The ear consists of 3 parts, external ear, middle ear and inner ear. The external ear consists of pinna and the external ear canal which collect the sound and transmit to the ear drum in the middle ear. The sound sets into vibration the ear drum and 3 small bones called ossicles situated in the middle ear and thus the sound gets transmitted to the inner ear. The middle ear is connected with the nose through a tube called Eustachian tube which equalises pressure on both sides of the ear drum. The inner ear consists of the cochlea, which is shaped like a shell where the sound is analysed. It also has 3 semi circular canals which maintain the balance of the body. The inner ear is connected to the brain by auditory nerve. The final hearing occurs in the brain.
The common problems affecting the ear are :
Deafness can be caused by diseases in one or more parts of the ear.
External ear : Wax, fungus, foreign bodies, acute infection.
Middle ear : Acute or chronic infection, collection of fluid in the ear, otosclerosis causing fixity of the ossicles, injury.
Inner ear : Birth defects,infections, injuries, tumor of the auditory nerve, ototoxic medicines, Meniere’s Disease (producing vertigo), uncontrolled blood pressure and diabetes, ageing, noise induced deafness.
Recognition of the hearing problem is the first step in rectifying it. Some of the common indicators of hearing loss are:
If a hearing loss is suspected, an appointment with an ENT specialist is essential in testing and evaluation. A short and simple test conducted by the hearing health care professional determines the type and severity of hearing loss. After the age of 50, a hearing test must be taken regularly along with a physical check-up.
Hearing is tested by audiometry and a graphic record of the hearing is obtained, which helps to determine the type and degree of hearing loss :
The deafness which occurs as a result of the diseases in the external ear and the middle ear is called conductive deafness and usually can be corrected by medicines or surgery. Wax and fungus in the ear along with various infections in the ear can be treated medically while diseases like perforations in the ear drum or fixation of the innermost small bone in the middle ear can be treated by operations like tympanoplasty or stapedectomy with teflon piston grafting. As all the structures in the ear are very small, the surgery of the ear has to be performed under a special binocular operating microscope, under good illumination and magnification. The deafness of the inner ear is called sensorineural deafness and is often difficult to treat. Whenever the deafness cannot be treated medically or surgically, the patient can use hearing aids.
Hearing aid is an electronic device which magnifies sounds selectively in various frequencies. For using a hearing aid, the patient should get his ears examined and an audiogram should be obtained. Audiogram is a graphic record of the hearing. A hearing aid which matches with the audiogram should be tried by the patient for a few minutes. If it is suitable, it can be purchased. To have better fitting, an ear mould having the shape of the ear of the patient is prepared for the hearing aid. Besides the old pockets type of hearing aids, smaller behind the ear hearing aids are also available. Of late, very small hearing aids are available which fit into the ear canal and are hardly visible.
Complete in the canal hearing aids cannot be seen from outside and hence are called “Invisible”. Different models of hearing-aids remedy different types of hearing loss. Completely in the Canal (CIC), In The Canal (ITC) and In The Ear (ITE) hearing-aids are custom designed to fit the wearer’s ear inconspicuously; (perfect for those conscious of their looks).
Behind The Ear (BTE) hearing aids are attached to a customised ear mould. These can be modified so as to be compatible to external sound sources such as hearing training equipment, stereos or TVs, etc. These are useful for children and those who require high amplification.
The pocket hearing-aid is economical and suitable for young children and elderly people with dexterity problems.
Digital and Programmable computerised aids are the most technologically advanced and are available in CIC, ITC, ITE and BTE models. Digital technology enables one to hear loud and soft sounds, high and low tones practically at the level of a person with normal hearing. Added to which comes excellent speech intelligibility in noise. This means that low frequency noise, such as in a car or aircraft, is reduced and the clarity of speech enhanced to a pleasant level. You hear your environment again just as you would like to. There are individually adjustable hearing programs to provide this facility, e.g. for your home and your place of work. No internal noise spoils the hearing experience and, thanks to the latest technology, interference from cordless and mobile telephones is now drastically reduced. With precise fitting and smooth functioning, it is the ideal hearing instrument class for all age groups.
Patients with very severe deafness who do not benefit with very powerful hearing aids can be treated by cochlear implant where electrodes are implanted in the inner ear. It is an expensive procedure and hearing is of limited type. It requires intensive speech therapy after the operation. In future, further improvements can make this procedure more desirable.
If a child loses his hearing before the age of 5 years, his speech is also lost. The speech develops by hearing the speech and if there is severe deafness, speech does not develop. Such children need education in special schools with the help of hearing aids and other educational aids and can develop useful speech. A sizable number of such children may be integrated in normal schools after proper training.
Some of the common causes of discharging ear are :
External ear : Fungus, acute infection of external ear, rarely cancer.
Middle ear : Acute or chronic infection of the middle ear with perforation of the eardrum, rarely cancer.
Certain dangerous perforations occurring in the upper or marginal areas of the ear drum can be associated with cholesteatoma, which gradually erodes surrounding bone leading to complications like mastoid infection, paralysis of the face, giddiness, meningitis and brain abscess. Majority of the perforation however are benign and do not result in dangerous complications. They cause deafness with intermittent discharge from the ear.
MEDICAL : The infection can be controlled by antibiotics, antibiotic or antiseptic ear drops along with care of ear like preventing entry of water into ears. Fungal infection is treated by antifungal ear drops and antibiotics. Perforations of a short duration may heal on their own in majority of cases. If they do not heal in one and half or two months, small perforations can be closed by chemical cautery to make the edges of the perforation raw and by paper patching under surgical microscope.
SURGICAL : Large benign perforations or perforations resistant to chemical cautery can be closed by tympanoplasty operation. As the structures in the ear are very small, the surgery of the ear is performed through a binocular surgical microscope for precision. Microsurgery has revolutionised the treatment of the ear diseases and benign perforations can be closed by tympanoplasty operation, where a new eardrum is created from the remnants of the eardrum and other tissues from the body.
Dangerous perforations can also treated by microsurgery and the offending cholesteatama can be removed with precision, making the ear safe and free from life threatening complications by tympano-mastoidectomy. These operations have a very high success rate in our clinic. With meticulous care, the results are still more improved. After tympanomastoidectomy for dangerous perforations, discharge from the ear can occur at times but the diseased ear does not lead to dangerous complications.
Some of the common causes of earache are :
The inner ear performs two functions, hearing by its cochlear part and maintenance of balance by its vestibular part. Lesions affecting the vestibular part of the ear can cause giddiness, but giddiness can also result from general diseases like high or low blood pressure, diabetes, anaemia and neurological disorders(including tumours). Mental stress can also cause vertigo or aggravate vertigo.
Examination and investigations of the ear and other parts of the body can help the ENT surgeon to diagnose the cause of giddiness, and then its treatment can be outlined. Consultation by other specialist also may be required. Treatment may have to be prolonged and recurrence of giddiness may occur. Majority of patients having giddiness do not have a dangerous disease, but giddiness occurring in a healthy individual often results in mental tension which can aggravate giddiness. Recurrence can be minimised by proper diagnosis, treatment and exercises for giddiness.
Tinnitus is the noise in the ear or head. It is a very annoying symptom which can be caused by diseases in the ear or diseases outside the ear. Rarely tinnitus can be a symptom of a dangerous disease. Hence the ear should be checked by an E.N.T. surgeon. It tends to be most harassing to the patient when he is in a quiet place. Treatment of the cause should take care of tinnitus but tinnitus may persist even after the disease causing tinnitus has been cured, which can be quite disturbing. If the patient hears voices of persons, he may need psychiatric opinion. Tinnitus maskers are sometimes recommended. These are similar to hearing aids and generate continuous noise. Their use is based on the fact that the patient is more comfortable in a noisy environment than in a quiet surrounding.