Ear Pain 

      

          Ear pain can occur most commonly due to filling of wax in the ear, allery, chillness, entry of any foreign body in the ear or infection in the Eustachian tube which connects ear, nose and throat.

 

Ear Discharge 

 

Alternative Names

     Drainage from the ear; Otorrhea; Ear bleeding; Bleeding from ear

Definition of Ear discharge:

     Ear discharge is drainage of blood, ear wax, pus, or fluid from the ear.

Considerations:

     Most of the time, any fluid leaking out of an ear is ear wax.

However, discharge may also be caused by a minor irritation or infection. A ruptured eardrum can cause a white, slightly bloody, or yellow discharge from the ear. Dry crusted material on a child's pillow is often a sign of a ruptured eardrum.

Bleeding from the ear may also be due to:

o                    Cancer

o                    Foreign object in the ear canal

o                    Injury

Common Causes:

o                    Eczema and other skin irritations in the ear canal

o                    Inflammation or infection:

o                                Otitis externa

o                                Otitis externa - chronic

o                                Otitis externa - malignant

o                                Otitis media

o                                Otitis media - chronic

o                                Mastoiditis

o                                Cholesteatoma ( Causes foul smelly scanty discharge)

o                    Injury from a blow to the head, foreign object, very loud noises, or sudden pressure changes (such as in airplanes), resulting in a ruptured or perforated eardrum

o                    Swimmer's ear -- usually accompanied by itching, scaling, a red or moist ear canal and pain that increases when you move the ear lobe.

Hearing Loss

           To understand hearing loss it is important to understand how normal hearing takes place. There are 2 different pathways by which sound waves produce the sensation of hearing: air conduction and bone conduction.

  • In air conduction, sound waves move through the air in the external auditory canal (the "ear canal" between the outside air and your eardrum). The sound waves hit the tympanic membrane (eardrum) and cause the tympanic membrane to move.
  • The bones in the middle ear are connected to the tympanic membrane. When the tympanic membrane moves, this movement is transmitted to the bones. These 3 bones are called the malleus, the incus, and the stapes. Movement of the stapes causes pressure waves in the fluid-filled inner ear.
  • The cochlea is an inner ear structure surrounded by fluid. It contains multiple small hairs. Pressure waves in the fluid cause the hairs to move. This movement stimulates the auditory nerve. Different frequencies of noises stimulate different hairs on the cochlea, which translate to the sensation of sounds of different pitch.
  • Hearing by bone conduction occurs when a sound wave or other source of vibration causes the bones of the skull to vibrate. These vibrations are transmitted to the fluid surrounding the cochlea and hearing results.

There are 2 basic types of hearing loss, which are called conductive and sensorineural. 

  • Conductive causes: Conductive hearing losses result from physical problems with the movement of the sound wave through the ear. A simple example is blockage of the ear canal. 

    • Obstructed external ear canal - Cerumen (wax) build-up, hematoma (blood collection), or foreign body in the ear canal. This is one of the most common causes of hearing loss and the easiest to fix. 

    • Perforated tympanic membrane - Caused by direct trauma such as a finger or cotton swab, middle-ear infections (otitis media), or explosions (blast injury) 

    • Dislocated ossicle (malleus, incus, or stapes) - Usually from trauma to the ear 

    • Otitis media - Middle ear infection 

    • Otitis externa - Infection of the ear canal that causes it to swell

  • Sensorineural causes: Sensorineural causes are from damage to the hair cells or nerves that sense sound waves. 

    • Acoustic trauma - Prolonged exposure to loud noises causes the hair cells on the cochlea to become less sensitive. 

    • Barotrauma (pressure trauma) or ear squeeze - Usually in divers 

    • Head trauma - A fracture of the temporal bone can disrupt the nerves of the auditory system 

    • Ototoxic drugs - Certain drugs can affect hearing by damaging the nerves involved in hearing. Usually this occurs when large or toxic doses are used but may also occur with lower doses. 

      • Antibiotics including aminoglycosides (gentamicin, vancomycin), erythromycins, and minocycline 

      • Diuretics including furosemide and ethacrynic acid 

      • Salicylates (aspirin) and nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen and naproxen 

      • Antineoplastics (cancer drugs)

    • Vascular diseases (problems with blood vessels) include sickle cell disease, diabetes, leukemia, polycythemia, and diseases in which excessive blood clotting occurs. 

    • Children and adults with kidney problems are more susceptible to sensorineural hearing loss. 

    • Ménière disease - A disease that affects hearing and balance. It is usually associated with tinnitus (ringing in the ears). It has a gradual onset and often progresses to deafness and severe vertigo. The cause is unknown. 

    • Acoustic neuroma - A tumor in the auditory nerve. Usually associated with ringing in the ears. 

    • Infections 

      • Mumps 

      • Measles 

      • Influenza 

      • Herpes simplex 

      • Herpes zoster 

      • Mononucleosis 

      • Syphilis 

      • Meningitis

    • Aging (presbycusis) 

Giddiness ( Vertigo)

Vertigo  is a type of dizziness, where there is a feeling of motion when one is stationary. The symptoms are due to a dysfunction of the vestibular system in the inner ear. It is often associated with nausea and vomiting as well as difficulties standing or walking. It occurs about two to three times more frequently in women than in men and in the elderly as opposed to younger people.

Classification
Vertigo is classified into either peripheral or central depending on the location of the dysfunction of the vestibular pathway.

Peripheral

Vertigo caused by problems with the inner ear or vestibular system is called "peripheral", "otologic" or "vestibular". The most common cause is benign paroxysmal positional vertigo (BPPV) but other causes include Ménière's disease, superior canal dehiscence syndrome,labyrithitis,vertigo any cause of inflammation uch as common cold, influenza and bacterial infections may cause transient vertigo if they involve the inner ear, as may chemical insults (e.g., aminoglycosides) or physical trauma. Motion sickness is sometimes classified as a cause of peripheral vertigo. 

Central

If vertigo arises from the balance centers of the brain, it is usually milder, and has accompanying neurologic deficits, such as slurred speech, double vision or pathologic nystagmus. Brain pathology can cause a sensation of disequilibrium which is an off-balance sensation.

A number of conditions that involve the central nervous system may lead to vertigo including: migraine headaches, lateral medullary syndrome, multiple sclerosis.

Signs and symptoms

Vertigo is a sensation of spinning while stationary.  It is commonly associated with vomiting or nausea, unsteadiness, and excessive perspiration.  Recurrent episodes in those with vertigo is common and they frequently impair the quality of life.

Blurred vision, difficulty speaking, a lowered level of consciousness, and hearing loss may also occur. Central nervous system disorders may lead to permanent symptoms.

 

Benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is brief periods of vertigo ( less than one minute ) which occur with change in position. It is the most common cause of vertigo. It occurs in 0.6% of the population yearly with 10% having an attack during their lifetime. It is believed to be due to a mechanical malfunction of the inner ear. BPPV can be effectively treated with repositioning movements.

Vestibular migraine

Vestibular migraine is the association of vertigo and migraines. It is the second most frequent cause of recurrent vertigo with a lifetime occurrence rate of about 1%.

Ménière's disease

Ménière's disease frequently presents with vertigo in combination with ringing in the ears, a feeling of pressure or fullness, severe nausea or vomiting, and hearing loss. As the disease worsens, hearing loss will progress.

Vestibular neuritis

Vestibular neuritis presented with severe vertigo. It is believed to be caused by a viral infection of the inner ear. Persisting balance problems may remain in 30% of people affected.

Motion sickness

Motion sickness is one of the biggest symptoms of vertigo and it develops most often in persons with inner ear problems. The feeling of dizziness and lightheadedness is often accompanied by nystagmus. This is when the eyes rapidly jerk to one side and then slowly find their way back to the original position. During a single episode of vertigo, this action will occur repeatedly. Symptoms can fade while sitting still with the eyes closed.