Ear problems and treatments

Transcription

1 Ear problems and treatments

2 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 (standard text message rates apply) 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

3 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 Exostosis 10 Middle ear conditions 10 Otitis media 10 Glue ear 11 Chronic suppurative otitis media (CSOM) 12 Damaged ossicles 12 Otosclerosis 12 Perforated eardrum 13 Inner ear conditions 14 Sensorineural hearing loss 14 Balance problems 15 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. actiononhearingloss.org.uk 3

4 Diagram of the ear Outer ear Middle ear The ossicles: Incus (anvil) Malleus (hammer) Inner ear Pinna 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). Illustration: Willie Ryan Hairs 42783/0407 Ear problems Illustration and treatments Willie Ryan

5 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). actiononhearingloss.org.uk 5

6 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. 6 Ear problems and treatments

7 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. actiononhearingloss.org.uk 7

8 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. 8 Ear problems and treatments

9 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. actiononhearingloss.org.uk 9

10 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

11 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. actiononhearingloss.org.uk 11

12 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. 12 Ear problems and treatments

13 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. actiononhearingloss.org.uk 13

14 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). 14 Ear problems and treatments

15 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 actiononhearingloss.org.uk 15

16 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 16 Ear problems and treatments

17 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). actiononhearingloss.org.uk 17

18 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 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 Alternative formats If you d like any of our leaflets or factsheets in Braille, large print or audio format, please contact our Information Line. 18 Ear problems and treatments

19 Information you can trust We are certified by The Information Standard as producers of high-quality, evidence-based information. For a list of references for this leaflet, please references@hearingloss.org.uk Can you help us improve our information? We d love to hear what you think of this leaflet please reviewpanel@hearingloss.org.uk And do let us know if you d like to join our Readers Panel, to help us create new publications and improve existing ones. Donate today and be part of the next life-changing breakthrough Your support can help our research scientists develop new treatments and cures that will change the world for people living with hearing loss and tinnitus. You ll not only help people coping with hearing loss today millions of people in future generations will enjoy a better quality of life thanks to your support. Donate today Visit Telephone Textphone

20 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 without your help. To find out more about what we do and how you can support us, go to Action on Hearing Loss Information Line Telephone Textphone SMS (standard text message rates apply) information@hearingloss.org.uk PUBLISHED: JANUARY REVIEW DATE: JANUARY Action on Hearing Loss is the trading name of The Royal National Institute for Deaf People. A registered charity in England and Wales (207720) and Scotland (SC038926) A0941/0115