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ENT Conditions
Ears
:: What is tinnitus?
Tinnitus is the sound of ringing, roaring, buzzing, or clicking that occurs inside the head. The sounds:
- may come and go
- may be continuous
- vary in pitch
- may occur in one or both ears
Currently, there are approximately 3 million people in the Australia who suffer from tinnitus. Almost everyone over 40 will hear some tinnitus if placed in an extremely quiet room.
What causes tinnitus?
Tinnitus may result from a variety of causes, including:
- damage to the nerve endings in the inner ear
- stiffening of bones in the middle ear
- advancing age
- exposure to loud noises
- allergy
- high or low blood pressure
- tumor
- diabetes
- thyroid problems
- head or neck injury
- reaction to certain medications
- infection in the external, middle or inner ear
- TMJ (jaw joint) problems
- Tumours of the ear or base of skull
When there is no defined cause for tinnitus it is usually generated by damaged hair cell nerves within the inner ear. This is nerve damage and, like nerve damage anywhere in the body is very difficult to treat.
Treatment for tinnitus:
Specific treatment will be determined by the physician(s) based on:
- patient's age, overall health, and medical history
- extent of the disease
- expectations for the course of the disease
- patient's tolerance for specific medications, procedures, or therapies
- patient's (or family's) opinion or preference
Generally, there is no specific treatment for tinnitus. It can be a very frustrating illness for both patient and practitioner because of this. If a particular cause can be identified, treatment for the cause may reduce or eliminate tinnitus.
Suggestions for reducing the severity of tinnitus include:
- avoid loud sounds
- have blood pressure checked
- decrease intake of salt
- avoid stimulants such as coffee, colas, and tobacco
- exercise daily to improve blood circulation
- get adequate rest
- learn to ignore the sounds of tinnitus as much as possible
- practice concentration and relaxation exercises
- hearing aid(s) may reduce the sounds of tinnitus
- mask the sounds of tinnitus with other, low-level sounds such as a ticking clock or specially-purchased "white noise" products
- stress appears to be a potent stimulator of tinnitus or tinnitus awareness
:: What is otitis media?
Otitis media is infection or inflammation located in the middle ear.
About 75 percent of children have at least one episode of otitis media by the time they are three years of age. Nearly half of these children have three or more infections by the time they are age three.
Otitis media can also affect adults, although it is primarily a disease that occurs most often in children.
What causes otitis media?
Inflammation usually begins when infections due to sore throats, colds, or other respiratory problems, spread to the middle ear.
What are the symptoms of otitis media?
The following are the most common symptoms for otitis media, however, individuals may experience symptoms differently.
Common signs of otitis media in children include:
- unusual irritability
- difficulty sleeping or staying asleep
- tugging or pulling at one or both ears
- fever
- fluid draining from ear(s)
- loss of balance
- hearing difficulties
The symptoms of otitis media may resemble other conditions or medical problems. Consult a physician for a diagnosis.
What are the effects of otitis media?
In addition to the symptoms of otitis media listed above, untreated otitis media can result in any/all of the following:
- infection in other parts of the head
- chronic infection and damage of the ear components
- permanent hearing loss
- problems with speech and language development
- perforation of the tympanic membrane (ear drum)
Can otitis media be prevented?
Cold and allergy medications do not appear to prevent otitis media. And, currently, there is no vaccine that can prevent the disease. However, there are certain factors that seem to increase the chances of otitis media developing in some children. These include:
- living in a home where cigarettes are smoked
- nursing with a bottle while lying down
- attendance at day care
How is otitis media diagnosed?
In addition to a complete medical history and physical examination, the physician will inspect the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the physician to see inside the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.
A tympanometry, a test that allows for air and sound to be directed into the middle ear, may also be performed.
A hearing test may be performed for people who have frequent ear infections.
Treatment for otitis media:
Specific treatment will be determined by the physician(s) based on:
- patient's age, overall health, and medical history
- extent of the disease
- expectations for the course of the disease
- patient's tolerance for specific medications, procedures, or therapies
- patient's (or family's) opinion or preference
Treatment may include:
- antibiotic medication
- medication for pain
- myringotomy (or grommets as they are commonly known) - surgery to insert tubes to ventilate the middle ear and keep air pressure level
Ear Wax
What Are the Symptoms of Wax Buildup?
- partial hearing loss, may be progressive
- tinnitus, noises in the ear
- earache
- fullness in the ear or a sensation the ear is plugged
Self Treatment
Most cases of ear wax 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 ear wax removal 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.
:: Ears, altitude and airplane travel
Ear problems are a common medical complaint of airplane travelers, and while they are usually simple, minor annoyances, they occasionally result in temporary pain and hearing loss.
The ear is divided into three parts:
- The outer ear meaning the part of the ear you can see on the side of the head plus the ear canal leading down to the ear drum.
- The middle ear: the ear drum and ear bones (ossicles), plus the air spaces behind the ear drum 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).
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 2nd or 3rd time) you swallow, your Eustachian tube equalizes pressure between your middle ear and that ambient pressure of the outside world. The eustachian tube is 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 air 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 (hayfever, etc.) are also causes. A stuffy nose leads to stuffy ears because the swollen membranes block the opening of the Eustachian tube.
Children are especially vulnerable to blockages because their Eustachian tubes are narrower and work less effectively than in adults.
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 tricks too.
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 before descent.)
If yawning and swallowing are not effective, unblock your ears is 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. This is called Valsalva or Toynbee manouvre. You may have to repeat this several times during descent. Do not apply too much pressure. Any pain is a sign that either technique or ears are not right.
Babies' ears
Babies cannot intentionally pop their ears, but popping may occur if they are sucking on a bottle or pacifier. Feed your baby during descent rather than letting her feed.
Precautions
- When inflating your ears, you should not use force. The proper technique involves only pressure created by your cheek and throat muscles.
- 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, they should be avoided by persons with heart disease, high blood pressure, irregular heart rhythms, thyroid disease or excessive nervousness. Such people should consult their physicians before using these medicines. Pregnant women should likewise consult their physicians first.
We suggest 2-4 sprays of drixine or otrovin spray at takeoff, and the beginning of descent. For patients that have had pain or difficulty before, we suggest adding 2 sudafed or sinutab tablets to be taken half an hour before the start of descent. This may be soon after takeoff on a short flight.
If your ears will not unblock
Even after landing you can continue the pressure equalizing techniques, and you may find the decongestants and nose sprays to be helpful. (However, avoid making a habit of nose 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 an ENT specialist. He/she may need to release the pressure or fluid with a small incision in the eardrum.
When should I just not fly?
If you have had severe pain or a perforation on descent before we suggest not flying until a full specialist assessment. If you have had some difficulty and now have a heavy head cold this is also a relative contraindication to flying.
Always fly with care and look after your ears. Please seek our advice any time you have concerns about flying and your ears.
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