DR. ORNOUMA SRIWANISHVIPAT MD, ENT OTORHINOLARYNGOLOGIST VOICE SURGEON (TRANSGENDER) SNORING, NOSE, SINUS SURGEON Yanhee International Hospital Charansanitwong, Bangok, Thaiand Website: dr-ornouma.com Email: [email_address] Ear Problems
CHOOSING THE RIGHT DOCTOR
Dr. Ornouma Sriwanishvipat is highly proficient in investigating and diagnosing ear disorders , with more than 15 years of experience. She offers a wide range of medical, therapeutic, and surgical solutions to treat noises in the ears (Tinnitus), ear infections, and body imbalance . Over the past 12 years, Dr. Ornouma has successfully attended to hundreds of patients from all over the Thailand and around the globe, making her distinguished for her competence in treating this condition.
The ear is a vertebrate organ of hearing responsible for sensing and collecting sounds as well as maintaining equilibrium. The ear is divided into three components, the outer ear (pinna), the middle ear, and the inner ear. Each component of the ear has its unique functions.
WHAT IS THE EAR AND HOW DOES THE EAR WORK?
PARTS OF THE EAR
The outer or external ear
Pinna - the skin covered flabby cartilage of the ear visible on both sides of the head. The basic function of the outer ear or pinna is to protect the eardrum (tympanic membrane). The outer ear also functions to collect sound waves to the eardrum through the ear canal.
Auditory ear canal or meatus - There are modified sweat glands that secrete ear wax in the ear canal. If ear wax is excessive, the ear drum can be damaged or lead to blockage of the transmission of sound.
PARTS OF THE EAR
The middle ear
Tympanic cavity – is the hollowed air-filled bony space in the temporal bone of the skull behind the eardrum. It is just separated from the outer ear by the ear drum. There are three tiny bones in the tympanic cavity that vibrates when exposed to sound waves, namely:
Malleus – Also known as hammer
Incus – Also known as anvil
Stapes – commonly called stirrup
These bones form a chain around the middle ear and extend to the oval window of the inner ear and their main function is to amplify sound.
The middle ear connects to the back of the throat and nose through the Eustachian tube. The Eustachian tube - is the auditory openings that we open when we yawn or swallow.
PARTS OF THE EAR
The inner ear
The inner ear is the most complicated component of the auditory system located into a tiny space of the hardest temporal bone and inaccessible to direct examination or clinical manipulation. The inner ear comprise of three intimately related structures:
The cochlea - is directly responsible for hearing and contains nerves responsible for converting energy vibrations within the inner ear fluid into nerve impulses which can be transmitted to the brain.
The vestibule - (labyrinth) and semicircular canals function to maintain balance or equilibrium.
Definition: This is a generalized infection involving the whole skin of the external canal of the ear.
A common source of the infection is increased moisture trapped in the ear canal, from baths, showers, swimming, or moist environments . When water is trapped in the ear canal, bacteria that normally inhabit the skin and ear canal multiply, causing infection of the ear canal. Swimmer’s ear needs to be treated to reduce pain and eliminate any effect it may have on your hearing, as well as to prevent the spread of infection.
Other factors that may contribute to swimmer’s ear include:
hot, humid climate
Excessive cleaning of the ear canal with cotton swabs or anything else
Contact with certain chemicals such as hair spray or hair dye (Avoid this by placing cotton balls in your ears when using these products.)
Insertion of foreign objects (dust, scratching of the ears, cotton swabs, fingernails, hearing aids, earplugs)
Damage to the skin of the ear canal following water irrigation to remove wax.
A cut in the skin of the ear canal
Fungus or bacteria
The outer is acutely inflamed and tender.
It is extremely painful to handle and nothing can be seen of the interior of the canal without causing the patient acute pain.
Slight hearing loss
If left untreated, complications resulting from swimmer’s ear may include: Hearing loss - When the infection clears up, hearing usually returns to normal. Recurring ear infections (chronic otitis externa) - Without treatment, infection can continue. Bone and cartilage damage (malignant otitis externa) - Ear infections when not treated can spread to the base of your skull, brain, or cranial nerves
Treatment for the early stages of swimmer’s ear includes careful cleaning of the ear canal and use of eardrops that inhibit bacterial or fungal growth and reduce inflammation. Before using any drops in the ear, it is important to be sure you do not have a perforated eardrum, Check with your otolaryngologist if you have ever had a perforated, punctured, or injured eardrum, or if you have had ear surgery.
Ear drops - Drops are more easily administered if done by someone other than the patient. • The patient should lie down with the affected ear facing upwards. • Drops should be placed in the ear until the ear is full. • After drops are administered, the patient should remain lying down for a few minutes so the drops can be absorbed.
Topical antibiotics , Analgesics, antipruritics, and antihistamines - may be indicated.
It is the inflammation of the middle ear (the cavity between the eardrum and the inner ear that causes the tubes to close causing the fluid to become trapped. Bacteria from the back of the nose travel through the eustachian tube directly into the middle ear cavity and multiply in the fluid. This tube may become blocked by a bacterial or viral infection.
Otitis media can only be detected by examining the ear with an otoscope. Only by directly looking in the ear and seeing how the eardrum responds to gentle pressure can the diagnosis be confirmed.
Allergy- Studies have shown that food and airborne allergies can cause otitis media.
Infection - bacteria to cause this infection are Streptococcus pneumoniae, Haemophilus influenzae and moraxella catarrhalis.
Nutritional deficiency -Vitamin A, zinc and iron deficiencies are more susceptible to upper respiratory and ear infection.
Fluid remaining in the middle ear for a long period of time may result in:
Rise in temperature
Burst of the eardrum
TREATMENT OF OTITIS MEDIA
TREATMENT OF OTITIS MEDIA
Your doctor may recommend surgery if the infection fails to respond to antibiotics, if the ear infections are chronic or hearing loss is indicated. The most common type of surgery is myringotomy/Tympanoplasty. This kind of surgery offers relief to children and some adults who suffer recurrent ear infections or persistent fluid in the middle ear, which can lead to hearing loss.
Normal eardrum Perforated eardrum Tympanoplasty
What is a tympanoplasty?
A tympanoplasty is a surgical procedure that repairs or reconstructs the eardrum (tympanic membrane) to help restore normal hearing. This procedure may also involve repair or reconstruction of the small bones behind the tympanic membrane (ossiculoplasty) if needed. Both the eardrum and middle ear bones (ossicles) need to function well together for normal hearing to occur.
What is a myringoplasty?
A myringoplasty is an operation to repair a hole (perforation) in the eardrum (tympanic membrane). A perforation is usually caused by an infection in the middle ear that bursts through the eardrum (see figure 1).
It can also be caused by trauma (for example, being hit across the ear). A perforated eardrum can lead to repeated ear infections and poorer hearing.
WHAT ARE THE BENEFITS OF SURGERY?
Surgery can prevent repeated ear infections and sometimes improve hearing.
ARE THERE ANY ALTERNATIVES TO SURGERY?
Keeping the ear dry by placing cotton wool and Vaseline in the ear when bathing or washing your hair may prevent infection.
An infection can be treated with antibiotics and a trained healthcare practitioner can clean the ear. A hearing aid can improve poor hearing.
WHAT DOES THE OPERATION INVOLVE?
A myringoplasty is usually performed under a general anaesthetic but a local anaesthetic can be used. The operation usually takes between an hour and an hour and a half.
Your surgeon will need to use a graft (piece of tissue) to cover the hole.
Your surgeon will insert the graft through a cut made either in front of or behind your ear or inside your ear canal. They will lift the eardrum and place the graft underneath it and support it with a dissolving sponge. They will then put the eardrum back.
WHAT COMPLICATIONS CAN HAPPEN?
1. General complications of any operation
2. Specific complications of this operation
Change of taste
HOW SOON WILL I RECOVER?
You may be able to go home the same day. If a head bandage has been used, it will be removed the morning after surgery.
Your surgeon will tell you when you can return to normal activities. You should stay off work for two weeks.
Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, you should ask a member of the healthcare team or your GP for advice.
You will be seen in the outpatient clinic two to three weeks after the operation to check the graft.