Our ear consists of three main parts; the outer, middle, and inner ear. Sound waves pass from the outer ear toward the inner ear as vibrations. We then convert these vibrations to signals that travel to the brain. This is what allows us to hear, however, hearing is not your ear’s only function. The tiny fluid-filled tubes in the semicircular canals of your inner ear contribute to your sense of balance. So, anything affecting these processes affects both your hearing and balance. Benign and malignant tumours, ear inflammation, impacted wax, and other ear problems are not uncommon.
Lead Ear, Nose, and Throat (ENT) specialist Dr Stephen Kleid offer various treatments for ear problems and disorders in Melbourne, Australia. His experience encompasses a wide array of both surgical and non-surgical treatments for diseases involving hearing and the ears.
Continue reading to find out more about the types of ear problems, as well as the symptoms, causes, and treatment options for each.
Acoustic neuroma is a type of benign, non-cancerous cell growth along the ear nerve. Another name for this is vestibular schwannoma.
The growth develops on either your vestibular or cochlear nerve, which controls your hearing and balance. If left untreated, the brain tumour grows larger and becomes severe, which in turn negatively affects both your hearing and balance.
Symptoms of acoustic neuroma develop because of the pressure of the tumour on nearby nerves, such as the facial and trigeminal nerves controlling your facial muscle movement and facial sensation.
At an early stage of schwannoma, the following subtle symptoms may occur:
- Hearing loss in only one ear
- Tinnitus, in other words, a ringing in the ear
- Vertigo, which refers to the feeling of spinning
When acoustic neuroma grows too large, it presents with more advanced symptoms, including:
- Hoarseness of the voice
- Difficulty swallowing
- Partial weakness, pain, and numbness of your face
- Double or temporary blurred vision
- Persistent headaches
- Partial ataxia – a lack of limb coordination
Unfortunately, Acoustic neuromas do not have any specific cause. However, most cases result from neurofibromatosis type 2, a genetic disorder involving tumour growth on nerves on both sides of your head. We call this ‘bilateral’ vestibular schwannoma.
Acoustic neuromas are challenging to diagnose because they share symptoms with other conditions, like Meniere’s disease. Dr Kleid performs different diagnostic tests to ensure the accurate diagnosis of your acoustic neuroma for appropriate treatment.
- Hearing Test: Acoustic neuromas affect your hearing function. Dr Kleid performs a hearing test using an audiometer. This machine evaluates your sense of hearing at different frequencies and pitches.
- Imaging Tests: He may request either Magnetic Resonance Imaging (MRI), or CT scans to better understand the tumour, its size, and also its position.
Depending on the size, position, and how fast the acoustic neuroma grows, Dr Kleid can apply various treatment methods. Surgery for acoustic neuroma is only recommended if the tumour grows.
- Ear and Brain Surgery
- Dr Kleid uses surgery to remove the tumour through an incision in the base of your skull.
- You will be under General Anesthesia for Acoustic neuroma surgery.
- However, Dr Kleid only considers brain surgery if your tumour grows large.
- Stereotactic Radiosurgery
- Dr Kleid may recommend this type of vestibular schwannoma surgery if your tumour is less than 2.5 cm in diameter.
- He uses a precise radiation beam to burn the tumour without making an incision or damaging nearby brain tissue.
Both surgical techniques to treat neuroma can come with the risk of temporary loss of sensation and movement in your face because of the nerves involved. It’s best to speak with Dr Kleid to discuss the best option for your condition.
If left untreated, an acoustic neuroma can lead to hydrocephalus in some patients. Hydrocephalus is a life-threatening medical condition in which fluids build up in the brain, this can affect not only your ability to drive but also your ability to work, and communicate.
Acoustic neuroma can also return after treatment. Regular MRI scans can detect the development of recurrent acoustic neuromas before they grow significantly.
Earaches are a common ear complaint rather than an independent condition. It is a result of either an infection or inflammation in any of the three parts of your ear: the outer, middle, or inner ear. Earaches are more common in children than adults and can affect one or both ears.
Although the symptoms depend on the cause of your earache, common symptoms of ear infection and inflammation include:
- Ear pain
- Sore throat
- Vertigo; refers to a spinning feeling
- Tinnitus is the medical term for ringing in the ear
Infections, irritations, or injuries to your ear are common causes of earache. However, referred pain or pain felt in other areas may also lead to pain in your ear.
Other causes of earache include:
- Middle ear infection
- Temporomandibular joint infection
- Bullous myringitis
- Swimmer’s ear
An appointment with Dr Kleid involves physical examinations and diagnostic tests for an accurate and expert diagnosis of your problem.
- Dr Kleid uses an otoscope, a lighted instrument, to look inside your ear. This allows him to examine your inner ear for redness or other symptoms of infection or disease.
- Hearing test
- Hearing tests evaluate your ability to hear sounds at different pitches.
- Through your hearing test results, Dr Kleid can determine if you are experiencing a hearing loss in one or both ears.
- This can help narrow down the cause of earache.
- Laboratory tests
- Dr Kleid may take a sample from your ear fluid for laboratory testing.
- Lab tests can determine either the cause of your pain or rule out other conditions.
- Imaging test
- He can also request an MRI or CT scan to investigate the cause of your ear pain further.
The treatment options will depend on the specific cause of your earache. In most cases of earaches, your doctor will prescribe either eardrops or antibiotics.
- Eardrops: Can be used for treating earache caused by a build-up of wax in your ear canal. Eardrops soften and break down the wax so it can be removed.
- Antibiotics: Antibiotics may treat infections like otitis media and bullous myringitis that may be causing your earaches.
If caused by infections, your earache may resolve without medical intervention. But antibiotics and pain relief methods will make for speedy healing and recovery.
Earwax is the waxy, yellowish substance that lines the inside of your ear canal. It helps to protect your canal from water, injury, infections, and foreign objects. Earwax becomes a problem if it accumulates, leading to impacted earwax.
Earwax doesn’t cause symptoms unless there is a severe build-up that blocks the ear canal. Signs of impacted earwax can develop slowly, and you may have only 1 or 2 of these symptoms:
- Conductive hearing loss
- Tinnitus, ringing in the ear
- Itching in the ears
- Fullness of ear
- Ear pain
Impacted earwax is present in several health conditions when your body is making earwax faster than it can remove it:
- Autoimmune diseases (e.g. lupus)
- Narrowed ear canal
- Skin diseases (e.g. eczema)
- Bone growth (e.g. osteoma) blocking the ear canal
Some of these conditions can promote earwax production, while others can cause a physical block wherein the earwax is difficult to remove.
Dr Kleid can diagnose impacted earwax by taking note of your medical history, as well as, performing physical examinations.
- Otoscopy: Dr Kleid uses an otoscope to see the wax when examining your ear. It is usually a straightforward diagnosis.
- Hearing Tests: He may perform a hearing test to investigate whether your condition has caused any sort of hearing loss.
Treatment options for impacted earwax depend on your health, age, symptoms, and severity of impaction. Your treatment options include:
- Eardrops: Dr Kleid drops medication into your ear canal to soften and remove the earwax.
- Ear Canal Irrigation: Irrigation is a routine method for breaking down the earwax. Dr Kleid uses a syringe-like tool to push a water and saline mixture into your ear to flush out the wax.
- Manual Removal: Dr Kleid uses a specialized clamp and spatula designed to remove the earwax manually and clear the ear canal.
Usually, there are no complications of impacted earwax. Complications that occur may be due to an underlying health condition associated with the buildup of earwax.
Glue ear, or adhesive otitis, occurs when your middle ear becomes filled with sticky, glue-like fluid. This usually happens after an infection, like a common cold.
When the fluid persists, it becomes sticky and stops the tiny bones in your middle ear from carrying sound vibrations to your cochlea, a hollow, spiral-shaped bone in the inner ear. Furthermore, this lack of vibration can lead to temporary hearing loss.
Glue ear symptoms are not definite, but glue ear may be noticed when you:
- Speak more loudly or quietly than usual
- Struggle to hear people
- Listening to very loud music or TV
- Easily get distracted when people talk
- Become either tired or irritable when trying to listen
Causes and risk factors of glue ear include:
- Children below 2 years old
- Seasonal allergies
- Exposure to tobacco smoke
- Recent cold or flu
Anything that leads to the accumulation of fluids in your middle ear can cause glue ear, it is common in children because their ‘eustachian tube’ is narrower than adults.
The eustachian tube is a passage that runs from the nose to the middle ear, it also drains mucous. Some cases, like severe allergies, can lead to a swollen and constricted eustachian tube and then fluid build-up.
Dr Kleid diagnoses glue ear with the use of an otoscope (which helps him look inside the ear), it also allows him to check if there are any infections or other ear problems.
Most cases resolve independently, but glue ear may need to be treated with antibiotics if it gets infected. Some treatments for glue ear include:
- Speech Therapy And Hearing Aids
- If glue ear remains untreated, it can affect your child’s ability to speak properly.
- Dr Kleid recommends both speech therapy and hearing aids for severe and chronic glue ear cases.
- This can help improve auditory skills whilst also lessening the negative impact it has on your child’s development.
- If glue ear stays long-term, Dr Kleid can treat it with adenoidectomy, wherein he removes your adenoid glands from behind your nose.
- Enlarged adenoids can block the eustachian tube and are a common contributor to the fluid accumulation in the middle ear.
If hearing loss persists, Dr Kleid may insert tiny tubes called grommets into your ear to allow air to drain the fluid.
Glue ear can take three months or more to clear up. If it has yet to resolve and is left untreated, glue ear can induce ear infections. A delay in speech and language development in children can also occur when hearing loss is severe.
Labyrinthitis is the inflammation of the labyrinth, a part of the inner ear. The hallmark sign is a sudden feeling of dizziness and spinning.
The labyrinth is where the eighth cranial nerve (called the “vestibulocochlear nerve”) passes, so the inflammation leads to its irritation. This nerve relays sensory signals for both hearing and balance to the brain.
Although the eighth cranial nerve is affected, labyrinthitis doesn’t cause severe neurological symptoms, like headaches or speech problems. Common symptoms of labyrinthitis include:
- Vertigo, the feeling of spinning, usually worse with movement
- Lack of balance
- Inability to focus
- Hearing loss
- As well as, uncontrolled eye movements
The symptoms usually occur acutely, and you notice them quickly as they start developing.
Labyrinthitis may be a result of a viral infection of the vestibulocochlear nerve or the labyrinth. The viruses that cause labyrinthitis are:
- Epstein Barr
In children, bacterial infections are a fairly common cause due to the spread of infection from the middle to the inner ear.
Dr Kleid will examine your medical history, he will also carry out several physical examinations to diagnose labyrinthitis. If you have typical symptoms of labyrinthitis vertigo, then the diagnosis is usually made based on history and physical exam alone.
Further testing may include a hearing test, imaging test, and balance test that evaluate your mobility and risk of falling if the diagnosis is still not clear.
We may include an examination of your nervous system to investigate other neurological and health conditions.
Since a viral infection causes labyrinthitis, it can often resolve alone. However, immediate treatment might sometimes, include some medications:
- Antiviral medication
- These medicines both attack and weaken the virus that’s causing your vertigo.
- Antibiotics are given if you have a bacterial infection that causes your labyrinthitis.
- Corticosteroids help reduce any inflammation present and are essential in viral infections.
- Medication For Nausea
- You are only to take these medicines for a short period.
- This is to control any dizziness or nausea you may experience in labyrinthitis.
Labyrinthitis rarely causes permanent damage to your cranial nerve, however, when it does, complications can include partial or total hearing loss and impaired balance.
Meniere’s disease is common among people between the age of 20 to 60. This disorder of the inner ear is caused by the accumulation of endolymph or fluid. It leads to sudden attacks of vertigo, tinnitus, and hearing loss, which can occur in clusters separated by either weeks or months.
A Meniere’s disease episode may comprise the following:
- Vertigo, the feeling of spinning
- Unsteady feet
- Tinnitus, ringing in the ears
- A sudden drop in hearing
Symptoms differ from person to person, but if you are suffering from Meniere’s attack you should always expect vertigo.
There is no known cause, but risk factors that affect the amount of endolymph in the inner ear may include:
- Improper fluid drainage
- Immune system abnormalities
- Genetic and family history
- Viral infection
Aside from understanding your medical history and symptoms, Dr Kleid has to conduct a further examination to assess the function of your inner ear, like hearing and balance.
- Hearing Test – Patients with Meniere’s disease often can’t hear low frequencies or a combination of high and low frequencies. Dr Kleid can verify your condition with the results of your hearing test.
- Videonystagmography (VNG) – VNG assesses your balance through your eye movement since the balance sensors in your inner ear are connected to the muscles controlling your eye movement. This helps in both the follow-up and evaluation of inner ear problems.
- Electrocochleography (ECoG) – Dr Kleid uses ECoG to test your inner ear’s response to sound. This way, he can determine if there is abnormal fluid accumulation in your inner ear.
- Video Head Impulse Test (vHIT) – He uses vHIT to gauge your eye’s reaction to abrupt movement. If your eye shows an abnormal reflex, this may be because of Meniere’s disease.
Unfortunate there are no current cures for Meniere’s disease, we can only manage it. Therefore, the current treatment options aim to reduce the frequency and severity of the Meniere attacks.
- Motion sickness and anti-nausea medication can reduce the spinning sensation. These also control nausea and vomiting during episodes.
- Non-Invasive Procedures And Therapies
- Rehabilitation may be necessary if you suffer from balance problems in between episodes.
- Hearing aids are also available to improve your hearing ability.
- Positive pressure therapy.
- This is another common treatment, it uses a pulse generator to apply pressure to the middle ear and loosen fluid build-up.
Surgery for Meniere is only used in severe conditions when other treatments don’t help.
- Endolymphatic Sac Procedure: This sac plays a vital role in controlling the fluid levels in your inner ear. Dr Kleid decompresses the endolymphatic sac, reducing the excess fluid.
- Labyrinthectomy: Dr Kleid removes the labyrinth, thus removing both the balance and hearing function of your affected inner ear. This procedure is only carried out when you are experiencing total hearing loss in the affected ear due to Meniere’s.
- Sectioning Of The Vestibular Nerve: The nerves that control both balance and movement are cut on the affected side. This procedure helps to correct your problems associated with vertigo and attempts to preserve hearing in the affected ear. Dr Kleid places you under general anaesthesia for this Meniere surgery option.
Unpredictable episodes of vertigo and permanent hearing loss are the most challenging complications of Meniere’s disease. Unfortunately, this often leads to fatigue and stress, which can affect not only your physical health but your mental health as well.
Fluid in the ear or “otitis media with effusion” (OME) means an abnormal accumulation of fluids in the middle ear, behind your eardrum, affecting the function of your eustachian tube. The eustachian tube is a narrow passage connecting your throat to your middle ear.
OME is usually associated with non-infected fluid, however, if it persists, the fluid may become infected. When infection occurs, it is called acute otitis media (acute middle ear infection).
Some cases of OME are asymptomatic, in other words, they show no symptoms whatsoever. Symptomatic patients of otitis media with effusion present the following:
- Vertigo, the feeling of spinning
- Tinnitus, ringing in the ear
- The feeling of fullness in the ear
- Hearing loss
- Plugged up ear from high blood pressure
- Earache during altitude change
Otitis media with effusion usually stems from a eustachian tube that is functioning poorly. The eustachian tube has a role in balancing the air pressure inside your middle ear, it also has a role in removing fluid and debris. Normal fluid drainage from your middle ear can’t be done when its function is impaired, leading to fluid build-up.
These are some reasons why your eustachian tube might not be functioning right, increasing your risk of OME, including:
- Tissue enlargement
- Exposure to chemicals
- High blood pressure
- Down’s syndrome/cleft palate
- Damage to the auditory tube
If you notice any of the symptoms, consult an otolaryngologist like Dr Kleid for a proper evaluation of your ear condition.
- Otoscopy: Dr Kleid may use a pneumatic otoscope that blows air into your ear to inspect your eardrum’s movement. If it doesn’t move freely, this indicates there is fluid accumulation in the middle ear.
- Tympanometry: In tympanometry, Dr Kleid uses a speculum. He will place it on the outer portion of your ear canal, measuring the air pressure inside. This is to test how well your middle ear is working and if there are any significant pressure changes.
Typically, when you develop fluid in the ears, it resolves within 4 to 6 weeks, and treatment is unnecessary. But if it does not, treatment will depend on the duration of fluid accumulation.
- Antibiotics: If your OME accompanies a respiratory infection, Dr Kleid can prescribe antibiotics to treat it.
- Myringotomy: Dr Kleid may perform a myringotomy, the surgical placement of ear tubes into your middle ear. These ear tubes aid in draining the fluid which also helps relieve the pressure. Myringotomy is usually recommended at the 12-week mark of OME.
Some cases of OME may lead to more severe issues such as acute otitis media, fluid in the ear with an active infection. Children are at higher risk since they may suffer from developmental delays due to hearing loss. However, permanent hearing loss due to fluid in the ear is very rare if properly treated.
The medical term for inflammation or infection of your middle ear is acute otitis media (AOM). This is often due to a virus or bacteria infecting your middle ear. AOM is more likely to affect children than adults, but it may resolve independently or with minor treatment.
The onset of AOM symptoms is usually rapid but may also differ from case to case.
- Discharge of fluid from the ears
- Ear pain
- Hearing difficulties
- Loss of balance
- Difficulty sleeping or staying asleep
Infection of your middle ear may stem from prior respiratory bacterial or viral infection (like a common cold). A sore throat or cold may spread to the middle ear and result in fluid build-up behind the eardrum. All this can lead to congestion or swelling of the lining of the throat, nose, and eustachian tubes.
Other factors that increase the risk of middle ear infection include:
- Malformation of the eustachian tube
- Recent cold
- Upper respiratory problems and infections
Since the signs and symptoms of an ear infection can resemble other conditions, Dr Kleid may perform or request other diagnostic tests to diagnose acute otitis media:
- Otoscopy: A pneumatic otoscope blows a puff of air into the eardrum to check your eardrum movement. If Dr Kleid observes little to no movement of your eardrum, your middle ear is filled with fluid that may be infected.
- Tympanometry: Tympanometry makes use of air pressure to check for fluid in your middle ear. Dr Kleid uses this to evaluate your eardrum movement. Little to no movement means that there is fluid build-up that could be infected.
Treatment for a middle ear infection is based on your age, health and medical history, as well as, the severity of the condition:
- Medication: Over-the-counter medication and pain relief ear drops are common treatments for reducing the pain of acute otitis media within a few hours.
- Antibiotics: Your doctor may prescribe antibiotics if the cause of your otitis media is bacterial. Antibiotics are only given if the infection does not clear up on its own.
- Myringotomy With Placement Of Tube: We recommend this surgical procedure if you suffer from chronic ear infections. Dr Kleid inserts a tiny tube through an incision in your eardrum. This tube allows air into your middle ear, effectively draining any fluid.
Myringotomy can take less than 10 minutes, and the tube can stay in place for up to 12 months.
If left unchecked middle ear infections can result in permanent hearing loss. This in turn can lead to impaired speech and language development in children. Infections may also spread to other parts of the head (like the brain), causing more significant disorders (e.g. meningitis, encephalitis).
Otosclerosis is a condition that is the result of abnormal bone growth in the middle ear. The stapes is an extremely tiny bone found in the middle ear that vibrates to transmit sound from the eardrums to the nerves. When boney tissue grows in the middle ear around the stapes, the latter can’t move freely, which affects the proper transmission of sound.
Otosclerosis is not uncommon in young adults, but it can affect any age group. The typical symptoms of otosclerosis include:
- Hearing loss
- Soft speaking
- Tinnitus, ringing in the ear
- Vertigo, the feeling of spinning
The symptoms tend to be more subtle and develop over some time.
There is no one cause of otosclerosis, however a combination of the below factors can play a role:
- Viral infections
- Low fluoride levels
- Genetic factors
Your doctor will use specific tests to diagnose otosclerosis and determine the severity of your condition:
- CT Scan: CT scans help visualize the bony growth and see whether there is damage to the cochlear nerve and labyrinth.
- Hearing Test: If you suffer from otosclerosis, your hearing loss may affect all pitches. Dr Kleid will evaluate this to guide the treatment.
Treatment of otosclerosis is dependent on your age as well as the cause and severity of the condition. A comprehensive treatment plan may include:
- Stapedectomy or Stapedotomy
- In stapedectomy, Dr Kleid removes the whole of the stapes, replacing it with an implant.
- In stapedotomy, he only removes the abnormal part of the stapes.
- If you get a stapes implant, it allows the bones to move again, correcting the hearing loss.
- Hearing aids
- This can help manage your hearing loss.
- They may not restore normal hearing but can improve communication by producing enhanced sounds.
- Some medications such as fluorides and vitamin D can slow the progression and restrict the worsening of otosclerosis.
In the long-term, otosclerosis does not develop into something worse, but can chronically affect your hearing ability.
Although not common in the hands of a skilled surgeon like Dr Kleid, complications can arise from otosclerosis surgery. There is a risk of damaging nerves in the ear which can lead to complete deafness and either permanent or temporary loss of taste.
Otitis externa, commonly known as swimmer’s ear, is an infection of the outer ear. The outer ear canal starts from your eardrum and extends to the outside of your ear. Swimmers ear is usually a bacterial infection that is a result of persistent water in the outer ear canal.
Symptoms associated with otitis externa include:
- Ear pain
- Visible redness
- Drainage of clear, odourless fluid
- Itching of the ears
The symptoms usually develop quickly over 1-2 days, and you’ll notice them as they occur.
Otitis externa is a result of water persistently entering your outer ear canal. This provides a moist environment for bacteria to grow, which in turn leads to infection. The condition is, therefore, commonly encountered in swimmers.
Risk factors that make you more susceptible to swimmer’s ear include:
- Excess moisture in the ear canal, either through heavy perspiration or humid weather
- Exposure to contaminated water with high bacteria levels
- Skin break that facilitates infection, for example, scratches and/or abrasions
The diagnosis of an external ear infection is usually straightforward. You won’t need a lab test, just a physical examination of your ear canal and eardrum with an otoscope. If required, tests and discharge sampling will be carried out to know the primary site of infection and its cause.
Treatment of otitis externa aims to stop the infection and allow your ear canal to heal. It may include:
- Cleaning: Dr Kleid may use a suction device to clear out debris, discharge, or earwax that may block eardrops from reaching the target area in your ear.
- Medication: Most medications for swimmer’s ear are in the form of eardrops. There are different types of eardrops to treat different types of infection. You can also use over-the-counter pain relievers to ease your discomfort.
If treated early, swimmer’s ear doesn’t have any complications, however, if left untreated, the infection can become widespread, moving to your deep tissues and becoming a long-term infection. The infection can even spread to bones and cartilage, causing osteomyelitis, as well as, bone and cartilage damage.
What are the most common ear problems?
- The most common ear problems we encounter in our ENT clinic include;
- Swimmer’s ear
- Both middle and outer ear infections
- Meniere’s disease
What are some symptoms of ear disorders?
- Symptoms common to ear disorders include;
- Loss of balance
- Pressure in the ear.
- It’s usually hard to tell what exact condition is causing the symptoms without proper examination.
Can ear problems affect your brain?
Yes. If left untreated, ear infections can spread to the brain. They can be a cause of meningitis or encephalitis and lead to severe adverse outcomes.
What causes the ears to hurt inside?
- Either allergies, colds or sinus infections can affect the anatomy of your ear, which can cause pain.
- Whereas, ear infection, otitis media, otitis externa, and impacted wax, can all be causes of earache.
What are the symptoms of inner ear damage?
Symptoms of inner ear damage include earache, tinnitus, hearing loss, fullness in your ear, and vertigo.
Can ear problems affect memory?
Cognitive overload may occur in a mild loss of hearing. It may lead to hearing-related memory loss in some people.
Can your ear tumour be cured?
If the tumour is only in the ear canal, yes it is possible to cure it through surgery, especially if diagnosed early.
What happens if hearing loss is not treated?
If you don’t treat hearing loss, it can lead to emotional troubles like depression, stress, tension and fatigue, as well as, withdrawal from social functions. Moreover, it reduces your ability to perform many professional and everyday tasks. In children, untreated hearing loss can lead to speech development problems.
Is tinnitus associated with Alzheimer’s?
Studies have shown that you stand a higher risk of developing either Parkinson’s disease or Alzheimer’s if you have tinnitus.
Why Choose Dr Kleid for Rhinoplasty?
Dr Stephen Kleid
Dr Stephen Kleid is an experienced ENT Surgeon (Otolaryngologist) based in Melbourne with a passion for Septo-rhinoplasty, Septoplasty and a strong interest in Rhinoplasty Revision.
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