Bacterial, viral and even fungal infections can affect the external, middle and even the inner ear, causing pain and decreased hearing due to inflammation and the buildup of fluids. Ear infections often clear up on their own, but antibiotics and anti-inflammatory medications, among others, may be necessary for infants, the elderly and severe cases. Ear canal infections, or “swimmer’s ear,” can usually be treated with topical ear drops alone, but sometimes the ear must be cleaned or have a wick placed to help the medicine get to the infected area. Chronic or recurring middle ear infections often require ear tube placement to drain the excess fluid and prevent the eardrum from rupturing or experiencing other complications. When in place and functioning, tubes also prevent most middle ear infections from occurring. Inner ear infections are usually viral and self-limited, but they can cause severe vertigo and nausea for weeks, and in rare cases inner ear infections can lead to meningitis and severe health problems.
Cholesteatomas And Other Tumors Of The Ear
A cholesteatoma is a cyst that either is present at birth (congenital) or forms as a result of poor eustachian tube function (acquired). Cholesteatomas are diagnosed in children and adults. When the pressure in the middle ear is constantly negative due to blockage of the eustachian tube, the weakest part of the eardrum is pulled inward, eventually creating a skin-lined cyst that fills with exfoliated skin and other waste material. Benign tumors, originating from nerves and blood vessels in the middle ear or caused by excess bone growth or chronic inflammation, can also occur in the ear canal and middle ear.
If you experience pain, dizziness, drainage from the ear and/or hearing loss, it’s important to see an ear, nose and throat specialist. A physical exam is necessary to determine whether a cyst is the cause and if the eardrum has been damaged. Often a CT scan is needed to assist with diagnosis if a cholesteatoma or other type of growth is suspected. Although benign tumors may disappear on their own on rare occasions, or just stop growing and therefore cause no problems, cholesteatomas will often continue to grow relentlessly unless surgery is performed, and they can eventually lead to permanent hearing loss, permanent balance problems and even death.
Ruptured Or Perforated Eardrums
A ruptured or torn eardrum can be associated with drainage from the ear, hearing loss, infection, vertigo/dizziness, earaches and general discomfort. Eardrum ruptures can be caused by:
- Loud noises close to the ear (gunshot or explosion)
- A foreign object, such as a cotton swab, being stuck too far into the ear canal
- Rapid changes in ear pressure due to flying or diving
- Infection of the air space behind the ear drum (middle ear space)
The eardrum will often heal itself after a rupture or tear. However, to determine the severity of the damage and to assess whether the eardrum healed correctly and fully, an ear, nose and throat specialist should examine the ear. A hearing test and examination under the microscope may also be recommended.
Tinnitus (Ringing In The Ears)
Tinnitus is a malfunction in the hearing system that results in a ringing, humming, buzzing or clicking sound in the ears. Patients also sometimes describe a hissing, roaring or whistling sound. These sounds can be intermittent or continuous, and may vary in loudness from time to time.
This bothersome condition is usually associated with some hearing loss, and impacts millions of people around the world. There are many different causes of tinnitus, ranging from something as simple as wax against the eardrum to the more complex issue of a tumor on the hearing nerve. Factors that are believed to increase tinnitus include past exposure to loud noises, caffeine, aspirin and stress.
Although there is no proven cure for tinnitus, some patients may respond well to behavioral and cognitive therapies, changes in their medications, repair of abnormal blood vessels or prescription drugs in managing this condition. When tinnitus is the result of hearing loss it is typically due to damaged nerves in the hearing organ, and thus is irreparable. In those cases, hearing aids can provide much-needed relief for patients. Tinnitus maskers are also available. These discrete devices are similar to hearing aids and mask the ringing or unwanted inner ear sound by generating a low-level noise. The tone and level of the masking sound can be set by our audiologists, based on the patient’s individual condition.
Sports injuries are a common cause of ear trauma. Any type of blunt force directed toward the external ear, which can occur in wrestling or football, can create a bruise, hematoma or laceration of the outside of the ear. External cuts or bruises are easily diagnosed by the naked eye and can often be treated at home with ice and close monitoring. If there is any doubt as to whether the ear has sustained significant damage, such as a hematoma, it is important to consult an ENT physician within a few days of the injury.
With severe lacerations or hematoma, cartilage damage can also occur. This condition is often referred to as “cauliflower ear” because the ear has a bumpy appearance similar to cauliflower. Without intervention, this disfigurement will become permanent and will be the cause of chronic discomfort and unsightly ear deformity for many people. Fortunately, new surgical techniques are available to prevent this from happening. Our surgeons can help drain the accumulated fluid after such an injury, which can prevent calcium deposits from forming and greatly improve the external appearance of the ear in the long term.
Deformities, Cysts And Sinus Tracts Of The Ear
The external ear forms as a result of seven hillocks of tissue combining to form the auricle, which on careful inspection has great complexity to it, along with numerous identifiable structures such as the tragus, ante-tragus, conchal bowl and meatus. On occasion, due to the physical conditions in the uterus (womb) or due to medications or other reasons, the ear does not form properly. When this happens, the ear can be absent (atresia), small (hypoplastic) or deformed in various ways. Most of the time simple deformities do not greatly alter hearing; but in some cases, the deformity is extensive and can even involve absence of an ear canal or the ear drum and attached bones (ossicles). In those cases, hearing is typically greatly impaired, but may be correctable. Lastly, the external ear can have small or large congenital cysts, pits and sinus tracts, which can be visible around or in front of the ear. These are often of little or no consequence, but they can lead to recurring infection and require excision.
The conditions listed here are just a few of the most common ear problems we frequently see, but we can help diagnose and treat any ear injury or disorder you might have. In general, if you experience ear pain, dizziness, drainage from the ear and/or hearing loss, contact CornerStone Ear, Nose & Throat to schedule your personal consultation with one of our board-certified ENT physicians.
The Most Common Causes Of Ear Canal Infections and Why Swimmer’s Ear Is Not Always Caused By Swimming
Painful infections of the ear canal in both children and adults tend to increase during warmer weather when water activities and swimming are more common (thus the term “swimmer’s ear”). Although ear canal infections are more likely to occur after swimming in a lake, an ocean, a pond or an undertreated pool, ear infections are also common in patients with dry, itchy (eczematous) ear canals. For people with eczema, scratching itchy ears usually causes more ear canal infections than swimming because bacteria can easily penetrate the tiny cracks found in dry skin or through scratches created in response to itchy ears.
Acute otitis externa (AOE) is a painful condition that causes sudden, painful inflammation of the ear canal and swelling of the surrounding tissues. It may also cause drainage from the ear and changes in hearing and may affect the eardrum (tympanic membrane) and the pinna (the visible part of the ear that is on the outside of the head).
The bacteria most often associated with AOE are Pseudomonas aeruginosa and Staphylococcus aureus. These bacteria can typically be treated with antibiotic ear drops called fluoroquinolones. When antibiotic ear drops cannot reach the ear canal due to swelling, a small, expanding sponge (otowick) soaked with the antibiotic drops is often used to treat pain in the ear canal. This treatment takes just a few minutes to perform and is extremely effective in allowing the antibiotic drops to reach deeper painful surfaces of the ear canal. If the infection spreads beyond the ear canal to the outer ear and surrounding skin, treatment for this condition, called cellulitis, involves both oral antibiotics and ear drops.
In rare cases, older adults with diabetes or immune disorders may develop a life-threatening ear infection condition known as necrotizing otitis externa. When a bacterial infection penetrates the skin of the ear canal and into the underlying temporal bone, it can quickly spread to the brain and blood vessels of the skull. This creates an ear, nose, and throat (ENT) emergency and requires immediate medical attention. Necrotizing otitis externa can lead to paralysis of the facial and cranial nerves and unrelenting deep ear pain, and eventually can even spread to the brain and cause death. Diagnosis of necrotizing otitis externa typically requires the expertise of an experienced otolaryngologist.
To prevent AOE, avoid putting your fingers, Q-tips or other foreign materials into your ear canals. Be warned that Q-tips are more correctly called “cotton-tipped applicators.” Their intended hygienic purpose is to apply materials to the external skin, NOT to be pushed into the ear canal. Earplugs should also be considered to prevent water from getting into the ear canals.
If you are suffering ear pain, drainage, and/or sudden changes in your hearing, we suggest you seek immediate evaluation by an ENT specialist to maintain healthy ears and avoid complications.