Hearing & Balance
Otitis Media
Otitis Externa (Swimmers Ear)
Hearing Loss
Vertigo (Dizziness)

Otitis Media
Otitis media is the medical term for middle ear disease. Basically, two types of otitis media are commonly seen and both types occur mainly in young children and both types are often preceded by a viral upper respiratory infection.

Acute otitis media is the term for the middle ear infection that results in an earache often followed a day or two later by pus draining from the ear. Antibiotics are the main treatment. If the child develops repeated bouts of acute otitis media over a relatively short period of time, insertion of ventilating tubes is recommended.

Otitis media with effusion is the collection of fluid in the middle ear that results from eustachian tube malfunction and causes a stuffy sensation in the ear and a mild to moderate hearing loss. Often otitis media with effusion will resolve without specific treatment. If it does not resolve spontaneously, antibiotics are often prescribed even though antibiotics are only effective in 15 to 20% of cases. If the fluid persists for more than 3 months and is causing a significant hearing loss, surgical removal of the fluid and insertion of ventilating tubes is warranted.

The intermittent or persistent hearing loss seen in young children with otitis media may result in delayed acquisition of speech and in learning disabilities.
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Otitis Externa (Swimmer's ear)
The symptoms of swimmer's ear are pain, itching and occasionally hearing loss. Swimmer's ear is a result of the change of the normal pH balance of the external auditory canal. This occurs from excessive use of Q-tips with resulting damage to the epithelial or skin lining of the ear canal or most commonly in children from long periods of water emersion such as happens at the beginning of summer or on trips to water vacation destinations. Due to the trauma of the Q-tips or the soaking of water emersion, the normal acid pH of the external auditory canal is lost. Psuedomonas aeruginosa is a normal bacterial inhabitant of the external auditory canal. The bacteria's growth is inhibited by the acid pH. When the acidity is lost the Psuedomonas bacteria proliferates. This causes a superficial infection with resultant pain, itching and discharge.

The standard treatment is an ear drop. The ear drop typically contains an acidifying agent and a drying agent. The home remedy ear drop contains equal parts of white table vinegar, 70% isopropyl alcohol and water. Commercial preparations are available over the counter and by prescription. The prescription drops contain antibiotics and steroid additions which are felt by many to enhance the ear drop efficacy. Oral antibiotics are not indicated, are not helpful and should neither be requested nor prescribed.

There is no question that this is a painful condition. Pain medicine such as Tylenol for young children, aspirin and non-steroidals for older individuals should be provided. Heat is also very comforting. In the old days this was a stone warmed in the fire. Today it is a dry heating pad. The ear drops are used until the pain and itching are gone. They can be used 3-4 times a day. Once improved, the child can return to swimming, bathing and normal activities.

In very difficult cases, accumulated debris may need to be suctioned or washed out of the ear canal. This can be performed by the otolaryngologist. In advanced cases where the ear canal is literally swollen closed, drops will not reach the inner portions of the infected canal and so a small sponge wick will be inserted. These normally stay in place for 1-4 days. Drops placed in the external canal are carried along the wick. Otitis externa should respond to treatment in 12-24 hours. If it does not, and certainly if it progresses, this is not only a serious discomfort, but a medical emergency and should be brought to the attention of the appropriate physicians.
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Hearing Loss:
Hearing loss can be the result of a wide variety of conditions. One way of classifying hearing loss is to divide it into conditions causing a conductive hearing loss or a sensorineural hearing loss.

A conductive hearing loss results when the sound waves have difficulty getting transmitted from the air outside the ear to the tiny hair cells in the cochlea (inner ear) where the sound waves are transmitted as nerve impulses. An obstruction of the ear canal from wax or from swelling of the ear canal as seen in swimmer's ear can result in a conductive hearing loss.

After the sound waves travel through the ear canal they cause the tympanic membrane (eardrum) to vibrate. These vibrations are transmitted through the three tiny ear bones of the middle ear space and cause movement in the fluid that resides in the inner ear. The middle ear contains air that is replenished through the eustachian tube each time that we swallow. An upper respiratory infection can cause the eustachian tube to malfunction resulting in fluid instead of air in the middle ear. This fluid dampens the effective transmission of sound through the ear bones resulting in a mild or even moderate hearing loss. A middle ear infection prevents sound transmission in the same fashion. Middle ear fluid is a very common occurrence in children, occurring at least on one occasion in 70% of children. Less common causes of conductive hearing loss include skin cysts that are related to eustachian tube malfunction, middle ear birth defects that result in malformed ear bones, and otosclerosis, a bone disease of the stapes that results in decreased movement of that bone and ineffective transmission of sound waves into the inner ear. Most causes of conductive hearing loss are treatable either medically or surgically.

Sensorineural hearing loss occurs when the hair cells in the cochlea are damaged and fail to transform vibrations of the inner ear fluids into electrical signals that are transmitted to the brain. Inherited malformations of the inner ear can either cause hearing loss at birth or else a progressive hearing loss later in life. Some inherited causes of hearing loss are associated with other inherited abnormalities, such as eye problems, heart abnormalities, or abnormalities of other body systems, but the majority of people with inherited hearing loss have no other abnormalities.

A very common cause of sensorineural hearing loss is exposure to loud noises. This type of hearing loss results from long-term exposure to noise, such as in coal mines, factories, or from shooting guns or listening to loud music. As a general rule if your ears are ringing after you leave a noisy environment, the sound could be damaging to your inner ears. Ear muffs or ear plugs can protect the individual from inner ear damage in most circumstances.

The aging process can also result in hearing loss. Part of the hearing loss seen in old age may be due to the long-term effects of noise exposure in our industrialized society. Elderly people in primitive societies usually do not exhibit the same degree of hearing loss as is seen in industrialized countries. Some individuals have a genetic predisposition for a progressive hearing loss as they get older.

A number of other conditions, such as Meniere's disease, sudden sensorineural hearing loss, and head injuries can cause sensorineural hearing loss.

Sensorineural hearing loss can also result from diseases that affect the auditory nerve that connects the hair cells to the brain. An example would be the acoustic neuroma, which is a benign tumor of the auditory nerve that results in a slowly progressive one-sided hearing loss often associated with ringing of the ear.

Most causes of sensorineural hearing loss can be treated with hearing aids. Those individuals with a profound hearing loss in whom a hearing aid is not providing adequate help may benefit from a cochlear implant.
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Vertigo ( Dizziness)
Meniere's Disease:
Meniere's disease is an inner ear problem that causes spells of vertigo (spinning) that last from 20 minutes to several hours and often result in nausea, and sometimes, vomiting. The episodes of vertigo are usually accompanied by temporary unilateral hearing loss, tinnitus (ringing in the ear), and often a pressure sensation in the involved ear or on the side of the head. Meniere's disease is rare in children but can occur in adults of any age. One of the characteristics of Meniere's disease is its unpredictable nature; the spells can occur from once a day to once a year. Over the course of months to years the person's hearing tends to fluctuate less with the spells, and often stays depressed between spells.

Meniere's disease is thought to result in an excess of fluid in parts of the inner ear. The main treatment consists of a diuretic, that is, a pill that helps the body get rid of excess fluid, and a low salt diet. Ancillary treatments may include symptomatic treatment with drugs to suppress dizziness, such as meclizine (Antivert) or diazepam (Valium), and drugs that are supposed to increase the blood circulation in the inner ear, such as, histamine shots. The majority of patients with Meniere's disease derive significant relief with medical treatment. Those who fail medical treatment are offered surgical treatment, which is often successful.
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