Doctor, what is a Cochlear Implant?
Insight into an implantable device to help you hear
A cochlear implant is an electronic device that
restores partial hearing to the deaf. It is surgically implanted
in the inner ear and activated by a device worn outside the
ear. Unlike a hearing aid, it does not make sound louder or
clearer. Instead, the device bypasses damaged parts of the auditory
system and directly stimulates the nerve of hearing, allowing
individuals who are profoundly hearing impaired to receive sound.
What is normal hearing?
Your ear consists of three parts that play a
vital role in hearing-the external ear, middle ear, and inner
Conductive hearing: Sound travels along the
ear canal of the external ear causing the eardrum to vibrate.
Three small bones of the middle ear conduct this vibration from
the eardrum to the cochlea (auditory chamber) of the inner ear.
hearing: When the three small bones move, they start
waves of fluid in the cochlea, and these waves stimulate more
than 16,000 delicate hearing cells (hair cells). As these hair
cells move, they generate an electrical current in the auditory
nerve. It travels through inter-connections to the brain area
that recognizes it as sound.
How is hearing impaired?
If you have disease or obstruction in your external or middle
ear, your conductive hearing may be impaired. Medical or surgical
treatment can probably correct this.
An inner ear problem, however, can result in
a sensorineural impairment or nerve deafness. In most cases,
the hair cells are damaged and do not function. Although many
auditory nerve fibers may be intact and can transmit electrical
impulses to the brain, these nerve fibers are unresponsive because
of hair cell damage. Since severe sensorineural hearing loss
cannot be corrected with medicine, it can be treated only with
a cochlear implant.
How do cochlear implants work?
Cochlear implants bypass damaged hair cells and convert speech
and environmental sounds into electrical signals and send these
signals to the hearing nerve.
The implant consists of a small electronic device,
which is surgically implanted under the skin behind the ear
and an external speech processor, which is usually worn on a
belt or in a pocket. A microphone is also worn outside the body
as a headpiece behind the ear to capture incoming sound. The
speech processor translates the sound into distinctive electrical
signals. These 'codes' travel up a thin cable to the headpiece
and are transmitted across the skin via radio waves to the implanted
electrodes in the cochlea. The electrodes' signals stimulate
the auditory nerve fibers to send information to the brain where
it is interpreted as meaningful sound.
Who can benefit from an implant?
Implants are designed only for individuals who attain almost
no benefit from a hearing aid. They must be two years of age
or older (unless childhood meningitis is responsible for deafness).
(ear, nose, and throat specialists) perform implant surgery,
though not all of them do this procedure. Your local doctor
can refer you to an implant clinic for an evaluation. The evaluation
will be done by an implant team (an otolaryngologist, audiologist,
nurse, and others) that will give you a series of tests:
Ear (otologic) evaluation: The otolaryngologist examines the
middle and inner ear to ensure that no active infection or other
abnormality precludes the implant surgery.
evaluation: The audiologist performs an extensive hearing test
to find out how much you can hear with and without a hearing
evaluation: Special X-rays are taken, usually computerized tomography
(CT) or magnetic resonance imaging (MRI) scans, to evaluate
your inner ear bone.
evaluation: Some patients may need a psychological evaluation
to learn if they can cope with the implant.
Your otolaryngologist also gives a physical examination to identify
any potential problems with the general anesthesia needed for
the implant procedure.
What about surgery?
Implant surgery is performed under general anesthesia and lasts
from two to three hours. An incision is made behind the ear
to open the mastoid bone leading to the middle ear. The procedure
may be done as an outpatient, or may require a stay in the hospital,
overnight or for several days, depending on the device used
and the anatomy of the inner ear.
Is there care and training after the
About one month after surgery, your team places
the signal processor, microphone, and implant transmitter outside
your ear and adjusts them. They teach you how to look after
the system and how to listen to sound through the implant. Some
implants take longer to fit and require more training. Your
team will probably ask you to come back to the clinic for regular
checkups and readjustment of the speech processor as needed.
What can I expect from an implant?
Cochlear implants do not restore normal hearing, and benefits
vary from one individual to another. Most users find that cochlear
implants help them communicate better through improved lip-reading,
and over half are able to discriminate speech without the use
of visual cues. There are many factors that contribute to the
degree of benefit a user receives from a cochlear implant, including:
How long a person has been deaf,
The number of
surviving auditory nerve fibers, and
motivation to learn to hear.
Your team will explain what you can reasonably expect. Before
deciding whether your implant is working well, you need to understand
clearly how much time you must commit. A few patients do not
benefit from implants.
How are new implant devices approved?
The Food and Drug Administration (FDA) regulates cochlear implant
devices for both adults and children and approves them only
after thorough clinical investigation.
Be sure to ask your otolaryngologist for written
information, including brochures provided by the implant manufacturers.
You need to be fully informed about the benefits and risks of
cochlear implants, including how much is known about how safe,
reliable, and effective a device is, how often you must come
back to the clinic for checkups, and whether your insurance
company pays for the procedure.
How much does an implant cost?
More expensive than a hearing aid, the total cost of a cochlear
implant including evaluation, surgery, the device, and rehabilitation
is around $30,000. Most insurance companies provide benefits
that cover the cost. (This is true whether or not the device
has received FDA clearance or is still in trial.)
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Doctor, explain earwax
Insight into causes and treatment of
Never put anything smaller than your elbow in
your ear! Cotton swabs are for cleaning bellybuttons-not ears.
You have probably heard these admonitions from relatives and
doctors since childhood...read on to find out what they meant.
The Outer Ear and Canal
The outer ear is the funnel-like part of the
ear you can see on the side of the head, plus the ear canal
(the hole which leads down to the eardrum).
The ear canal is shaped somewhat like an hourglass-narrowing
part way down. The skin of the outer part of the canal has special
glands that produce earwax. This wax is supposed to trap dust
and dirt particles to keep them from reaching the eardrum. Usually
the wax accumulates a bit, dries out and then comes tumbling
out of the ear, carrying dirt and dust with it. Or it may slowly
migrate to the outside where it can be wiped off. The ear canal
may be blocked by wax when attempts to clean the ear push wax
deeper into the ear canal and cause a blockage. Wax blockage
is one of the most common causes of hearing loss.
Should You Clean Your Ears?
Wax is not formed in the deep part of the ear
canal near the eardrum, but only in the outer part of the canal.
So when a patient has wax blocked up against the eardrum, it
is often because he has been probing his ear with such things
as cotton-tipped applicators, bobby pins, or twisted napkin
corners. These objects only push the wax in deeper. Also, the
skin of the ear canal and the eardrum is very thin and fragile
and is easily injured.
Earwax is healthy in normal amounts and serves
to coat the skin of the ear canal where it acts as a temporary
water repellent. The absence of earwax may result in dry, itchy
Most of the time the ear canals are self-cleaning;
that is, there is a slow and orderly migration of ear canal
skin from the eardrum to the ear opening. Old earwax is constantly
being transported from the ear canal to the ear opening where
it usually dries, flakes, and falls out.
Under ideal circumstances, you should never
have to clean your ear canals. However, we all know that this
isn't always so. If you want to clean your ears, you can wash
the external ear with a cloth over a finger, but do not insert
anything into the ear canal.
What are the symptoms of wax buildup?
loss, may be progressive
in the ear
the ear or a sensation the ear is plugged
Most cases of earwax blockage respond to home
treatments used to soften wax if there is no hole in the eardrum.
Patients can try placing a few drops of mineral oil, baby oil,
glycerin, or commercial drops, such as Debrox®, or Murine® Ear
Drops in the ear. These remedies are not as strong as the prescription
wax softeners but are effective for many patients. Rarely, people
have allergic reactions to commercial preparations. Detergent
drops such as hydrogen peroxide or carbamide peroxide may also
aid in the removal of wax. Patients should know that rinsing
the ear canal with hydrogen peroxide (H2O2) results in oxygen
bubbling off and water being left behind; wet, warm ear canals
make good incubators for growth of bacteria. Flushing the ear
canal with rubbing alcohol displaces the water and dries the
canal skin. If alcohol causes severe pain, it suggests the presence
of an eardrum perforation.
When Should I See My Doctor?
If you are uncertain whether you have a hole
(perforation or puncture) in your eardrum, consult your physician
prior to trying any over-the-counter remedies. Putting eardrops
or other products in your ear in the presence of an eardrum
perforation may cause an infection. Certainly, washing water
through such a hole could start an infection. In the event that
the home treatments discussed in this leaflet are not satisfactory,
or if wax has accumulated so much that it blocks the ear canal
(and hearing), your physician may prescribe eardrops designed
to soften wax, or he may wash or vacuum it out. Occasionally,
an otolaryngologist (ENT specialist) may need to remove the
wax using microscopic visualization.
What are other possible causes of hearing loss?
middle ear infection
infection (otitis externa)
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Doctor, why does my child's Ear Ache?
Insight into otitis media and treatments
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.
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
does the ear work?
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 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
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?
and toddlers look for:
Pulling or scratching at the ear, especially
if accompanied by the following...
children, adolescents, and adults look for:
Feeling of fullness or pressure
Dizziness, loss of balance
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
Sometimes the doctor may recommend a medication
to reduce fever and/or pain. Analgesic eardrops 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, your physician may
recommend further treatment. 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
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
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.
If you would like to schedule a consultation
please call 972-492-6990.
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Ears, Altitude and Airplane Travel
Have you ever wondered why your ears pop when you fly on an
airplane? Or why, when they fail to pop, you get an earache?
Have you ever wondered why the babies on an airplane fuss and
cry so much during descent?
Ear problems are the most common medical complaint
of airplane travelers, and while they are usually simple, minor
annoyances, they occasionally result in temporary pain and hearing
The Ear and Air Pressure
It is the middle ear that causes discomfort
during air travel, because it is an air pocket inside the head
that is vulnerable to changes in air pressure.
Normally, each time (or each second or third
time) you swallow, your ears make a little click or popping
sound. This occurs because a small bubble of air has entered
your middle ear, up from the back of your nose. It passes through
the Eustachian tube, a membrane-lined tube about the size of
a pencil lead that connects the back of the nose with the middle
ear. The air in the middle ear is constantly being absorbed
by its membranous lining and resupplied through the Eustachian
tube. In this manner, air pressure on both sides of the eardrum
stays about equal. If and when the air pressure is not equal,
the ear feels blocked.
Blocked ears and Eustachian tubes
The Eustachian tube can be blocked, or obstructed,
for a variety of reasons. When that occurs, the middle ear pressure
cannot be equalized. The air already there is absorbed and a
vacuum occurs, sucking the eardrum inward and stretching it.
Such an eardrum cannot vibrate naturally, so sounds are muffled
or blocked, and the stretching can be painful. If the tube remains
blocked, fluid (like blood serum) will seep into the area from
the membranes in an attempt to overcome the vacuum. This is
called "fluid in the ear," serous otitis, or aero-otitis.
The most common cause for a blocked Eustachian
tube is the common cold. Sinus infections and nasal allergies
(hay fever, etc.) are also causes. A stuffy nose leads to stuffy
ears because the swollen membranes block the opening of the
Children are especially vulnerable to blockages
because their Eustachian tubes are narrower than adults.
The ear is divided into three parts:
The outer ear: the part that you can see on the side of the
head plus the ear canal leading down to the eardrum.
The middle ear:
the eardrum and ear bones (ossicles), plus the air spaces behind
the eardrum and in the mastoid cavities (vulnerable to air pressure).
The inner ear:
the area that contains the nerve endings for the organs of hearing
and balance (equilibrium).
How can air travel cause problems?
Air travel is sometimes associated with rapid
changes in air pressure. To maintain comfort, the Eustachian
tube must open frequently and wide enough to equalize the changes
in pressure. This is especially true when the airplane is landing,
going from low atmospheric pressure down closer to earth where
the air pressure is higher.
Actually, any situation in which rapid altitude
or pressure changes occur creates the problem. You may have
experienced it when riding in elevators or when diving to the
bottom of a swimming pool. Deep-sea divers are taught how to
equalize their ear pressures; so are pilots. You can learn the
How to unblock your ears
Swallowing activates the muscle that opens the
Eustachian tube. You swallow more often when you chew gum or
let mints melt in your mouth. These are good air travel practices,
especially just before take-off and during descent. Yawning
is even better. Avoid sleeping during descent, because you may
not be swallowing often enough to keep up with the pressure
changes. (The flight attendant will be happy to awaken you just
If yawning and swallowing are not effective,
unblock your ears as follows:
Step 1: Pinch your nostrils shut.
Step 2: Take
a mouthful of air.
Step 3: Using
your cheek and throat muscles, force the air into the back of
your nose as if you were trying to blow your thumb and fingers
off your nostrils.
When you hear a loud pop in your ears, you have succeeded. You
may have to repeat this several times during descent.
Babies cannot intentionally pop their ears,
but popping may occur if they are sucking on a bottle or pacifier.
Feed your baby during the flight, and do not allow him or her
to sleep during descent.
When inflating your ears, you should not use force. The proper
technique involves only pressure created by your check and throat
If you have
a cold, a sinus infection, or an allergy attack, it is best
to postpone an airplane trip.
If you recently
have undergone ear surgery, consult with your surgeon on how
soon you may safely fly.
What about decongestants and nose sprays?
Many experienced air travelers use a decongestant
pill or nasal spray an hour or so before descent. This will
shrink the membranes and help the ears pop more easily. Travelers
with allergy problems should take their medication at the beginning
of the flight for the same reason.
Decongestant tablets and sprays can be purchased
without a prescription. However, people with heart disease,
high blood pressure, irregular heart rhythms, thyroid disease,
or excessive nervousness should avoid them. Such people should
consult their physicians before using these medicines. Pregnant
women should likewise consult their physicians first.
If your ears will not unblock
Even after landing you can continue the pressure
equalizing techniques, and you may find decongestants and nasal
sprays to be helpful. (However, avoid making a habit of nasal
sprays. After a few days, they may cause more congestion than
they relieve.) If your ears fail to open, or if pain persists,
you will need to seek the help of a physician who has experience
in the care of ear disorders. He/she may need to release the
pressure or fluid with a small incision in the eardrum.
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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, voice,
a car horn, etc.).
Anatomy of the Ear
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A perforated eardrum is a hole or rupture in the eardrum, a
thin membrane that separates the ear canal and the middle ear.
The medical term for eardrum is tympanic membrane. The middle
ear is connected to the nose by the eustachian tube, which equalizes
pressure in the middle ear.
A perforated eardrum is often accompanied by
decreased hearing and occasional discharge. Pain is usually
Causes of Eardrum Perforation
The causes of perforated eardrum are usually from trauma or
infection. A perforated eardrum can occur:
If the ear is struck squarely with an open hand
With a skull
After a sudden
If an object
(such as a bobby pin, Q-tip, or stick) is pushed too far into
the ear canal
As a result
of hot slag (from welding) or acid entering the ear canal
Middle ear infections may cause pain, hearing
loss, and spontaneous rupture (tear) of the eardrum resulting
in a perforation. In this circumstance, there maybe infected
or bloody drainage from the ear. In medical terms, this is called
otitis media with perforation.
On rare occasions a small hole may remain in
the eardrum after a previously placed PE tube (pressure equalizing)
either falls out or is removed by the physician.
Most eardrum perforations heal spontaneously
within weeks after rupture, although some may take up to several
months. During the healing process the ear must be protected
from water and trauma. Those eardrum perforations which do not
heal on their own may require surgery.
Effects on Hearing from Perforated Eardrum
Usually, the larger the perforation, the greater the loss of
hearing. The location of the hole (perforation) in the eardrum
also effects the degree of hearing loss. If severe trauma (e.g.
skull fracture) disrupts the bones in the middle ear which transmit
sound or causes injury to the inner ear structures, the loss
of hearing may be quite severe.
If the perforated eardrum is due to a sudden
traumatic or explosive event, the loss of hearing can be great
and ringing in the ear (tinnitus) may be severe. In this case
the hearing usually returns partially, and the ringing diminishes
in a few days. Chronic infection as a result of the perforation
can cause major hearing loss.
Treatment of the Perforated Eardrum
Before attempting any correction of the perforation, a hearing
test should be performed. The benefits of closing a perforation
include prevention of water entering the ear while showering,
bathing, or swimming (which could cause ear infection), improved
hearing, and diminished tinnitus. It also may prevent the development
of cholesteatoma (skin cyst in the middle ear), which can cause
chronic infection and destruction of ear structures.
If the perforation is very small, otolaryngologists
may choose to observe the perforation over time to see if it
will dose spontaneously. They also might try to patch a cooperative
patient's eardrum in the office. Working with a microscope,
your doctor may touch the edges of the eardrum with a chemical
to stimulate growth and then place a thin paper patch on the
eardrum. Usually with closure of the tympanic membrane improvement
in hearing is noted. Several applications of a patch (up to
three or four) may be required before the perforation doses
completely. if your physician feels that a paper patch will
not provide prompt or adequate closure of the hole in the eardrum,
or attempts with paper patching do not promote healing, surgery
There are a variety of surgical techniques,
but all basically place tissue across the perforation allowing
healing. The name of this procedure is called tympanoplasty.
Surgery is typically quite successful in closing the perforation
permanently, and improving hearing. It is usually done on an
Your doctor will advise you regarding the proper
management of a perforated eardrum.
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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.
Signs and Symptoms
Why do my ears itch?
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
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 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.
A dry ear is unlikely to become infected, so
it is important to keep the ears free of moisture after swimming
or bathing. 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.
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Chronic Otitis Media
What is otitis media?
Otitis media refers to inflammation of the middle
ear. When infection occurs, the condition is called "acute
otitis media." Acute otitis media occurs when a cold, allergy,
or upper respiratory infection, and the presence of bacteria
or viruses lead to the accumulation of pus and mucus behind
the eardrum, blocking the Eustachian tube. This causes earache
When fluid forms in the middle ear, the condition
is known as "otitis media with effusion." This occurs
in a recovering ear infection or when one is about to occur.
Fluid can remain in the ear for weeks to many months. When a
discharge from the ear persists or repeatedly returns, this
is sometimes called chronic middle ear infection. Fluid can
remain in the ear up to three weeks following the infection.
If not treated, chronic ear infections have potentially serious
consequences such as temporary or permanent hearing loss.
How does otitis media affect a child’s hearing?
If you believe your child has
a hearing loss, the young patient should be examined by an ear,
nose, and throat specialist at the earliest opportunity.
All children with middle ear infection or fluid have some degree
of hearing loss. The average hearing loss in ears with fluid
is 24 decibels...equivalent to wearing ear plugs. (Twenty-four
decibels is about the level of the very softest of whispers.)
Thicker fluid can cause much more loss, up to 45 decibels (the
range of conversational speech).
Your child may have hearin g loss if he or she
is unable to understand certain words and speaks louder than
normal. Essentially, a child experiencing hearing loss from
middle ear infections will hear muffled sounds and misunderstand
speech rather than incur a complete hearing loss. Even so, the
consequences can be significant – the young patient could permanently
lose the ability to consistently understand speech in a noisy
environment (such as a classroom) leading to a delay in learning
important speech and language skills.
Types of hearing loss
Conductive hearing loss is a form of hearing
impairment due to a lesion in the external auditory canal or
middle ear. This form of hearing loss is usually temporary and
found in those ages 40 or younger. Untreated chronic ear infections
can lead to conductive hearing loss; draining the infected middle
ear drum will usually return hearing to normal.
The other form of hearing loss is sensorineural
hearing loss, hearing loss due to a lesion of the auditory division
of the 8th cranial nerve or the inner ear. Historically, this
condition is most prevalent in middle age and older patients;
however, extended exposure to loud music can lead to sensorineural
hearing loss in adolescents.
When should a hearing test be performed?
A hearing test should be performed for children
who have frequent ear infections, hearing loss that lasts more
than six weeks, or fluid in the middle ear for more than three
months. There are a wide range of medical devices now available
to test a child’s hearing, Eustachian tube function, and reliability
of the ear drum. They include the otoscopy, tympanometer, and
Do children lose their hearing for reasons other than
chronic otitis media?
Children can incur temporary hearing loss for
other reasons than chronic middle ear infection and Eustachian
tube dysfunction. They include:
Cerumen impaction (compressed earwax)
Inflammation of the external auditory canal, also called “swimmer's
A mass of horn shaped squamous cell epithelium and cholesterol
in the middle ear, usually resulting from chronic otitis media.
This is a disease of the otic capsule (bony labyrinth) in the
ear, which is more prevalent in adults and characterized by
formation of soft, vascular bone leading to progressive conductive
hearing loss. It occurs due to fixation of the stapes (bones
in the ear). Sensorineural hearing loss may result because of
involvement of the cochlear duct.
Trauma: A trauma
to the ear or head may cause temporary or permanent hearing
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