Common Disorders of the Ear
NAEH 2015 Conference
1. Welcome
2. External Ear
 Normal ear canal
3. External Otitis
 Infection of the external ear canal
 Varies in degree of inflammation
 Entire canal or pimple/boil
 Smelly discharge, itchy, painful
4. Infection in the ear canal
 Swimmer’s ear (external otitis)
 Ear canal narrows with a bend in the middle
 Tip to remove water is to place arm around head and pull on opposite outer ear to
straighten the canal
5. Ear Wax
 Normal liquid or dry ear wax (The Asian culture has dry ear wax)
6. Impacted Ear Wax
7. Foreign body in the ear canal
 Q-tip
 Ear bud that fell off
8. Things you’ll find in children’s ears
9. Exotosis
 Abnormal bone growth in the ear canal
 Commonly referred to as Surfer’s Ear (80% of surfers develop exotosis)
 Frequent exposure to cold water, wet, and windy conditions
o Includes surfing, sailing, diving, kayaking, fishing, water skiing
 Symptoms include:
 decreased hearing
 increased ear infections
 increased water trapped in the ear
 visible closure of the ear canal
10. Middle Ear – a hollow air filled space
11. Normal eardrum and Perforated eardrum
 Perforation impairs hearing
 May lead to infection and/or injury of the middle and/or inner ear
 Sudden loss of hearing, tinnitus, or vertigo
 Causes
 Bad middle ear infection
 Loud noise close to ear (explosion, gunshot)
 Foreign object in ear (crayon, q-tip, hair pin)
 Rapid change in ear pressure (flying, scuba diving)
 Severe head trauma
12. Perforation of the eardrum by a Q-tip
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13. Myringitis
 Eardrum becomes inflamed; small blisters on the eardrum
 Due to bacterial or viral infection
 Pain lasts 24-48 hours
 Drainage from ear
 Hearing loss occurs but returns when inflammation clears
 There is no middle ear infection with myringitis
14. Eustachian tube
15. Eustachian tube
 Closure and opening at back of the throat
 Swells closed from allergies, second hand smoke, upper respiratory infections
 Closes or becomes blocked from drinking while laying on back, sudden increase
in air pressure
16. Middle ear infection
 a.k.a. Otitis Media or Acute Otitis Media
 Viruses or bacteria enter the Eustachian tube through the throat
o Severe, persistent ear pain
o Fever
o Tendency is for just one middle ear to be infected
17. Serous Otitis Media
 a.k.a. Otitis media with Effusion
 Serous is a yellow transparent fluid of protein and water that fills body cavities
 Chronic inflammation of the lining of the Eustachian tube obstructs the
tube from draining causing build-up of Serous fluid in the middle ear
 Middle ear progresses from no fluid to fluid filled
 No infection is present
 No obvious symptoms
 No pain or fever
 Usually in both ears
 Serous Otitis Media may cause Acute Otitis Media; Acute Otitis Media may cause
Serous Otitis Media
18. Tube inserted in the eardrum allows fluid to drain
19. One mom’s remedy for an ear infection!
20. Airplane ascending
 Cabin pressure decreases
 Middle ear pressure increases
 Excess air in the middle ear
 Plug nose and swallow to open the Eustachian tubes to release air from middle ear
21. Airplane descending
 Negative air pressure causes eardrum to retract
 Eardrum is being pulled in
 Plug nose and gently blow with mouth closed
 This forces air through the Eustachian tube into the middle ear
22. Visual of eardrum
 a. eardrum bulging outward when plane climbs
 b. eardrum drawn inward when plane descends
 c. normal eardrum pressure from the inside and outside
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23. Scuba Diving
 Ear issues range from simple swimmer’s ear to serious damage to middle or inner
ear
 Be aware of rapid pressure changes
 Divers are taught to equalize ear pressure frequently (as often as every 2 feet of
change in depth)
24. Otosclerosis
 Excessive bone growth surrounding the middle ear
 Immobilizes the stapes attached to the oval window
 Unable to transmit sound efficiently
 Hereditary condition
 Slow yet progressive hearing loss
 Difficult hearing low pitch sounds
o May include dizziness, balance problems, or tinnitus symptoms
 May be helped with a hearing aid or surgically inserting a prosthetic stapes
25. Stiffness in the Middle Ear
 Causes
 Air pressure of middle ear not equalized (flying or diving)
 Infection or fluid of middle ear make eardrum and middle ear bones stiff
 Middle ear bones themselves become stiff
 Eardrum is stiff from repeated trauma
 Scar tissue in the middle ear from history of infections or traumas
26. Inner Ear
 Conductive Hearing Loss = Outer/Middle Ear
 Sound moving from the outer ear through the middle ear
o Some causes: allergies, fluid/infection in middle ear, ear wax, boil,
foreign body, tumor, exotosis, otosclerosis, perforated eardrum
 Most common in children due to high occurrences of middle ear infections
 Sensorineural Hearing Loss = Inner Ear
 Damage to inner ear cochlea or nerve pathways to brain
 Most common type of permanent hearing loss for adults
 Some level of permanent hearing loss
o Some causes: aging, head injury, brain tumor, prescription drugs,
damage to hair cells, damage to auditory nerve, sudden or loud
noises over time
27. Auditory Hair Cells
 Responsible for detecting sound
 Sounds louder than 90 decibels flatten hair cells
 Long term exposure to loud sounds cause permanent hearing loss
28. Hearing Loss Frequencies
 High frequency hearing loss
 Difficulty hearing high pitched sounds
 Can hear but not understand – sounds mumbly
o Don’t hear the consonants of words, only hears the vowels
 Low frequency hearing loss
 Able to hear higher frequencies
 Often able to understand speech
 Difficulty hearing in groups or noisy places
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29. Source of noise and decibels associated with hearing loss
30. Can you hear me now?
 Take good care of your hearing
 We get frustrated when we have to keep repeating ourselves when someone can’t
hear us
31. Vertigo
 Sensation of spinning, dizziness, swaying, tilting, feeling unbalanced
 Most often caused by and inner ear issue
 Ear crystals are most common cause of vertigo
 Other causes
 Meniere’s disease, labyrinthitis, vestibular neuritis
 Vertigo is not usually caused by
 Neck or head injury, stroke or brain tumor, medications, migraines
 Symptoms include:
 Triggered by change of head position, feeling nauseated, jerky eye
movements, headaches, ringing in the ear, or experience hearing loss
 Non ear associated symptoms with vertigo include:
 Sudden drop in blood pressure, dehydration, certain medications, getting
up too quickly from lying down or sitting
32. Labyrinthitis
 a.k.a. Inner ear infection; labyrinth becomes infected and inflamed
 Most commonly it is a secondary infection from a cold or flu virus
 Bacterial infection is rarely the cause but may develop as a secondary infection
from a severe case of otitis media or damage to the ear from a head injury
 Symptoms: severe dizziness, vertigo, temporary loss of hearing in infected ear,
possible deafness, tinnitus, nausea, vomiting, eyes may move slowly to one side
and then dart back to original position
33. Labyrinthitis – another view
34. Meniere’s Disease
 Caused by excess fluid in the semicircular canal
 Symptoms: balance and hearing are affected, dizziness, loss of hearing in one or
both ears
 Tinnitus (ringing in the ears)
35. Tinnitus
 Not a disease – it’s a symptom
 Ringing or buzz in one or both ears
 Noise may also be hissing, roaring, whistling, chirping, or clicking
 Noise may be constant or intermittent
 Subtle or loud
 Single or multiple tones
 Causes: impacted earwax, eardrum inflamed, middle ear infection, fluid in the
middle ear, inner ear infection, noise damage from overstraining the hearing cells,
head or neck trauma, jaw misalignment, damage to auditory nerve
 May be secondary to hypothyroidism or hyperthyroidism, Meniere’s
disease, Lyme’s disease, fibromyalgia
 Treatment of the underlying cause may resolve tinnitus.
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36. Oversensitive Hearing
 Increased sensitivity to everyday sounds
 e.g. Water faucet, dishwasher, walking in leaves, shuffling paper, any
noise
o High frequency noises are particularly troublesome
 Quality of life is compromised – reluctance to interact with environment
o Becomes depressed and isolated
 Usually affects both ears
 Happens at any age
 May come on slowly or suddenly
 Causes pain and discomfort
 Causes:
 Head injury, medications, Bell’s Palsy, TMJ, Meniere’s disease, PTSD,
Chronic Fatigue Syndrome, autism, Down’s syndrome, depression,
migraines, sudden loud noise, some forms of epilepsy
 1 in 1,000 people who have tinnitus have oversensitive hearing
 There are millions of people who have tinnitus
37. Ear Crystals
 a.k.a. Benign Paroxysmal Positional Vertigo (BPPV)
 Most common inner ear disorder
 Most common cause of vertigo
 Tiny crystals of calcium carbonate are a normal part of the ear anatomy
 Crystals detach from membrane in the utricle
 If move into the semicircular canal then when head is moved the crystals
disrupt the flow of fluid sending a false sense of motion to the brain
 Causes: head injury to simple miss-step off a curb; secondary to viruses of the
inner ear, labyrinthitis or vestibular neuritis; may be associated with migraines;
half the time the cause is unknown
 Symptoms: vertigo, dizziness, nausea, vomiting, unbalanced, involuntary rapid
side to side eye movement
 You do not experience with BPPV: hearing loss, feeling of fullness in the ear,
head noise.
 If any of these symptoms are present then another inner ear disorder is
present
38. Ear Crystals – another view
Inner or Outer Ear – may be caused by an inner or outer ear disorder or condition
39. Muffled Hearing
 Causes
 Ear wax or foreign body
 Middle ear infection
 Eustachian tube issue
 Asymmetric hearing – hearing better in one ear than the other
 Sensorineural hearing loss; High or low frequency hearing loss
 If happens suddenly seek medical attention
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Other
40. Selective Hearing
 The tendency to ignore the things people don’t want to hear
 Not a psychological issue
 Words are heard; mind chooses not to acknowledge what’s being said
 Selective inattention done consciously or subconsciously
 No – this is not just a male issue!
 Affects both genders
 Affects all ages – adults and children
41. Selective Hearing - Pets
42. Wiggling Ears!
 10-20% of population are ear wigglers
 Some move one ear at a time
 Others can move both ears at the same time
 Ear wiggling is a vestigial feature
 Useful for our ancestors to focus on the direction of certain sounds
o We still have the muscles but they became functionless
 Muscles around outside of ear
 Auricularis anterior moves ear up and forward (1)
 Auricularis superior raises the ear (2)
 Auricularis posterior pulls the ear backwards (3)
 Maller, Jerome, (2014, December). Neuroplasticity in normal and brain injured
patients: potential relevance of ear wiggling locus of control and cortical
projections. [Abstract in PubMed, National Library of Medicine.]
 Hypothesis relates to dormant white matter pathways in the brain
 Complex task of ear wiggling may activate and promote advanced
recovery after a brain injury.
 Trigger the pathways with electrical/magnetic stimulation into becoming
consciously controllable
 A complex skill like ear wiggling may assist in the repair of damaged
pathways
 The broader potential impact of the proposed hypothesis is that ear wiggling could
be used for improving the recovery of TBI or stroke subjects via neuroplasticity
processes.
43. References
44. References
by Bonnie K. Dysinger, B.Msc., CPEH, C.Ht.
www.gtheal.com
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