

Doctors often prescribe a cortisone eardrop at bedtime when the ears itch. There is no long-term cure, but it can be kept controlled.

Noise & Hearing Protection

One in 10 Americans has a hearing loss that affects his or her ability to understand normal speech. Excessive noise exposure is the most common cause of hearing loss.

Can Noise Really Hurt My Ears?

Yes, noise can be dangerous. If it is loud enough and lasts long enough, it can damage your hearing.

The damage caused by noise, called sensorineural hearing loss or nerve deafness, can be caused by several factors other than noise, but noise-induced hearing loss is different in one important way, it can be reduced or prevented altogether.

Can I “Toughen Up” My Ears?

No. If you think you have grown used to a loud noise, it probably has damaged your ears, and there is no treatment–no medicine, no surgery, not even a hearing aid–that completely restores your hearing once it is damaged by noise.

How Does the Ear Work?

The ear has three main parts: the outer, middle, and inner ear. The outer ear (the part you can see) opens into the ear canal. The eardrum separates the ear canal from the middle ear. Small bones in the middle ear help transfer sound to the inner ear. The inner ear contains the auditory (hearing) nerve, which leads to the brain.

Any source of sound sends vibrations or sound waves into the air. These funnel through the ear opening, down the ear canal, and strike your eardrum, causing it to vibrate. The vibrations are passed to the small bones of the middle ear, which transmit them to the hearing nerve in the inner ear. Here, the vibrations become nerve impulses and go directly to the brain, which interprets the impulses as sound: music, a slamming door, a voice, etc.

When noise is too loud, it begins to kill the nerve endings in the inner ear. As the exposure time to loud noise increases, more and more nerve endings are destroyed. As the number of nerve endings decreases, so does your hearing. There is no way to restore life to dead nerve endings; the damage is permanent.

How Can I Tell If a Noise Is Dangerous?

People differ in their sensitivity to noise. As a general rule, noise may damage your hearing if you have to shout over background noise to make yourself heard, the noise hurts your ears, it makes your ears ring, or you have difficulty hearing for several hours after exposure to the noise.

Sound can be measured scientifically in two ways. Intensity, or loudness of sound, is measured in decibels. Pitch is measured in frequency of sound vibrations per second. A low pitch, such as a deep voice or a tuba, makes fewer vibrations per second than a high voice or violin.

What Does Frequency of Sound Vibration Have to Do with Hearing Loss?

Frequency is measured in cycles per second, or Hertz (Hz). The higher the pitch of the sound, the higher the frequency.

Young children, who generally have the best hearing, can often distinguish sounds from about 20 Hz, such as the lowest note on a large pipe organ, to 20,000 Hz, such as the high shrill of a dog whistle that many people are unable to hear.

Human speech, which ranges from 300 to 4,000 Hz, sounds louder to most people than noises at very high or very low frequencies. When hearing impairment begins, the high frequencies are usually lost first, which is why people with hearing loss often have difficulty hearing the high pitched voices of women and children. Loss of high frequency hearing also can distort sound, so that speech is difficult to understand even though it can be heard. People with hearing loss often have difficulty detecting differences between certain words that sound alike, especially words that contain S, F, SH, CH, H, or soft C sounds, because the sound of these consonants is in a much higher frequency range than vowels and other consonants.

What about Decibels?

Intensity of sound is measured in decibels (dB). The scale runs from the faintest sound the human ear can detect, which is labeled 0 dB, to over 180 dB, the noise at a rocket pad during launch.

Decibels are measured logarithmically. This means that as decibel intensity increases by units of 10, each increase is 10 times the lower figure. Thus, 20 decibels is 10 times the intensity of 10 decibels, and 30 decibels is 100 times as intense as 10 decibels.

Approximate Decibel Levels

Example

0	Faintest sound heard by human ear.
30	Whisper, quiet library
60	Normal conversation, sewing machine, typewriter.
90	Lawnmower, shop tools, truck traffic; 8 hours per day is the maximum exposure to protect 90% of people.
100	Chainsaw, pneumatic drill, snowmobile; 2 hours per day is the maximum exposure without protection.
115	Sandblasting, loud rock concert, auto horn; 15 minutes per day is the maximum exposure without protection.
140	Gun muzzle blast, jet engine; noise causes pain and even brief exposure injures unprotected ears. Maximum allowed noise with hearing protectors.

 

How High Can the Decibels Go without Affecting My Hearing?

Many experts agree that continual exposure to more than 85 decibels is dangerous.

Does the Length of Time I Hear a Noise Have Anything to Do with the Danger to My Hearing?

It certainly does. The longer you are exposed to a loud noise, the more damaging it may be. Also, the closer you are to the source of intense noise, the more damaging it is.

Every gunshot produces a noise that could damage the ears of anyone in close hearing range. Large bore guns and artillery are the worse because they are the loudest. But even cap guns and firecrackers can damage your hearing if the explosion is close to your ear. Anyone who uses firearms without some form of ear protection risks hearing loss.
Recent studies show an alarming increase in hearing loss in youngsters. Evidence suggests that loud rock music along with increased use of portable radios with earphones may be responsible for this phenomenon.

Can Noise Affect More Than My Hearing?

A ringing in the ears, called tinnitus, commonly occurs after noise exposure, and it often becomes permanent. Some people react to loud noise with anxiety and irritability, an increase in pulse rate and blood pressure, or an increase in stomach acid. Very loud noise can reduce efficiency in performing difficult tasks by diverting attention from the job.

Who Should Wear Hearing Protectors?

If you must work in an excessively noisy environment, you should wear protectors. You should also wear them when using power tools, noisy yard equipment, or firearms, or riding a motorcycle or snowmobile.

What Are the Laws for on-the-Job Exposure?

• Habitual exposure to noise above 85 dB will cause a gradual hearing loss in a significant number of individuals, and louder noises will accelerate this damage.
  
• For unprotected ears, the allowed exposure time decreases by one-half for each 5 dB increase in the average noise level. For instance, exposure is limited to 8 hours at 90 dB, 4 hours at 95 dB, and 2 hours at 100 dB.
  
• The highest permissible noise exposure for the unprotected ear is 115 dB for 15 minutes/day. Any noise above 140 dB is not permitted.

The Occupational Safety and Health Administration, in its Hearing Conservation Amendment of 1983, requires hearing conservation programs in noisy work places. This includes a yearly hearing test for the approximately five million workers exposed to an average of 85 dB or more of noise during an 8-hour work day.

Ideally, noisy machinery and work places should be engineered to be more quiet or the worker’s time in the noise should be reduced; however, the cost of these actions is often prohibitive. As an alternative, individual hearing protectors are required when noise averages more than 90 dB during an 8-hour day.

When noise measurements indicate that hearing protectors are needed, the employer must offer at least one type of earplug and one type of earmuff without cost to employees. If the yearly hearing tests reveal hearing loss of 10 dB or more in higher pitches in either ear, the worker must be informed and must wear hearing protectors when noise averages more than 85 dB for an 8-hour day.

Larger losses of hearing and/or the possibility of ear disease should result in referral to an ear, nose and throat physician (otolaryngologist).

What Are Hearing Protectors? How Effective Are They?

Hearing protection devices decrease the intensity of sound that reaches the eardrum. They come in two forms: earplugs and earmuffs. Earplugs are small inserts that fit into the outer ear canal. They must be snugly sealed so the entire circumference of the ear canal is blocked. An improperly fitted, dirty or worn-out plug may not seal and can irritate the ear canal. They are available in a variety of shapes and sizes to fit individual ear canals and can be custom made. For people who have trouble keeping them in their ears, they can be fitted to a headband.

Earmuffs fit over the entire outer ear to form an air seal so the entire circumference of the ear canal is blocked, and they are held in place by an adjustable band. Earmuffs will not seal around eyeglasses or long hair, and the adjustable headband tension must be sufficient to hold earmuffs firmly around the ear.

Properly fitted earplugs or muffs reduce noise 15 to 30 dB. The better earplugs and muffs are approximately equal in sound reductions, although earplugs are better for low frequency noise and earmuffs for high frequency noise.

Simultaneous use of earplugs and muffs usually adds 10 to 15dB more protection than either used alone. Combined use should be considered when noise exceeds 105 dB.

Why Can’t I just Stuff My Ears with Cotton?

Ordinary cotton balls or tissue paper wads stuffed into the ear canals are very poor protectors; they reduce noise only by approximately 7 dB.

What Are the Common Problems of Hearing Protectors?

Studies have shown that one-half of the workers wearing hearing protectors receive one-half or less of the noise reduction potential of their protectors because these devices are not worn continuously while in noise or because they do not fit properly.

A hearing protector that gives an average of 30 dB of noise reduction if worn continuously during an 8-hour work day becomes equivalent to only 9 dB of protection if taken off for one hour in the noise. This is because decibels are measured on a logarithmic scale, and there is a 10-fold increase in noise energy for each 10 dB increase.

During the hour with unprotected ears, the worker is exposed to 1,000 times more sound energy than if earplugs or muffs had been worn.

In addition, noise exposure is cumulative. So the noise at home or at play must be counted in the total exposure during any one day. A maximum allowable while on-the-job followed by exposure to a noisy lawnmower or loud music will definitely exceed the safe daily limit.

Even if earplugs and/or muffs are worn continuously while in noise, they do little good if there is an incomplete air seal between the hearing protector and the skin.

When using hearing protectors, you will hear your own voice as louder and deeper. This is a useful sign that the hearing protectors are properly positioned.

Can I Hear Other People and Machine Problems If I Wear Hearing Protectors?

Just as sunglasses help vision in very bright light, so do hearing protectors enhance speech understanding in very noisy places. Even in a quiet setting, a normal-hearing person wearing hearing protectors should be able to understand a regular conversation.

Hearing protectors do slightly reduce the ability of those with damaged hearing or poor comprehension of language to understand normal conversation. However, it is essential that persons with impaired hearing wear earplugs or muffs to prevent further inner ear damage.

It has been argued that hearing protectors might REDUCE a worker’s ability to hear the noises that signify an improperly functioning machine. However, most workers readily adjust to the quieter sounds and can still detect such problems.

What If My Hearing Is Already Damaged? How Can I Tell?

Hearing loss usually develops over a period of several years. Since it is painless and gradual, you might not notice it. What you might notice is a ringing or other sound in your ear (called tinnitus), which could be the result of long-term exposure to noise that has damaged the hearing nerve. Or, you may have trouble understanding what people say; they may seem to be mumbling, especially when you are in a noisy place such as in a crowd or at a party. This could be the beginning of high-frequency hearing loss; a hearing test will detect it.

If you have any of these symptoms, you may have nothing more serious than impacted wax or an ear infection, which might be simply corrected. However, it might be hearing loss from noise. In any case, take no chances with noise—the hearing loss it causes is permanent. If you suspect a hearing loss, consult a physician with special training in ear care and hearing disorders (called an otolaryngologist or otologist). This doctor can diagnose your hearing problem and recommend the best way to manage it.