Audiology

Conductive hearing loss results when there is any problem in delivering sound energy to your cochlea, the hearing part in the inner ear. Common reasons for conductive hearing loss include blockage of your ear canal, a hole in your ear drum, problems with three small bones in your ear, or fluid in the space between your ear drum and cochlea. Fortunately, most cases of conductive hearing loss can be improved.

Symptoms of conductive hearing loss can vary depending on the exact cause and severity (see below), but may include or be associated with:Muffled hearing

• Sudden or steady loss of hearing
• Full or “stuffy” sensation in the ear
• Dizziness
• Draining of the ear
• Pain or tenderness in the ear

Conductive hearing loss happens when the natural movement of sound through the external ear or middle ear is blocked, and the full sound does not reach the inner ear. Conductive loss from the exterior ear structures may result from:

• Earwax—Your body normally produces earwax. In some cases, it can collect and completely block your ear canal causing hearing loss.
• Swimmer’s ear—Swimmer’s ear, also called otitis externa, is an infection in the ear canal often related to water exposure, or cotton swab use.
• Foreign body—This is typically a problem in children who may put common objects including beads and beans in their ears but can also be seen in adults most often by accident, such as when a bug gets into the ear.
• Bony lesions—These are non-cancerous growths of bone in the ear canal often linked with cold water swimming.
• Defects of the external ear canal, called aural atresia—This is most commonly noted at birth and often seen with defects of the outer ear structure, called microtia.
• Middle ear fluid or infection
• Ear drum problems
• Middle ear fluid or infection—The middle ear space normally contains air, but it can become inflamed and fluid filled (otitis media). An active infection in this area with fluid is called acute otitis media and is often painful and can cause fever. Serous otitis media is fluid in middle ear without active infection. Both conditions are common in children. Chronic otitis media is associated with lasting ear discharge and/or damage to the ear drum or middle ear bones (ossicles).
• Ear drum collapse—Severe imbalance of pressure in the middle ear can result from poor function of the Eustachian tube, causing the ear drum to collapse onto the middle ear bones.
• Hole in the ear drum—A hole in the ear drum (called the tympanic membrane) can be caused by trauma, infection, or severe eustachian tube dysfunction.
• Cholesteatoma—Skin cells that are present in the middle ear space that are not usually there. When skin is present in the middle ear, it is called a cholesteatoma. Cholesteatomas start small as a lump or pocket, but can grow and cause damage to the bones.
• Damage to the middle ear bones—This may result from trauma, infection, cholesteatoma, or a retracted ear drum.
• Otosclerosis—This is an inherited disease in which the stapes or stirrup bone in the middle ear fuses with bones around it and fails to vibrate well. It affects slightly less than one percent of the population, occurring in women more often than men.

If you are experiencing hearing loss, you should see an ENT (ear, nose, and throat) specialist, or otolaryngologist, who can make a specific diagnosis for you, and talk to you about treatment options, including surgical procedures. A critical part of the evaluation will be a hearing test (audiogram) performed by an audiologist (a professional who tests hearing function) to determine the severity of your loss as well as determine if the hearing loss is conductive, sensorineural, or a mix of both.

Based on the results of your hearing test and what your ENT specialist’s examination shows, as well as results from other potential tests such as imaging your ears with a CT or MRI, the specialist will make various recommendations for treatment options.

The treatment options can include:

• Observation with repeat hearing testing at a subsequent follow up visit
• Evaluation and fitting of a hearing aid(s) and other assistive listening devices
• Preferential seating in class for school children
• Surgery to address the cause of hearing loss
• Surgery to implant a hearing device

Sensorineural hearing loss (SNHL) happens when there is damage to tiny hair cells in the cochlear and/or the auditory nerve. In children, the most common causes of SNHL include inner ear abnormalities, genetic variations, jaundice (or a yellowing of the skin or whites of the eyes), and viral infection from the mother during pregnancy. In adults, SNHL is most commonly caused by aging, exposure to loud noises, head trauma, or other conditions (see below for more detail).

Symptoms of SNHL may include:

• Muffled hearing
• Difficulty understanding speech
• Sudden or steady loss of hearing
• Full or “stuffy” sensation in the ear
• Ringing in the ear
• Dizziness

SNHL happens when there is damage to tiny hair cells in the cochlear and/or the auditory nerve. Sound energy reaches the cochlea, but damaged hair cells are unable to convert sound waves into neural signals that pass through the auditory nerve to the brain. Auditory nerve abnormalities will also cause SNHL. Other causes may include:

• Sudden hearing loss—caused by a virus; you should see an ENT (ear, nose, and throat) specialist, or otolaryngologist, for urgent treatment that could help recover some hearing
• Aging—gradual SNHL that cannot be reversed (most common)
• Acoustic trauma—exposure to loud noises (e.g., industrial/machinery or explosion/gunfire close to the ear; can be prevented with proper protection)
• Head trauma or abrupt changes in air pressure—this can cause the space that contains inner ear fluid to rupture
• Autoimmune inner ear disease—the body’s immune system attacks the inner ear and causes progressive hearing loss in both ears
• Ménière’s disease—a condition characterized by fluctuating hearing loss, dizziness, ear fullness, or ringing in the ears (called tinnitus)
• Central nervous disease—damage caused by a condition such as multiple sclerosis
• Cochlear otosclerosis—abnormal bone growth in the inner ear
• Congenital inner ear malformation—genetic or environmental abnormalities (very common cause in children)
• Benign tumor—called “vestibular schwannoma,” this is a noncancerous tumor on the adjacent balance nerve that compresses the hearing nerve that connects the inner ear to the brain, causing SNHL

If you are experiencing hearing loss, you should see an ENT specialist who can make the correct diagnosis. This is important because the treatment for hearing loss depends on the cause. Once a diagnosis is made, your physician will be able to talk to you about all treatment options. A critical part of the evaluation will be a hearing test (audiogram) performed by an audiologist to determine the severity of your hearing loss, as well as whether it is conductive, sensorineural, or a combination of both.

Your ENT specialist may recommend specific treatment options based on the results of your hearing test, or other potential tests such as a CT or MRI imaging scan. Treatment options can include:

• Continuing observation with repeated hearing tests
• Medical therapy—corticosteroids (oral or injection through the eardrum) may be used to reduce cochlear hair cell swelling and inflammation after exposure to loud noises; diuretics may be used for Ménière’s disease
• Low-sodium diet
• Evaluation and fitting of a hearing aid(s) or other assistive listening devices
• Preferential seating in class for school children
• Surgery to correct the cause of the hearing loss
• Surgery to implant a hearing device

SNHL can be treated with the use of conventional hearing aids or an implantable hearing device. Again, your ENT specialist and/or audiologist can help you decide which device may work best for you depending on your hearing test results and your lifestyle.

Over 50 million Americans have experienced tinnitus, or ringing in ears, which is the perception of sound without an external source being present.

About one in five people with tinnitus have bothersome tinnitus, which negatively affects their quality of life and/or functional health. Tinnitus may be an intermittent or continuous sound in one or both ears. Its pitch can go from a low roar to a high squeal or whine, or it can have many sounds.

Persistent tinnitus lasts more than six months. Prior to any treatment, it is important to undergo a thorough examination and evaluation by an ENT (ears, nose, and throat) specialist, or otolaryngologist, and an audiologist. Your understanding of tinnitus and its causes will enhance your treatment.

Tinnitus is not a disease per se, but a common symptom, and because it involves the perception of hearing sound or sounds in one or both ears, it is commonly associated with the hearing system. In fact, various parts of the hearing system, including the inner ear, are often responsible for this symptom. At times, it is relatively easy to associate the symptom of tinnitus with specific problems affecting the hearing system; at other times, the connection is less clear.

Common symptoms of tinnitus include:

• Constant high- or low-pitched ringing in ears
• Intermittent or constant roaring in ears
• Pulsation or beating noises in ears
• Associated with or without hearing loss

Most tinnitus is primary tinnitus, where no cause can be identified aside from hearing loss. Secondary tinnitus is associated with a specific underlying cause that may be treatable. Your ENT specialist will help you distinguish whether your tinnitus is primary or secondary.

Tinnitus may be caused by different parts of the hearing system. The outer ear (pinna and ear canal) may be involved. Excessive ear wax, especially if the wax touches the ear drum, causing pressure and changing how the ear drum vibrates, can result in tinnitus.

Middle ear problems can also cause tinnitus, including middle ear infection (common) and otosclerosis (uncommon), which hardens the tiny ear bones or ossicles. Another rare cause of tinnitus from the middle ear that does not result in hearing loss is muscle spasms in one of the two tiny muscles in the ear. In this case, the tinnitus can be intermittent and sometimes your examiner may also be able to hear the sounds.

Most subjective tinnitus associated with the hearing system originates in the inner ear. Damage and loss of the tiny sensory hair cells in the inner ear (that can be caused by different factors such as noise damage, medications, and age) may also be associated with tinnitus.

One of the preventable causes of tinnitus is excessive noise exposure. In some instances of noise exposure, tinnitus can be noticed even before hearing loss develops, so be careful to take special precautions to protect your ears and hearing in noisy environments.

Medications can also damage inner ear hair cells and cause tinnitus. These include both non-prescription medications such as aspirin and acetaminophen, when taken in high doses, and prescription medication including certain diuretics and antibiotics. As we age, the incidence of tinnitus increases.

Tinnitus may also originate from an abnormality in, or near, the hearing portion of the brain. These include a variety of uncommon disorders such as damage from head trauma, or a benign tumor called “vestibular schwannoma” (acoustic neuroma).

Tinnitus that sounds like your pulse or heartbeat is known as “pulsatile tinnitus.” Infrequently, pulsatile tinnitus may signal the presence of cardiovascular disease, narrowed arteries, or a vascular tumor in your head and neck, or ear. If you are experiencing this type of tinnitus, you should consult a physician as soon as possible for evaluation.

Finally, non-auditory conditions and lifestyle factors can exacerbate tinnitus. Medical conditions such as temporomandibular joint arthralgia (TMJ), depression, anxiety, insomnia, and muscular stress and fatigue may lead to, or exacerbate, tinnitus.

When you are evaluated for tinnitus, the first thing the doctor will do is obtain a complete history and perform a thorough, targeted physical examination. If your tinnitus is one-sided (unilateral), associated with hearing loss, or persistent, a hearing test, or audiogram, should be ordered. There is typically no need for radiologic testing (X-ray, CT scan or MRI scan) unless your tinnitus is pulsatile or associated with uneven, asymmetric hearing loss or neurological abnormalities. Your doctor will determine how bothersome your tinnitus is by asking you certain questions or having you complete a self-assessment questionnaire.

Although there is no one “cure” for tinnitus, there are several options available that can help patients with tinnitus. Because tinnitus is relatively common and not always worrisome, not all patients need an evaluation. If your ENT specialist finds a specific cause for your tinnitus, they may be able to offer specific treatment to eliminate the noise. This may include removing wax or hair from your ear canal, treating middle ear fluid, treating arthritis in the jaw joint, etc. For many patients who have experienced tinnitus for less than six months, its natural course is to improve over time, and most people do not go on to have persistent, bothersome tinnitus.

Some patients with hearing loss and tinnitus have improvement with the use of hearing aids, with or without built-in ear-level maskers. Sound therapies that involve simple things like background music or noise or specialized ear-level maskers may be a reasonable treatment option. The effects of tinnitus on quality of life may also be improved by cognitive behavioral therapy (CBT) counseling, which usually involves a series of weekly sessions led by a trained professional.

Tinnitus can be so bothersome in some patients that it causes depression or anxiety; additionally, in a patient with depression and/or anxiety, it may be very difficult to tolerate tinnitus. Consultation with a psychiatrist or psychologist with treatment directed to the underlying condition can be beneficial.

Routine prescription of medications including antidepressants, anticonvulsants, anxiolytics, or intratympanic injection of medications is not recommended for treating tinnitus without an underlying or associated medical problem that may benefit from such treatment.

Dietary supplements for tinnitus treatment are frequently advertised on the internet, television, and radio, but there is no evidence that supplements such as ginkgo biloba, melatonin, zinc, Lipoflavonoid, and vitamin supplements are beneficial for tinnitus.

Acupuncture may or may not be help your tinnitus; there are not enough quality studies of this type of treatment to make a recommendation. Transcranial magnetic stimulation is a new modality, or therapeutic agent, but its long-term benefits are unproven and cannot be recommended for treating tinnitus at this time.

Earaches can be due to a problem with the ear or structures close to the ear. The pain may be dull, sharp, or burning and can occur in one or both ears. It may be constant or come and go.

• Hearing problems
• Pulling or scratching the ear
• Crying or irritability
• Ear drainage
• Fever

Symptoms of earaches in young children, adolescents, and adults may include:

• Pain
• Hearing problems
• Full or “stuffy” sensation in the ear
• Dizziness or loss of balance
• Nausea, vomiting
• Ear drainage
• Fever

A variety of problems can cause earaches in children and adults:

• Middle ear infection (called acute otitis media)
• Swimmer’s ear (called otitis externa)
• Temporomandibular joint (TMJ) dysfunction or jaw joint pain
• Eustachian tube dysfunction
• Inflammation of the outer ear (called chondritis)
• Cotton swab use
• Throat infection
• Throat cancer (rarely)

What Causes Earaches in Children?

In children, earaches are commonly due to an infection of the middle ear (acute otitis media), and can affect one or both ears. Otitis media can be serious because the infection can spread to nearby structures in the head, especially the mastoid located behind the ear. Otitis media may also cause hearing loss; in children, it may impair learning ability and even delay speech development. However, if it is treated promptly and effectively, hearing can almost always be restored to normal.

Many cases of otitis media can be treated by your pediatrician or family doctor; more serious cases may need attention from an ENT (ear, nose, and throat) specialist, or otolaryngologist.

Ear infections are often due to eustachian tube dysfunction. Inside your ear you have something called a eustachian tube that equalizes pressure behind the ear drum and naturally clears middle-ear secretions. When the eustachian tube becomes blocked due to a cold, allergy, upper respiratory infection (URI), bacteria, or a virus, negative pressure can develop and mucus can collect behind the eardrum causing pain, swelling, and redness.

What Causes Earaches in Adults?

In adults, common causes of earaches include otitis externa or swimmer’s ear and TMJ dysfunction. Swimmer’s ear is an infection of the ear canal and results from swimming in contaminated water or as a result of cotton swab use. In people with diabetes, otitis externa can spread far beyond the ear canal and can be life threatening. Therefore, prompt treatment with antibiotic ear drops as well as cleaning of the ear canal with specialized tools available to an ENT specialist is critical. Another common cause of ear pain is due to referred pain from the jaw joint. This is usually due to grinding of teeth during sleep. TMJ pain can be treated with ibuprofen, eating softer food, avoiding chewing gum, and using a night guard.

An avoidable cause of earache is the use of cotton swabs or other instruments to clean wax from the ear, which can damage the ear canal. Following the old adage that “nothing smaller than an elbow goes in the ear” can avoid dangerous injury to the ear canal and the eardrum. A rare cause of earache is referred pain from infection or cancer of the throat.

During an examination, your ENT specialist will use an otoscope to look inside and assess your ear. They check for redness in the ear, and/or fluid behind the eardrum, and to see if the eardrum moves. These are the signs of an ear infection. If your hearing is decreased, your ENT specialist may also perform an audiogram to test for any potential hearing loss by presenting tones at various pitches, or a tympanogram, which measures the air pressure in your middle ear to see how well your eustachian tube is working.

Your ENT specialist may also prescribe medications, which must be taken as directed. Often, antibiotics to fight the infection will make your earache go away rapidly, but the infection may need more time to clear up. Other medications that 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. Special ear drops can also help ease the pain.

Children who experience multiple episodes of acute otitis media within a short time, chronic otitis media that lasts for more than three months, and/or hearing loss may require the insertion of ventilation tubes, also called pressure-equalization (PE) tubes. This is a short surgical procedure in which a small incision is made in the eardrum, any fluid is suctioned out, and a tube is placed in the eardrum. This tube will eventually fall out on its own, and the eardrum heals.

hearing loss as well as more severe infections to the surrounding important structures.

Ménière’s disease (also called idiopathic endolymphatic hydrops) is one of the most common causes of dizziness originating in the inner ear. In most cases only one ear is involved, but both ears may be affected in about 15 percent of patients.

Ménière’s disease typically affects people between the ages of 20- and 50-years-old and can impact anyone. Occasional symptoms include vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. These episodes typically last from 20 minutes up to four hours.

Hearing loss is often intermittent, occurring mainly at the time of the attacks of vertigo. Loud sounds may seem distorted and cause discomfort. Usually, the hearing loss involves mainly the lower frequencies, but over time this often affects higher tones as well. While hearing loss initially fluctuates, it often becomes more permanent as the disease progresses.

Ménière’s disease symptoms may include:

• Dizziness or vertigo (attacks of a spinning sensation)
• Hearing loss
• Tinnitus (a roaring, buzzing, or ringing sound in the ear)
• Sensation of fullness in the affected ear
• Symptoms tend to come and go together

Although the cause is unknown, Ménière’s disease symptoms are due to increased volume of fluid in the inner ear. Too much fluid may accumulate either due to excess production or inadequate absorption. In some individuals, especially those with involvement of both ears, allergies or autoimmune disorders may play a role in producing Ménière’s disease. In some cases, other conditions may cause symptoms similar to those of Ménière’s disease.

People with Ménière’s disease have a “sick” inner ear and are more sensitive to factors such as fatigue and stress that may influence the frequency of attacks.

To find out how to help and what is causing this condition, your physician will take a history of the frequency, duration, severity, and character of your attacks, the duration of hearing loss, or whether it has been changing, and whether you have had tinnitus or fullness in either or both ears. When the history has been completed, diagnostic tests to assess your hearing and balance may be performed. They may include:

Hearing tests—An audiometric examination (hearing test) typically shows a sensory type of hearing loss in the affected ear. Speech discrimination (the patient’s ability to tell one word from another) is tested as well.

Balance tests—An electronystagmogram (ENG) test may be performed to measure balance by following eye movement when warm and cool water, or air, are inserted into the ear. Often this shows that the balance function is reduced in the affected ear. Rotational or balance platform testing may also be used to evaluate balance.

Other tests—Electrocochleography (ECoG) looks for inner ear fluid pressure in some cases of Ménière’s disease. Other hearing and imaging may help to rule out other causes as well.

Although there is no cure for Ménière’s disease, the attacks of vertigo can be controlled in nearly all cases. Treatment options include:

• A low salt diet and a diuretic (water pill)
• Anti-vertigo medications
• Intratympanic injection with either dexamethasone or gentamicin
• An air pressure pulse generator
• Surgery

Your ENT (ear, nose, and throat) specialist, or otolaryngologist, will help you choose the treatment that is best for you, as each has advantages and drawbacks. In many people, careful control of salt in the diet and the use of medication to help release extra fluid can control symptoms well.

Treatments aim to save the inner ear parts that work and clear out parts that are permanently injured.

Intratympanic injections inject medication through the eardrum into the middle ear space where the ear bones reside. This treatment is done in your ENT specialist’s office one or more times. One type of medication, Gentamicin, eases dizziness but may increase hearing loss and worsen overall balance. Corticosteroids do not cause hearing loss but are less helpful for dizzy spells.

An air pressure pulse generator is another option. Used five minutes three times a day following the placement of a tube through the eardrum close to the middle ear, air is pulsed that adjusts the internal pressure. The success rate of this device has been variable.

Surgery is needed in only a small minority of patients with Ménière’s disease. If vertigo attacks are not controlled by conservative measures and are disabling, one of the following surgical procedures might be recommended:

• Endolymphatic sac shunt or decompression procedure relieves attacks of vertigo in nearly 80 percent of cases and the sensation of ear fullness is often improved. Control is often temporary but can last up to 10 years. Endolymphatic sac surgery does not improve hearing, but only has a small risk of worsening it. Recovery time after this procedure is short compared to the other procedures.
• Vestibular neurectomy or nerve section is a procedure in which the balance nerve is cut as it leaves the inner ear and goes to the brain. While vertigo attacks are permanently cured, in a high percentage of cases, patients may continue to experience imbalance and often patients remain impaired. Similar to endolymphatic sac procedures, hearing function is usually preserved.
• Labryrinthectomy and eighth nerve section are procedures in which the balance and hearing mechanism in the inner ear are destroyed on one side. This is considered when the patient with Ménière’s disease has poor hearing in the affected ear. Labryrinthectomy and eighth nerve section result in the highest rates for control of vertigo attacks.

What Should I Do If I Have an Attack of Ménière’s Disease?

Lie flat and still, and focus on an unmoving object. You might even fall asleep while lying down and feel better when you wake up.

Take vestibular suppressants including meclizine, which calm the inner ear.

To help prevent an attack, avoid stress and excess salt ingestion, caffeine, smoking, and alcohol. Get regular sleep and eat properly. Remain physically active, but avoid excessive fatigue. Consult your ENT specialist about other treatment options.

Swimmer’s ear (also called acute otitis externa) is a painful condition that affects the outer ear and ear canal that is caused by infection, inflammation, or irritation.

These symptoms often occur after water gets trapped in your ear, especially if the water has bacteria or fungal organisms in it. Because this condition commonly affects swimmers, it is known as swimmer’s ear.

Swimmer’s ear often affects children and teenagers, but can also affect those with eczema (a condition that causes the skin to itch), those with highly sensitive or allergic skin reactions, excess earwax, and who wear hearing aids or earbuds. Your primary care provider or ENT (ear, nose, and throat) specialist, or otolaryngologist, will prescribe treatment to reduce your pain and to treat the infection.

Signs and symptoms of swimmer’s ear may include:

• Itching inside the ear (common)
• Pain inside the ear that gets worse when you tug on the outer ear (common)
• Sensation that the ear is blocked or full
• Drainage from the ear
• Fever
• Decreased hearing
• Intense pain that may spread to the neck, face, or side of the head
• Swollen lymph nodes around the ear or in the upper neck
• Redness or swelling of the skin around the ear

If left untreated, a certain amount of hearing loss may occur. When the infection clears up, hearing usually returns to normal. Recurring ear infections (chronic otitis externa) are also possible. Without treatment, infections can continue to occur or persist.

Bone and cartilage damage (malignant otitis externa) are also possible due to untreated swimmer’s ear. If left untreated, ear infections can spread to the base of your skull, brain, or cranial nerves. Diabetics, older adults, and those with conditions that weaken the immune system are at higher risk for such dangerous complications.

To evaluate you for swimmer’s ear, your doctor will look for redness and swelling in your ear canal, and ask if you are experiencing any pain. Your doctor may also take a sample of any abnormal fluid or discharge in your ear (ear culture) to test for the presence of bacteria or fungus if you have recurrent or severe infections.

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:

• Contact with excessive bacteria that may be present in hot tubs or polluted water
• Excessive cleaning of the ear canal with cotton swabs or anything else that may cause breaks in the ear canal skin allowing bacteria in
• Contact with certain chemicals such as hair spray or hair dye (avoid this by placing cotton balls in your ears when using these products)
• Damage to the skin of the ear canal following water irrigation to remove wax
• A cut in the skin of the ear canal
• Other skin conditions affecting the ear canal, such as eczema or seborrhea

Finally, what’s often called swimmer’s ear can also caused by ill-fitting hearing aids, or contaminated earbuds, earphones, or other ear devices.

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. Mildly acidic solutions containing boric or acetic acid are often effective for early infections.

Before using any drops in the ear, it is important to be sure you do not have a perforated eardrum (an eardrum with a hole in it). Check with your ENT specialist if you have ever had a perforated, punctured, or injured eardrum, or if you have had prior ear surgery.

Drops are more easily administered if done by someone other than the patient, and the patient should lie down with the affected ear facing upwards. Prescription drops should be placed in the ear as directed on the label. After drops are administered, the patient should remain lying down for a few minutes, so the drops have time to work.

If you do not have a perforated eardrum or a tube in your eardrum placed by a doctor in the past, you can make your own eardrops using rubbing alcohol or a mixture of half alcohol and half vinegar. These eardrops will evaporate excess water and keep your ears dry.

For more severe infections, your doctor may prescribe antibiotics to be applied directly to the ear. If the ear canal is swollen shut, a sponge or wick may be placed in the canal so the antibiotic drops will enter the swollen canal more effectively. Pain medication may also be prescribed. If you have tubes in your eardrum, a non-ototoxic (do not damage your hearing) topical treatment should be used. Topical antibiotics are effective for infection limited to the ear canal. Oral antibiotics may also be prescribed if the infection goes beyond the skin of the ear canal.

Follow-up appointments are very important to monitor your condition, to clean the ear again, and to replace the ear wick as needed. Your ENT specialist has specific equipment and expertise to effectively clean the ear canal and treat swimmer’s ear. With proper treatment, most infections should clear up in seven to 10 days.

How Can Swimmer’s Ear be Prevented?

A dry ear is unlikely to become infected, so it is important to keep the ears free of moisture during swimming or bathing. Prevention tips include:

• Use ear plugs when swimming.
• Use a dry towel or hair dryer (from a distance) to dry your ears.
• Have your ears cleaned periodically by an ENT specialist if you have itchy, flaky or scaly ears, or extensive earwax.
• Do not use cotton swabs to remove ear wax. They may pack ear wax and dirt deeper into the ear canal, remove the layer of earwax that protects your ear, and irritate the thin skin of the ear canal. This creates an ideal environment for infection.

Earwax, called cerumen, is produced by special wax-forming glands located in the skin of the outer one-third of the ear canal.

It is normal to have cerumen in ear canal as this waxy substance serves as a self-cleaning agent with protective, lubricating, and antibacterial properties. The absence of earwax may result in dry, itchy ears. Self-cleaning means there is a slow and orderly movement of earwax and dead skin cells from the eardrum to the ear opening. Old earwax is constantly being transported, assisted by chewing and jaw motion, from the ear canal to the ear opening where, most of the time, it dries, flakes, and falls out.

Symptoms of an earwax problem may include:

• Earache
• Feeling of plugged hearing or fullness in the ear
• Partial hearing loss that gets worse
• Tinnitus, ringing, or noises in the ear
• Itching, odor, or discharge
• Coughing
• Pain
• Infection

When a patient has wax blockage against the eardrum, it is often because they have been probing the ear with such things as cotton-tipped swabs, bobby pins, or twisted napkin corners. These objects only push the wax in deeper in the ear canal.

Cleaning a working ear can be done by washing it with a soft cloth, but do not insert anything into the ear. Ideally, the ear canals should never have to be cleaned. However, that isn’t always the case. The ears should be cleaned when enough earwax gathers to cause symptoms or to prevent a needed assessment of the ear by your doctor. This condition is call cerumen impaction.

Most cases of ear wax blockage respond to home treatments used to soften wax. Patients can try placing a few drops of mineral oil, baby oil, glycerin, or commercial drops in the ear. Detergent drops such as hydrogen peroxide or carbamide peroxide (available in most pharmacies) may also aid in the removal of wax.

Irrigation or ear syringing is commonly used for cleaning and can be performed by a physician or at home using a commercially available irrigation kit. Common solutions used for syringing include water and saline, which should be warmed to body temperature to prevent dizziness. Ear syringing is most effective when water, saline, or wax dissolving drops are put in the ear canal 15 to 30 minutes before treatment. Caution is advised to avoid having your ears irrigated if you have diabetes, a hole in the eardrum (perforation), tube in the eardrum, skin problems such as eczema in the ear canal or a weakened immune system.

Manual removal of earwax is also effective. This is most often performed by an ENT (ear, nose, and throat) specialist, or otolaryngologist, using suction or special miniature instruments, and a microscope to magnify the ear canal. Manual removal is preferred if your ear canal is narrow, the eardrum has a perforation or tube, other methods have failed, or if you have skin problems affecting the ear canal, diabetes or a weakened immune system.

Why Is It Dangerous to Use Swabs to Remove Earwax?

Wax blockage is one of the most common causes of hearing loss. This is often caused by attempts to clean the ear with cotton swabs. Most cleaning attempts merely push the wax deeper into the ear canal which is shaped like an hourglass, causing a blockage at the narrowing part of the ear canal. In addition, accidental trauma to the ear drum or ear bones can occur if the swab is pushed too deep.

Good intentions to keep ears clean may lessen the ability to hear. The ear is a delicate and complicated body part, including the skin of the ear canal and the eardrum. Therefore, special care should be given to this part of the body. Discontinue the habit of inserting cotton-tipped swabs or other objects into the ear canals.

If home treatments do not help, or if wax has accumulated so much that it blocks your ear canal and your ability to hear, an ENT specialist may prescribe eardrops designed to soften wax, or they may wash or vacuum it out. Your ENT specialist may also need to remove the wax under microscopic visualization.

If there is a possibility of a perforation in the eardrum, consult a physician prior to trying any over-the-counter remedies. Putting eardrops or other products in the ear with the presence of an eardrum perforation may cause pain or an infection. Washing water through such a hole could start an infection.

If you are prone to repeated wax impaction or use hearing aids, consider seeing your doctor every six to 12 months for a checkup and routine preventive cleaning.