Ear Disease

The human ear is a complex sensory organ that is responsible for converting vibratory sound waves into electrical signals that are ultimately processed by the brain into our perception of sound. The ear is composed of three regions: the outer, middle and inner ear which each has a role in handling and transmitting sound energy.  

  • The outer ear includes the external ear, or pinna, and ear canal down to the outer surface of the ear drum. Processes that disrupt the transmission of sound through the ear canal such as ear wax impactions or significant swelling as seen in swimmer’s ear impede the propagating of sound waves and induce hearing loss.  This variety of hearing loss is known as conductive hearing loss.

  • The middle ear is an air containing chamber found deep to the ear drum. This is a very complex space that houses three mobile bones that transmit the vibrations of the ear drum to the fluids of the inner ear.  The design of the middle ear results in the amplification of sound energy as it conducted to the inner ear.  This space is in communication with the nasal airway through a narrow tube called the Eustachian tube.  The middle ear depends on this tube to keep a pressure regulated air chamber suitable for a functional, stable and healthy ear.  There are many possible medical conditions that can involve the middle ear and we will review a few of the more common issues below:

    • Acute middle ear infections are most common in the first few years of life. This is what most people refer to as simply an ear infections. The bacteria that cause these infections are very similar to those that cause sinus infections and have shifted in pattern of bacteria involved since the introduction of the pneumococcal vaccine. Risk factors for ear infections have been extensively explored and include day care attendance, male sex, white non-hispanic race, a family history especially in siblings and allergy (atopy). Breast feeding for the first 6 months of life is protective.

      • A pediatrician or primary care doctor may refer a patient for a consultation to consider ear tubes if the volume of infections has been significant or persistent. In appropriately selected patients ear tubes may significantly reduce the burden of ear infections.

    • Eustachian tube dysfunction (ETD) is a term used to signify poor ventilation of the middle ear space. ETD is thought to be an underlying risk factor for many medical conditions of the middle ear including acute ear infections, ear drum damage including perforations and skin cyst formation known as cholesteatoma. In a subset of patients suffering with this condition the exam and testing may be normal despite significant symptoms. These symptoms may include muffled or distorted hearing, the sense of ear pressure or discomfort, and ear popping or clicking. It is best to seek evaluation and formal assessment if any of these symptoms are problematic and persistent.

    • Ear drainage may represent a significant underlying issue with ear. Episodes of ear drainage may result from problems in the outer ear but frequently are a result of deeper issues such as a perforated ear drum, chronically infected middle ear or abnormal accumulation of skin in the middle ear. A patient with intermittent or chronic ear drainage should seek formal evaluation.

  • The inner ear is a very complex labyrinth of fluid containing spaces bathing the nerve elements that detect fluid vibrations which are then encoded into nerve signals bound for the brain. There are many conditions that can affect this part of the ear and disorders in this part of the ear not infrequently present with associated issues with vertigo or imbalance owing to the fact that the balanced organ is closely associated.  Perhaps the most common condition affecting the inner ear is nerve damage resulting in sensorineural hearing loss.  This is the hearing loss we associate with aging.  This may present with symptoms such as difficulty understanding, having to increase volume on electronic devises, saying what frequently or having to have others repeat things frequently and ear ringing.   The evaluation of these sorts of complaints requires hearing testing in most instances after a though exam.