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Ear Conditions

What Is an Eardrum Rupture or Perforated Eardrum?

An eardrum rupture is a small hole or tears in your eardrum. The ear drum or tympanic membrane is a thin membrane that divides your middle ear and outer ear canal and it vibrates when sound waves enter your ear leading to vibration of hearing bones which then passes vibrations to the hearing nerve. So, if your eardrum is ruptured your hearing can be affected.

What are causes of Ear drum Rupture or holes?
The common causes for tympanic membrane perforations (ear drum holes) are:

1. Infection When you have an ear infection, fluids like pus accumulate behind the eardrum causing pressure to build up which then ruptures your ear drum.
2. Trauma like slapping over the ear with an open hand, ear bud use
3. Barotrauma like sudden changes in air pressure per example scuba diving, flight journey, driving at high altitudes
4. Acoustic trauma due to extremely loud noises

Can a ruptured eardrum heal?

Ear Drum Holes usually heal spontaneously. This spontaneous healing largely depends upon two factors: the size of the hole and the presence of infection. Holes or perforations greater than 40 – 50% of the size if the ear drums rarely heal by themselves. Infected perforations rarely close spontaneously. Holes of ear drum from blunt trauma like slapping over the ear is most likely heal spontaneously. This is true only for ear drum holes from blunt trauma that does not become infected.

How long does it take for a perforated eardrum to heal?
Usually, ear drums holes which are due to injury heal in one two months period, if not healed that must be closed with operation.

Precautions to promote healing of ear drum holes

Keeps your ear dry to prevent further infection Preventing water from entering the ear canal by stuffing your ears with cotton with Vaseline helps to avoid infections in the ear and better healing
Don’t blow the nose note more than absolutely necessary. Blowing your nose causes pressure to rise in your middle ears which can be painful and can also slow your eardrum’s healing

What are treatments for Ear Drum Holes or Rupture?

Antibiotics and pain killers

The immediate problem, you may feel is the pain. To get relief from pain, you may be given anti-inflammatory medicines. And the next problem is chance of infection of your middle ear in case of traumatic ear drum holes. To prevent the infection, you may be given antibiotics which are also given in already infected cases.

Observation

Eardrum holes often heal without any invasive treatment. You may experience a temporary hearing loss, but usually you can expect a full recovery within eight weeks.

Surgery or eardrum hole operation

In cases where your ear drum hole is not healed, surgery is required patch the hole in the eardrum. A surgical repair of a perforated eardrum is called tympanoplasty where your ENT micro surgeon takes grafts from another area of your body and places it onto the hole of your eardrum.

Ear Pus or Discharge

What is Ear infection with discharge?

Ear discharge is drainage of pus, blood, ear wax or fluid from the ear. An infected ear produces pus discharge continuously, sometimes intermittently that can damage your hearing. That means you are having a hole in the ear drum as the fluid builds up behind the eardrum and tear the eardrum. Doctors call this as chronic otitis media

What are causes of Ear Pus or Discharge?

Frequent cold is a common cause. The cold could result in the blockage of the eustachian tube, the connection between the throat and middle ear that equalizes air pressure.
Living in overcrowded housing and eating a poor-quality diet.
A ruptured eardrum
Skin irritations in the ear canal
Allergies
Enlarged adenoids

What will happen to me?

It may lead to hearing loss, speech language problem in children. If untreated for long time, lead to infection of the large bone behind your ear (mastoiditis) and extra skin growing in your ear (cholesteatoma) and also a very slight risk of infection spreading into your brain and causing meningitis.

Is ear pus contagious?

No, it is not generally contagious.

What precautions help me from getting ear infection?

DO NOT USE COTTON BUDS TO CLEAN EARS! These cotton buds tend to push ear wax back into the canal causing wax to build up or can injure the ear drum. Ears are having self-cleaning mechanism to clean it selves. Allow the natural way to remove earwax by letting tiny hairs in the ear propel the wax outward as the canal moves with talking or chewing. Only you can use cloth or let the nature follow its course otherwise contact your ENT specialist.

Take treatment at the first sign of cold and sore throat. Otherwise it may cause ear infection

What treatments work for Ear Pus or Discharge?

Micro suction cleaning of your ears
Specialist ENT microsurgeon cleans your ears with micro suction. Cleaning your ears clears out pus and any debris in the canal so that the ear drops can reach the point of infection.

Ear drops

Antibiotic ear drops help to dry up your ear as antibiotics kill the bacteria that cause infection. Some antibiotics might damage your hearing if you have a hole in your eardrum so, only specialist doctors prescribe these types of antibiotics.

Surgery

The operation called myringoplasty or tympanoplasty is done to repair hole in your eardrum. The specialist ENT microsurgeon puts a small patch of graft onto your eardrum hole. The Surgery is more likely to work if your surgeon is experienced in this kind of micro surgeries.

Common myths

Going in cold weather causes ear infections: No, ear infections are not caused by going in cold weather without your ears covered. The middle ear most often becomes infected from bacteria that travel up the eustachian tube which is opened behind the nose from the throat.

Ear infections run in families: No, there is no evidence that ear infections are inherited and runs in families. Ear infections are common in infants and young children because they have immature immune system and a shorter, less angled eustachian tube. Those who had frequent ear infections as a child may or may not continue to get ear infections them as adults.

Ear Wax

Ear wax is made up of a slightly different mixture of substances in each individuals depending upon their environment, age, race, and diet.

Where does ear wax come from?

Ear wax is typically produced by glands in the skin of ear canal, only in your outer ear and NOT in the middle ear or inner ear.

Why do we have ear wax?

The main purpose of the wax produced by your ears is to protect the ear from dust, foreign particles and microorganisms. It also protects ear canal skin from irritation due to water or pollutants. Ear wax absorbs debris and dead skin cells preventing them from being pulled deeper into the ear canal. It prevents insects and bugs from creeping in. Ear wax repels insects or traps insects that try to get into your ear. Your ears stay bug and insect-free. Essentially, it is your last line of defence in the ear.

How is ear wax blocked in the ear canal?

Your ear canal produces oily secretions called earwax or cerumen. In normal circumstances, wax turns into dry flakes and falls on its own due to movements of jaw.

When your ear canal skin glands make more earwax than is necessary, it may get hard and block the ear. When you try to clean your ears with ear buds, bobby pins or other objects, the wax will be pushed deep inside more and more and causing a wax blockage. It may also cause a temporary hearing loss.

Earwax in children

Children just like adults produce earwax naturally. Don’t try to remove ear wax in children with cotton buds that may push the wax deep inside and block it. If you suspect your child has earwax blockage, see you ENT surgeon, who will clean with special instruments without damaging ear drum.

Earwax in older adults

Earwax can also be problematic especially in old age people.

When to see a doctor

Most people don’t need frequent doctor visit for earwax removal. If you are unable to clear the way, you should seek attention of your ENT doctor. Your doctor may use irrigation, suction, or a curette to remove the wax blockage.

How to get rid of excess earwax

Softening Earwax
You can use wax softening drops to soften earwax and later visit your doctor to get removed of wax. You should never attempt to remove the earwax yourself. This can damage your ear drum and lead to infection or hearing loss. However, you will often be able to remove the excess earwax yourself but, use cotton buds on the outer portion of your ears only.

Ear Irrigation
You should never attempt to irrigate your ear yourself. Irrigation in case of a ruptured eardrum could cause infection or hearing loss.

Microsuction
Your specialist ENT doctor will do micro irrigation and suction to remove the blocked wax.

How to clean your ears yourself? What are best ways to remove ear wax?

How to Clean Your Ears at Home?

You need to clean your ears properly when TOO MUCH ear wax is produced. Everyone has some myths about ear wax. Many feel it is not normal. But the truth is it is the normal human body secretion, produced as a protective measure from keeping out dust, bacteria, and bugs from your ear. It helps to protect your sensitive and important middle and inner ear structures. Sometimes too much ear wax is produced causing irritation or hearing loss. Then, you are having the only option of cleaning yourself or seeing your ENT doctor.

People tend to use Cotton buds, hydrogen peroxide or bike keys to clean ear wax.

Cotton swabs are very popular ear cleaning method. These cottar buds are available everywhere in supermarkets, pharmacy and convenience stores and also give you feel of goodness as it is easy and used quickly and through it away. But the usage of cotton buds is not good for ears. Instead it harms your ears. It looks like cotton buds usage is a simple and effective cleaning method, but actually, it pushes the ear wax deeper inside. Only little amount wax comes out with cotton buds. The more you push the ear wax deeper into your ear, the more wax builds up eventually, it block the canal completely leading to hearing problem, infections by injuring the skin of the canal and also chance of injuring the ear drum which is a thin membrane.

So, it is recommended that Do NOT use cotton buds for ear cleaning. If you still want to use, you can use to clean the outer third of your ear canal where the ear wax is produced.

Don’t use any tools like tip of a pen, car keys, and head of bobby pins.

Hydrogen Peroxide

Hydrogen peroxide is another method for cleaning ear wax used by many people. It helps you to remove wax by softening and loosening the ear wax, making it easier for you to remove with a cotton ball or make it easier for your ear to clean itself. But, it can cause irritation, dryness and an increased risk of infection. Sometimes unknowingly if you pour hydrogen peroxide in an ear with ear drum hole, it may lead to permanent hearing loss by damaging hearing nerves. So this is also NOT a choice for ear cleaning at home.

Ear Irrigation at home

People tend to use warm tap water which works as they soften and loosen the wax. But they can irritate your ear skin and any manipulation to remove oil may injure your ear drum. So this is also NOT a choice for ear cleaning at home.

Mineral Oil

Warm coconut oil, usually room temperature will soften and loosen the ear wax, making it easier for your ear to drain itself. However, it cannot remove hardened wax or when used in perforated ear drum cases, lead to definite infection. So this is also NOT a choice for ear cleaning at home.

Professional Ear Syringing

Ear syringing is an effective method to clean ear wax. This is an old method of cleaning.
It works by loosening up large chunks of wax when water is pushed towards the walls of the ear canal not to towards the ear drum. Once the wax is loosened, it can be removed with medical suction. It is a highly efficient ear cleaning method.

However, there are potential risks with this ear cleaning method like damage to the ear canal or ear drum and dizziness and nausea when the sudden pressure of water and its temperature affects your inner ear.

Those who like this “old school” solution can take Ear syringing NOT at home but BY professional ENT doctor of any local primary care physician.

The BEST Method Recommended for Ear Cleaning at Home

THE BEST WAY TO CLEAN YOUR EARS AT HOME IS NOT TO CLEAN YOUR EARS. Ears clean themselves, no need of cleaning by external methods. If you don’t do anything for cleaning, your ears will be clean on their own and will be healthy. Don’t try to disturb natural self-cleaning mechanism.

You can use cloth to remove wax in outer part of ear canal. More than this, nothing is required. Even if water enters your ear canal after bath, you can clean with cloth, otherwise leave it alone, it come out on its own. However when you have excess wax, you can see your ENT doctor who can remove the wax safely with Micro Suction method and special micro instruments.

How often should you clean your ears?

Wax cleaning is not at all required regularly.

Hearing Loss or Deafness

Hearing and understanding speech are essentials parts of everyday life. They facilitate the communication that connects you to the world.

What are Consequences of Hearing Impairment?

Hearing loss is an invisible condition. we cannot see hearing loss, only its effects can be felt. Hearing loss can affect people of all ages, from new born to elderly. Hearing loss may be a sudden or gradual loss, depending on the cause, it can be mild or severe, temporary or permanent. The degrees of hearing loss: mild, moderate, severe, profound.

Hearing impairment lead to inability to understand speech sound, decreased capability to communicate, delay in language development, economic and educational backwardness, social isolation and stigmatization.

Statistics of Hearing Disability in India

Hearing loss is a major public health issue and economic burden to the country and is the third most common physical condition after arthritis and heart disease.

Hearing impairment is the most frequent sensory deficit in human population, affecting more than 250 million people in the world.

In India, 63 million people (6.3%) suffer from significant hearing loss. The National Sample
Survey (NSS) 58th round (2002) surveyed disability in Indian households and found that hearing disability was 2nd most common cause of disability and the most common cause of sensory deficit. It was estimated that the number of persons with hearing disability per 1, 00,000 persons was 291. Out of that, about 32% of the people had profound hearing disability (person could not hear at all) and 39% had severe hearing disability (Person could hear only shouted words). The survey also revealed that about 7% of people were born with a hearing disability and about 56% reported the onset of hearing disability at ≥ 60 years of age. The incidence of hearing disability during that year was reported to be 7 per 1, 00,000 population.

Deafness in Indian Constitution

The Rehabilitation Council of India Act, 1992 defined “hearing handicapped” as hearing impairment of 70dB and above, in better ear or total loss of hearing in both ears.
This law is applicable to only those persons with severe hearing impairment whose hearing loss is 70dB and above. Persons with hearing levels of 61 to 70dB, although suffering from severe hearing impairment, as per WHO classification, are automatically excluded from the hearing handicap category.

Section 2(i)(iv) of the persons with Disability Act, 1995(PWD) states that ‘hearing impairment’ is a disability and “hearing disability” has been redefined as – “a hearing disable person is one who has the hearing loss of 60dB or more in the better ear for conversational range of frequencies.” This is a step in the right direction, as all person with severe hearing impairment is now included in the hearing handicapped category.

Who will get affected with hearing loss?

Causes of hearing loss

Congenital hearing loss: child born without hearing
Noise: when exposed to noises such as listening to very loud music, being in a noisy work environment can lead to hearing loss over many years. Sudden, noise-induced hearing loss from Deepawali crackers, gunfire and explosions is the number one disability caused by combat in current wars.
Aging: Age-related hearing loss is also known as Presbycusis.
Other causes of hearing loss: earwax build-up, injury to the ear or head, ear infection, a ruptured eardrum and other conditions that affect the middle or inner ear.
Medications: some antibiotics and chemotherapy drugs, aspirin, loop diuretics, anti-malaria drugs and several drugs for erectile dysfunction.
Diseases: heart disease, high blood pressure and diabetes; Otosclerosis, a bone disease of the middle ear and Ménière’s disease that affects the inner ear.

Diagnosing hearing loss

See Diagnosing hearing loss

Hearing Tests

See Hearing Tests

Newborn Hearing Screening programme

See Newborn Hearing Screening programme

Treatment for Hearing loss

How hearing loss is treated depends on the underlying cause of the hearing loss. If your hearing is impaired, treatment can improve your hearing and quality of life.

Hearing loss caused by damage to the middle ear:

Hearing loss that occurs when sounds are unable to pass through the middle ear into the inner ear (conductive hearing loss) is often temporary and treatable.

For example, earwax build-up can be removed by drops, a syringe or micro suction. Hearing loss caused by a bacterial infection can be treated conservatively with antibiotics. Micro Ear Surgery can be used to drain a fluid build-up, repair a perforated eardrum or correct problems with the hearing bones.

Hearing loss caused by damage to the inner ear:

Hearing loss due to the damage to the hearing nerves that transmit sound to brain (sensorineural hearing loss) is permanent.

You can use hearing aids suitable to you or cochlear implants if indicated to you.

See Hearing Aids
See Cochlear Implant Surgery

Preventing hearing loss

The risk of hearing loss loud noises depends on how loud the noises are and how long you are exposed to loud noise. Continuous exposure to the noise at or above 85dB (eg. loud traffic) can over time cause hearing loss.

However, you can reduce risk of noise-induced hearing loss by following the advice below.

Don’t put your television, radio or music too loud.

Use headphones that block more of outside noise (noise cancelling headphones) rather than turning up the volume.

Use ear plugs if you work in a noisy environment, such as a garage workshop, pub, nightclub or a building site or at loud concerts and at other events where there are high noise levels, such as motor races.

Don’t insert objects like cotton buds, fingers or sticks into your ears or into your children ears.

Be aware of the symptoms of common causes of hearing loss such as ear infections

Visit your ENT specialist if you or your child is experiencing hearing problems.Hearing and understanding speech are essentials parts of everyday life. They facilitate the communication that connects you to the world.

What are Consequences of Hearing Impairment?

Hearing loss is an invisible condition. we cannot see hearing loss, only its effects can be felt. Hearing loss can affect people of all ages, from new born to elderly. Hearing loss may be a sudden or gradual loss, depending on the cause, it can be mild or severe, temporary or permanent. The degrees of hearing loss: mild, moderate, severe, profound.

Hearing impairment lead to inability to understand speech sound, decreased capability to communicate, delay in language development, economic and educational backwardness, social isolation and stigmatization.

Statistics of Hearing Disability in India

Hearing loss is a major public health issue and economic burden to the country and is the third most common physical condition after arthritis and heart disease.

Hearing impairment is the most frequent sensory deficit in human population, affecting more than 250 million people in the world.

In India, 63 million people (6.3%) suffer from significant hearing loss. The National Sample
Survey (NSS) 58th round (2002) surveyed disability in Indian households and found that hearing disability was 2nd most common cause of disability and the most common cause of sensory deficit. It was estimated that the number of persons with hearing disability per 1, 00,000 persons was 291. Out of that, about 32% of the people had profound hearing disability (person could not hear at all) and 39% had severe hearing disability (Person could hear only shouted words). The survey also revealed that about 7% of people were born with a hearing disability and about 56% reported the onset of hearing disability at ≥ 60 years of age. The incidence of hearing disability during that year was reported to be 7 per 1, 00,000 population.

Deafness in Indian Constitution

The Rehabilitation Council of India Act, 1992 defined “hearing handicapped” as hearing impairment of 70dB and above, in better ear or total loss of hearing in both ears.
This law is applicable to only those persons with severe hearing impairment whose hearing loss is 70dB and above. Persons with hearing levels of 61 to 70dB, although suffering from severe hearing impairment, as per WHO classification, are automatically excluded from the hearing handicap category.

Section 2(i)(iv) of the persons with Disability Act, 1995(PWD) states that ‘hearing impairment’ is a disability and “hearing disability” has been redefined as – “a hearing disable person is one who has the hearing loss of 60dB or more in the better ear for conversational range of frequencies.” This is a step in the right direction, as all person with severe hearing impairment is now included in the hearing handicapped category.

Who will get affected with hearing loss?

Causes of hearing loss

Congenital hearing loss: child born without hearing
Noise: when exposed to noises such as listening to very loud music, being in a noisy work environment can lead to hearing loss over many years. Sudden, noise-induced hearing loss from Deepawali crackers, gunfire and explosions is the number one disability caused by combat in current wars.
Aging: Age-related hearing loss is also known as Presbycusis.
Other causes of hearing loss: earwax build-up, injury to the ear or head, ear infection, a ruptured eardrum and other conditions that affect the middle or inner ear.
Medications: some antibiotics and chemotherapy drugs, aspirin, loop diuretics, anti-malaria drugs and several drugs for erectile dysfunction.
Diseases: heart disease, high blood pressure and diabetes; Otosclerosis, a bone disease of the middle ear and Ménière’s disease that affects the inner ear.

Diagnosing hearing loss

See Diagnosing hearing loss

Hearing Tests

See Hearing Tests

Newborn Hearing Screening programme

See Newborn Hearing Screening programme

Treatment for Hearing loss

How hearing loss is treated depends on the underlying cause of the hearing loss. If your hearing is impaired, treatment can improve your hearing and quality of life.

Hearing loss caused by damage to the middle ear:

Hearing loss that occurs when sounds are unable to pass through the middle ear into the inner ear (conductive hearing loss) is often temporary and treatable.

For example, earwax build-up can be removed by drops, a syringe or micro suction. Hearing loss caused by a bacterial infection can be treated conservatively with antibiotics. Micro Ear Surgery can be used to drain a fluid build-up, repair a perforated eardrum or correct problems with the hearing bones.

See Micro Ear Surgery

Hearing loss caused by damage to the inner ear:

Hearing loss due to the damage to the hearing nerves that transmit sound to brain (sensorineural hearing loss) is permanent.

You can use hearing aids suitable to you or cochlear implants if indicated to you.

See Hearing Aids
See Cochlear Implant Surgery

Preventing hearing loss

The risk of hearing loss loud noises depends on how loud the noises are and how long you are exposed to loud noise. Continuous exposure to the noise at or above 85dB (eg. loud traffic) can over time cause hearing loss.

However, you can reduce risk of noise-induced hearing loss by following the advice below.

Don’t put your television, radio or music too loud.

Use headphones that block more of outside noise (noise cancelling headphones) rather than turning up the volume.

Use ear plugs if you work in a noisy environment, such as a garage workshop, pub, nightclub or a building site or at loud concerts and at other events where there are high noise levels, such as motor races.

Don’t insert objects like cotton buds, fingers or sticks into your ears or into your children ears.

Be aware of the symptoms of common causes of hearing loss such as ear infections

Visit your ENT specialist if you or your child is experiencing hearing problems.

Tinnitus or Ringing in Ears

What is tinnitus?

Tinnitus is a ringing, buzzing, hissing, clicking whistling or high-pitched ringing in the ears that seems to originate in the ear or head. Sometimes pulsatile tinnitus may occur (the noise like your heartbeat). Usually you hear sound but it cannot be heard by others.

Tinnitus in many cases is not a serious problem, but rather constitutes a nuisance so severely that it interferes with their daily activities. Tinnitus can be extremely disturbing to people who are suffering from it. Many of times, tinnitus is not a sign of something serious disease. Although bothersome, it can worsen with age in many people, sometimes it can improve with treatment. However, some people may require medical or surgical treatment for tinnitus.

Tinnitus may start in any of the four parts of the hearing system: the outer ear, the middle ear, the inner ear and the brain.

Current theories suggest that as we age, the hearing cells called “hair cells” in the cochlea get damaged and when it is no longer sending the normal hearing signals to the brain, is confused and develops its own noise to make up for the lack of normal sound signals. This is then interpreted as tinnitus.

What are symptoms of tinnitus?

With tinnitus, you hear a noise originating in your ears or head that no one around you hears. This noise is usually
Ringing
Buzzing
Hissing
Clicking
Whistling
high-pitched ringing in the ears

Tinnitus may be present all the time or it may be intermittent. Tinnitus may be more audible during night time when outside environmental noise is less. The Tinnitus is sometimes accompanied by hearing loss and giddiness in a condition called Meniere’s disease.

What conditions cause tinnitus symptoms?

You may never find an exact cause in many cases. Tinnitus is not a disease itself. It is a symptom of an underlying condition, such as age-related hearing loss, ear injury or a circulatory system disorder or some other disease. Tinnitus caused by exposure to noise or drugs is usually noticed in both ears because; both ears are usually exposed to the same noise and drugs.

Age-related hearing loss: Probably the most common cause for tinnitus is aging process associated with hearing loss. This tinnitus becomes worse by anything that makes our hearing worse like ear infection or excess wax in the ear.

Exposure to loud noise: Loud noise exposure is a very common cause of hearing loss today and it often is the common cause of tinnitus as well. Unfortunately, many people are unconcerned about the harmful effects of excessive loud noise from high intensity music, crackers, firearms or other sources.

Earwax blockage: When too much earwax accumulates in the ear canal, it becomes too hard to wash away naturally cause hearing loss and irritation of the eardrum which lead to tinnitus.
Drugs such as aspirin, some antibiotics like polymyxin B, erythromycin, vancomycin and neomycin, quinine are also common cause of tinnitus.

Meniere’s disease often presents with dizziness, tinnitus and changing hearing loss that can last for hours but then goes away. This disease is actually caused by fluid imbalance that causes excessive pressure in the ear itself. The tinnitus is merely a symptom of that.

Hearing bone changes: otosclerosis where thickening of hearing bones in your middle ear occurs may affect your hearing and cause tinnitus. This condition tends to run in families.

Brain tumours like acoustic neuroma also cause tinnitus. These tumours arise on the hearing nerve itself and cause tinnitus. This type of tinnitus is usually present in one ear that is affected and not present in the other normal ear.

Pulsatile tinnitus is usually related to blood flow changes occur during pregnancy, anaemia overactive thyroid, or tumours involving blood vessels near the ear and also in a condition known as benign intracranial hypertension (an increase in the pressure of the fluid surrounding the brain).

Temperomandibular joint, joint between ear and mandible malalignment problems or “twitching” of muscles of the ear or throat causes clicking type tinnitus.

Head injuries or neck injuries: Head or neck trauma which is affecting the inner ear, hearing nerves or brain function may cause tinnitus usually in one ear.

When to see a doctor

You can visit your doctor if you have tinnitus that bothers you. If you develop tinnitus after an upper respiratory infection like cold and it is not improving within a week, then you need to visit your ENT surgeon.

If your tinnitus started suddenly or without an apparent cause or if you have hearing loss or dizziness with the tinnitus, take it as an emergency and meet your ENT surgeon immediately within hours. It helps your doctor to get time to treat before it is too late.

It is particularly important if the tinnitus is only heard on one side as it is usually caused by nerve tumours.

What kind of a doctor treats tinnitus?

The tinnitus is best treated by ENT microsurgeon as many of conditions of tinnitus are caused by ENT related conditions. But depending upon the underlying cause of the tinnitus you may also see other specialists like Neurologist, Dentist for temporomandibular joint (TMJ) disorder, Cardiologist for heart disease, Psychologist to counsel you in dealing with your tinnitus to treat this condition

How is the tinnitus diagnosed?

ENT specialist will examine your ears, head and neck include a complete history and physical examination of the head and neck including the various nerves in the area to look for possible causes of tinnitus. The cause of tinnitus may never be found in many cases.

The complete hearing tests performed if required a special audiogram known as an auditory brainstem response (ABR). Computerized tomography (CT) scan or Magnetic resonance imaging (MRI) may also be required depending on the type of tinnitus.

The Tinnitus sounds you hear also can help your ENT surgeon to identify possible underlying causes.

> Heartbeat like sounds shows blood vessel problems such as high blood pressure, an aneurysm or a tumour that causes the blockage of the ear canal or eustachian tube which amplifies the sound of your heartbeat in your ears called pulsatile tinnitus.

> Clicking sounds show muscle contractions in and around your ear that can hear in bursts.
Humming sounds shows the tinnitus is usually vascular in origin, sound fluctuations may occur when you exercise or change positions like when you lie down or stand up.

> Low-pitched ringing in Meniere’s disease may become very loud before an attack of vertigo or giddiness. Otosclerosis also cause low pitched tinnitus.

> High-pitched ringing occurs usually to exposure to very loud noise or a blow to the ear that usually goes away after a few hours. If hearing loss occurs, tinnitus becomes permanent. Long-term noise exposure, age-related hearing loss, drugs or acoustic neuroma may cause a continuous, high-pitched ringing tinnitus in both ears.

> Earwax, foreign bodies or hairs in the ear canal can rub against the eardrum and cause a variety of sounds.

Psychoacoustics
Several acoustic parameters of tinnitus can be measured like pitch or frequency in cases of monotone tinnitus or frequency range and bandwidth in cases of narrow band noise tinnitus. And also loudness above hearing threshold at the indicated frequency in dB and minimum masking level are measured. In general, tinnitus pitch or frequency range is between 5000 Hz and 8000 Hz and loudness less than 10 dB above the hearing threshold.

What is the treatment for tinnitus?

Treatment of tinnitus depends upon the cause. These include medications, stress management techniques, biofeedback and lifestyle changes. You will be discussed with steps you can take to reduce the severity of tinnitus or to help you cope better with the tinnitus.

> Treating an underlying health condition

ENT specialist microsurgeons will first try to identify any underlying, treatable condition that is causing your tinnitus. If there is an underlying cause, treating the cause may lead to improvement of your tinnitus.

Earwax removal: removing impacted earwax can decrease tinnitus.

Treating blood vessel condition: Underlying vascular conditions may require medication or surgery to address the problem.

Changing the medication: If drugs are the cause of tinnitus, you may be recommended to stop the drug and switch over to a different drug.

Noise suppression: Outside environmental sounds like fans, air conditioners or music help to suppress the internal tinnitus at night so that it is less bothersome. Electronic devices like White noise machines which produce simulated environmental sounds such as falling rain or ocean waves are often an effective treatment for tinnitus are used to suppress the noise.

Hearing aids: Hearing aids are especially helpful if you have hearing problem as well as tinnitus.

Tinnitus Maskers: Worn just like hearing aids, these tinnitus maskers produce a continuous, low-level white noise that suppresses tinnitus symptoms. Tinnitus maskers will help the brain ignore the specific tinnitus frequency.
How effective tinnitus maskers? Following a period of masking, there will be residual inhibition, the temporary suppression and/or disappearance of tinnitus accounts for effectiveness of tinnitus maskers.

Tinnitus retraining: You are delivered individually programmed tonal music to mask the specific frequencies of the tinnitus you experience. Tinnitus retraining technique over time may accustom you to the tinnitus, helping you not to focus on it. Counselling is often a component of tinnitus retraining technique.

Medications: Medications can sometimes cure tinnitus or at least may help to reduce the severity of symptoms. Antidepressants like amitriptyline and nortriptyline in cases of severe tinnitus have been used with some success. Beware of troublesome side effects like dry mouth, blurred vision, constipation and heart problems. Alprazolam may help to reduce tinnitus symptoms. Side effects are drowsiness, nausea and also can become habit-forming.

Alternative medicine: Alternative therapies that have been used for tinnitus include:
Acupuncture
Hypnosis
Ginkgo biloba
Zinc supplements
B vitamins

Transcranial Magnetic Stimulation (TMS): Neuromodulation technique has been successful in reducing tinnitus symptoms. It is a painless, non-invasive therapy currently under trials in Europe and U.S.
Cognitive Behavioural Therapy (CBT): This is a type of psychological counselling which can be delivered via the internet or in person. It benefits by decreasing the amount of stress those with tinnitus feel.

Acceptance and commitment therapy (ACT)

Relaxation techniques may also be useful

What home remedies and lifestyle changes soothe tinnitus symptoms?

Self-management techniques some tips may help your tinnitus less bothersome. Simple adjustments make you feel better although the tinnitus can’t be cured.

Avoid possible aggravants: Reduce exposure to things that may aggravate your tinnitus like loud noises, caffeine and nicotine.

Mask the tinnitus: during nights, a noisy fan, air conditioner, soft music may help mask the noise from tinnitus.

Stress management: Stress can make the tinnitus worse. So, relaxation therapy, biofeedback or exercise alleviate stress and provide some relief.

Reduce alcohol consumption: Alcohol increases blood flow to the inner ear by dilating your blood vessels and increases the tinnitus. So avoid alcohol intake.

Psychological Counselling: Tinnitus does not always go away completely with the treatment. Psychologist can help you learn coping techniques to make tinnitus symptoms less bothersome. Psychological Counselling can also help problems like anxiety and depression often associated with tinnitus.

Support groups: There are tinnitus support groups that meet in person or in Internet forums that share your tinnitus experience with others who have tinnitus. This may be helpful.
Education. Learning as much as you can about tinnitus and ways to alleviate symptoms can make it less bothersome for some people.

Can tinnitus be prevented?

Some precautions can help prevent certain types of tinnitus though in many cases, tinnitus is the result of unknown cause that cannot be prevented.

Use protection from loud noises: If you are working in noisy environment like industries that uses loud machinery or use firearms or listening to music at very high volume through headphones, always wear ear plugs to protect your hearing as continuous exposure to loud noise can damage hearing nerves and cause hearing loss and tinnitus.

Take care of your cardiovascular health: Eating healthy food and regular exercise to keep you healthy and fit to keep your blood vessels healthy can help prevent tinnitus linked to blood vessel disorders.

Do many people suffer from tinnitus?

Yes, millions around the world suffer from tinnitus. Many people with tinnitus from developed countries like UK, US, Germany, Canada, New Zealand, Australia form self-help groups to support each other. Given professional help and commitment, tinnitus symptoms can be reduced for many people.

Does tinnitus mean that one is going deaf?

Tinnitus is a symptom of some unknown problem in the hearing system. It is usually associated with hearing loss, though sometimes may present with normal hearing. TINNITUS IS A WARNING SIGNAL that you may have some problem in the hearing system or may have conditions that affect blood supply of inner ear so, get evaluated for the underlying causes and PROTECT AGAINST EXCESSIVE NOISE to further prevent damage to hearing nerves.

Giddiness or Vertigo

What is vertigo?

Vertigo is a sense of rotation or the world spinning, experienced even when someone is perfectly still.

Dizziness is a term that is used to explain different sensations like light-headedness and spinning (vertigo) accompanied by an involuntary, rapid, rhythmic eye movements (nystagmus); giddiness; or feeling as if one is going to faint (syncope).

Vertigo when not associated with other symptoms is not serious.

What are causes of vertigo?

There are many causes for giddiness.

A) Disorders involving the balance organs in ears:

Balance organs in inner ears get affected from infection of the inner ear (labyrinthitis), inner ear fluid imbalance (Ménière’s disease), viral infection of the vestibular nerve (vestibular neuronitis) and inner ear fluid leaking into the middle ear. These conditions cause giddiness and also ringing in the ears (tinnitus). Prevalence of dizziness caused by fluid disturbances in the inner ear (e.g., Ménière’s disease) is 1,000 per 100,000 populations.

Ear diseases like mastoiditis, otitis media, cholesteatoma, vestibular neuronitis also causes giddiness when affects inner ear.

B) Disorders involving decrease in blood circulation and oxygen to the brain:

Any decrease in blood circulation and oxygen to the brain can cause dizziness and fainting.

Irregular heart rhythm (dysrhythmia) can result in a sudden reduction in the amount of blood pumped to the brain and can cause dizziness.
Cerebral transient ischemic attack or TIA: Temporary deficiency of blood in the brain secondary to narrowing of the arteries in the brain also can result in dizziness.
Orthostatic or postural hypotension: Sudden change in position from sitting or lying to standing can cause a drop in blood pressure and dizziness.
Medications: Dizziness can result from taking medications such as antihypertensives, antidepressants, , antihistamines or diuretics;
Anaemia: from due to blood loss;
trauma or sweating (dehydration): from decreased blood volume or fluid loss
Diabetes mellitus, multiple sclerosis, and Parkinson’s disease.
Double vision (diplopia) is a more serious symptom that may indicate a disease affecting the brainstem and is a warning of a serious stroke or other disease processes.
Slurred speech (dysarthria) that accompanies dizziness and vertigo point to a disease process that is affecting the brain itself (e.g. a stroke, brain tumour).

When dizziness leads to syncope or loss of consciousness, problems with blood circulation (heart, blood vessels and problems that affect their function) must be checked.

Other causes of dizziness include severe pain, anxiety, stress, fatigue, high fever, pressure on the neck (e.g. tight collar), strenuous coughing, straining with defecation or urination, , spinning rapidly around in a circle (as during carnival rides), injury, fright, low blood pressure (hypotension), standing rigidly at attention for an extended period, alcohol intoxication, use of illicit drugs, hyperventilation, low blood glucose (hypoglycaemia), and hysterical seizures.

Treatment

Treatment for giddiness is based on its underlying cause and may consist of bed rest and taking medication like vestibular suppressants, antihistamines, medications to lessen nausea, corticosteroids or medications affecting the GABA (gamma-aminobutyric acid) receptors.

Dietary changes like reducing the salt content and reducing alcohol, caffeine and nicotine intake may be helpful in the treatment of giddiness.

Regular physical exercise and improving general health are also important in treating giddiness.

Vestibular Rehabilitation Therapy

Vertigo is also treated with individualized head, neck, and body movements that assist brain compensation.

Benign paroxysmal positional vertigo (BPPV) is treated with canalith repositioning maneuvers (Epley maneuver) to move canaliths within the semicircular canals of the inner ear to a position where giddiness is reduced.

Surgical procedures

When medical management is not working, surgery may be done. A variety of surgical procedures are done which include the removal of the labyrinth that constitute the inner ear (labyrinthectomy), cutting the balance nerve (selective vestibular neurectomy) or placing a shunt within the labyrinth (endolymphatic shunt).What is vertigo?

Vertigo is a sense of rotation or the world spinning, experienced even when someone is perfectly still.

Dizziness is a term that is used to explain different sensations like light-headedness and spinning (vertigo) accompanied by an involuntary, rapid, rhythmic eye movements (nystagmus); giddiness; or feeling as if one is going to faint (syncope).

Vertigo when not associated with other symptoms is not serious.

What are causes of vertigo?

There are many causes for giddiness.

A) Disorders involving the balance organs in ears:

Balance organs in inner ears get affected from infection of the inner ear (labyrinthitis), inner ear fluid imbalance (Ménière’s disease), viral infection of the vestibular nerve (vestibular neuronitis) and inner ear fluid leaking into the middle ear. These conditions cause giddiness and also ringing in the ears (tinnitus). Prevalence of dizziness caused by fluid disturbances in the inner ear (e.g., Ménière’s disease) is 1,000 per 100,000 populations.

Ear diseases like mastoiditis, otitis media, cholesteatoma, vestibular neuronitis also causes giddiness when affects inner ear.

B) Disorders involving decrease in blood circulation and oxygen to the brain:

Any decrease in blood circulation and oxygen to the brain can cause dizziness and fainting.

Irregular heart rhythm (dysrhythmia) can result in a sudden reduction in the amount of blood pumped to the brain and can cause dizziness.
Cerebral transient ischemic attack or TIA: Temporary deficiency of blood in the brain secondary to narrowing of the arteries in the brain also can result in dizziness.
Orthostatic or postural hypotension: Sudden change in position from sitting or lying to standing can cause a drop in blood pressure and dizziness.
Medications: Dizziness can result from taking medications such as antihypertensives, antidepressants, , antihistamines or diuretics;
Anaemia: from due to blood loss;
trauma or sweating (dehydration): from decreased blood volume or fluid loss
Diabetes mellitus, multiple sclerosis, and Parkinson’s disease.
Double vision (diplopia) is a more serious symptom that may indicate a disease affecting the brainstem and is a warning of a serious stroke or other disease processes.
Slurred speech (dysarthria) that accompanies dizziness and vertigo point to a disease process that is affecting the brain itself (e.g. a stroke, brain tumour).

When dizziness leads to syncope or loss of consciousness, problems with blood circulation (heart, blood vessels and problems that affect their function) must be checked.

Other causes of dizziness include severe pain, anxiety, stress, fatigue, high fever, pressure on the neck (e.g. tight collar), strenuous coughing, straining with defecation or urination, , spinning rapidly around in a circle (as during carnival rides), injury, fright, low blood pressure (hypotension), standing rigidly at attention for an extended period, alcohol intoxication, use of illicit drugs, hyperventilation, low blood glucose (hypoglycaemia), and hysterical seizures.

Treatment

Treatment for giddiness is based on its underlying cause and may consist of bed rest and taking medication like vestibular suppressants, antihistamines, medications to lessen nausea, corticosteroids or medications affecting the GABA (gamma-aminobutyric acid) receptors.

Dietary changes like reducing the salt content and reducing alcohol, caffeine and nicotine intake may be helpful in the treatment of giddiness.

Regular physical exercise and improving general health are also important in treating giddiness.

Vestibular Rehabilitation Therapy

Vertigo is also treated with individualized head, neck, and body movements that assist brain compensation.

Benign paroxysmal positional vertigo (BPPV) is treated with canalith repositioning maneuvers (Epley maneuver) to move canaliths within the semicircular canals of the inner ear to a position where giddiness is reduced.

Surgical procedures

When medical management is not working, surgery may be done. A variety of surgical procedures are done which include the removal of the labyrinth that constitute the inner ear (labyrinthectomy), cutting the balance nerve (selective vestibular neurectomy) or placing a shunt within the labyrinth (endolymphatic shunt).