Common Disorders of the Ear NAEH 2015 Conference

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1 Common Disorders of the Ear NAEH 2015 Conference 1. Welcome 2. External Ear Normal ear canal 3. External Otitis Infection of the external ear canal Varies in degree of inflammation Entire canal or pimple/boil Smelly discharge, itchy, painful 4. Infection in the ear canal Swimmer s ear (external otitis) Ear canal narrows with a bend in the middle Tip to remove water is to place arm around head and pull on opposite outer ear to straighten the canal 5. Ear Wax Normal liquid or dry ear wax (The Asian culture has dry ear wax) 6. Impacted Ear Wax 7. Foreign body in the ear canal Q-tip Ear bud that fell off 8. Things you ll find in children s ears 9. Exotosis Abnormal bone growth in the ear canal Commonly referred to as Surfer s Ear (80% of surfers develop exotosis) Frequent exposure to cold water, wet, and windy conditions o Includes surfing, sailing, diving, kayaking, fishing, water skiing Symptoms include: decreased hearing increased ear infections increased water trapped in the ear visible closure of the ear canal 10. Middle Ear a hollow air filled space 11. Normal eardrum and Perforated eardrum Perforation impairs hearing May lead to infection and/or injury of the middle and/or inner ear Sudden loss of hearing, tinnitus, or vertigo Causes Bad middle ear infection Loud noise close to ear (explosion, gunshot) Foreign object in ear (crayon, q-tip, hair pin) Rapid change in ear pressure (flying, scuba diving) Severe head trauma 12. Perforation of the eardrum by a Q-tip 1

2 13. Myringitis Eardrum becomes inflamed; small blisters on the eardrum Due to bacterial or viral infection Pain lasts hours Drainage from ear Hearing loss occurs but returns when inflammation clears There is no middle ear infection with myringitis 14. Eustachian tube 15. Eustachian tube Closure and opening at back of the throat Swells closed from allergies, second hand smoke, upper respiratory infections Closes or becomes blocked from drinking while laying on back, sudden increase in air pressure 16. Middle ear infection a.k.a. Otitis Media or Acute Otitis Media Viruses or bacteria enter the Eustachian tube through the throat o Severe, persistent ear pain o Fever o Tendency is for just one middle ear to be infected 17. Serous Otitis Media a.k.a. Otitis media with Effusion Serous is a yellow transparent fluid of protein and water that fills body cavities Chronic inflammation of the lining of the Eustachian tube obstructs the tube from draining causing build-up of Serous fluid in the middle ear Middle ear progresses from no fluid to fluid filled No infection is present No obvious symptoms No pain or fever Usually in both ears Serous Otitis Media may cause Acute Otitis Media; Acute Otitis Media may cause Serous Otitis Media 18. Tube inserted in the eardrum allows fluid to drain 19. One mom s remedy for an ear infection! 20. Airplane ascending Cabin pressure decreases Middle ear pressure increases Excess air in the middle ear Plug nose and swallow to open the Eustachian tubes to release air from middle ear 21. Airplane descending Negative air pressure causes eardrum to retract Eardrum is being pulled in Plug nose and gently blow with mouth closed This forces air through the Eustachian tube into the middle ear 22. Visual of eardrum a. eardrum bulging outward when plane climbs b. eardrum drawn inward when plane descends c. normal eardrum pressure from the inside and outside 2

3 23. Scuba Diving Ear issues range from simple swimmer s ear to serious damage to middle or inner ear Be aware of rapid pressure changes Divers are taught to equalize ear pressure frequently (as often as every 2 feet of change in depth) 24. Otosclerosis Excessive bone growth surrounding the middle ear Immobilizes the stapes attached to the oval window Unable to transmit sound efficiently Hereditary condition Slow yet progressive hearing loss Difficult hearing low pitch sounds o May include dizziness, balance problems, or tinnitus symptoms May be helped with a hearing aid or surgically inserting a prosthetic stapes 25. Stiffness in the Middle Ear Causes Air pressure of middle ear not equalized (flying or diving) Infection or fluid of middle ear make eardrum and middle ear bones stiff Middle ear bones themselves become stiff Eardrum is stiff from repeated trauma Scar tissue in the middle ear from history of infections or traumas 26. Inner Ear Conductive Hearing Loss = Outer/Middle Ear Sound moving from the outer ear through the middle ear o Some causes: allergies, fluid/infection in middle ear, ear wax, boil, foreign body, tumor, exotosis, otosclerosis, perforated eardrum Most common in children due to high occurrences of middle ear infections Sensorineural Hearing Loss = Inner Ear Damage to inner ear cochlea or nerve pathways to brain Most common type of permanent hearing loss for adults Some level of permanent hearing loss o Some causes: aging, head injury, brain tumor, prescription drugs, damage to hair cells, damage to auditory nerve, sudden or loud noises over time 27. Auditory Hair Cells Responsible for detecting sound Sounds louder than 90 decibels flatten hair cells Long term exposure to loud sounds cause permanent hearing loss 28. Hearing Loss Frequencies High frequency hearing loss Difficulty hearing high pitched sounds Can hear but not understand sounds mumbly o Don t hear the consonants of words, only hears the vowels Low frequency hearing loss Able to hear higher frequencies Often able to understand speech Difficulty hearing in groups or noisy places 3

4 29. Source of noise and decibels associated with hearing loss 30. Can you hear me now? Take good care of your hearing We get frustrated when we have to keep repeating ourselves when someone can t hear us 31. Vertigo Sensation of spinning, dizziness, swaying, tilting, feeling unbalanced Most often caused by and inner ear issue Ear crystals are most common cause of vertigo Other causes Meniere s disease, labyrinthitis, vestibular neuritis Vertigo is not usually caused by Neck or head injury, stroke or brain tumor, medications, migraines Symptoms include: Triggered by change of head position, feeling nauseated, jerky eye movements, headaches, ringing in the ear, or experience hearing loss Non ear associated symptoms with vertigo include: Sudden drop in blood pressure, dehydration, certain medications, getting up too quickly from lying down or sitting 32. Labyrinthitis a.k.a. Inner ear infection; labyrinth becomes infected and inflamed Most commonly it is a secondary infection from a cold or flu virus Bacterial infection is rarely the cause but may develop as a secondary infection from a severe case of otitis media or damage to the ear from a head injury Symptoms: severe dizziness, vertigo, temporary loss of hearing in infected ear, possible deafness, tinnitus, nausea, vomiting, eyes may move slowly to one side and then dart back to original position 33. Labyrinthitis another view 34. Meniere s Disease Caused by excess fluid in the semicircular canal Symptoms: balance and hearing are affected, dizziness, loss of hearing in one or both ears Tinnitus (ringing in the ears) 35. Tinnitus Not a disease it s a symptom Ringing or buzz in one or both ears Noise may also be hissing, roaring, whistling, chirping, or clicking Noise may be constant or intermittent Subtle or loud Single or multiple tones Causes: impacted earwax, eardrum inflamed, middle ear infection, fluid in the middle ear, inner ear infection, noise damage from overstraining the hearing cells, head or neck trauma, jaw misalignment, damage to auditory nerve May be secondary to hypothyroidism or hyperthyroidism, Meniere s disease, Lyme s disease, fibromyalgia Treatment of the underlying cause may resolve tinnitus. 4

5 36. Oversensitive Hearing Increased sensitivity to everyday sounds e.g. Water faucet, dishwasher, walking in leaves, shuffling paper, any noise o High frequency noises are particularly troublesome Quality of life is compromised reluctance to interact with environment o Becomes depressed and isolated Usually affects both ears Happens at any age May come on slowly or suddenly Causes pain and discomfort Causes: Head injury, medications, Bell s Palsy, TMJ, Meniere s disease, PTSD, Chronic Fatigue Syndrome, autism, Down s syndrome, depression, migraines, sudden loud noise, some forms of epilepsy 1 in 1,000 people who have tinnitus have oversensitive hearing There are millions of people who have tinnitus 37. Ear Crystals a.k.a. Benign Paroxysmal Positional Vertigo (BPPV) Most common inner ear disorder Most common cause of vertigo Tiny crystals of calcium carbonate are a normal part of the ear anatomy Crystals detach from membrane in the utricle If move into the semicircular canal then when head is moved the crystals disrupt the flow of fluid sending a false sense of motion to the brain Causes: head injury to simple miss-step off a curb; secondary to viruses of the inner ear, labyrinthitis or vestibular neuritis; may be associated with migraines; half the time the cause is unknown Symptoms: vertigo, dizziness, nausea, vomiting, unbalanced, involuntary rapid side to side eye movement You do not experience with BPPV: hearing loss, feeling of fullness in the ear, head noise. If any of these symptoms are present then another inner ear disorder is present 38. Ear Crystals another view Inner or Outer Ear may be caused by an inner or outer ear disorder or condition 39. Muffled Hearing Causes Ear wax or foreign body Middle ear infection Eustachian tube issue Asymmetric hearing hearing better in one ear than the other Sensorineural hearing loss; High or low frequency hearing loss If happens suddenly seek medical attention 5

6 Other 40. Selective Hearing The tendency to ignore the things people don t want to hear Not a psychological issue Words are heard; mind chooses not to acknowledge what s being said Selective inattention done consciously or subconsciously No this is not just a male issue! Affects both genders Affects all ages adults and children 41. Selective Hearing - Pets 42. Wiggling Ears! 10-20% of population are ear wigglers Some move one ear at a time Others can move both ears at the same time Ear wiggling is a vestigial feature Useful for our ancestors to focus on the direction of certain sounds o We still have the muscles but they became functionless Muscles around outside of ear Auricularis anterior moves ear up and forward (1) Auricularis superior raises the ear (2) Auricularis posterior pulls the ear backwards (3) Maller, Jerome, (2014, December). Neuroplasticity in normal and brain injured patients: potential relevance of ear wiggling locus of control and cortical projections. [Abstract in PubMed, National Library of Medicine.] Hypothesis relates to dormant white matter pathways in the brain Complex task of ear wiggling may activate and promote advanced recovery after a brain injury. Trigger the pathways with electrical/magnetic stimulation into becoming consciously controllable A complex skill like ear wiggling may assist in the repair of damaged pathways The broader potential impact of the proposed hypothesis is that ear wiggling could be used for improving the recovery of TBI or stroke subjects via neuroplasticity processes. 43. References 44. References by Bonnie K. Dysinger, B.Msc., CPEH, C.Ht. 6

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