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THE HUMAN EAR

The Human ear performs a very important role in our daily life. Hearing is one of the important senses and like vision, is important for distant warning and communication. The function of this sense is to alert & to communicate pleasure/fear. It is a conscious comprehension of vibration as sound. In order to do this, the appropriate signal must reach the higher parts of the brain which is called the cortex. The function of the ear is to convert physical vibration into an encoded nervous impulse.


Introduction

The ear is divided, semi-artificially, into three regions: Outer Ear, Middle Ear and Inner Ear.



The Outer Ear

The Outer Ear consists of Pinna or external ear, Meatus or ear canal, the Tympanic membrane or the eardrum. The most important function of the pinna in hearing is the capture and localization of the sound. The meatus or ear canal is about 2.5 cm deep, basically a narrow and slightly bend tube into the side of your head. If you look at someone’s ear from the side, you can see the entrance. The meatus is lined with hairs and wax producing glands. The hairs actually move the wax out along the walls of the canal to the opening. It is a self-cleaning organ and it is not actually a good idea to clean it, except around the opening of the meatus. Shoving a q-tip in the meatus can remove some of the wax, but push the rest down against the eardrum, which can interfere with the proper function of the eardrum. If you have excessive wax buildup, there are gentle drops you can put in your ear which loosen the wax and help it to get out. If this doesn’t help then one should consult a doctor.

 

The Middle Ear
The middle ear is an air filled space or cavity about 1.3cm (one-half inch) across. The cavity is connected with your nose and throat by thin tube called the eustachian tube. The eustachian tube functions as a pressure equalizing valve for the middle ear which is normally filled with air. When functioning properly, the eustachian tube opens for a fraction of a second periodically (about once every three minutes) in response to swallowing or yawning.
The middle ear space houses three little bones called the hammer, anvil and stirrup (malleus, incus and stapes) which conduct sound from the eardrum to the inner ear.


When sound enters into your ears and it produces a vibration in the eardrum, the vibrations pass from the eardrum along the ossicular chain. The stapes sets in motion like a little piston against the membrane (called round window) in the opening of the cochlea, the inner ear.





The Inner Ear

The inner ear has two parts – cochlea, the organ of hearing and the semicircular canals, the organ of balance. In the cochlea, mechanical energy generated by the action of the stapes, is translated into chemo-electric energy, and carried to the brain, via the acoustic nerve.

EAR DISEASE (EAR CONDITIONS)

Outer ear

Swimmers Ear

Middle Ear

Otitis Media
Otosclerosis
Cholesteatoma
Perforated Eardrum

Inner Ear

Sensorineural Deafness

EAR CONDITIONS: OUTER EAR


Swimmers Ear (Otitis Externa)
Otitis Externa is an infection of the ear canal. It can be caused by many different types of bacteria or fungi. The infection commonly occurs in children who spend a lot of time in the water. Too much moisture in the ear can irritate and break down the skin in the canal, allowing bacteria or fungi to penetrate. In temperate climates, otitis externa occurs more frequently during the summers, where swimming is more common.








Causes and Symptoms

The primary symptom of otitis externa is ear pain, which can be severe and gets worse when the exterior part of the ear is pulled or pressed on. It may also be painful for a person with otitis externa to chew. Sometimes the ear canal itches before the pain begins. There may be some discharge from the ear canal as well; it may be clear at first but then turn cloudy, yellowish, and pus-like. Hearing may temporarily be affected if pus and debris or swelling of the canal blocks the passage of sound into the ear.


Treatment

Treatment of otitis externa depends on the severity of the infection. For milder cases, doctor may prescribe eardrops that fight the infection and a steroid to reduce swelling of the ear canal. Eardrops are usually given several times a day for 7 to 10 days. If swelling of the ear canal makes it difficult to give the drops, doctor may insert a cotton wick into the canal to help carry the medicine inside the ear. In some cases, the doctor may need to remove pus and debris from the ear with gentle cleaning or suction. This will allow the eardrops to work more effectively.


When to Call the Doctor
?
Call doctor immediately in any of the following conditions: pain in the ear with or without fever, decreased hearing in one or both ears, or abnormal discharge from the ear.



EAR CONDITIONS: MIDDLE EAR


1. OTITIS MEDIA/ EAR INFECTION

Otitis media is an infection or inflammation of the middle ear. This inflammation often begins when infections that cause sore throats, colds, or other respiratory or breathing problems spread to the middle ear. These can be viral or bacterial infections. Otitis media is primarily a disease of infants and young children, it can also affect adults.


Causes and Symptoms

Otitis media not only causes severe pain but may result in serious complications if it is not treated. An untreated infection can travel from the middle ear to the nearby parts of the head, including the brain. Although the hearing loss caused by otitis media is usually temporary, untreated otitis media may lead to permanent hearing impairment. Persistent fluid in the middle ear and chronic otitis media can reduce a child's hearing at a time that is critical for speech and language development. Children who have early hearing impairment from frequent ear infections are likely to have speech and language disabilities.

Otitis media is often difficult to detect because most children affected by this disorder do not yet have sufficient speech and language skills to tell someone what is bothering them.


Common signs:

  • Unusual irritability

  • Difficulty sleeping

  • Tugging or pulling at one or both ears

  • Fever

  • Fluid draining from the ear

  • Loss of balance


Treatment

Many physicians recommend the use of an antibiotic (a drug that kills bacteria) when there is an active middle ear infection. If a patient is experiencing pain, the physician may also recommend a pain reliever.

If fluid remains in the ear for more than 3 months, physician may suggest surgical treatment called Myringotomy. Myringotomy, surgical insertion of tubes. Small metal or plastic tubes are inserted through the eardrum to equalize pressure between the middle and
outer ear.This outpatient procedure is usually done under general anesthesia. The tubes will remain in from 6 to 12 months and normally fall out on their own.

When treated, Middle ear infection usually resolves without permanent damage to the ear or to hearing.




When to call the doctor
?
Although quite rare, unresolved ear infections (those that don't go away) or severe repeated middle ear infections can lead to complications, including spread of the infection to nearby bones. Therefore, children with an earache or a sense of fullness in the ear, especially when combined with fever, should be evaluated by their doctors if they aren't improving.

Other conditions can also result in earaches, such as teething, a foreign object in the ear, or hard earwax. Doctor can likely diagnose the cause of the discomfort and offer specific advice.


2. Otosclerosis
Otosclerosis is the abnormal growth of bone of the middle ear. Otosclerosis usually affects the stapes. When otosclerosis affects the stapes, the stapes becomes fixed into the oval window and interferes with sound waves passing to the inner ear.







Causes and Symptoms

Otosclerosis is the most frequent cause of middle ear hearing loss in young adults and women than men. It can run in families and often begins around the age of 30. Hearing loss may occur in this condition; slow hearing loss that continues to get worse. Hearing may be better in noisy environments than quiet areas and ringing in the ears persists (tinnitus).


Treatment

Medication may help to control the hearing loss, but the benefits have not been proven. A hearing aid may be used to amplify the sound waves, but this will not cure or prevent hearing loss but this will not cure or prevent hearing loss from getting worse, but may help relieve some of the symptoms.

The surgery to remove the infected stapes and replace it with prosthesis, which can cure the otosclerosis condition is called a stapedectomy. This operation has a very high success rate.


When to call the doctor
?
Call doctor if hearing loss, fever, ear pain occur.



3. Cholesteatoma

Cholesteatoma is a unique disease of the ear in which a skin cyst grows into the middle ear and mastoid. The cyst is not cancerous but erodes tissue of the middle ear.







Causes and Symptoms

Most evidences indicate that improper function of the Eustachian tube contributes to the formation of a cholesteatoma. If the Eustachian tube does not open often enough to equalize the pressures in the middle ear, negative pressure will develop behind the ear drum. This causes the drum to become retracted, forming a pocket. As the pocket deepens, it becomes trapped in the ear as a skin cyst or sac. Like skin tissue anywhere in the body, dead skin cells slough off. This also occurs in the cholesteatoma sac. In other cases, skin grows around the margin of a perforation into the middle ear.

Initially, the ear may drain, sometimes with a foul odor. As the cholesteatoma sac enlarges, it can cause a full feeling or pressure in the ear, along with hearing loss. Dizziness, or muscle weakness on one side of the face (the side of the infected ear) can also occur. Any, or all, of these symptoms are good reasons to seek medical evaluation.


Treatment

Surgery to remove cholesteatoma and infection and achieve an infection-free, dry ear. Then hearing preservation or restoration is the second goal of surgery which can be treated using prosthesis.

 



When to call the doctor
?
Consult a doctor in case of gradual loss of hearing, discharge from the ear, history of past ear infection / fluid problems.



4. Perforated Eardrum

A perforated eardrum is a hole or rupture in the eardrum. A perforated eardrum is often accompanied by decreased hearing and occasional discharge. Pain is usually not persistent.










Causes and Symptoms

The causes of perforated eardrum are usually from trauma or infection. A perforated eardrum can occur; if the ear is struck squarely with an open hand, with a skull fracture, after a sudden explosion, if an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the ear canal, as a result of hot slag (from welding) or acid entering the ear canal.

Usually,  the larger the perforation, the greater the loss of hearing. The location of the perforation in the eardrum also affects the degree of hearing loss. If severe trauma disrupts the bones in the middle ear which transmit sound or causes injury to the inner ear structures, the loss of hearing may be quite severe.



Treatments

If the perforation is very small, otolaryngologists may choose to observe the perforation over time to see if it will close spontaneously. Working with a microscope, your doctor may touch the edges of the eardrum with a chemical to stimulate growth and then place a thin paper patch on the eardrum. Usually with closure of the tympanic membrane, improvement in hearing is noted. If doctor feels that a paper patch will not provide prompt or adequate closure of the hole in the eardrum, or attempts with paper patching do not promote healing, surgery is considered.

In surgery, cholesteatoma can be treated by an operation called a Myringoplasty, where a tissue graft is used to seal up the hole. There are a variety of surgical techniques, but all basically place tissue across the perforation allowing healing. The name of this procedure is called tympanoplasty.


When to call the doctor
?
Consult the doctor when you feel difficulty in hearing and found occasional discharge from the ear.


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