Otology

Ear Infections

 

Ear infections are very common. They are more common in summer than they are in the winter months. Causes include placing a foreign body such as a cotton bud into the ear. An ear infection can also result from fluid being introduced into the ear due to swimming in infected waters and pools. Ear infections can come on quite suddenly and can be a very painful condition. If normal medications such as oral antibiotics and topical drops don’t relieve conditions, the ear will need to be seen to quite quickly.

 

An ear infection type falls into three different categories; there can be a viral infection which is very unusual and almost always has vesicles and is associated with conditions such as herpes and shingles. Bacterial infection which is the most common and is the most painful with the swelling of the outer canal and sometimes the external ear. It often has a throbbing sensation and is much worse when the outer ear is moved. The third type of infection is a fungal infection. This fungal infection or thrush is likely to follow a bacterial infection that has been treated with topical or oral antibiotics. Just as in any other complaints in the body when treated with antibiotics the good and bad bacteria are killed at the same time and this allows the opportunity for fungal infections to take hold. The fungal infections are quite insidious in that they continue to occur every 4 to 5 weeks, almost indefinitely if not treated correctly. The fungal infection is less painful than the bacterial infection, but is very itchy, blocks the ear canal and has a large amount of discharge associated with it.

 

The role of the ENT Surgeon in ear infections is to toilet the ear. This involves suctioning the ear out, cleaning any debris and allowing the normal bacteria to return. This is very different from having the ear syringed,where water debris and further infection are pushed around into the entire ear canal. An ear toilet is suctioning of the ear under inspection by the ENT Surgeon. This gives a better evaluation of the ear health, both the external and the tympanic membrane. It also allows infectious material to be removed from the ear and returning hearing to normal more quickly. If this material is not removed, the infection may resolve for a period of time, but tends to reoccur with water contact.

 

The most important thing with ear infections is to keep the area completely dry. Any fluid introduced to the ear whilst the infective process is occurring will only worsen the condition.

 

Hearing Loss assessment

 

The most common cause of long term hearing loss is wax build up in the ear. This accounts for about 80% of all long term slow hearing loss. There are many other forms of hearing loss, noise exposure, congenital and family history, but there are some forms of sudden loss that are quite sever and disabling. These need urgent attention.

 

Hearing falls into three different categories; there is conductive hearing where the sound is being transmitted from the outer ear through the external auditory canal, through the tympanic membrane and the ossicles, to the small bones in the middle ear. The sound moving through this area is considered to be conductive hearing. The cochlea then senses and converts this hearing into electrical impulses called the sensory hearing. The neural component is the neural pathway from the cochlear and the brain itself.

 

A sudden onset of a sensorineural hearing loss is a severe emergency and needs to be seen within a very short period of time. Often the patient will need to be treated with high dose steroids and sometimes antiviral medication depending upon their condition.

 

Most hearing losses can be differentiated between conductive hearing which is most likely wax, infection and debris in the external canal from the sensorineural type which is actually a nerve or sensory loss. Occasionally a hearing assessment is required to differentiate between these.

 

VERTIGO

 

A sudden onset of vertigo is quite distressing for any individual who has never experienced it before. Unfortunately this is a very common complicated situation and there is no one test that is going to show the actual cause of vertigo. Most of the testing and examination process involved in treating vertigo is to try and exclude any conditions that could be causing a danger to the patient. This will almost involve an MRI scan or CT scan. This will exclude any neurological lesions or neoplastic changes, i.e. cancers that could be causing this vertigo. A hearing assessment is also worthwhile, but it needs to be a diagnostic audiological assessment, rather than just a screening test. In some instances, a full balance assessment and testing is needed to determine the underlying cause of vertigo.

 

A number of conditions are often passed around between patients such as Benign Paroxysmal positional Vertigo, Meniere’s, and labyrinthitis or vestibular neuritis. These are often determined by the history alone.

 

As a name would suggest, Benign Paroxysmal Positional Vertigo is a condition that comes and goes. It is associated with particular movement such as rolling over in bed or reaching up or down to get something out of the cupboard.

 

Meniere’s disease is a constellation of four symptoms; these are tinnitus, which is new onset or changes in the tinnitus already present, vertigo, oral fullness which is a sensation of a blocked ear and also the fourth symptom being fluctuating sensorineural hearing loss.

 

In most cases acute vertigo management will be done in a hospital setting or by your primary care giver such as your GP. An ENT Surgeon is normally seen in the coming weeks to months after having a vertigo attack to try and fully diagnose and hopefully treat the condition.

 

TINNITUS

 

Tinnitus is the sensation of noise experienced by a patient that is not experienced by others. This is a very common condition, particularly high frequency tinnitus. High frequency tinnitus is equated to a cicada type noise or an electrical feedback type noise that can be quite intrusive. If this is only unilateral, meaning on one side, it is important that it is investigated fully, as the ears are normally affected equally on both sides by any condition normally causing tinnitus. This may require an MRI scan to exclude a tumour in the brain that could be causing this condition.

 

The second type of tinnitus is called a pulsatile tinnitus where the patient experiences a pattern type pulsation in the noise within their ear. This could be caused by a vascular or a blood vessel type lesion on the eardrum, middle ear or within the neck. This needs to be investigated fully to exclude a lesion of this type.

 

There are a number of treatments for tinnitus, but none of these are 100% successful. Most consultations about tinnitus are discussing the possible causes, investigating reversible causes and then talking to the patients about managing their tinnitus long term.

 

HEARING AID ASSESSMENT

 

Often ENT Specialists are seen to give an unbiased opinion about hearing aids. Hearing aids themselves can be quite expensive and in some cases may be suggested where the patient does not necessarily need the aid. A formal assessment of hearing loss with a full diagnostic audiological assessment is often beneficial before seeing the ENT Surgeon. Then a full discussion can cover all the areas of hearing loss and the patient’s needs.

 

ORAL TOILET

 

Oral toilet is a name of suctioning of the ears. This suctioning is done under vision using a microscope. This gives the ENT Surgeon the opportunity to examine the health of the outer and middle ear whilst cleaning the ears of debris. This is sometimes required for a regular wax build up, infections or post surgical care.

 

GROMMETS

 

The insertion of grommets is one of the most common procedures performed on paediatric patients worldwide. This involves placing a small aeration tube in the tympanic membrane. This tube grows across the tympanic membrane with the skin that normally migrates to the outer surface of the tympanic membrane. The grommet falls out on its own after a given period of time. While the grommet is in, it allows the Eustachian tube, the tube used by an adult to pop their ears, to be bypassed. This stops ears infections and also makes the hearing normal whilst the grommet is in place. This is done for recurrent middle ear infections and conductive hearing loss which is often associated with speech delay.

 

SPECIALIST EAR SURGERY

 

A number of conditions of the outer ear and middle ear often require surgical intervention by an ENT Specialist. These can be the following;

 

Myringoplasty, the correction of a perforation or hole in the outer drum. This causes infections with water exposure over and over again. The operation is performed to make the ear dry and safe and also in the hope of improving hearing in large perforations.

 

Exostoses, which is bony outer growth or surfer’s ear. This involves the lay down of bone in the outer canal over many years. This is very common in people with cold water contact, not necessarily surfers. This requires an operation to drill out the ear and remove this bone allowing the normal migration of skin and wax through the outer ear and also to stop further infections and improve hearing.

 

Cholesteatoma, which is a tumour of the middle ear. This is a benign tumour where there is an overgrowth of skin from the tympanic membrane that migrates into the middle ear and can erode bones, the small ossicles in the middle ear. This can cause erosion into the skull or brain and also destruction of the balance and hearing part of the middle ear. This often requires surgical intervention to remove this lesion.

 

Stapedectomy is a surgical procedure in a condition called otosclerosis. This is a congenital condition where the foot plate or stapes becomes fixed to the oval window of the cochlea. This stops the transmission or conduction of sound through to the cochlea. A stapedectomy is a procedure in which the stapes is removed and a small piston is placed from the incus, one of the ossicles in the middle ear, into the cochlea itself.