Your child with hearing loss can succeed in school, at work, and in life!

It is important to have this as your focus, whatever your child's age or degree of hearing loss. While you will have the support of many professionals, ultimately you as parents will make many decisions about what is in the best interest of your child. As with all children, there is no magic formula for raising a child with hearing loss. It helps to keep a positive attitude, educate yourself about hearing loss, seek out the best resources, and take an active role in your child's education.

Above all, keep in mind that your child is a first child, and a second child with hearing loss.

This booklet is written online for parents of children of all ages and all degrees of hearing loss. With so much to cover the information presented here is only a brief summary, supplemented with a variety of resources and reference materials so you can follow up on topics in more depth. In addition, you are encouraged to join the Alexander Graham Bell Association for the Deaf and Hard of Hearing for access to a wide variety of resources, including education programmes for you and your child, a large inventory of books and other publications, videotapes, conferences, and a national support network.

Does your child have a “normal” life? While some mild-moderate hearing loss can be corrected by surgical or medical intervention, most hearing loss is a permanent condition. Therefore, your child's life will have its challenges. However, these challenges sometimes turn into advantages. For example, the ability to work hard and concentrate more, along with audiological and speech therapy routines, often produces children who are self-disciplined and focused. Moreover, outcomes for children with hearing loss have improved greatly over the past two decades due to major advances in technology and the emphasis on early detection and early intervention programmes.

Emotional impact of diagnosis: Parents can benefit from counselling and support after the diagnosis of hearing loss. Grief, anger, fear and denial are natural responses hearing parents feel when they learn that their child has a hearing loss. Your “normal” child expects to have a problem and this problem is going to present many challenges. We express our love through words and tone of voice as well as through hugs and kisses. We comfort a child through the sound of our voice, or by singing a lullaby. We teach children that objects in their room, their toys, their food, and the people around them have names. We show children how to pronounce words by our example. We discipline and warn children of danger by words as well as actions. How are we going to do this now?

Deaf parents of deaf children are not necessarily prone to grief, because they are already familiar with life in a world without sound. Deaf parents may feel more comfortable with a child who is deaf, because this seems natural. But this is not the case for most hearing parents, who probably know little or nothing about hearing loss and who have never met a child with a hearing loss. Many deaf parents will teach their children sign language as naturally as hearing parents teach their children unconsciously to speak. But hearing parents must commit themselves to the goal of helping their child to listen and speak in order to participate fully in a hearing world, or the equally arduous task of becoming fluent in sign language and learning about Deaf culture.

Grief is a common emotion and an honest expression of disappointment and fear of the unknown. Grief that is not acknowledged and dealt with can lead to the child's denial of a problem, which in turn can lead to procrastination in taking constructive action. Unacknowledged grief can lead to anger and unfocused displacement on the part of parents that can last a lifetime. Acknowledging grief, painful as it is, will dissipate anger and denial, enabling parents to care more effectively for their children.

An abnormal growth of skin in the middle ear behind the tympanic membrane is a cholesteatoma. Repeated infections and/or a retraction pocket of the tympanic membrane can cause the skin to thicken and form an expanding sac. Cholesteatomas usually develop as cysts or pockets that flake off layers of old skin, which grows into the middle ear. Over time, the cholesteatoma may increase in size and destroy the neighbouring middle ear ossicles. Hearing loss, dizziness, and paralysis of facial muscles are rare, but may result from the continued growth of the cholesteatoma.

Why does a cholesteatoma originate?

A cholesteatoma usually arises due to poor function of the Eustachian tube as well as a middle ear infection. The Eustachian tube conducts air from the back of the nose into the middle ear to equalise ear pressure (unclogs the ears). When the Eustachian tube works improperly, perhaps due to an allergic cause, a cold or sinusitis, the air in the middle ear is sucked into the body, creating a partial vacuum in the ear. This vacuum sucks in a pouch or sac from the tympanic membrane, especially in areas weakened by previous infection. This can develop the sac into a cholesteatoma. A rare congenital form of cholesteatoma (present at birth) can occur in the middle ear and elsewhere, such as in the vicinity of the skull bones. However, the type of cholesteatoma associated with ear infections is the most common.

How is a cholesteatoma treated?

An examination by an otolaryngologist-head and neck surgeon can confirm the presence of a cholesteatoma. Initial treatment consists of careful cleaning of the ear, antibiotics and eye drops. Therapy aims to stop the drainage from the ear by controlling the infection. The growth characteristics of the cholesteatoma should also be evaluated.

A large or complicated cholesteatoma usually requires surgical treatment to protect the patient from serious complications. Hearing and balance tests, x-rays of the mastoid (the skull bone near the ear), and CT scans of the mastoid may be necessary. These tests are performed to determine the level of hearing in the ear and the extent of destruction that the cholesteatoma has caused.

Surgery is performed under general anaesthesia in most cases. The primary goal of surgery is to remove the cholesteatoma so that it drains the ear and the infection is eliminated. Hearing preservation or restoration is the second goal of the surgery. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely necessary. Reconstruction of the middle ear is not always possible in a single surgical time, therefore a second surgery may be necessary within 6 to 12 months. This second operation will attempt to restore hearing and, at the same time, allow the surgeon to inspect the middle ear and mastoid space for residual parts of the cholesteatoma.

Surgery can sometimes be done on an outpatient basis. For some patients an overnight stay is necessary. In some rare cases of severe infection, prolonged hospitalisation for antibiotic treatment will be necessary. Common time off work is one to two weeks.

After surgery, in-office follow-up is necessary to evaluate results and to assess for possible recurrence. In cases where an open mastoidectomy cavity has been created, in-office follow-up every few months is necessary to clean the mastoid cavity and prevent new infections. Some patients will need periodic ear examinations throughout their lives. Cholesteatoma is a serious but treatable ear condition that can be diagnosed by medical examination alone. Persistent ear pain, drainage, ear pressure, hearing loss, dizziness or weakness of facial muscles should be evaluated by an ear, nose and throat specialist.

Symptoms and Risks

Initially the ear may ooze with a foul odour. As the cholesteatoma sac enlarges, it may cause a sensation of pressure or fullness in the ear, accompanied by hearing loss. A pain behind or inside the ear, especially at night, can cause considerable discomfort.

Dizziness or weakness in the muscles of one half of the face (the half on the side of the infected ear) may also occur. Any of these symptoms are good reasons to seek medical evaluation.

Cholesteatoma can be dangerous and should never be ignored. Erosion of the bone can cause infection to spread to neighbouring areas, including the inner ear and brain. If left untreated, deafness, brain abscesses, meningitis and rarely death can occur.

A cochlear implant is an electronic device that partially restores hearing to the deaf. It is surgically implanted in the inner ear and powered by a device worn outside the ear. Unlike a hearing aid, it does not make sound louder or clearer. Instead, the device bypasses the damaged parts of the auditory system and directly stimulates the auditory nerve, allowing individuals who are profoundly deaf to receive sound.

What is normal hearing?

The ear consists of three parts that play a vital role in hearing: the outer ear, middle ear and inner ear.

• Conductive hearing: sound travels along the ear canal of the outer ear causing the eardrum to vibrate. Three small bones in the middle ear carry this vibration from the eardrum to the cochlea (auditory chamber) of the inner ear.
• Sensorineural hearing: When the three small bones move, waves of fluid begin to ripple in the cochlea, and these waves stimulate more than 16,000 delicate auditory cells (hair cells). As these hair cells move, they generate an electrical current in the auditory nerve, which travels through interconnections in the brain area that recognises it as sound.

How do you treat people with hearing problems?

If you have a disease or blockage in the outer or middle ear, your conductive hearing may be affected. Medical or surgical treatment can probably correct this.

A problem in the inner ear, however, can result in sensorineural impairment or nerve deafness. In most cases, the hair cells are damaged and do not function. Although many auditory nerve fibres may be intact and can transmit electrical impulses to the brain, the nerve fibres do not respond because of hair cell damage. Since severe sensorineural hearing loss cannot be corrected with medication, it can be treated only with a cochlear implant.

How do cochlear implants work?

Cochlear implants bypass damaged hair cells and convert speech and environmental sounds into electrical signals and send these signals to the auditory nerve.

The implant consists of a small electronic device that is surgically implanted under the skin behind the ear and an external speech processor, usually worn on a belt or in a pocket. A microphone is also worn on the outside of the body as it is tapped behind the ear to capture incoming sound. The speech processor translates the sound into distinctive electrical signals. These “code” travels from a thin wire to the helmet and are transmitted through the skin via radio waves to electrodes implanted in the cochlea. Signals from the electrodes stimulate the auditory nerve fibres to send the information to the brain where it is interpreted as meaningful sound.

Cochlear Implant Benefits

Implants are designed only for individuals who achieve almost no benefit from a hearing aid. They must be 12 months of age or older (unless infantile meningitis is responsible for the deafness).

Otolaryngologists (ear, nose, and throat specialists) perform implant surgery, although not all do this procedure. Your general practitioner may refer you to an implant clinic for an evaluation. The evaluation will be performed by an implant team (an otolaryngologist, audiologist, nurse, and others) who will give you a series of tes

• Ear (otological) Evaluation: The otolaryngologist examines the middle and inner ear to ensure that no active infection or other abnormalities oppose implant surgery.
• Hearing (audiological) Screening: The audiologist conducts a comprehensive hearing test to find out how much you can hear with and without a hearing aid.
• X-ray (radiographic) evaluation: Special x-rays are taken, usually computed tomography (CT) or magnetic resonance imaging (MRI), to evaluate the inner ear bone.
• Psychological evaluation: Some patients may need a psychological evaluation to see if they can cope with the implant.
• Physical exam: The otolaryngologist also gives you a physical exam to identify any potential problems with the general anaesthesia needed for the implant procedure.

Cochlear Surgery

Implant surgery is performed under general anaesthesia and takes two to three hours. An incision is made behind the ear to open the mastoid bone leading to the middle ear. The procedure can be performed on an outpatient basis, or may require a hospital stay, overnight or for several days, depending on the device used and the anatomy of the inner ear.

Is there care and training after the operation?

About a month after surgery, your team puts the signal processor, microphone and transmitter implant out of your ear and adjusts them. They teach you how to care for the system and how to hear sound through the implant. Some implants take longer to fit and require more training. Your team will probably ask you to return to the clinic for regular check-ups and readjustment of the speech processor as needed.

What can I expect from an implant?

Cochlear implants do not restore normal hearing, and the benefits vary from individual to individual. Most users find that cochlear implants help them communicate better through better lip-reading, and more than half are able to discriminate speech without the use of visual cues. There are many factors that contribute to the degree of benefit a user receives from a cochlear implant, which include:

• how long a person has been deaf
• the number of surviving auditory nerve fibres, and
• the patient's motivation to learn to listen.

Before deciding whether the implant is working well, it is necessary to have a clear understanding of how much time to commit. Some patients do not benefit from implants.

FDA approval for the implants

The Food and Drug Administration (FDA) regulates cochlear implant devices for children and adults and approves them only after thorough clinical research.

Be sure to ask your otolaryngologist for written information, including brochures provided by implant manufacturers. You need to be fully informed about the benefits and risks of cochlear implants, including how much is known about how safe, reliable and effective a device is, how often you should return to the clinic for examinations, and whether your insurance company pays for the procedure.

Implant costs

More expensive than a hearing aid, the total cost of a cochlear implant, including evaluation, surgery, the device, and rehabilitation is about $40,000. Most insurance companies offer benefits that cover the cost. (This is true if the device has received FDA approval or is still in process).

Protruding and drooping ears or torn earlobes can be corrected with surgery. Exceptionally large or protruding ears make children vulnerable to teasing. These procedures do not alter the patient's hearing, but can improve appearance and self-confidence.

What is involved in the “pin” Back 'the ears?

Corrective surgery, called otoplasty, should be considered on ears that protrude more than 4/5 inch (2 cm) from the back of the head. It can be performed at any age after the ears have reached their final size, usually at five or six years of age. Surgery at an early age has two benefits: the cartilage is more flexible, making it easier to reshape, and the child will experience the psychological benefits of the aesthetic improvement. However, a patient can have the surgery at any age.

Surgery begins with an incision behind the ear, in the crease where the ear meets the head. The surgeon may remove the skin and cartilage or trim and shape the cartilage. In addition to correcting protrusion, the ears may also be reshaped, reduced in size, or made more symmetrical. The cartilage is then secured in the new position with permanent stitches that are anchored in the ear while healing occurs.

Typically, otoplasty surgery takes about two hours. Soft bandages over the ears will be used for a couple of weeks as protection, and the patient normally experiences only mild discomfort. Headbands are sometimes recommended to hold the ears in place for a month following surgery or may be prescribed for night wear only.

Can ear deformities be corrected?

The “double” hard, raised cartilage that shapes the top of the ear does not form in all people. This is called “lop-ear deformity”, and is hereditary. Absence of the ear can sometimes cause the ear to protrude or droop. To correct this problem, the surgeon places permanent sutures in the upper ear cartilage and ties them in a way that creates a crease and pulls the ear upward. Scar tissue forms later, holding the flap in place.

Some babies are born without an opening in their middle ear. These ears can be surgically opened, and the outer ear reshaped to resemble the other ear. This procedure will restore hearing if the inner ear is intact.

Those who are born without an ear, or lose an ear due to injury, may have an artificial ear surgically attached for cosmetic reasons. These are custom shaped to match the patient's other ear. Alternatively, rib cartilage or a biomedical implant, in addition to the patient's own soft tissues, can be used to construct a new ear.

Can earlobes be corrected by tearing?

Many mothers have had their earlobes torn by a baby tugging on their earrings. Earrings also snagged on clothing and other objects, resulting in torn earlobes. These tears can be easily repaired surgically, usually in the doctor's office. In severe cases, the surgeon may cut a small triangular notch in the lower part of the lobe. A flap is then put in place, created from tissue on the other side of the tear, and the two wedges are supported by each other and stitched together.

Earlobes usually heal quickly with minimal scarring. In most cases, the earlobe can be reattached four to six weeks after surgery to receive lightweight earrings.

Is insurance cover payable for cosmetic ear surgery?

Insurance usually does not cover surgery solely for cosmetic reasons. However, insurance may cover, in whole or in part, surgery to correct a congenital or traumatic defect. Before cosmetic ear surgery, discuss the procedure with your insurance company to determine what type of coverage, if any, you can expect.

Understanding the causes and treatment options

• Who needs ear tubes and why?
• What to expect after surgery
• and much more ...

Painful ear infections are a rite of passage for children - by the age of five, almost every child has experienced at least one episode. Most ear infections either resolve on their own (viral) or are effectively treated with antibiotics (bacterial). But sometimes, ear infections and/or fluid in the middle ear can become a chronic problem leading to other issues such as hearing loss, behavioural and speech problems. In these cases, insertion of an ear tube by an otolaryngologist (ear, nose, and throat surgeon) may be considered.

What are ear tubes?

Ventilation tubes are cylinders that are inserted through the eardrum (tympanic membrane) to bring air into the middle ear. They may also be called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PE (pressure equalisation) tubes. These tubes may be made of plastic, metal, or Teflon and may have a lining intended to reduce the possibility of infection. There are two basic types of ear tubes. Short-term and long-term tubes are smaller and usually stay in place for six months to a year before falling out on their own. Long-term tubes are larger and have wings that secure them in place for a longer period of time. Long-term tubes may fall out on their own, but removal by an otolaryngologist is often necessary.

Who needs ear tubes?

Ventilation tubes are often recommended when a person experiences repeated middle ear infections (acute otitis media) or has hearing loss caused by the persistent presence of fluid in the middle ear (otitis media with effusion). These conditions occur most commonly in children, but may also be present in adolescents and adults and can lead to speech and balance problems, hearing loss, or drum changes in the structure of the ear. Other less common conditions that may warrant ear tubes are malformation of the eardrum or Eustachian tube, Down syndrome, cleft palate, and barotrauma (injury to the middle ear, caused by a reduction in air pressure), which often occurs with changes in altitude such as flying and diving.

Each year, more than half a million ear tube surgeries are performed on children, making it the most common childhood surgery performed under anaesthesia. The average age of ear tube insertion is one to three years old. Placement of these tubes can:

• reduce the risk of future ear infection,
• restore hearing loss caused by middle ear fluid,
• improve speech problems and balance of problems, and
• improve behavioural and sleep problems caused by chronic ear infections.

How are ear tubes inserted?

Ventilation tubes are inserted through an outpatient surgical procedure called a myringotomy. Myringotomy refers to an incision (a hole) in the eardrum or tympanic membrane. This is most often done under a surgical microscope with a small scalpel (small knife), but can also be performed with a laser. If an ear tube is not inserted, the hole will heal and close within a few days. To prevent this, an ear tube is placed in the hole to keep it open and allow air to reach the middle ear space (ventilation).

Ear tube surgery

Light general anaesthesia (laughing gas) is administered to young children. Some older children and adults may be able to tolerate the procedure without anaesthesia. The myringotomy is performed and the fluid drum behind the ear (in the middle ear space) is suctioned out. The ear tube is placed in the hole. Ear drops may be administered after the ear tube is placed and may be needed for a few days. The procedure usually takes less than 15 minutes and patients wake up quickly. Sometimes the otolaryngologist will recommend removal of adenoid tissues (lymphatic tissue located in the upper airway behind the nose) when tubes are placed in the ears. This is often considered to necessitate the insertion of a repeat tube. Current research indicates that removal of adenoid tissues concurrent with ear tube placement may reduce the risk of recurrent ear infection and the need for repeat surgery.

What to expect after surgery

After surgery, the patient is observed in the recovery room and will usually go home within an hour if no complications are present. Patients usually experience little or no postoperative pain, but drowsiness, irritability, and/or nausea from the anaesthesia may occur temporarily. Hearing loss caused by the presence of fluid in the middle ear will be resolved immediately by surgery. Sometimes children can hear so much better that they complain that normal sounds seem too loud. The otolaryngologist will provide specific instructions for each postoperative patient including when to seek immediate care and follow-up appointments. He or she may also prescribe antibiotic ear drops for a few days. To prevent the possibility of bacteria entering the middle ear through the ventilation tube, doctors may recommend keeping the ears dry by using earplugs or other waterproof devices during bathing, swimming and water activities. However, recent research suggests that ear protection may not be necessary except when diving or participating in water activities in dirty water, such as lakes and rivers. Parents should consult with the treating physician about ear protection after surgery.

Possible complications

Myringotomy with insertion of ventilation tubes is a very common and safe procedure with minimal complications. When complications do occur, they can include:

• Perforation - This can happen when a tube comes out or a long-term tube is removed and the hole in the tympanic membrane (eardrum) does not close. The hole can be repaired through a minor surgical procedure called tympanoplasty or myringoplasty.
• Scars - Any irritation of the tympanic membrane (recurrent ear infections), including repeated insertion of tubes into the ears, can cause scarring called tympanosclerosis or myringosclerosis. In most cases, this does not cause problems with hearing.
• Infection - Ear infections can occur in the middle ear or around the tube in the ear. However, these infections are usually less frequent, result in less hearing loss and are easier to treat - often just with ear drops. Sometimes an oral antibiotic is still necessary.
• Ventilation pipes come out too early or stay too long - If an ear tube is expelled from the eardrum too soon (which is unpredictable), the fluid may return and repeat surgery may be necessary. Ventilation tubes that remain too long may produce a perforation or may need to be removed by the otolaryngologist.

Consultation with an otolaryngologist (ear, nose, and throat surgeon) may be warranted if you or your child has experienced repeated or severe ear infections, ear infections that do not resolve with antibiotics, hearing loss caused by fluid in the middle ear, barotrauma, or has an anatomical abnormality that inhibits middle ear drainage.

Perception of otitis media and treatment

• What is otitis media?
• Is it serious?
• What are the symptoms?
• and much more ...

What is otitis media?

Otitis media means inflammation of the middle ear. The inflammation is caused by an infection of the middle ear. It can occur in one or both ears. Otitis media is the most common diagnosis recorded for children visiting the doctor for illness. It is also the most common cause of hearing loss in children.

Although otitis media is most common in young children, it also affects adults from time to time. It occurs most commonly in the winter and early spring months.

Is it serious?

Yes, it is serious because of the severe ear pain and hearing loss it can create. Hearing loss, especially in children, can impair learning ability and even delay speech development. However, if treated promptly and effectively, hearing can almost always be returned to normal.

Otitis media is also serious because the infection can spread to neighbouring structures in the head, especially the mastoid. It is therefore very important to recognise the symptoms (see list) of otitis media and to bring it to the immediate attention of your doctor.

How does the ear work?

The outer ear collects sounds. The middle ear is a pea-sized, air-filled cavity separated from the outer ear by the paper-thin eardrum. Attached to the eardrum are three small ear bones. When sound waves hit the eardrum, it vibrates and sets the bones in motion which they transmit to the inner ear. The inner ear converts the vibrations into electrical signals and sends them to the brain. It also helps to maintain balance.

A healthy middle ear contains air at the same atmospheric pressure as the outer ear, which allows free vibration. Air enters the middle ear through the narrow eustachian tube that connects the back of the nose to the ear. When you yawn and listen to each other, your eustachian tube just sends a small bubble of air into the middle ear to equalise the air pressure.

What causes otitis media?

Blockage of the eustachian tube during a cold, allergies or upper respiratory infections and the presence of bacteria or viruses lead to the accumulation of fluid (a build-up of pus and mucus) behind the eardrum, the infection called acute otitis media. The accumulation of pus under pressure in the middle ear causes ear pain, swelling and redness. Because the eardrum cannot vibrate properly, you or your child may have hearing problems.

Sometimes the eardrum ruptures, and pus drains out of the ear; however, more commonly, pus and mucus remain in the middle ear due to a swollen and inflamed eustachian tube. This is called middle ear effusion or serous otitis media. Often, after the acute infection has passed, the effusion remains and becomes chronic, lasting weeks, months or even years. This condition makes one subject to frequent recurrences of the acute infection and can cause difficulty in hearing.

What will happen in the doctor's office?

During an examination, the doctor uses an instrument called an otoscope to assess the condition of the ear. With it, the doctor will perform an examination to check for redness in the ear and/or fluid behind the eardrum. With the gentle use of air pressure, the doctor can also see if the eardrum moves. If the eardrum does not move and/or is red, an ear infection is probably present.

Two other tests can be performed to obtain more information:

• An audiogram tests whether hearing loss has occurred by presenting the tones on various football pitches.
• A tympanogram measures the air pressure in the middle ear to see how well the eustachian tube is working and how well the eardrum can move.

The importance of medication

The doctor may prescribe one or more medications. It is important that all medication(s) is taken as directed and that follow-up visits are kept. Often, antibiotics to fight the infection will make the earache go away quickly, but the infection may need more time to clear up. Therefore, make sure that the medicine is taken for as long as your doctor has instructed. Other medications your doctor may prescribe include an antihistamine (for allergies), a decongestant (especially with a cold), or both.

Sometimes the doctor may recommend a medication to reduce fever and/or pain. Analgesic ear drops may help relieve the pain of an earache. Call your doctor if you have any questions about you or your child's medication or if symptoms do not go away.

What further treatment may be necessary?

Most of the time, otitis media is cured with appropriate medication and home treatment. In many cases, however, additional treatment may be recommended by your doctor. An operation, called a myringotomy, may be recommended. This is a small surgical incision (opening) in the eardrum to promote fluid drainage and relieve pain. The incision heals within a few days with almost no scarring or injury to the eardrum. In fact, the surgical opening can heal so quickly that it often closes before the infection and fluid are gone. A ventilation tube can be placed in the incision, preventing fluid build-up and thus improving hearing.

The surgeon chooses a ventilation tube for your child that will remain in place for as long as it takes for the middle ear infection to improve and for the Eustachian tube to return to normal. This may require several weeks or months. During this time, you should keep water out of the ears, as it could cause an infection. Otherwise, the tube does not cause problems, and you will probably notice a noticeable improvement in hearing and a decrease in the frequency of ear infections.

Otitis media may recur as a result of chronically infected adenoids and tonsils. If this becomes a problem, the doctor may recommend removal of one or both. This may be done at the same time, as ventilation tubes are inserted.

Allergies may also require treatment.

So remember...

Otitis media is usually not serious if it is promptly and properly treated. With your doctor's help, you and/or your child may feel and hear better very soon.

Be sure to follow the treatment plan and consult your doctor until he/she tells you that the situation is completely cured.

What are the symptoms of otitis media?

In infants and young children look for:

• pulling or scratching of the ear, especially if accompanied by other symptoms
• hearing problems
• crying, irritability
• fever
• vomiting
• ear drainage

In young children, adolescents and adults look for:

• ear pain
• feeling of fullness or pressure
• hearing problems
• dizziness, loss of balance
• nausea, vomiting
• ear drainage
• fever

Remember, without proper treatment, damage caused by an ear infection can lead to chronic or permanent hearing loss.

Idea de hacer más cómodo el transporte aéreo

• Why the pop ears?
• How can air travel cause hearing problems?
• How to help babies unblock their ears?
• and much more ...

Ear problems are the most common medical complaint of air travellers, and while they are usually simple, minor annoyances, they occasionally result in pain and temporary hearing loss.

Why the pop ears?

Swallowing usually causes a clicking or popping noise in the ear. This is due to a small bubble of air that has entered the middle ear, above the back of the nose. It passes through the Eustachian tube, a membrane-lined pencil-sized tube that connects the back of the nose to the middle ear. Air in the middle ear is constantly being sucked into its membranous lining and re-supplied through the Eustachian tube. In this way, the air pressure on both sides of the eardrum remains almost equal. If, and when, the air pressure is not equal the ear feels clogged.

The Eustachian tube can be blocked, or obstructed, for a variety of reasons. When that happens, the middle ear pressure cannot be equalised. Air is no longer sucked in and a vacuum is produced, sucking the eardrum inwards and stretching it. Such an eardrum cannot vibrate naturally, so sounds are muffled or blocked, and the stretching can be painful. If the tube becomes blocked, fluid (such as blood serum) will leak into the area of the membranes in an attempt to overcome the vacuum. This is called “fluid in the ear,” serous otitis aero- or otitis media.

The most common cause of eustachian tube obstruction is the common cold. Sinusitis and nasal allergies are also causes. Nasal congestion leads to blocked ears because swollen membranes block the opening of the Eustachian tube.

How can air travel cause hearing problems?

Air transport is sometimes associated with rapid changes in atmospheric pressure. To maintain comfort, the Eustachian tube must open frequently and wide enough to equalise changes in pressure. This is especially true when the aircraft is landing, as it passes from low atmospheric pressure down near the ground, where the air pressure is higher.

Actually, any situation in which rapid altitude or pressure changes occur creates the problem. It can be experienced when riding in lifts or when diving to the bottom of a pool. Deep sea divers, as well as pilots, are taught to balance ear pressure. Anyone can learn the trick too.

How to unblock the ears?

Swallowing activates the muscle that opens the Eustachian tube. Swallowing is more frequent when chewing gum or mints that melt in the mouth. These are good air travel practices, especially just before take-off and during descent. Yawning is even better. Avoid sleeping during descent, because you can't swallow enough to keep up with the pressure changes. (The flight attendant will be a pleasure to wake up just before descent).

If yawning and swallowing are not effective, pinch the nostrils, take a puff of air, and direct the air towards the back of the nose as if trying to blow the nose gently. The ears have been successfully unblocked when the pop is heard. This may have to be repeated several times during the descent. Even after landing, continue with pressure stabilising techniques and use decongestants and nasal sprays if the ears do not open or if pain persists, seek the help of a physician who is experienced in the care of ear disorders. The ear specialist may need to release pressure or fluid with a small incision in the eardrum.

How to help babies unblock their ears?

Babies may unintentionally pop their ears, but popping may occur if they suck on a bottle or dummy. Feed your baby during the flight, and do not allow him or her to sleep during descent. Children are especially vulnerable to blockages because their eustachian tubes are narrower than in adults.

Is the use of decongestants and nasal sprays recommended?

Many experienced travellers use a decongestant pill or nasal spray at least an hour before the descent. This will shrink the membranes and help the ears pop more easily. Travellers with allergy problems should take their medication at the start of the flight for the same reason. However, do not make a habit of nasal sprays. After a few days, they can cause more congestion than relief.

Decongestant pills and sprays can be purchased without a prescription. However, they should be avoided by people with heart disease, high blood pressure, irregular heart rhythms, thyroid disease, or excessive nervousness. These people should consult their doctor before using these medications. Pregnant women should also consult their doctor first.

Tips to avoid discomfort during air travel

• Consult with a surgeon for speed after ear surgery that is safe to fly.
• Postpone air travel if a cold, sinusitis, or allergy attack is present.
• Patients in good health can take a decongestant pill or nasal spray about an hour before descent to help the ears pop more easily.
• Avoid sleeping during the descent.
• Chew gum or suck on a piece of candy just before take-off and during descent.
• When inflating the ears, do not use force. The correct technique involves only the pressure created by the cheek and throat muscles.

Ear care penetration

• Why does the body produce earwax?
• What is the recommended method for cleaning the ears?
• When should a doctor be consulted?
• and much more ...

Good intentions to keep the ears clean can put the ability to hear at risk. The ear is a delicate and complex area, including the skin of the ear canal and the eardrum. Therefore, special attention should be paid to this part of the body. To begin with, discontinue the use of cotton buds and the habit of probing the ears.

Why does the body produce earwax?

Cerumen or earwax is healthy in normal amounts and serves as a self-cleaning agent with protective, lubricating, and antibacterial properties. The absence of earwax can cause dry, itchy ears. Most of the time ear canals are self-cleaning, i.e. there is a slow and orderly migration of earwax cells and skin from the eardrum to the ear cavity. Old wax is constantly being transported, assisted by chewing and jaw movement, from the ear canal to the ear opening where it usually dries, flakes, and falls out.

Earwax does not form in the deep part of the ear canal near the eardrum, but on the outside one-third of the ear canal. So when a patient has wax blockage against the eardrum, it is often because he has been probing the ear with such things as swabs, pins, or napkin twisted corners.

When should the ears be cleaned?

Under ideal circumstances, the ear canals should never have to be cleaned. Ears should be cleaned when earwax accumulates enough to cause symptoms or to prevent a necessary evaluation of the ear by your doctor. This condition is called cerumen impaction, and can cause one or more of the following symptoms:

• Earache, sensation of fullness in the ear, or a sensation in the ear is connected
• partial hearing loss, which may be progressive
• Tinnitus, ringing or buzzing noises in the ear
• Itching, odour, or discharge
• Cough

What is the recommended method for cleaning the ears?

To clean the ears, wash the outer ear with a cloth, but do not insert anything into the ear canal.

Most cases of earwax blockage respond to home treatments used to soften the wax. Patients can try placing a few drops of mineral oil, baby oil, glycerine or commercial ear drops in the ear. Detergent drops such as hydrogen peroxide or carbamide peroxide may also help in removing wax.

Ear irrigation or syringing is commonly used for cleaning and can be performed by a doctor or at home using a commercially available irrigation kit. Common solutions used for injection include water and saline, which should be warmed to body temperature to avoid dizziness. Ear syringing is most effective when water, saline, or dissolving wax drops are placed in the ear canal 15 to 30 minutes prior to treatment. Caution is advised to prevent watering ears if you have diabetes, a perforated eardrum, tube in the eardrum, or a weakened immune system.

Manual removal of the wax is also effective. This is most often performed by an otolaryngologist using suction, special miniature instruments, and a microscope to magnify the ear canal. Manual removal is preferable if the ear canal is narrow, the eardrum has a perforation or tube, other methods have failed, or if you have diabetes or a weakened immune system.

Why not cotton buds to clean the wax?

Earwax blockage is one of the most common causes of hearing loss. This is often caused by attempts to clean the ear with cotton buds. Most cleaning attempts simply push the wax deeper into the ear canal, causing a blockage.

The outer ear is the funnel-shaped part of the ear that can be seen on the side of the head, plus the ear canal (the hole leading to the eardrum). The ear canal is a shape similar to an hourglass-shaped part of the narrowing downwards. The skin on the outside of the canal has special glands that produce earwax. This wax is supposed to trap dust and dirt particles to prevent them from reaching the eardrum. Usually the wax builds up a little, dries out, and then falls out of the ear, carrying the dirt and dust out of it. Or it can slowly migrate to the outside, where it can be wiped away.

If ear candles an option to remove wax build up?

No, ear candles are not a safe wax removal option, as they can produce serious injury. Since users are instructed to insert the 10' to 15' long, cone-shaped, hollow candles, usually made of wax-impregnated cloth, into the ear canal and light the exposed end, some of the most common injuries are burns, blockage of the ear canal with candle wax, or perforation of the membrane separating the ear canal and middle ear.

The US Food and Drug Administration (FDA) became concerned about safety issues with ear candles after receiving reports of patient injury caused by the ear candling procedure. There are no controlled studies or other scientific evidence supporting the safety and efficacy of these devices for any of the purported claims or intended uses listed on the labelling.

Based on growing concerns related to the manufacture, marketing and use of ear candles, the FDA has undertaken several successful regulatory actions, including product seizures and injunctions, since 1996. These actions were based, in part, on violations of the Food, Drug and Cosmetic Act that pose an imminent health hazard.

When should a doctor be consulted?

If the home treatments discussed in this booklet are not satisfactory or if the wax has accumulated so much that it blocks the ear canal (and ear), a physician may prescribe ear drops designed to soften the wax, or it may be washed or vacuumed out. Occasionally, an otolaryngologist (ear, nose and throat specialist) may be required to remove the wax with microscopic visualisation.

If there is a possibility of a hole (perforation or puncture) in the eardrum, consult a doctor before trying any over-the-counter remedy. Putting eardrops or other products in the ear in the presence of a perforated eardrum may cause pain or infection. Certainly, flushing water through a hole could start an infection.

What can I do to prevent excessive earwax?

There are unproven ways to prevent earwax impaction, but inserting cotton-tipped applicators or other objects into the ear canal is highly recommended. If you are prone to repeated wax impaction or use hearing aids, consider visiting your doctor every 6 to 12 months for a preventive cleaning and routine check-up.

Your child has ear pain. After your first visit to a doctor you may hear some of the following terms related to the diagnosis and treatment of this common childhood disorder.

Acute otitis media - the medical term for the common ear infection. Otitis refers to an inflammation of the ear, and media means middle. Acute otitis media is an infection of the middle ear, which lies behind the eardrum. This diagnosis includes fluid effusion trapped in the middle ear.

The adenoidectomy – removal of the adenoids, the tonsils also called the pharynx. Some believe that their removal helps prevent ear infections.

Amoxicillin – a semi-synthetic penicillin antibiotic often used as the first line of medical treatment for acute otitis media or otitis media with effusion. A higher dose may be recommended for a second treatment.

Analgesia – immediate pain relief. For an earache, it can be provided by paracetamol, ibuprofen and Auralgan.

Antibiotic – a soluble substance derived from a mould or bacterium that inhibits the growth of other bacterial micro-organisms.

Antibiotic resistance – a condition where microorganisms continue to multiply despite exposure to antibiotic agents, often because the bacteria have become immune to the medication. o inappropriate overuse of antibiotics leads to antibiotic resistance.

Audiometer – an electronic device used in hearing measurement for pure tones of frequencies, usually ranging from 125-8000 Hz, and speech (which are recorded in terms of decibels).

Azithromyacin – an antibiotic prescribed for acute otitis media due to Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. It is also known by its brand name, Zithromax®.

Bacteria – organisms responsible for about 70 percent of cases of otitis media. The most common bacterial offenders are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis.

Chronic otitis media – when the middle ear infection persists, leading to possible permanent damage to the middle ear and eardrum.

Decibel – one tenth of a bel, the unit of measurement that expresses the relative loudness of a sound. The results of a hearing test have been expressed in decibels.

Spillage – an accumulation of fluid in general, containing a bacterial culture.

-First line agent – The first antibiotic treatment prescribed for an ear infection, often amoxicillin.

Myringotomy – an incision is made in the eardrum.

Otitis media without effusion – an inflammation of the eardrum without fluid in the middle ear.

Otitis media with effusion – the presence of fluid in the middle ear without signs or symptoms of ear infection. It is sometimes called serous otitis media. This condition does not usually require antibiotic treatment.

Otitis media with perforation – a spontaneous rupture or perforation in the eardrum as a result of infection. The hole in the eardrum usually repairs itself within several weeks.

OtoLAM ™ – a myringotomy performed with computer technology-driven laser (instead of incision with a conventional manual scalpel).

pneumatic otoscopy – a test administered via the middle ear consisting of an inspection of the ear with a device capable of varying the air pressure against the eardrum. If the tympanic membrane moves during the test, normal middle ear function is indicated. Lack of movement indicates increased impedance, as with middle ear fluid, or perforation of the tympanic membrane.

recurrent otitis media – when the patient incurs three infections in three months, four in six months, or six in 12 months. This is often an indicator that a tympanostomy tube may be recommended.

Second-line treatment – antibiotics prescribed in the first line of treatment fail to resolve symptoms after 48 hours.

Trimetoprim sulfametoxazol – a first-line alternative treatment for children allergic to amoxicillin.

Tympanostomy tubes – small tubes inserted into the eardrum to allow drainage of the infection.

Do not hesitate to ask your doctor for clarification if he or she uses a term that is not fully understood.

What is AIED?

Autoimmune inner ear disease (AIED) is an inflammatory disease of the inner ear. It occurs when the body attacks immune system cells in the inner ear that are mistaken for a virus or bacteria. AIED is a rare disease that occurs in less than one percent of the 28 million Americans with hearing loss.

How does the healthy ear work?

The ear has three main parts: the outer, middle and inner ear. The outer ear (the part you can see) opens into the ear canal. The eardrum separates the ear canal from the middle ear. The small bones in the middle ear transfer sound to the inner ear. The inner ear contains the auditory (hearing) nerve, which leads to the brain.

Any sound source sends vibrations or sound waves into the air. These funnel through the opening of the ear, below the ear canal, and hit the eardrum, making it vibrate. The vibrations are transmitted to the tiny bones of the middle ear, which transmit them to the auditory nerve in the inner ear. Here, the vibrations become nerve impulses and go directly to the brain, which interprets the impulses as sound (music, voice, car horn, etc.).

AIED Symptoms

Symptoms of AIED are sudden hearing loss in one ear progressing rapidly to the other ear, hearing loss can progress over weeks or months. Patients may feel fullness in vertigo.