Ear Conditions

Wax impaction has many causes, but it is generally the result of overzealous use of cotton buds (ENTs never refer to them as “earbuds”, because they are NOT meant for the ears!). This can produce different symptoms, including a feeling of “fullness” in the ear, ear pain, an itchy feeling, hearing loss, funny noises in the ear, dizziness or a discharge from the ear.

Wax impaction can be seen in people of all ages and it can be treated by cleaning the ears, rinsing the ear canal with saline or water, and removing wax manually using specific instruments. Your physician can accurately assess these ear problems and make a recommendation as to what your treatment should be.

A perforated eardrum is quite a common ear condition and it refers to a tear or a hole in the eardrum. The eardrum, or tympanic membrane, is a thin membrane that separates the middle ear from the outer ear canal. This membrane needs to move as sound enters the ear, just like the membrane of a speaker moves when sound is played though it. The movement of the membrane moves the tiny bones known as ossicles, which takes the sound to the cochlea in your inner ear.

There are many causes of perforated eardrums, including infection and injury. If there is an infection, this will be treated first. Once the infection has resolved your physician may order a hearing test to measure the amount of conductive hearing loss caused by the perforation.

Quite often, a perforation does not cause any problem, or heals itself. Sometimes, however, your ENT may advise doing a surgery called a tympanoplasty. This involves placing a “patch” on the perforation to allow for healing. The patch is usually some of your own tissue. The commonest patches are the covering of the muscle behind your ear, a piece of cartilage from the ear itself, or fat from the lobe of the ear. All result in aesthetically pleasing scars, and most people don’t even realise they’ve had surgery once the wound has healed.

Sometimes, an ear infection does not clear up completely, and some fluid gets left behind. This fluid becomes sticky, and gums up the tiny bones that vibrate in the ear, very similarly to a car engine that has sludge build up. When this happens, the patient may not hear well, and may occasionally have pain. In children, who cannot communicate such symptoms effectively, this is manifest as an irritable child, or constantly pulling on the ears.

Sometimes there is no ear infection before a glue ear, but a bad cold or sinus infection damages the Eustachian tube. This tube runs from the back of your nose to your ear and is responsible for ventilating your middle ear and constantly equalising the air pressure. If the tube is damaged, fluid can build up in the middle ear and cause the same symptoms as mentioned above.

If the fluid in the ear is persistent and causes hearing loss, a grommet or ventilation tube can be inserted in the eardrum.

Glue ear in adults can be a sign of more serious pathology, such as a tumour in the nasopharynx (the area behind the nose).

A cholesteatoma is a type of cyst that forms when skin from the outer ear, instead of migrating outwards, instead forms a ball, or “pearl” in the middle ear. Cholesteatomas are not tumours, but can be dangerous nonetheless. People with this condition will complain of a constant ear discharge, hearing loss and sometimes even dizziness and facial weakness.

Cholesteatomas can be left alone if they are very mild, but most of the time the disease progresses and needs an operation. The primary aim of surgery for cholesteatoma is to create a safe cavity that will not endanger the patient’s life. Hearing restoration is a secondary concern, and is not always possible.

Vertigo is a specific symptom caused by conditions that affect the balance organ of your inner ear. Some people call it dizziness, but vertigo is not the same as a feeling of “wanting to faint” or light-headedness. Vertigo is a feeling motion, either of yourself, or your surroundings. This usually causes nausea and vomiting as well, and can be a very debilitating symptom.

The most common condition that causes vertigo is Benign Paroxsysmal Positional Vertigo, or BPPV. BPPV is caused by loosening of small crystals in your balance organ, which is located in your inner ear. The exact cause of this loosening is unknown, but viral infection and trauma (even minor) have been postulated. BPPV produces brief episodes of vertigo and nausea, lasting not more than a few minutes, usually when turning around in bed, or tilting the head back, such as when one looks at the top shelf of a cupboards. The condition can be cured by a small procedure in the rooms called the Epley manoeuvre.

Another common cause of vertigo is Vestibular Neuritis. This is caused by an infection, usually viral, that inflames the balance part of the hearing nerve. If the hearing is also affected it is called a Labyrinthitis, where both the hearing and the balance parts of the nerve are affected.

Méniér’s Disease is a rare condition where brief spells of vertigo are accompanied by tinnitis (ringing ears), a feeling of fullness in the ear and brief hearing loss in the same ear.

The ENT will distinguish vertigo caused by problems in the balance organ, from those caused by problems in the brain itself, such as multiple sclerosis. In some cases, further consultation with another ENT, or a neurologist may be required.