Ear Infections

Also called: Otitis media

Ear infections are the most common illnesses in babies and young children. Most often, the infection affects the middle ear and is called otitis media. The tubes inside the ears become clogged with fluid and mucus. This can affect hearing, because sound cannot get through all that fluid. If your child does not yet talk, you need to look for signs of an infection: Tugging at ears Crying more than usual Ear drainage Trouble sleeping Balance difficulties Hearing problems Often, ear infections go away on their own, but your health care provider may recommend pain relievers. Severe infections and infections in young babies may require antibiotics. Children who get frequent infections may need surgery to place small tubes inside their ears. The tubes relieve pressure in the ears so that the child can hear again.

Tinnitus

Do you hear a ringing, roaring, clicking or hissing sound in your ears? Do you hear this sound often or all the time? Does the sound bother you? If you answer is yes, you might have tinnitus. Millions of people in the U.S. have tinnitus. People with severe tinnitus may have trouble hearing, working or even sleeping. Causes of tinnitus include hearing loss, exposure to loud noises or medicines you may be taking for a different problem. Tinnitus may also be a symptom of other health problems, such as allergies, high or low blood pressure, tumors and problems in the heart, blood vessels, jaw and neck. Treatment depends on the cause. Treatments may include hearing aids, sound-masking devices, medicines and ways to learn how to cope with the noise.

Hearing Disorders and Deafness

Also called: Hearing loss, Presbycusis

It's frustrating to be unable to hear well enough to enjoy talking with friends or family. Hearing disorders make it hard, but not impossible, to hear. They can often be helped. Deafness can keep you from hearing sound at all. What causes hearing loss? Some possibilities are Heredity Diseases such as ear infections and meningitis Trauma Certain medicines Long-term exposure to loud noise Aging There are two main types of hearing loss. One happens when your inner ear or auditory nerve is damaged. This type is permanent. The other kind happens when sound waves cannot reach your inner ear. Earwax build-up, fluid or a punctured eardrum can cause it. Untreated, hearing problems can get worse. If you have trouble hearing, you can get help. Possible treatments include hearing aids, cochlear implants, special training, certain medicines and surgery

Ear discharge is drainage of blood, ear wax, pus, or fluid from the ear.

Considerations
Most of the time, any fluid leaking out of an ear is ear wax. However, discharge may also be caused by a minor irritation or infection. A ruptured eardrum can cause a white, slightly bloody, or yellow discharge from the ear. Dry crusted material on a child's pillow is often a sign of a ruptured eardrum. Bleeding from the ear may also be due to: Trauma to the ear canal Foreign object in the ear canal Injury Cancer

Causes
Eczema and other skin irritations in the ear canal Inflammation or infection: o Otitis externa o Otitis externa - chronic o Otitis externa - malignant

o Otitis media o Otitis media - chronic o Mastoiditis Injury from a blow to the head, foreign object, very loud noises, or sudden pressure changes (such as in airplanes), resulting in a ruptured or perforated eardrum Swimmer's ear -- usually accompanied by itching, scaling, a red or moist ear canal and pain that increases when you move the earlobe

Home Care
To be safe, never put anything in the ear that is smaller than the tip of your little finger. EAR INFECTIONS Treat inflammation or infection as your health care provider recommends. Your doctor may suggest ear drops. EAR WAX Use a gentle, warm water flush with a syringe (available at the drug store) to remove packed-down ear wax. Do not attempt to remove impacted ear wax in very young children. If you can easily see and retrieve ear wax in older children, do so carefully. NEVER use sharp objects to attempt to remove wax. INJURY Seek medical help for: Head injury Injury from a foreign object Noises or pressure changes Suspected clotting or bleeding problem

Don't get alarmed over a ruptured eardrum. Antibiotics can help prevent further infection during the healing process. Eardrum ruptures in children will usually heal completely within a few weeks. SWIMMER'S EAR For swimmer's ear (unless the eardrum is perforated): Tilt the head sideways, with the water-filled ear up. Pull the ear upward and backward. Carefully squeeze a medicine-dropper full of rubbing alcohol or a mixture of half rubbing alcohol and half white vinegar into the ear. This mixture will dry out the ear and kill any bacteria or fungi. Wiggle the ear to move the solution all the way down. Tilt the head again so that the affected ear is now down, and let the fluids drain out.

Putting a little mineral oil or baby oil in each ear before swimming may help prevent the problem.

When to Contact a Medical Professional

The discharge is white, yellow, clear, or bloody. The discharge is the result of an injury. The discharge has lasted more than 5 days. There is severe pain. The discharge is associated with other symptoms, such as fever or headache. There is loss of hearing. There is redness or swelling coming out of the ear canal.

What to Expect at Your Office Visit

The health care provider will perform a physical examination and look inside the ears. You may be asked questions, such as: When did the ear drainage begin? What does it look like? How long has it lasted? Does it drain all the time or off-and-on? What other symptoms do you have (for example, fever, ear pain, headache)?

The doctor may take a sample of the ear drainage and send it to a lab for examination. The doctor may recommend anti-inflammatory or antibiotic medicines, which are placed in the ear. Antibiotics may be given by mouth if a ruptured eardrum from an ear infection is causing the discharge.

Alternative Names
Drainage from the ear; Otorrhea; Ear bleeding; Bleeding from ear

Tinnitus Management
While tinnitus is a fairly common problem, there are many effective methods to treat (or at least reduce the impact of) the sensation. What should I do? Since tinnitus is a symptom of a problem, the first thing you should do is to try to find out the underlying cause. You should have a medical examination with special attention given to checking factors associated with tinnitus. A full hearing evaluation can identify hearing loss that may be associated with the tinnitus. Tinnitus can be associated with conditions that occur at all levels of the auditory system. Some of these conditions are:

Impacted wax (external ear) Ear infection

Middle ear tumors Otosclerosis Vascular problems (circulation disorders) Mnires disease Ototoxic medications (more than 200 medicines can cause tinnitus) Noise-induced hearing loss (inner ear) At the central levelthe eighth cranial (auditory) nerve and other tumors, migraine, and epilepsy Should I see an audiologist? Your hearing should be evaluated by an audiologist certified by ASHA to determine if a hearing loss is present. Since tinnitus can be associated with a number of auditory conditions, the audiologic evaluation can yield extensive information regarding the cause and options for treatment. Can tinnitus actually be measured? Tinnitus cannot be measured objectively. Rather, the audiologist relies on information you provide in describing the tinnitus. The audiologist will ask you questions such as:

Which ear is involved? Right left both? Is the ringing constant? Do you notice it more at certain times of the day or night? Can you describe the sound or the ringing? Does the sound have a pitch to it? High pitch low pitch? How loud does it seem? Does it seem loud or soft? Does the sound change or fluctuate? Do you notice conditions that make the tinnitus worsesuch as when drinking caffeinated beverages, when taking particular medicines, or after exposure to noise? Does the tinnitus affect your sleep your work your ability to concentrate? How annoying is it? Extremely so or not terribly bothersome? In discussing your answers to these questions, the audiologist can give you information that will increase your understanding of the tinnitus. Knowing the cause of your tinnitus can provide relief instead of having to live with the uncertainty of the condition. When the possible cause of your tinnitus is understood, your stress level (which can make tinnitus worse) is frequently reduced. You can take charge by anticipating, preventing, and changing situations that make your tinnitus worse. How is tinnitus treated? The most effective treatment for tinnitus is to eliminate the underlying cause. Because tinnitus can be a symptom of a treatable medical condition, medical or surgical treatment may correct the tinnitus. Unfortunately, in many cases, the cause of tinnitus cannot be identified, or medical or surgical treatment is not an option. In these cases, the tinnitus itself may need to be treated. Be sure to discuss with your doctor any treatment options you are considering prior to beginning the treatment. Forms of tinnitus management include:

Biofeedback Hypnosis

Electrical stimulation Relaxation therapy Counseling Habituation therapies Tinnitus maskers Audiologists and otolaryngologists (ear, nose, and throat doctors, or ENTs) routinely collaborate in identifying the cause and providing treatment. A treatment that is useful and successful for one person may not be appropriate for another. The American Tinnitus Association (ATA) has information on various treatment options. Will a hearing aid help my tinnitus? If you have a hearing loss, there is a good chance that a hearing aid will both relieve your tinnitus and help you hear. Contact an ASHA-certified audiologist to determine if you will benefit from using a hearing aid. The audiologist can assist with the selection, fitting, and purchase of the most appropriate aid. The audiologist will also help train you to use the aid effectively. What is a tinnitus masker? Tinnitus maskers look like hearing aids and produce sounds that mask, or cover up, the tinnitus. The masking sound acts as a distractor and is usually more tolerable than the tinnitus. The characteristics of the tinnitus (pitch, loudness, location, etc.) that you described for the audiologist determine what kind of masking noise might bring relief. If you have a hearing loss as well as tinnitus, the masker and the hearing aid may operate together as one instrument. Like all other treatments for tinnitus, maskers are useful for some, but not all, people. As with a hearing aid, a careful evaluation by an audiologist will help decide whether a tinnitus masker will help you. Are there other devices that can help me? Sound machines that provide a steady background of comforting noise can be useful at night or in a quiet environment. Fish tanks, fans, low-volume music, indoor waterfalls, and so forth can also be helpful. Today there are even applications for iPod portable media players that offer a variety of masking sounds that may reduce the annoyance of tinnitus. Should I join a self-help group? Tinnitus can be debilitating because it is can be difficult to describe, predict, and manage. Self-help groups are available in many communities for sharing information and coping strategies for living with tinnitus. People with mild tinnitus generally do not require treatment. Often a self-help group promotes feelings of hope and control. Members of the group share strategies they have found successful in dealing with their tinnitus. It can help to be reassured that you do not have a rare disease or serious brain disorder or are not going deaf. With support, people with tinnitus usually find that they can cope with or ignore their tinnitus.

Wax blockage is an obstruction of the ear canal with wax (cerumen).

Causes
The ear canal is lined with hair follicles and glands that produce a waxy oil called cerumen. Ear wax protects the ear by trapping dust, bacteria and other microorganisms, and other foreign particles to prevent them from entering and damaging the ear. Ear wax also helps protect the delicate skin of the ear canal from becoming irritated when water is in the canal. The wax usually makes its way to the opening of the ear, where it falls out or is removed by washing. In some people, the glands produce more wax than can be easily removed from the ear. This extra wax may harden in the ear canal and block the ear. More commonly, wax may block the ear canal if you try to clean the ear and accidentally push wax deeper into the ear canal. Wax blockage is one of the most common causes of hearing loss.

Symptoms
Earache Fullness in the ear or a sensation that the ear is plugged Noises in the ear (tinnitus) Partial hearing loss, may get worse

Exams and Tests

During a physical examination, the health care provider will look into the ear for signs of wax blockage.

Treatment
Most cases of ear wax blockage can be treated at home. The following can be used to soften the wax in the ear: Baby oil Commercial drops Glycerin Mineral oil

Detergent drops such as hydrogen peroxide or carbamide peroxide may help remove the wax. Another method of removing wax is called irrigation. Use body-temperature water (cooler or warmer water may cause brief but severe dizziness or vertigo). With your head upright, straighten the ear canal by holding the outside ear and gently pulling upward. Use a syringe to gently direct a small stream of water against the ear canal wall next to the wax plug. Tip your head to allow the water to drain. You may need to repeat irrigation several times. Never irrigate the ear if the eardrum may not be intact. Irrigation with a ruptured eardrum may cause ear infectionor acoustic trauma. Do not irrigate the ear with a jet irrigator designed for cleaning teeth (such as a WaterPik) because the force of the irrigation may damage the eardrum.

After the wax is removed, dry the ear thoroughly. You may use a few drops of alcohol in the ear or a hair dryer set on low to help dry the ear. If you cannot remove the wax plug or irrigation causes discomfort, consult a health care provider, who may remove the wax by: Repeating the irrigation attempts Suctioning the ear canal Using a small device called a curette

Occasionally, the wax must be removed with the help of a microscope.

Outlook (Prognosis)
Wax blockage of the ear usually responds well to removal attempts. However, it may happen again in the future. Hearing loss is usually temporary. Hearing usually returns completely after the blockage is removed.

Possible Complications
External ear infection (otitis externa)

When to Contact a Medical Professional

Call for an appointment with your health care provider if your ears are blocked with wax and you are unable to remove the wax. Also call if you have an ear wax blockage and you develop new symptoms, especially: Drainage from the ear Fever Persistent hearing loss Persistent or severe ear pain

Prevention
People who have frequent blockages may benefit from weekly irrigations. Never attempt to clean the ear by placing any object into the ear canal, such as a Q-tip. It is better to clean the outer ear canal by using a cloth or paper tissue wrapped around your finger.

Alternative Names
Ear impaction; Cerumen impaction; Ear blockage; Ear wax