The Sunday Times MediScene - Earful of problems?

There are many different types of ear problems and there are also a corresponding number of root causes. Some are serious, while others are not; and since it may be difficult to tell, it always pays to have a doctor take a look, says Dr. Devanand Jha, a consultant ENT specialist. If left without treatment, it could lead to serious complications such as irreversible loss of hearing.

"One of the indicators of a serious infection is scanty, foul smelling discharge," reveals Dr. Jha, adding that such discharge usually never comes out onto the pillow. Pain, dizziness, irritation, itching, soreness, or lumps, all accompanied by fever may also appear and require attention. Symptoms of impaired hearing, however slight, should not be ignored.

While many ear infections are easily dealt with, Dr. Jha cautions that such problems are not always driven away by a simple course of ear drops. Certain symptoms may be caused by cancer of some kind or may be linked to serious illnesses that require immediate treatment.

This is one of the more common infections Dr. Jha says. "It is an infection of the ear canal," he says, explaining that because the canal is dark and warm, bacteria and fungus can flourish. Our hot, humid weather also adds to the condition. Several other factors may increase your risk of getting OE such as over vigorous removal of ear wax, or damage to the tender skin inside.

Itching and pain accompany the infection. You might find an increase in those sensations while chewing food. In addition, your ears might feel all plugged up and it might be difficult to hear clearly. A build-up of fluid and pus may occur in which case you will need to have your doctor examine your ear canal and treat you, explains Dr. Jha. The doctor will also inspect your ear drum to rule out any other problem, once the swelling in the ear has settled down.

"Otitis media refers to inflammation in the middle ear area," says Dr. Jha, adding that the infection often follows a viral upper respiratory tract illness, such as a cold or sore throat. While there are different forms of otitis media, acute otitis media is most common. Such cases are marked by the presence of fluid, typically pus, in the middle ear with symptoms of pain, redness of the eardrum, and possible fever. Many children will have several bouts of otitis media before they are seven years old. Symptoms include crying, ear pulling, mild fever and irritability.

Glue ear is a type of chronic otitis media. "This is a common problem,” says Dr. Jha. He explains that over a long period of time as fluids build up behind the eardrum, they begin to thicken and get sticky. The fluid dampens the vibrations of the eardrum and bones (ossicles) made by the sound waves. The cochlea in turn receives these dampened vibrations. The result? Hearing loss. Glue ear usually occurs in young children, says Dr. Jha, due to the fact that their Eustachian tubes are much smaller and more horizontal than those of adults.

"This is a bone destroying disease," says Dr. Jha, explaining that a cholesteatoma is a slow-growing mass in the middle ear, that if left unchecked will slowly erode and destroy anything in its way, beginning with the three middle ear bones, (also known as the "hammer", the "anvil" and the "stirrup") and the bone surrounding the ear next to the brain.

Cholesteatomas may also erode into the balance and hearing organs of the inner ear. For this reason, cholesteatomas are best removed as soon as possible.

We've all heard that ringing in our ears. Though, tinnitus is not itself a disease, it can be an unwelcome symptom resulting from a range of underlying causes. Someone with the problem may hear anything from a quiet background noise to one loud enough to drown out all outside sounds.

Tinnitus can be noise trauma induced, drug induced (including alcohol!), or due to hearing problems (both conductive and sensorineural). "Tinnitus may also be the only symptom of sinister problems such as a tumour in the brain," says Dr. Jha. He adds, "Tinnitus patients should get certain investigations done to rule out serious problems." Unfortunately, tinnitus doesn't have a direct cure, though once the cause is ascertained and depending on it, something could be done.

In a normal ear, wax acts as protection. If you feel the need to use an ear bud, keep it light and easy instead of plumbing the depths of your ear, recommends Dr. Jha. "There are tiny hairs in your ear that expel the wax," he says. "Let nature take its course." In cases where a build-up of wax becomes a problem, wax softening drops may be used and sometimes the ears may also need to be syringed clean by the doctor.

It is unfortunate that those who fall victim most easily to these infections, may also be those most unable to express their discomfort. For this reason, parents should keep an eye out for changes in behaviour patterns, such as sudden inattention in school, lack of response to instructions, apparent disobedience, or wanting the television very loud.

Also if a child is too young to identify an earache, he or she might just be more cranky and reluctant to do things that affect the ear such as chewing and swallowing.