Ear Article

EAR is one of the important specialized sensory organ of our body. We all very well know that it makes us aware of environmental sounds including other person’s voice. More than this, it helps in maintaining the body balance while performing various bodily activities. This is done along with the help of eyes, and joint sense etc. However, ear balances the body faster than the other two and is very essential in keeping the body balance in running and other rapid action events.

Structure of the Ear

The ear consists of three parts

1. Outer Ear

The funnel shaped projecting part of ear called “pinna” along with the narrow canal ending at “ear drum” or Tympanic membrane constitutes outer ear. This part of the ear helps in collecting sound from the environment and its transmission up to the ear drum.

2. Middle Ear

This is an air-filled space between ear drum and inner ear. This space contains three small, interconnected bones. This part of the ear acts as a bridge for transmission of sound from outer ear to inner ear.

3. Inner Ear

Inner Ear consists of very delicate nerve organs for hearing and balance situated inside a tough bony shell. Mechanical sound waves are converted into electrical nerve signals here. The nerve signals are later on transmitted along the hearing nerves to the brain. In the same way mechanical movements of the head are signaled in to electrical impulses and sent to the brain to perform the function of the balance.

Common Ear Problems

Ear pain : This is a very common problem especially in children below 6-7 years of age. Most of the time “children” start screaming at odd hours in the night with ear pain. Contrary to popular belief, it is not due to “wax”. Wax never causes sudden pain. So putting dewaxing ear drops does not serve any purpose. This problem of earache in child is mostly due to infection of the middle ear due to virus or bacteria which travel To middle ear during an attack of “cold” or throat infection. (There is a small narrow tube for regulation of air-pressure in middle ear which opens behind the nose. This is called Eustachean tube).

For some relief during odd hours of night, it is better to give child a pain killer like “Paracetamol” or “Combiflam” which is usually available at home. This will reduce pain for the time being at night. If the child had cold in the near past, then nasal decongestant drops like naseveon/ Diconal can be put in the nose in the suggested position and ask the child to breathe the steam of plain hot water through the nose. This will open the blocked Eustachean tube which supplies air to the middle ear and hence further progression of the infection is arrested.

Next day, parents should consult a doctor for appropriate medication. If this care is not taken, the ear drum may give way to the pressure due to accumulated secretions and a hole in the ear drum results (Acute Suppurative Otits media). If this is not treated with proper medication, the hole becomes a permanent one and ear discharge becomes perpetual (Chronic Suppurative otits media). In such situation, to avoid ear discharge, one should not allow water into the ears by keeping petroleum jelly (Vaseline) smeared cotton plug in the ear during bath and early treatment of attacks of the common cold/ sinusitis.

This needs a surgical correction as early as possible to prevent further complications like paralysis of the muscles of face; brain abscess etc. This long standing discharging ear is the only one condition which needs antibiotic ear drops. In other conditions of ear ache, ear drops are better avoided.

If an adult gets an earache it is usually because of skin infection of the outer ear. A localized “boil” in the ear is very painful. Likewise a larger part of skin can get infection with bacteria. This happens usually due to scratching of the ear or contaminated water getting into the ear. This needs specific antibiotics under the guidance of the ENT surgeon. Self medication like putting hot mustard oil/ hydrogen peroxide should be avoided as they don’t help and at times may damage the delicate skin of ear and ear drum.

In humid rainy season, fungal infection of the ear is very common. This leads to ear itching and pain which can be mild very severe. (Remember: Pain with itching in the ear due to fungus and putting antibiotic ear drops or oil will further aggravate the damage to the tender structures of the ear). Occasionally, hard wax can lead to pain.

For prevention of ear pain, one should not scratch his/her ear either by nails or bud or matchsticks. It is better to use hearing plug during swimming. Once a person gets pain, self-medication with ear drops should be avoided as its of no benefit.

Wax in the Ear : Wax in the ear is normal. This normal wax comes out on its own due a physiological process of epithelial migration towards the outer end of the ear canal. Accumulation of wax in the ear canal is seen 5% of the population and commonest cause for this is self cleansing with ear buds. Bulky ends of these buds tend to push the wax deep into the ear. One need not clean his ears, rather this attempt leads to accumulation. At times while cleaning the ear canal one may injure the canal skin or even the ear drum.

Glue Ear :This is also called secretory Otitis media or serous otits media or Otitis media with effusion (OME). This is a very common condition in school children and is due to adenoid tissue blocking the ET tube opening. This is commonest cause of hearing loss in children and precursor for the bone eroding disease of the ear (Cholesteatoma) also called as unsafe CSOM. Due to negative pressure in the middle ear, fluid accumulates and leads to thinning of the ear drum and ear drum with the skin gets sucked in over a long period and turns into Cholesteatoma. This has to be identified by the school teacher/parent by screening all children who are inattentive/ frequent complainers of ear ache. Impedance audiometry helps in early and correct diagnosis of this condition. There should not be any hesitation to correct this by removing the adenoids and putting a grommet/ ventilating tube in the ear.
Hearing Loss :Hearing loss is a serious concern especially in children as it can lead to impaired development of speech. If a parent suspects that his/her child’s hearing is probably not right, he/she should have no hesitation in consulting an ENT specialist. Now because of availability of sophisticated instruments it is possible to determine the extent of loss of hearing even in a newborn child.

If a child is suspected to have a hearing loss, he/she should be fitted with a hearing aid as early as possible. This measure can prevent the problem of deafness in a child to a large extent. For profound to severe hearing loss in a child, “Cochlear-Implant” is being done at the age of 1-2 years, with very good result. So, never wait for a deaf child to grow up to address the hearing loss problem.

After the age of 4-5years, “almost nothing” can be done for most of the deaf and mute children. A lot of school going children have problem of mild hearing loss which may be due to secretary Otitis media. (A silent form of ear infection leading to collection of fluid in the middle ear).

If a parent suspects that his/her child is probably not listening properly or is becoming inattentive or raising the volume of TV, they should consult a doctor. Teachers of primary school should be made aware of this.
Hearing losses in adults are either due to problems in the middle ear or in the inner ear/ Depending upon the cause, most of the hearing loss can be corrected either by surgery or hearing aids.