Ear
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Ear
Ear problems
The softening and removal of ear wax is the only ear problem which can safely be treated without medical advice.
If pain is present this could indicate a more serious condition.
Removal of hard wax can only be achieved effectively by syringing, but drops for softening wax can be used for a few days before syringing or as a preventive measure in patients prone to wax build up.
The ear has various self-cleaning mechanisms which help protect it from infection.Cotton buds or other devices should not be inserted into the outer ear canal as this can impact the wax still further or even perforate the ear drum.

Otitis externa is an inflammation of the outer auditory canal, often referred to as swimmer's ear. Excessive exposure to water leads to removal of the protective, ceruminous coat. Many cases recover after thorough cleansing by suction or gentle syringing.
Corticosteroid ear drops or astringents such as aluminium acetate solution are considered to be the most effective treatments. Topical aminoglycosides, polymyxins or chlorhexidine should be avoided in those with a perforated tympanic membrane as they may increase the risk of drug-induced deafness.Antibiotics and analgesics may be required if there is severe pain.

Acute otitis media is characterised by severe pain and deafness, possibly accompanied by fever, nausea and vomiting. Severe attacks of bacterial origin may be treated with antibiotics, but the cause may be viral, in which case treatment is with a simple analgesic.

Sero-mucinous otitis media or 'glue ear" is characterised by a viscous fluid in the middle ear. It is most common in children and often follows repeated attacks of acute otitis media arising from respiratory tract infections. The condition is referred to hospital as it may result in permanent deafness.

EARDRUM, RUPTURED
(Tympanic-Membrane Perforation)
What is It?
A hole in the thin membrane (tympanic membrane) that separates the inner ear from the outer ear.
Causes
1. Severe middle-ear infection.
2. Sudden inward pressure in the ear, such as with a slap, a swimming or diving accident, a nearby explosion.
3. Sudden outward pressure or suction, such as with a kiss over the ear.
4. Perforation of the eardrum when a sharp object is inserted in the ear, such as: a cotton swab or paper clip to clean the ear or relieve an itch; an unseen twig on a tree.
Signs and Symptoms
* Sudden pain in the ear.
* Bleeding or discharge from the ear.
* Partial hearing loss.
* Ringing in the ear.
* Dizziness.
* Occasionally, perforation causes relief to earache.
Risk Factors
* Recent middle-ear infection.
* Head injury.
Prevention
* Don't put any object into the ear canal.
* Avoid injuries that may cause a rupture (see Causes).
* Obtain prompt medical treatment for middle-ear infections.
Diagnosis and Treatment
General Measures
* Diagnosis is verified by otoscope examination of the ear. A culture of the fluid from the ear may be done also.
* Treatment involves medication to prevent or treat infection and supportive care for pain.
* Don't blow your nose, if possible. If you must, blow gently.
* Keep the ear canal dry. Don't swim, take showers or get caught in the rain.
* Microsurgery to repair the perforation if it doesn't heal spontaneously.
Medication
* Antibiotics to prevent or treat infections.
* Pain relievers. For minor pain, you may use non-prescription drugs such as acetaminophen.
Activity
Resume your normal activities as soon as symptoms improve.
Diet
No special diet.
Possible Complications
* Ear infection, with fever, vomiting and diarrhea.
* Significant blood loss (rare).
* Meningitis (rare).
* Mastoiditis (infection of the mastoid bone situated just behind the ear).
* Permanent hearing loss (rare).
Prognosis
* If the ruptured eardrum does not become infected, it will usually repair itself in 2 months. If it becomes infected, the infection is curable with treatment, and hearing is usually not affected permanently.
* If the perforation does not heal, surgery is needed.




EARWAX BLOCKAGE
(Cerumen Impaction)
What is It?
Overproduction of earwax, causing blockage of the external ear canal. Wax is produced by glands in the ear to protect the canal leading from the eardrum to the outside. The amount of wax produced varies from person to person. Produce enough to block the and need treatment.
Causes
Overproduction of wax by glands in the external-ear canal.
Signs and Symptoms
1. Decreased hearing.
2. Plugged feeling in the ear.
3. Ringing in the ear.
4. Ear pain.
Risk Factors
1. Exposure to dust or debris.
2. Family history of overproduction of earwax.
3. Water in the ear can cause the wax to swell.
4. Use of cotton swabs in an attempt to clean the ear canal.
Prevention
* Avoid area where the air is dusty of filled with debris. This stimulates overproduction of earwax. Consider wearing earplugs if you must be in this type of environment.
* Monthly use of 1-2 drops of mineral oil in the ear may soften the wax and prevent recurrent blockage.
Diagnosis and Treatment
General Measure
To remove earwax at home:
* Buy non-prescription wax-softening ear drops, or use mineral oil, warmed.
* Lie down with the affected ear toward the ceiling.
* Pull the top of the ear gently up and back toward the back of the head.
* Instill the ear drops or 2 drops of mineral oil.
* Leave the drops in the ear for 4 to 5 minutes. Continue to lie down, if possible. Plug the ear with cotton.
* Sit up, leaning a little toward the affected side.
* Don't try to remove wax with a stick or cotton swab. You may damage the eardrum or cause infection in the ear canal. Caution: if you have a perforated eardrum, don't try to remove the wax, call your doctors office.
* If it is still blocked, obtain prompt medical attention.
Medication
For minor pain, you may use non-prescription drugs such as acetaminophen.
Activity
No restrictions.
Diet
No special diet.
Possible Complications
* Ear infection.
* Eardrum damage.
Prognosis
Earwax can be removed, but stubborn cases require patience.


LABYRINTHITIS
What is It?
Inflammation of the semicircular canals in the inner ear. These are fluid-filled chambers that sense and help maintain balance.
Causes
Virus infection (usually) in the inner ear.
Bacterial infection in the inner ear.
Head injury.
Signs and Symptoms
Extreme dizziness especially with head movement that begins gradually and peaks in 48 hours.
Involuntary eye movement.
Nausea and vomiting (sometimes).
Loss of balance, especially falling toward the affected side.
Temporary hearing loss (sometimes).
Ringing in the ear (tinnitus).
Risk Factors
Recent viral illness, especially respiratory infection.
Spread of a chronic middle-ear infection.
Ingestion of toxic drugs.
Stress.
Allergy or family history of allergies.
Smoking.
Excess alcohol consumption.
Use of some prescription or non-prescription drugs, especially aspirin.
Cardiovascular or cerebrovascular disease.
Prevention
Obtain prompt medical treatment for ear infections.
Don't take medication that has produced dizziness without getting medical advice.
Diagnosis and Treatment
General Measures
Diagnostic tests may include hearing studies, culture of any purulent drainage; other studies as needed to determine any underlying disorder.
Treatment of any underlying disorder.
Treatment of symptoms (rest, medication).
Surgical removal of cholesteatoma (an infected collection of debris in the middle ear) and drainage of infected areas may be necessary if conservative measures fail.
Medication
Anti-nausea medications may be prescribed (oral or suppositories).
Tranquilizers to reduce dizziness (rare).
Diuretics to decrease fluid accumulation in the inner ear.
Antibiotics if bacterial infection present.
Antihistamines to relieve symptoms.
Activity
Keep the head as still as possible. Rest in bed until dizziness subsides. Then resume your normal activities gradually. Avoid hazardous activities, such as driving, climbing or working around dangerous machinery, until 1 week after symptoms disappear.
Diet
No special diet.
Possible Complications
None known. This is a self-limiting condition.
Prognosis
Recovery either spontaneous or with treatment in 1 to 6 weeks.


OTITIS EXTERNA
(EAR INFECTION, OUTER; SWIMMER'S EAR)
What is It?
Inflammation or infection of the external ear canal that extends from the eardrum to the outside.
Causes
1. Bacterial or fungal infection of the delicate skin lining of the ear canal.
2. Injury to the ear canal.
Signs and Symptoms
1. Discharge of pus from the ear.
2. Ear pain that worsens when the earlobe is pulled or pressed.
3. Itching in the ear.
4. Slight fever (sometimes).
Risk Factors
1. Swimming dirty, polluted water.
2. Excessive swimming in chlorinated pools. Chlorinated water dries out the ear canal, allowing bacteria or fungi to enter the skin.
3. Immersing ears in hot tub with infected water.
4. Excess moisture from any cause.
5. Irritation from swabs; metal objects, such as bobby pins; or ear plugs, especially if they are left in a long time.
6. Inadequate production of protective ear wax (cerumen).
7. Previous ear infections.
8. Skin allergies.
9. Diabetes mellitus or other disorders that predispose to infection.
10. Use of hair spray or hair dye that may enter the ear canal.
Prevention
* Don't clean your ears with any object or chemical.
* After you have had otitis externa, keep the prescription ear drops on hand. If the ear canals get wet for any reason, such as swimming or shampooing, put drops in both ear at bedtime.
Diagnosis and Treatment
General Measures
* Diagnosis made by examination of the ear. Fluid from the ear may be cultured.
* Medication and supportive care to relieve pain.
* Gentle cleaning of the era canal.
* Warm compress over the ear may help relieve the pain.
* Keep the infected ear dry. Wear ear plugs or shower cap for showering.
Medication
* You may use non-prescription drugs, such as acetaminophen or aspirin, for minor pain.
* Ear drops that contain antibiotics and cortisone drugs to control inflammation and fight infection.
* Topical creams or ointments for fungal or bacterial infections.
* Oral antibiotics for severe infection.
Activity
Resume your normal activities as soon as symptoms improve. Avoid getting water in the eras for 3 weeks after all symptoms disappear. Any moisture, even from showering or washing hair, can trigger a recurrence.
Diet
No special diet.
Possible Complications
* Sever pain.
* Chronic inflammation that is difficult to cure.
* A boil in the ear canal.
* Cellulitis (deep-tissue infection).
Prognosis
Usually curable with treatment in 7 to 10 days.


OTITIS MEDIA
(MIDDLE EAR INFECTION)
What is It?
* An infection (viral or bacterial) of the lining of the middle ear.
* Common in children.
* It involves the middle ear space, with the ear drum on one side, the nerve on the other and the eustachian tube in between.
* Not infection per say, but the underlying upper respiratory infeciton may be infecitous.
* 50% of ear infections are viral, the rest are bacterial.
Causes
A virus or bacterial infection in the upper respiratory tract which spread to the middle ear via the eustchian tube.
Signs and Symptoms
1. Fever.
2. Hearing loss.
3. Earache.
4. Irritability.
5. Feeling of fullness in the ear.
6. Discharge of leakage from the ear.
7. Diarrhea, vomiting (sometimes).
8. Pulling at the ear (small children).
Risk Factors
1. Recent illness, such as a respiratory infection, that has lowered resistance.
2. Crowded or unsanitary living conditions.
3. Genetic factors. Some American Indians, especially the Navajo, seem more susceptible.
4. Children who had first attack before 6 months of age.
Prevention
* No smoking in household.
* Treat infections promptly.
Diagnosis and Treatment
General Measures
* Diagnosis is usually made by examination of the ear. Fluid from the ear may be cultured.
* Treatment usually involves medication and supportive care to relieve pain.
* Apply heat to the area around the ears to releive pain.
* Swimming should be avoided until infection clears.
* Surgery to insert plastic tubes through the eardrum to drain pus or fluid from the middle ear (rare); or surgery to remove the adenoids.
* If the eardrum is bulging, a small cut, or myringotomy, may be made in it to relieve pressure and pain.
Medication
* Ear drops to relieve pain.
* Use non-prescription drugs, such as acetaminophen, to reduce pain and fever.
* Antibiotics may be prescribed (penicillin resistance a concern in some regions), if the infection appears to be bacterial rather than
* viral. Finish the medication. The infeciton may remain active for several days after symptoms disappear.
* A follow-up with your family doctor is necessary.
Activity
Rest in bed or reduce activity until fever and pain subside.
Diet
No special diet.
Possible Complications
* May recur.
* Chronic otitis media (pus comes from perforation in eardrum).
* Hearing impairment usually temporary, but sometimes permanent leading to delay of normal language development in children.
* Enlarged adenoids in children from repeated middle-ear infections, causing chronic middle-ear infections.
* Mastoiditis (infection of the mastoid [bony area just behind the ear]; rare), cholesteatome (infection mass with middle ear).
* Meningitis (rare).
Prognosis
Usually curable with treatment.


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Much time, effort and thought has gone into the design and production. The publishers, authors, reviewers and consultants have used their best efforts to provide accurate information. The authors, reviewers and consultants hereby disclaim all responsibility for any loss suffered by any person, and for all errors or omissions in this material.