Archive for January, 2018

Pair of ear plugs used to guard against noise-induced hearing loss

Noise-Induced Hearing Loss

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Noise-induced hearing loss is a condition which currently affects about 10 million Americans. It is the most common preventable cause of hearing loss which is due to damage of the ear’s sensory nerve. The prevalence of noise-induced hearing loss and the number of people affected have steadily grown right along with the development of society—as more and more of man’s creations create noise pollution which damage a person’s hearing.

Probably most people understand the damage that can result from being close to a gunshot, but far fewer people are aware of potential damage from more mundane causes like leaf blowers, lawnmowers, traffic sounds, car alarms, music concerts, and even the stadium noise at a sporting event.

The truth is, any loud noises which are received by the ears over an extended period of time, no matter where they came from, can cause significant damage to the inner ear. Eventually this can lead to dizziness, ringing in the ears, some degree of hearing loss, and even issues unrelated to hearing, such as high blood pressure and an irregular heartbeat.

What is Noise-Induced Hearing Loss?

Noise-induced hearing loss is the condition which results from having an excess of sound energy reaching the inner ear. When the excess sound energy is temporary, any hearing loss is also likely to be temporary and reversible. A good example of this would be attending a loud rock concert where sound undergoes a great deal of amplification, and excess sound energy reaches every person in attendance, regardless of where they’re sitting.

It is fairly typical for someone attending a concert like this to completely recover within the next day or two, because the excess sound energy has dissipated. If that noise were to persist over a longer period of time, however, it is quite likely that the damage to the inner ear would be irreversible, and the listener would be subjected to a permanent loss of hearing.

It is also possible for excess sound energy to be so profound as to rupture a person’s eardrums, rendering them more or less deaf. Still more problems can be created if a person’s eardrums are shattered and he or she also develops severe dizziness, which is usually an sign that there is a perilymphatic fistula, i.e. an inner ear hole, created between the middle ear space and the inner ear fluid. Surgery in such cases may eliminate the dizziness, but the hearing loss is likely to remain permanent.

Pair of ear plugs used to guard against noise-induced hearing loss

Ear plugs can aid against noise-induced hearing loss.

Prevention of Noise-Induced Hearing Loss

Two of the best kinds of protection for the inner ear are the simple devices we know as earplugs and earmuffs. Earplugs are small-sized devices made of various materials, which can easily fit into the outer ear canal to block sound reception. Since they come in many different shapes and sizes, earplugs can be fitted to virtually anyone’s ears, and the fit is very important because there must be an airtight seal in the ear canal to block excess sound energy from reaching the inner ear.

Earmuffs on the other hand, are devices fitted to the head, and they cover the entire outer ear to prevent sound energy from reaching the ear canal. These devices usually have an adjustable band which allows for a tight fit, and as in the case of earplugs, a tight fit is very important so as to make a good seal against excess sound energy.

The choice of which of these devices to use for any given situation is contingent upon which kinds of sounds need to be blocked. Earplugs are much more effective in providing protection from noises in the low frequency spectrum, whereas earmuffs offer better protection against noises on the high end of the spectrum. Either one will reduce the sound energy that reaches the inner ear by between 15 and 30 dB of sound, and when the two devices are used in tandem, a person wearing them can expect to have twice as much protection than by using either one alone.

Treatment for Noise-Induced Hearing Loss

Anyone who suspects that they may have sustained noise-induced hearing loss should seek professional advice from a doctor who has been trained in ear and hearing disorders. This kind of doctor will be able to diagnose the specific condition affecting a person’s hearing, and can recommend the most effective kind of treatment program.

Unfortunately, there is no real cure for noise-induced hearing loss, because damage to the inner ear is irreversible. There are various devices available which can help restore hearing if only one ear has been affected, and there are also amplification systems such as hearing aids, which can be used in certain situations.

There’s also a great deal of very promising research being conducted by such organizations as the National Institute on Deafness and Other Communication Disorders. One of the specific areas being researched now is how using antioxidants may be able to prevent hearing loss due to noise-induced causes, and may actually be able to restore relatively normal hearing.

Early results have already demonstrated that vitamin D and aspirin can reduce the effects of hearing loss when they are used prior to the event which produces excess sound energy. Other research conducted on laboratory animals has shown that exposure to loud noises does not result in hearing loss when the animals are provided with vitamins A, C, and E before being exposed to a loud noise.

Young woman with an ear infection, such as cholesteatoma, touching her painful ear.

Cholesteatoma: What It Is and What You Need to Know

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Young woman with an ear infection, such as cholesteatoma, touching her painful ear.

Cholesteatoma is a non-cancerous growth in the middle ear.

With a name that confuses many, cholesteatoma is a delicate and troublesome problem within the ear. Describing an abnormal skin growth behind the eardrum, the middle ear, cholesteatoma is normally caused by multiple infections. However, there are other causes to note including a dysfunction in the eustachian tube.

What is the Eustachian Tube?

Running to the middle of the ear from the back of the nose, this tube is essential for our hearing. Since it allows air to reach the ear, ear pressure is equalized efficiently and our hearing works as expected. Sadly, an issue can occur with a simple cold along with allergies, sinus infections, and chronic ear infections.

With a failure in the eustachian tube, the middle ear can experience a partial vacuum and, in turn, the eardrum, or certain sections of the eardrum, is pulled out of position. As you can see, each step of the process causes another problem and it ends with a growth or cyst in the middle ear.

When left untreated, willingly or unknowingly, the size of the cholesteatoma can change while causing severe damage to the delicate bones located in the middle ear. If left for too long, hearing loss is experienced and surgery becomes one of just a few select options. Fortunately, there aren’t any serious side effects when the issue is treated which means that permanent hearing loss and muscle paralysis in the face are both unlikely. This being said, there has been cases of all three when the cholesteatoma is allowed to keep growing.

Causes of Cholesteatoma

As we’ve seen, the main causes are problems with the eustachian tube and chronic infections but there are also small numbers of people who are born with a cholesteatoma. Ultimately, this is seen as a birth defect and should be picked up on soon after birth. If children experience numerous ear infections, cholesteatoma can also become a problem at a young age.

Symptoms of Cholesteatoma

With any health issue such as this, the key information comes in knowing the symptoms so it can be recognized early. With cholesteatoma, many are actually drawn to a foul odor before anything else and this is where the ear drains fluids. After this, you might feel building pressure or a sense of fullness in the ear where the sac enlarges over time.

As with ear infections themselves, cholesteatoma will cause discomfort whether it comes through an ache in the ear, a difficulty to fall asleep at night, or a slight loss of hearing. Finally, there may be muscle weakness on the side of the cyst in addition to dizziness. If you experience any of these symptoms, we advise you to visit your doctor as soon as possible. Even if it turns out to be a simple ear infection, this will still need treatment.

Treating Cholesteatoma

As you visit your doctor, they’ll examine the inside of the ear because the signs of a cyst can often be seen early whether it’s a congregation of blood vessels or excess skin cells. If they don’t find anything but are still a little worried, they may ask for you to attend a CT scan which will show the cyst or whatever it may be causing your discomfort.

As with any other cyst, a cholesteatoma is something that needs surgery for removal. Unfortunately, cysts don’t just go away on their own; in fact, they do the opposite and grow. While you’re waiting for surgery, your doctor might suggest ear drops, antibiotics, careful cleaning, and other forms of light therapy.

During surgery, most cases are completed under a general anesthesia with the main aim of removing the cyst. If the cyst is removed, this is great news but it might not be the end of the problem depending on how serious the issue was and the state of your ear now. Typically, a second surgery will be planned at the very least to check the cyst has gone. However, you may also require a reconstruction of the damaged bones in the middle ear; this will improve your hearing and reverse other symptoms experienced. Of course, this will be judged on a case-by-case basis as not all patients would benefit from reconstruction if the damage is too severe.

In terms of the logistics, you’ll be an outpatient and a certain percentage will stay in the facility overnight as a precaution. If the cholesteatoma was extremely damaging, you might be required to stay in hospital for a few days with a course of antibiotics. On the whole, you can expect to need one or two weeks away from work. In the months ahead, check-ups and evaluations will ensure the problem has gone for good.

Summary

Although we can’t provide any prevention tips for congenital cholesteatomas, we do advise visiting the doctor as soon as you notice any of the symptoms we’ve listed. Whether it’s yourself or your child, quick action is the best way to remove the problem and ensure the middle ear bones aren’t damaged. Despite cholesteatoma being a serious ear condition, it is treatable with the right steps.

A little girl with herpangina getting her throat examined by an ENT doctor.

Herpangina: What You Need to Know

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As the known term for a blister-like ulcer within the mouth, herpangina occurs typically in childhood. Unfortunately, being an infection, herpangina can cause other health issues – we’re here to discuss what you need to know.

What is Herpangina?

In the past, the infection has been compared to hand-foot-mouth disease since they’re both viral infections found mostly in children. As a group of viruses known to affect the gastrointestinal tract, enteroviruses are to blame for herpangina. The immune system will typically jump into action as soon as it detects an enterovirus. Since young children and infants aren’t always equipped with the right antibodies, they’re more susceptible to these viruses.

When it comes to herpangina, the main issue is its contagiousness. After spotting or hearing of an ulcer in the roof of the mouth or back of the throat, you should look to treat the symptoms and have the infection cleared as soon as possible. If left untreated, it can spread around a nursery or classroom.

Herpangina Risks

Although herpangina can affect anyone of any age, those around the age of 5 to 10 years experience it most frequently. Since it’s highly-contagious, breeding grounds can form in classrooms, camps, and other locations where children regularly congregate. In the U.S., researchers have found the problem to be most common in fall and summer.

Symptoms of Herpangina

Both for yourself and your children, some health conditions can be hard to diagnose since the symptoms are very similar to other health issues. Luckily, the signs of herpangina can be spotted and tested more easily. For example, the primary symptoms one might experience include swollen lymph glands, sudden onset of fever, neck pain, difficulty in swallowing, sore throat, loss of appetite, and a headache.

For smaller children, there may be an issue with verbal communication of symptoms, but indicators include excessive drooling or vomiting. Of course, ulcers may also be visible on the roof of the mouth or towards the back of the throat. In appearance, specialists suggest a gray color with a red border for ulcers; in the majority of cases, they clear within a week.

A little girl with herpangina is given a diagnosis at the doctor's office.

Herpangina is easier to diagnose in older children who have learned how to speak and communicate their symptoms. However, in younger kids, look out for vomiting and excessive drooling.

Should I Contact a Doctor?

For many, especially with worried parents, this is the key question because you want to help your child feel better but you don’t want to exaggerate what may be a small issue. Therefore, we advise contacting the doctor if a fever measures above 106 degrees (or stays for longer than usual), if there are signs of dehydration, and if mouth sores remain for longer than five days.

Herpangina Treatment

After paying a visit to your doctor, they can typically diagnose the issue with ease since the ulcers are unique in their appearance. With a simple physical examination of yourself or your child, they can see the problem while also assessing all symptoms and your medical history. With herpangina, specialized diagnostic tests aren’t required.

Regarding treatment, the goal is to reduce the symptoms while also keeping them under control in the days ahead. Depending on your age and a number of other factors – including your medical history and symptoms – doctor’s can recommend different types of treatment. A course of antibiotics won’t be especially useful since herpangina is a viral infection.

With this in mind, the first suggestion would be acetaminophen or ibuprofen. It’s crucial that the patient doesn’t take aspirin since herpangina has been linked to the potentially life-threatening Reyes disease that is associated with a severe aspirin allergy.

Elsewhere, topical anesthetics could be used to relieve any mouth pain (and sore throat), including lidocaine. Regardless of the treatment, the doctor will suggest an increased intake of liquids with a focus on water and milk; hot drinks and citrus-based beverages will worsen the symptoms. Strangely enough, many sufferers have found popsicles to ease throat issues so this could also be advised.

Preventative Measures

Finally, you might be wondering whether you can avoid this disease altogether. First and foremost, you can take preventative measure by practicing good hygiene habits. For example, all the necessary rules apply such as covering your mouth when sneezing or coughing, washing hands after using the toilet, and washing hands before meals. If you teach your children the basic hygiene rules, you’ll decrease the likelihood of them suffering from herpangina too.

If your child currently has herpangina, remember these rules when helping them to recover. Throughout the day, wash your hands and pay particular attention before and after changing diapers or dealing with mucus. Furthermore, try to keep areas of high activity clean for your child including toys, surfaces, and their beds. To avoid becoming the enemy of all other parents, we also advise keeping your child from school or day-care while recovering too. If you follow these tips, you or your child will be back to full health in no time!

A young woman holding her head due to BPPV.

What is BPPV? (Benign Paroxysmal Positional Vertigo)

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It may look like a mouthful to say, but the medical condition known as benign paroxysmal positional vertigo (BPPV) can easily be understood by breaking it down into its constituent terms. Benign means non-life threatening and paroxysmal means that it occurs only in sudden bursts. Positional means that it is triggered by specific positions or head movements and vertigo is a sensation of dizziness. Taken altogether, someone who has BPPV would experience brief periods of dizziness, which are brought on by abrupt, unanticipated head motions.

Your Body During a BPPV Episode

Many of the issues which affect your balance originate in the inner ear, like BPPV. It starts when some of the calcium carbonate crystals which are normally carried in the gel of the utricle, somehow navigate out of that environment and into at least one of the three semi-circular canals, which are filled with fluid, and are thus also capable of hosting the crystals.

These semi-circular canals depend on fluids to determine head motions, and when the fluids become oversaturated with calcium carbonate crystals, your ability to balance is disrupted. These particulates cause excessive movement in the fluids within your inner ear, creating what we commonly know as vertigo (dizziness).

When this fluid moves, there are nerve endings inside the ear which sense that motion and transmit messages to the brain about head movements. Inaccurate signals are sent to the brain, and as a result, the BPPV patient feels dizzy and disoriented.

People Affected by BPPV

Even though you might never have heard of BPPV, it’s not an exceptionally rare condition. In fact, more than 100 out of every 100,000 people in America are affected by BPPV, most of whom are adults. The disorder rarely impacts children, and is far more prevalent in older people, particularly seniors.

The cause of the disorder is not yet understood, with most people reporting that they simply woke up one day, and as they got out of bed, realized that the bedroom was spinning all around them. Although the beginnings of BPPV are unclear, scientists and doctors have noted a correlation between the disorder and other diseases such as diabetes, osteoporosis, and inner ear infections.

A diagram of the inner ear, as related to BPPV

In diagnosing BPPV, ENT doctors look for nystagmus, which is an pattern of eye movements caused by the sensation of vertigo.

Diagnosing BPPV

It can be difficult to diagnose BPPV, because the movement of the calcium carbonate crystals does not show up on imaging scans such as magnetic resonance imaging (MRI). However, a BPPV can abruptly position their head in a way that causes the crystals to move within the fluid of the semi-circular canals, which triggers the false signals that induce dizziness.

This dizziness causes the person’s eyes to move in a very definite and predictable pattern known as nystagmus. This occurs because there is a close relationship between the eye muscles and the inner ear, which allows for a person to remain focused on immediate surroundings during head movements.

Because the false signals sent to the brain make it think the head is moving, it also mistakenly triggers eye movement, which is supposed to help maintain equilibrium. However, in this false scenario, nystagmus acts as a telltale sign.

Treatment of BPPV

Sometimes medications are prescribed as a treatment for BPPV, and in other cases, surgical solutions are recommended. But in most cases, the most effective treatment by far is relocating the wandering calcium carbonate crystals back into the utricle chamber where they belong.

The first step in this mechanical approach calls for identification of which semi-circular canal(s) the crystals have migrated to. Once that is known, a doctor will guide the patient through a series of head maneuvers which are designed to encourage the crystals to return to their original position. Self-treatment is not recommended, and it calls for a doctor who is skilled in guiding a patient through the proper maneuvers so that no damage is done to the head or neck areas.

Effectiveness of Treatment Programs

Studies have demonstrated that the success rate for properly diagnosed and guided BPPV treatment is around 90%. Once the calcium carbonate crystals have been returned to their proper position, most patients report no more than minor residual spinning sensations, and even these diminish within a couple of months.

However, it is possible for the condition to recur, and come back in full force. This usually occurs within five years of treatment, and when it does come back, it can again be treated successfully, using the gravity method of guiding the crystals back to their proper position in the ear.

An isolated ear with a swimmer's ear infection.

How to Prevent Swimmer’s Ear Infections

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Swimmer’s ear is something of a misnomer since you don’t have to be splashing around the pool or swimming to get the kind of ear infection attributed to swimmer’s ear. This ear infection is of a specific type which begins as a mild, barely noticeable itching or redness, which gradually escalates into an inflamed condition that can become very tender to the touch, and can eventually even disrupt your hearing.

You can contract swimmer’s ear infection in any number of ways, including swimming in some body of water, but also by taking a bath or shower, or even by cleaning your ears out with a cotton swab.

Causes of Swimmer’s Ear

The formal medical name for swimmer’s ear infection is otitis externa, and it occurs when water gets trapped in your ear. When that water is allowed to stay there, bacteria and sometimes fungi can grow in the ear and multiply, which then leads to an infection near the opening of the ear.

There are other causes of swimmer’s ear as well, which are not brought about by any exposure to water. If a cut or scrape occurs just inside the ear canal, that can also trigger the formation of the bacteria necessary to create an infection.

Aggressive cleaning with cotton swabs is another relatively common cause of swimmer’s ear since the swab can scratch the skin inside the ear, and bacteria can begin growing and multiplying as a result. In fact, people with excessive amounts of earwax are prone to developing swimmer’s ear, as are people bothered by eczema, which is a chronic skin condition.

Symptoms of Swimmer’s Ear

As mentioned, the first indication of swimmer’s ear is usually a mild form of itching, often accompanied by redness and swelling around the ear. When the infection begins to progress, the area becomes more inflamed and more painful. Many people who have contracted swimmers ear report that it’s extremely painful, far beyond what you might expect from such a seemingly simple medical condition.

Other symptoms can develop if swimmer’s ear is left untreated, some of which can be quite serious. Fluid build-up in the ear, swollen lymph nodes, a swollen or closed up ear, and a high fever are all symptoms that can result from an untreated ear infection. This damage is not permanent and will subside once the infection is cleared up with medication.

An ENT examines a patient's swimmer's ear infection.

The best thing to do if you have a swimmer’s ear infection is to seek the attention of your physician or ENT. They’ll be able to give you antibiotics you need to clear up the infection.

Treatment for Swimmer’s Ear

Someone who has contracted swimmer’s ear infection should take a pain reliever like Ibuprofen if the patient cannot see a doctor immediately. In some milder cases, the pain and discomfort will subside on its own, but if that doesn’t happen within just a few days, it’s always advisable to make an appointment with a physician. If you can’t get an appointment to see your doctor for treatment, you should try to get into an urgent care facility and have the infected ear examined.

To confirm a diagnosis of swimmer’s ear, a physician will take a fluid sample from the area around the ear, and the first treatment option will usually be antibiotic eardrops. If these don’t clear up the problem in a short timeframe, an oral antibiotic is likely to be the next option.

There are times however, when this line of treatment is ineffective and something else has to be tried. If ear antibiotics don’t work, it’s usually because there has been so much debris or fluid built up in the ear canal, that antibiotic eardrops cannot penetrate the obstruction. If this is the case, your doctor may attempt to clear the debris out of the ear canal by using a vacuum apparatus.

Once the buildup of debris has been dissipated, antibiotic eardrops will again probably be effective. One reason why oral antibiotics could possibly be ineffective as a means of treatment, is if the infection wasn’t really caused by bacteria in the first place, but was triggered by a fungus.

Preventing Swimmer’s Ear Infections

You don’t have to avoid swimming, bathing, or showering in order to avoid swimmer’s ear infections. One of the most effective ways of ensuring that water doesn’t become trapped in the inner ear is to wear earplugs when swimming. After showers or baths, you can lean your body toward the side which feels like it has water trapped, and shake your head somewhat vigorously. This will usually dislodge any inner ear water, and clear out the ear canals. It’s also advisable to limit your cotton swab cleaning of the ears as much as possible, so you don’t scratch the interior skin and trigger an infection.

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