The term, otitis media means inflammation of the middle ear. It is most commonly used in the context of acute otitis media, the common middle ear infection of early childhood. When someone has a middle ear infection, infected fluid fills the usually air-filled space behind the ear drum. Symptoms include ear pain, fever, and decreased hearing. This type of infection affects children more than adults because the Eustachian tube, (which should keep the middle ear drained of fluid and full of air) doesn’t work right in children 0-6 years of age. Treatment often involves oral antibiotics, although in children over two, a 48-hour observation period is often employed prior to initiating antibiotics. Motrin or acetaminophen may be used for the pain. In children with recurrent infections, sometimes myringotomy tubes are recommended. These are put in while the patient is under general anesthesia and is a 3 minute procedure. Chronic serous otitis media is also more common in children than adults. This is when fluid is present in the middle ear space for a prolonged period of time and often this keeps getting re-infected. Many times, the only symptom is hearing loss, but discomfort may be present on occasion. This can be one cause of speech delay in children, and if persistent and causing enough hearing loss, may be treated with drainage and myringotomy tubes. Typically if children have 3 or more middle ear infections in a year or have fluid behind the drum fro more than 2 months, the placement of tubes should be considered.
Swimmer’s Ear (otitis externa)
This is an infection of the skin in the external ear canal and typically does not involve the ear drum. The ear feels plugged. Pulling on the outside ear will elicit pain. It is due to moisture in the canal and bacteria that infects the skin. Fungus infections can also occur but are less common in Utah. Treatment involves cleaning the ear canal of the infected debris and antibiotic ear drops. If people are prone to get these infections often, treatment also includes keeping the ears dry by the use of a 50/50 mix of alcohol and white vinegar after swimming. Skin conditions like seborrheic dermatitis or psoriasis can contribute to a chronic problem. Keeping the ear dry with the alcohol and vinegar mix and also use of a blow dryer to keep the canal dry will help.
TinnitusAny noise that occurs in the ear is called tinnitus. Different noises have been described such as a high pitched tone, ringing, buzzing or a frying sound. The noise can sometimes pulsate. These noises seem to be worse in quiet situations. There are many causes of tinnitus but the most common cause is a decrease in hearing. This can be due to wax build up, noise exposure (either a sudden loud sound like a gun going off or long term noise exposure like heavy machinery) or an upper respiratory condition that clogs the ears. Persistent tinnitus should be evaluated as this may be due to noise induced hearing loss, brain tumors, certain medications and possible vascular problems. Pulsatile tinnitus sounds like your heart beating or thumping in your ear. You should see an ENT to evaluate the possible cause of the tinnitus. The ears will be examined and any obvious causes taken care of. However, a hearing test may be required especially if there is a noted decrease in hearing or especially one-sided tinnitus. In this case an MRI may be needed to help establish the cause and/or rule our any other causes. Treatment involves find the cause. Over the counter treatments make claims that this will help tinnitus but none of the studies have shown this to be true.
Ear WaxEar wax is mostly skin and oil from your ear canal with possibly some debris. It is always there but in some people it seems to accumulate and will occasionally plug up the ear. Ear wax has antibiotic properties, however, it can accumulate and can cause your hearing to go down, make your ear feel full, and make your ear have a noise in it (tinnitus). Wax can plug the ear due to use of “Q tips”, excess hairs in the outer ear, wearing ear plugs and hearing aids as well as having a narrow ear canal. Removing ear wax in the office is a common procedure and we utilize suction and gentle warm water irrigation as well as the use of small ear curettes to “scoop” the wax out.
DizzinessDizziness means different things to many people. It can mean feeling light headed, or a spinning sensation, or confusion. It is also a scary condition and people feel they will never get better. It is important that a person experiencing dizziness be seen by a physician. Vertigo is a spinning sensation often causing some nausea and can be caused by several things. The most common diagnoses that can cause vertigo include:
- Meniere’s disease. This is a disorder of the inner ear causing recurrent bouts of spinning, decreased hearing and tinnitus. This is due to an imbalance of fluid pressure in the inner ear causing rupture of a membrane with the ensuing vertigo, hearing loss and tinnitus.
- Benign Positional Vertigo. This is the most common type of recurrent vertigo and is caused by “crystals” in the inner ear that normally are in one part of the inner ear and these help us orient ourselves to our environment, but have fallen into the semicircular canals. These then can cause a disorientation with a spinning sensation. There is not a hearing loss with this vertigo.
- Labryrinthitis. An inflammation of the inner ear most often due to a virus. This is typically a “one time” episode that causes severe vertigo that improves over the next few days. Usually there is not a hearing loss.
- Vestibular Migraine. This causes repeated bouts of vertigo but may not have an associated headache however there can be the other symptoms of migraine present; shimmering or flashing lights, sensitivity to light and sounds.
- Other causes include tumors of the brain.
Treatment includes an accurate diagnosis as what may be causing the vertigo. This will include a series of positional tests performed in the office. Once a diagnosis is established a treatment regimen can be started which may include repositioning exercises (video references will be provided) oral medication, medication instilled into the middle ear and diet changes.