Ear problems and treatments

Ear problems
and treatments
You’ll find this leaflet helpful if you want to know
more about the common ear conditions that can
cause hearing loss and/or balance problems. We
explain how the ear works, the problems that can
develop in the different parts of the ear, and the
treatments available. If you’re at all worried about
your hearing or balance, see your GP.
If you have any questions or would like more information,
please contact our free Information Line:
Telephone Textphone SMS Email 0808 808 0123
0808 808 9000
0780 000 0360
(standard text message rates apply)
[email protected]
The cochlea is an amazing structure
containing 15,000 tiny hair cells
exquisitely arranged to detect and
separate out all the different sounds
that make up speech and music. They are
so sensitive that they can detect movement
down to one millionth of a millimetre.
Damage to these cells is a common cause
of hearing loss, so it’s important to look
after your ears.
Dr Ralph Holme, Head of Biomedical Research,
Action on Hearing Loss
Contents
• Diagram of the ear
4
• How the ear works
6
• Different types of hearing loss
7
• Outer ear conditions
8
–– Excess ear wax
8
–– Otitis externa
9
10
–– Exostosis
• Middle ear conditions
10
–– Otitis media
10
–– Glue ear
11
–– Chronic suppurative otitis media (CSOM)
12
–– Damaged ossicles
12
–– Otosclerosis
12
–– Perforated eardrum
13
14
• Inner ear conditions
14
–– Sensorineural hearing loss
15
• Balance problems
–– Viral infections
15
–– Migraine
16
–– Benign paroxysmal positional vertigo (BPPV)
16
–– Ménière’s disease
16
• Tinnitus
17
• Where can I get further information?
18
Please see page 18 for our medical disclaimer.
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3
Diagram of the ear
The ossicles:
Outer ear
Incus (anvil)
Middle ear
Malleus (hammer)
Inner ear
Ear canal:
Inflammation of the
ear canal is called otitis
externa. This and other
problems, such as eczema
or too much wax, may
need treatment from
a GP (see pages 8–10).
Hairs
2783/0407
Illustration
Willie Ryan
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Ear problems
and treatments
Illustration: Willie Ryan
Pinna
Stapes (stirrup):
The stapes fits into the oval window.
If the stapes becomes fixed, this is
called otosclerosis (see page 12).
Vestibular system:
Problems here may
cause balance problems
(see page 15).
Vestibular nerve and
auditory (hearing) nerve:
These lead to your brain.
Occasionally, a tumour
here, called an acoustic
neuroma, can cause
sensorineural hearing loss
(see page 14).
Cochlea:
Damage here results in
sensorineural hearing loss
(see page 14).
Round window
Oval window
Eardrum or tympanic membrane
Eustachian tube:
If this stops opening,
the air pressure is not
equal in both sides of
the eardrum. This can
cause the eardrum to
become retracted and
lead to earache. The
middle ear can then fill
with fluid, which can
affect your hearing
(see ‘Glue ear’, page 11).
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How the ear works
The ear is the organ of hearing and balance. As you can see from
the illustration on pages 4–5, it is made up of the outer, middle
and inner ear.
Outer ear
The folds of cartilage that surround the ear canal are called the
pinna. Sound waves (vibrations) are gathered by the pinna and
travel down the ear canal until they reach the eardrum, causing
it to vibrate.
Middle ear
The middle ear is an air-filled space that links the outer ear with
the inner ear. Within the middle ear, there are three tiny bones
called the ossicles (or the incus, malleus and stapes). These bones
stretch from the eardrum to the cochlea (your hearing organ in
the inner ear). When the eardrum vibrates, it causes the ossicles to
move backwards and forwards. This movement passes the sound
waves through to the inner ear.
The middle ear is also connected to the space at the back of the
nose by a small passage called the Eustachian tube. When you
swallow or blow your nose, the Eustachian tube opens and allows
air into the middle ear.
Inner ear
The inner ear has two parts:
• the cochlea, responsible for hearing
• the vestibular system, responsible for balance.
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Ear problems and treatments
The cochlea is a fluid-filled chamber that looks a bit like a snail
shell. It’s lined with thousands of tiny sensory cells known as hair
cells. When sound waves enter the cochlea, the hair cells change
the vibrations into electrical signals. The hearing nerve sends
these signals to the brain, which then tells you that you’re hearing
a sound and what that sound is.
The vestibular system is also filled with fluid and has three small
sections lined with hair cells. When you move your head, the fluid
within these sections moves. In response to this movement, hair
cells create electrical signals that are sent to the brain. The brain
uses this information to create a detailed idea of your overall body
movement and head position. Together with your vision and the
sensors in your joints, this helps you keep your balance.
Different types of hearing loss
There are two main types of hearing loss:
1 Conductive hearing loss – this occurs when sound waves can’t
pass freely to the inner ear. It’s usually caused by a blockage or
problem in the outer or middle ear. Sounds become quieter and
sometimes sound muffled. Depending on its cause, conductive
hearing loss can either be temporary or permanent.
2 Sensorineural hearing loss – this is the result of damage to
the cochlea within the inner ear or the hearing nerve (or both).
Sensorineural hearing loss is permanent and can’t be cured, at
least at the present time. It changes your ability to hear quiet
sounds and reduces the quality of the sound that you hear,
making it difficult for you to understand speech.
It’s also possible to have both types of hearing loss – this is known
as mixed hearing loss.
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Outer ear conditions
Excess ear wax
Ear wax is an oily substance produced by the glands in the skin
of the outer half of the ear canal. It is antiseptic and protects and
cleans the ear. It usually comes out of the ear by itself, because the
skin of the outer ear canal moves outwards as it grows. However, if
you have too much ear wax, you may need to have it removed if:
• you experience hearing loss, earache or itchiness
• the wax is blocking the ear canal, preventing a doctor
or nurse from examining it
• you wear hearing aids and the wax is affecting how they work.
How is ear wax removed?
Ear wax is most commonly removed through syringing. This is
usually done by a nurse, using a device called an irrigator that
washes the wax out of the ear with warm water. If this method
isn’t suitable – for example, if you have a perforated (torn)
eardrum (see page 13) – a specialist can lift or suck the wax out
of the ear using special instruments.
See your GP if you think you have an ear-wax blockage. Don’t try
to remove wax from your ears yourself. Never push cotton wool
buds, fingers or anything else into your ears, as you could push
any wax back into the ear or even damage the eardrum.
See our factsheet Ear wax to find out more.
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Ear problems and treatments
Otitis externa
The medical term for inflammation (redness and swelling) of the
outer ear canal is otitis externa. The symptoms can include ear
pain, liquid discharge and some degree of temporary hearing loss.
The condition can be caused by:
• bacterial or fungal infections
• skin conditions such as eczema or psoriasis – broken skin
is more likely to become inflamed
• allergies – for example, antibiotic ear drops or hair products
may irritate your ear canal.
You’re more at risk of an infection in the outer ear canal if you:
• have excessive moisture in your ear due to swimming (particularly
in dirty water), sweating or being in a humid environment
• damage your ear canal – for example, by using cotton buds,
scratching or putting other objects in your ear.
How is otitis externa treated?
See your GP if you have any of the symptoms of otitis externa,
because it tends to last for several weeks if it isn’t treated.
Your GP may prescribe medicated ear drops to help speed up the
healing process. If the condition is caused by an infection, you
may be prescribed antibiotic tablets, or a doctor or nurse may put
a dressing covered in antibiotic ointment into your ear, which will
stay there for a couple of days. They may also try to remove the
discharge in your ear canal, if necessary.
With treatment, otitis externa should clear up within two to three
days. If it doesn’t, you should go back to your GP.
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Exostosis
Exostosis is a condition that develops when repeated exposure
to cold water causes abnormal bone growths in the ear canal.
Usually, two bony swellings (exostoses) slowly appear on the
lower wall of the deep part of the ear canal, often with a third,
smaller lump in the upper part.
People who swim or surf a lot in cold water often get this
condition. With continued exposure to cold wind and water,
exostosis will get worse over the years. If the swellings narrow
the ear canal too much, wax and water can get trapped in the ear,
which can cause infection and hearing loss.
How is exostosis treated?
You can have surgery to remove the abnormal bone growths.
Depending on the condition of your ear canal and the type of
surgery you have, it might take several weeks to several months
for your ear canal to heal.
Avoiding exposure to cold water by not swimming, or by using
earplugs while swimming, should prevent the swellings from
growing bigger.
Middle ear conditions
Otitis media
Otitis media is a middle ear infection that most commonly affects
younger children. Most cases are caused by a bacterial or viral
infection of the upper respiratory tract (nose and throat).
The infection travels from the nose and throat up the Eustachian
tube and into the middle ear (see illustration, pages 4–5). It causes
fluid to build up in the middle ear, and this results in hearing loss
10 Ear problems and treatments
because sound waves are unable to reach the inner ear. The buildup of fluid makes the eardrum bulge outwards, which is painful.
Sometimes, the eardrum can tear, with a sudden discharge of
pus and blood into the outer ear canal – this can relieve the pain.
How is otitis media treated?
Most cases of otitis media will clear up within a few days to a
week without the need for treatment. But get advice from your
GP anyway, because, although rare, complications from an ear
infection can be serious.
If there’s no improvement after several days, or if you’re very
unwell, you may be prescribed antibiotics. If so, you must take
the entire course. See page 13 for more about perforated eardrums.
Glue ear
Glue ear (otitis media with effusion: OME) is more common in
younger children, where it often occurs after otitis media. After
the infection has been treated, fluid remains in the middle ear and
fails to drain back down the Eustachian tube. The child will have a
temporary reduction in hearing in one or both ears. If this persists
in a young child, it may cause noticeable deafness, behavioural
problems and a delay in speech development.
How is glue ear treated?
If your child has glue ear and it doesn’t get better, an ear, nose
and throat (ENT) surgeon may recommend an operation called
a myringotomy, where a tiny ventilation tube called a grommet
is inserted temporarily into the eardrum. This allows air into
the middle ear and allows the fluid to drain back down the
Eustachian tube.
See our factsheet Glue ear.
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Chronic suppurative otitis media (CSOM)
CSOM usually occurs as the result of repeated episodes of otitis
media. The eardrum can fail to heal, leaving a permanent hole
(see page 13). In some cases, there may be a build-up of dead skin,
called a cholesteatoma, in the middle ear.
How is CSOM treated?
If you have a cholesteatoma, you’ll need an operation called a
mastoidectomy to remove the dead skin and prevent it from
causing damage to the middle ear and even the inner ear. The
surgeon will then try to rebuild the damaged middle ear, including
the eardrum, and, if possible, restore your hearing.
Damaged ossicles
The ossicles are tiny bones in the middle ear (the incus, malleus
and stapes – see illustration, pages 4–5). Serious infections and
head injuries can damage them, causing hearing loss. Occasionally,
babies are born with misshapen ossicles.
What treatment is available?
Damaged ossicles can be repaired or replaced with artificial bone.
How much your hearing will improve after surgery depends on
how severe the damage has been to the ossicles and middle ear,
and what type of artificial bone is needed to repair the damage.
Otosclerosis
Otosclerosis is an abnormal swelling of the stapes – one of the
three tiny bones (ossicles) in the middle ear. The condition affects
more women than men; it can run in families and often begins
around the age of 30. It can occur in one or both ears, and women
may find it worsens during pregnancy due to hormonal changes.
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Ear problems and treatments
As a result of the abnormal growth, the stapes becomes rigid
and sound waves can’t pass freely through the ossicles into the
cochlea, causing hearing loss. If otosclerosis isn’t treated, it will
get worse and cause more severe hearing loss.
How is otosclerosis treated?
Hearing aids are very useful if you have otosclerosis. And most
people can have an operation called a stapedectomy, where the
surgeon replaces the stapes with a tiny piston so that sound can
travel to the inner ear. This operation has a high success rate.
Perforated eardrum
A perforated eardrum (a hole or tear in the eardrum) can
be caused by:
• serious middle ear infections, such as untreated otitis media
(see page 10)
• injury to the eardrum, caused by, for example, a severe blow
to the ear or poking things in your ear
• sudden loud noise, such as an explosion, accompanied by
a pressure change.
• changes in air pressure, such as when changing altitude
in an aeroplane or when scuba diving.
A perforated eardrum may give you earache. The hearing loss is
usually only temporary and your hearing will return once your
eardrum has healed.
It’s important not to get water or any other liquid in your ear while
your eardrum is perforated, as this can cause an infection in the
middle ear.
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How is a perforated eardrum treated?
A perforated eardrum normally heals on its own within two
months. For more serious damage, usually following repeated
episodes of otitis media, you might need an operation called a
myringoplasty – a tissue graft is used to seal up the hole.
See our factsheet Middle ear conditions to find out more
about the conditions listed in this section.
Inner ear conditions
Sensorineural hearing loss
Sensorineural hearing loss is caused by damage to the tiny hair
cells within the cochlea or damage to the hearing nerve (or both).
This damage is permanent and so is the hearing loss.
A particular type of sensorineural hearing loss, called presbycusis,
happens naturally as part of the ageing process. But there are many
things that cause sensorineural hearing loss, or add to it, such as:
• regular and prolonged exposure to loud sounds and/or very
loud sounds such as blasts
• medicines used to treat serious diseases, such as certain
cancer drugs and powerful antibiotics
• certain infectious diseases, including mumps and meningitis
• complications at birth
• non-cancerous tumours on the hearing nerve (see our
factsheet Acoustic neuroma)
• some disorders such as Ménière’s disease and Usher syndrome
• genetics (see our factsheet Genetics and deafness).
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Ear problems and treatments
How is sensorineural hearing loss treated?
People with sensorineural deafness usually find hearing aids very
helpful. If you think you have a hearing loss, see your GP, who can
refer you to a hearing specialist for a full hearing assessment.
Cochlear implants may be an option for people who have become
profoundly deaf and can’t get much help from hearing aids, or for
children who are born deaf (see our factsheet Cochlear implants).
Protect your ears
Exposure to loud noise can damage your hearing without you
realising it until years later. By law, if you work somewhere very
noisy, you must be given earplugs or earmuffs to protect your
hearing. It’s also a good idea to use hearing protection when
you go to music concerts, nightclubs and other noisy places.
See our factsheet Noise exposure.
Balance problems
Feelings of dizziness are usually short-lived, but some people
experience long-lasting dizziness and balance problems. Most
often, these symptoms are caused by a problem in the inner ear.
The good news is that there’s almost always a treatment to help.
Viral infections
The most common cause of sudden dizziness is a simple viral
infection (such as the common cold or flu) spreading to your inner
ear or the nerve of balance. Although your immune system gets
rid of the virus quite quickly, your balance organ (the vestibular
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system, see page 7) might have been damaged while you had
the infection. You may feel dizzy until your brain can adjust to
the damage. This sort of balance problem is usually helped by
vestibular rehabilitation physiotherapy, which includes head and
balance exercises.
Migraine
With a migraine, you’ll usually have a severe headache, but it’s
also a common cause of dizziness. Often, the dizziness is severe
and you’ll also vomit. Some people have what’s known as a ‘silent
migraine’ without any head pain – this can also cause dizziness –
but it’s rare. There are effective treatments for migraines, and ways
to stop them developing. Speak to your GP to find out more.
Benign paroxysmal positional vertigo (BPPV)
BPPV is an inner ear disorder that can cause short but severe
spells of vertigo (a spinning sensation), especially if you tip your
head backwards – for example, if you look up at the sky or when
you first lie down in bed. It’s thought that BPPV is caused when
small calcium crystals are dislodged and float around in the fluid in
the vestibular system. If you have BPPV, you’ll feel as if your head
is turning when it isn’t.
Your specialist can help with some, if not all, of the symptoms of
BPPV through a procedure known as the Epley or Semont manoeuvre.
This moves the dislodged calcium crystals into another part of the
vestibular system, where they don’t cause the same symptoms.
Ménière’s disease
Ménière’s disease is a rare condition thought to be caused by
changes in the pressure of the fluid in the inner ear. It leads to
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Ear problems and treatments
sudden attacks of severe dizziness that can last from 20 minutes
to 24 hours. With an attack, you’ll usually have a feeling of ear
‘fullness’ followed by nausea and vomiting, as well as hearing
loss and tinnitus (see below), and, possibly, sensitivity to sound
(hyperacusis). However, the symptoms and severity of Ménière’s
disease vary greatly from person to person. Repeated attacks
can cause a degree of permanent hearing loss.
You can reduce or control the symptoms of Ménière’s disease
through diet and medication. Rarely, you might need some type
of surgery (see our factsheet Ménière’s disease).
See our factsheet Dizziness and balance problems to find
out more about the problems listed in this section. Other health
conditions can also cause balance problems – ask your GP for
more information.
Tinnitus
Tinnitus is the word for noises that some people hear in their
ear(s) or head – buzzing, ringing, whistling, hissing and other
sounds – which don’t have an external source.
The cause of tinnitus isn’t completely understood, but it can
be linked to:
• hearing loss (but hearing loss and tinnitus can
occur independently)
• exposure to loud noise
• emotional stress
• certain medications used to treat seriously ill people
• injuries to the ear or head
• some ear conditions (including excess ear wax).
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Although there’s not yet a cure for tinnitus, there are different
therapies and products that can help you to manage it effectively.
In most cases, tinnitus improves over time.
See our leaflet Understanding tinnitus to find out more.
Medical disclaimer
The information given in this leaflet is not medical advice and, by
providing it, neither Action on Hearing Loss nor our medical advisers
undertake any responsibility for your medical care, or accept you as a
patient. Before acting on any of the information contained in this leaflet,
or deciding on a course of treatment, you should discuss the matter with
your GP or other medical professional who is treating you.
Where can I get further information?
We produce a wide range of free information covering hearing loss,
deafness, tinnitus and related issues such as ear problems, hearing
aids, communication support, benefits, rights, equipment and deaf
awareness. Our leaflets are a good place to start as they cover the
basics, while our factsheets go into more detail.
You can find our publications on our website at
www.actiononhearingloss.org.uk/factsheets or order free copies
from our Information Line (see last page for details). Our friendly
Information Line Officers will also answer any queries you have.
You can find lots of other useful information online at
www.actiononhearingloss.org.uk
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or audio format, please contact our Information Line.
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Ear problems and treatments
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We’re Action on Hearing Loss, the charity
working for a world where hearing loss
doesn’t limit or label people, where tinnitus
is silenced – and where people value and
look after their hearing. We can’t do this
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To find out more about what we do
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PUBLISHED: JANUARY 2015. REVIEW DATE: JANUARY 2016.
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