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.
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.
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.
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.
A middle ear infection, also known as ‘otitis media,’ is an infection or inflammation that occurs inside the eardrums. This can cause sinus issues, among others. Generally speaking, people with middle ear infections pick them up from colds, coughs, sore throats, and other respiratory problems. Of course, the word ‘chronic’ suggests this is an ongoing problem, which is why we want to address the treatment side of things today.
With ear infections, doctors like to wait at least two months to three months before classifying it as ‘chronic.’ ‘Acute’ ear infections usually only last for a few weeks. Typically, those with an acute infection will experience fluids accumulating behind the eardrum.
These fluids can remain behind the eardrum for a few months. If the fluid stays in place for a prolonged period or there’s some form of negative pressure, the patient will continue to see problems long into the future. Over time, the middle ear may develop a hole in the eardrum, leading to more severe issues. Doctors talk about middle ear infections in terms of months as opposed to days or weeks because chronic middle ear infections typically start without pain or any real symptoms. As time goes on, the ears may pop after sustained pressure and result in hearing loss.
Before talking about the treatments and what you can do to alleviate the issue, we should note that infants and young children are particularly prone to middle ear infections. In fact, three in every four children will experience a middle ear infection before their third birthday. As the canal that connects the back of the nose/throat to the middle ear, the ‘Eustachian tube’ is more horizontal and much shorter when children are younger. For the microorganisms that cause infection, a shorter tube allows them to enter the middle ear faster. In combination with a young child’s weaker immune system, and children find it hard to stave off.
Treating Middle Ear Infections
In the majority of cases, antibiotics will be the first course of treatment. Even though there’s no real evidence to suggest their effectiveness in treating otitis media, since most middle ear infections are viral, they can remove various symptoms and make it easier for the infection to resolve itself. Antibiotics usually fix the problem in around five days. Doctors often prescribe amoxicillin, allowing you to get back on your feet in no time.
After medication, many children and adults require grommets, which are also an option if the middle ear infection doesn’t clear up immediately. Grommets are tiny tubes placed inside the eardrum that aid with drainage. As we discovered earlier, the problem worsens when the fluid doesn’t drain away, so grommets could stop the negative spiral of events that makes otitis media worse.
Under general anesthesia, these grommets can be installed in around 15 minutes and are left inside the ear for several months. With the eardrum open, the middle ear infection can heal fully, and the grommet will eventually be pushed out. You typically won’t feel any pain, and the majority of grommets are removed between six months and a year after being installed.
If the problem is too severe for either of these solutions, surgery is recommended if there aren’t any other solutions available. With this option, the idea will be to remove the infected tissue and the areas causing the recurring pain and discomfort. Once these problem areas have been eliminated, an intact eardrum can then recreate a middle ear space as found in healthy ears. Hearing can then be restored.
At first, you may find it strange that hearing is the last thing to be restored, but the first two steps are pivotal to stop the infection from returning. If these two steps aren’t met at the beginning, anything else done to improve hearing will be futile. If the infection comes back after the hearing is restored, hearing can be lost again so this is why the order of priority has been developed in this way.
In most cases, the problem will clear itself up with the help of antibiotics. If this doesn’t work, your doctor should discuss more great solutions so you can move forward with your life without worrying about infection and discomfort in your ears.
“My Ear Hurts” is a statement that parents often dread. Immediately, you think ear infection. However, it is important that you don’t jump to conclusions. Before you start panicking, here are a few facts about ear infections that you should know to not only help your child but know when to seek help from a doctor or otolaryngologist.
Most illnesses are caused by either bacterium of viruses. The eustachian tubes is a part of the body that drains fluids from the middle ear. When it is swollen due to infection, it doesn’t function properly. Fluid is instead pulled into the middle ear, causing bacteria to grow.
Common Symptoms of an Ear Infection
Symptoms are your number one indicator of an ear infection. So, it’s crucial that you know what to look for. If you are worried, then check to see if your child has any of the following:
- The common cold.
- Irritation during the day or night.
- Hearing loss.
- Trouble laying down straight.
- Blood or pus in the ear.
- Ear pain.
When to Call Your Doctor
These symptoms are serious. Blood or pus coming out of the ear probably means a ruptured ear drum. The ear drums swell and can burst, especially if your child messes with it. Now, this can heal, but a professional can tell you what to do so it heals properly.
If the pain is too great or your child cannot hear, then visit your doctor or an otolaryngologist. You shouldn’t wait for their temperature to go down. Ear infection can also be the cause of a fever and stiff neck. Home treatment only works so much, and very little if your child’s condition is severe.
Hopefully, this helps you find the signs of an ear infection. Next week, find out how to prevent an ear infection from occurring.
Sometimes, hearing loss can occur because of a variety of reasons: buildup of earwax, an ear infection, or even exposure to loud noises. Many people believe having a little trouble hearing every now and then is a minor inconvenience, and that the condition is only temporary. However, a new study suggests the sound deprivation can lead to irreversible hearing loss.
How Is Sound Deprivation Affecting Hearing?
When sound’s ability to travel between the ear canal and the inner ear is damaged, conductive hearing loss occurs. Sounds and voices will seem faint or muffled to anyone suffering with the disorder. In the study, performed by the Massachusetts Eye and Ear Infirmary, scientists wanted to be able to determine what happens to people with a recurring case of hearing loss.
By testing mice dealing with chronic conductive hearing loss in one ear, they were able to determine that sound deprivation causes irreversible damage to the inner ear.
“After a year of sound deprivation, we observed dramatic changes in the inner ear – notably, a significant loss of the synaptic connections through which the sensory cells send their electrical signals to the brain,” says Stephane F. Maison, Ph.D., lead researcher, investigator in the Eaton-Peabody Laboratories at Massachusetts Eye and Ear Infirmary, and assistant professor of otolaryngology at Harvard Medical School.
What About Your Good Ear?
Even with the damage from sound deprivation, some individuals feel that not being able to hear from one ear is not a situation worth fixing.
“Although these conditions are routinely treated in industrial societies, a number of patients choose not to receive treatment, particularly when their medical condition affects only one ear,” Dr. Maison said. “For instance, patients with unilateral atresia, a condition in which the ear canal is closed or absent, see limited benefits of undergoing surgery when they can simply use their good ear.”
However, choosing not to deal with hearing loss is not a wise decision. Other studies have shown how a lack of hearing can affect memory and speech. The same is true for those with children dealing with hearing loss or ear infections, as it can be the causes of dizziness and balance problems. With the research in this study, Dr. Maison advises that “audiologists and physicians should advocate for early intervention and treat these middle ear conditions.”
For children with a common middle-ear problem, a new study reports that a simple treatment with a nasal balloon may diminish issues of hearing loss and avoid the unnecessary use of antibiotics, according to a study published in CMAJ (Canadian Medical Association Journal).
Common to young children is their developing otitis media with effusion, aka “glue ear.” This condition occurs when the middle ear fills with thick fluid that may affect the development in hearing. Currently, no symptoms manifest themselves, so parents most often take their children with hearing difficulties to see a doctor. In 2004 in the US, 2.2 million were diagnosed with otitis media with effusion, costing an estimated $4 billion.
“Unfortunately, all available medical treatments for otitis media with effusion such as antibiotics, antihistamines, decongestants and intranasal steroids are ineffective and have unwanted effects, and therefore cannot be recommended,” writes Dr. Ian Williamson, Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom, with coauthors.
In the study published in the CMAJ, researchers from the United Kingdom surveyed a randomized control trial to determine if auto-inflation with a nasal balloon could be used on a large scale in order to see if children could inflate a balloon in each nostril within a primary care setting. The results were surprising in the effectiveness of such a procedure, although shown only in small trials.
“Autoinflation is a simple, low-cost procedure that can be taught to young children in a primary care setting with a reasonable expectation of compliance,” write the authors. “We have found use of autoinflation in young, school-aged children with otitis media with effusion to be feasible, safe and effective in clearing effusions, and in improving important ear symptoms, concerns and related quality of life over a 3-month watch-and-wait period.”
The nasal balloon has been around for decades, known as a home remedy. This treatment is similar to popping your nose when your ears get clogged on airplanes.
The researchers suggest that this treatment should be used more widely in children over age 4 to manage otitis media with effusion and help treat the associated hearing loss.
What’s important about this DIY therapy for autoinflation is that it’s a nondrug intervention, and that it’s underrepresented in research and clinical practice. If you’re child suffers from otitis media, ask you doctor about this simple procedure that has been around for decades.
While there are barriers to using nondrug therapies, in the case of autoinflation, doctors need to know about other effective techniques; how they are done and how to instruct patients and families in how to use it.
Avoiding a Summertime Ear Infection: Summertime Isn’t Only Fun in the Sun
Summer is here, and so is the amount of time children and adults alike spend in the pool. This increase in the time spent floating around in the cool water is appealing, that is, until you are faced with swimmer’s ear. What is swimmer’s ear? What measures can you take for avoiding a summertime ear infection like this? What are the treatment options if one does have it? Here are some answers to these common questions.
Swimmer’s ear is caused when water is trapped in the ear canal. Bacteria forms and an infection is born. One of the reasons that the summer season sees an increase in the number of swimmer’s ear cases is because people are spending far more time in the water. This is especially true for children. However, swimmer’s ear can occur even after a bath or shower. This outer ear infection is not contagious but it can cause discomfort or pain.
Knowing how the infection occurs can help you from getting it. Of course, limiting your time spent in the water is one way to do it. But what’s the fun in that when the sun is shining? A better way to prevent the problem is to make sure ears are nice and dry after swimming, bathing, or showering. Removing excess moisture is the best way to keep swimmer’s ear away. Using a swimming cap and ear plugs is also effective, and this strategy is highly recommended for those who are more avid swimmers.
If the infection is in the outer ear, it is much easier to treat. Moreover, symptoms will generally be on the mild side. If the ear is tugged, and there is pain, it usually means the infection is in the ear canal. This indicates a condition that will be a little more difficult to treat. A visit to your ear, nose, and throat doctor will determine if the infection is indeed swimmer’s ear. A prescription for antibiotic ear drops and possibly a round of oral antibiotics is usually needed to quickly clear up this type of infection.
Everyone wants to enjoy the summer to the full. By taking a few simple precautions for avoiding a summertime ear infection will insure that you can swim with impunity. More importantly, you can focus on having fun.
Is Ear Tube Surgery Worth the Benefits?
When a child has fluid in their middle ear, parents are faced with a big decision. Do they choose to take the risk of ear tube surgery and put in ear tubes or do they wait and see? New research is causing doctors to reconsider their positions on this subject.
Researchers looked at cases of children who suffered from otitis media with effusion, or OME, and subsequently who had ear tube surgery. They found that while this procedure improved hearing for a time and relieved some of the pain, putting in ear tubes, in the long run, did not amount to the effects they were hoping for. The improvements in hearing ability as a result of ear tube surgery only lasted less than a year.
Fluid in the middle ear can cause pain and hearing loss, but the fluid itself does not carry an infection. OME affects most children and has at least one case in their childhood years. It is the leading cause for ear tube surgery. One technique is to make a small cut and insert a tube to relieve pain by draining fluid and decreasing pressure. At times this procedure is coupled with another where tissue is removed from the throat. Treatment results were seen to last up to two years. The conclusion of the case review was that while these types of procedures can have positive short-term effects, they do not really make a difference in the long-term development of speech and hearing.
When weighing their options for ear tube surgery, parents should consider the possible positive effects and the short-term improvements in their child’s life against the possible risks that come with undergoing surgery. In the studies, researchers were also hoping to find what the effects of these types of procedures would be on adults, but unfortunately the results were inconclusive.
Decrease in Number of Ear Infections
For many children, ear infections are a part of life. They are the number-one reason children are taken to the doctor’s office. Childhood surgeries are also mostly due to ear infections and their related problems. This is not that surprising when you consider that nearly 80% of toddlers will have had at least one ear infection by age 3. That’s just for one occurrence—nearly 40% will have as many as three bouts with infection by that age.
However, in recent years, a particular vaccine seems to have helped reduce the number of incidents related to ear infections. A nearly decade-long study helped sort out the facts related to this fortunate decline.
An introduction to the pneumococcal conjugate vaccine came to the United States in the year 2000. What researchers noted while tracking this was a decline in ear infections and related illnesses, a trend particularly noticeable in 2004. The PCV13 vaccine was then introduced in 2010, and since then, toddlers aged 2 and younger saw a drastic improvement in middle ear infections. Researchers were able to determine this fact by analyzing the number of ear infection-associated medical visits.
This is significant not just for the children who have to suffer through the infection, but for parents and healthcare workers as well. Less missed days from school and work also reduced the expense of medical treatment. The number of prescribed antibiotics in children was also reduced, which is a good turn as well. While some vaccines have been around for a few years, there are newer ones, and researchers are keen on continuing to monitor the response to such preventative methods and their outcomes.
Chronic Ear Infections Caused by Undetected Bacteria
For many of us, ear infections are a part of childhood not fondly remembered. Unfortunately, the number of children that suffer from chronic ear infections is substantial—and the reason for this, as researchers have discovered, is that some bacteria go unnoticed. One kind in particular can lead not only to ear infections, but also to other respiratory issues that may become chronic.
The strain, known as NTHI, can be found around the mucus membranes of almost 50% of children. However, under the right conditions, the bacteria can begin to thrive and grow. It has been known to cause a number of infections in the ear, sinuses and lungs, therefore making chronic conditions likely to occur. The problem with NTHI is that is has become difficult to treat: While preferred treatments for ear infections, for example, may clear up the problem, it may not completely rid the middle ear of infection. This allows for another flare-up, which may then lead to another ear infection. Medicine-resistant strains such as this have been the focus of some recent studies.
While looking into the causes of some of these chronic respiratory infections, scientists were able to observe how the bacteria reacted to the body’s own defense mechanism, our immune system. It was noted that certain processes of the immune system actually help NTHI become stronger and maintain its hold on its host. By using the immune system against itself, the strain is now not only able to feed, but also goes through a sort of transformation. By structurally changing or mutating, the strain, in effect, camouflages itself. When this happens, it is no longer targeted by the immune system; it is now overlooked.
Resistant strains are nothing new to the medical community, but impetus is being put on finding ways to prevent this from happening. More study is needed to determine the best way to treat infections caused by bacteria such as NTHI, and researchers have some avenues they feel may lead to effective treatment.