Middle Ear Disease
Otosclerosis
Otosclerosis is the abnormal growth of bone of the middle ear. This bone prevents structures
within the ear from working properly and causes hearing loss. For some people with otosclerosis, the hearing loss may become severe.
How do we hear?
Hearing is a series of events in which the ear converts sound waves into electrical signals and causes nerve impulses to be sent to the brain where they are interpreted as sound. The ear has three main parts: the outer, middle, and inner ear. Sound waves enter through the outer ear and reach the middle ear, where they cause the ear drum to vibrate. The vibrations are transmitted through three tiny bones in the middle ear called the ossicles. These three bones are named the malleus, incus, and stapes (and are also known as the hammer, anvil, and stirrup). The ear drum and ossicles carry the vibrations to the inner ear. The stirrup transmits the vibrations through the oval window and into the fluid that fills the inner ear. The vibrations move through fluid in the snail-shaped hearing part of the inner ear (cochlea) that contains the hair cells. The fluid in the cochlea moves the top of the hair cells, which initiates the changes that lead to the production of the nerve impulses. These nerve impulses are carried to the brain, where they are interpreted as sound. Different sounds stimulate different parts of the inner ear, allowing the brain to distinguish among various sounds, for example, different vowel and consonant sounds.
How does otosclerosis cause hearing impairment?
Otosclerosis can cause different types of hearing loss, depending on which structure within the ear is affected. Otosclerosis usually affects the last bone in the chain, the stapes, which rests in the entrance to the inner ear (the oval window). The abnormal bone fixates the stapes in the oval window and interferes with sound passing waves to the inner ear.
Otosclerosis usually causes a conductive hearing loss, a hearing loss caused by a problem in the outer or middle ear. Less frequently, otosclerosis may cause a sensorineural hearing loss (damaged sensory cells and/or nerve fibers of the inner ear), as well as a conductive hearing loss.
What causes otosclerosis?
The cause of otosclerosis is not fully understood, although research has shown that otosclerosis tends to run in families and may be hereditary, or passed down from parent to child. People who have a family history of otosclerosis are more likely to develop the disorder. On average, a person who has one parent with otosclerosis has a 25 percent chance of developing the disorder. If both parents have otosclerosis, the risk goes up to 50 percent. Research shows that white, middle-aged women are most at risk.
Some research suggests a relationship between otosclerosis and the hormonal changes associated with pregnancy. While the exact cause remains unknown, there is some evidence associating viral infections (such as measles) and otosclerosis.
What are the symptoms of otosclerosis?
Hearing loss is the most frequent symptom of otosclerosis. The loss may appear very gradually. Many people with otosclerosis first notice that they cannot hear low-pitched sounds or that they can no longer hear a whisper.
In addition to hearing loss, some people with otosclerosis may experience dizziness, balance problems, or tinnitus. Tinnitus is a sensation of ringing, roaring, buzzing, or hissing in the ears or head that accompanies many forms of hearing loss.
How is otosclerosis diagnosed?
An examination by an otolaryngologist (ear, nose, and throat physician) or otologist (ear physician) is needed to rule out other diseases or health problems that may cause these same symptoms. An audiologist is a hearing health care professional who is trained to identify, measure, and rehabilitate hearing impairment and related disorders. An audiologist uses a variety of tests and procedures to assess hearing and balance function. The audiologist may produce an audiogram (a graph that shows a person's hearing sensitivity) and a tympanogram (a graph that shows how well the middle ear functions to conduct sound). Discuss these results with your audiologist/otologist.
How is otosclerosis treated?
In many cases surgery is an option for treatment of otosclerosis. In an operation called a stapedectomy, a surgeon (otolaryngologist or otologist) bypasses the diseased bone with a prosthetic device that allows sound waves to be passed to the inner ear. It is important to discuss the risks and possible complications of this procedure, as well as the benefits, with the surgeon. In rare cases, surgery can worsen the hearing loss.
If the hearing loss is mild, surgery may not be an option. Also, on occasion, some hearing loss persists after surgery. A properly fitted hearing aid may help some people with otosclerosis in situations that include persistent hearing loss. A hearing aid is designed to compensate for a hearing loss by amplifying sound. An audiologist can discuss the various types of hearing aids available and make a recommendation based on the specific needs of an individual.
Otitis Media - Ear Infection
What is otitis media?
Otitis media is an ear infection. Three out of four children experience otitis media by the time they are 3 years old. In fact, ear infections are the most common illnesses in babies and young children.
Are there different types of otitis media?
Yes. There are two main types. The first type is called acute otitis media (AOM). This means that parts of the ear are infected and swollen. It also means that fluid and mucus are trapped inside the ear. AOM can be painful.
The second type is called otitis media with effusion (fluid), or OME. This means fluid and mucus stay trapped in the ear after the infection is over. OME makes it harder for the ear to fight new infections. This fluid can also affect your child's hearing.
How does otitis media happen?
Otitis media usually happens when viruses and/or bacteria get inside the ear and cause an infection. It often happens as a result of another illness, such as a cold. If your child gets sick, it might affect his or her ears.
It is harder for children to fight illness than it is for adults, so children develop ear infections more often. Some researchers believe that other factors, such as being around cigarette smoke, can contribute to ear infections.
What's happening inside the ear when my child has an ear infection?
When the ears are infected the eustachian tubes become inflamed and swollen. The adenoids can also become infected.
The eustachian tubes are inside the ear. They keep air pressure stable in the ear. These tubes also help supply the ears with fresh air.
The adenoids are located near the eustachian tubes. Adenoids are clumps of cells that fight infections.
Swollen and inflamed eustachian tubes often get clogged with fluid and mucus from a cold. If the fluids plug the openings of the eustachian tubes, air and fluid get trapped inside the ear. These tubes are smaller and straighter in children than they are in adults. This makes it harder for fluid to drain out of the ear and is one reason that children get more ear infections than adults. The infections are usually painful.
Adenoids are located in the throat, near the eustachian tubes. Adenoids can become infected and swollen. They can also block the openings of the eustachian tubes, trapping air and fluid. Just like the eustachian tubes, the adenoids are different in children than in adults. In children, the adenoids are larger, so they can more easily block the opening of the eustachian tube.
Can otitis media affect my child's hearing?
Yes. An ear infection can cause temporary hearing problems. Temporary speech and language problems can happen, too. If left untreated, these problems can become more serious.
An ear infection affects important parts in the ear that help us hear. Sounds around us are collected by the outer ear. Then sound travels to the middle ear, which has three tiny bones and is filled with air. After that, sound moves on to the inner ear. The inner ear is where sounds are turned into electrical signals and sent to the brain. An ear infection affects the whole ear, but especially the middle and inner ear. Hearing is affected because sound cannot get through an ear that is filled with fluid.
How do I know if my child has otitis media?
It is not always easy to know if your child has an ear infection. Sometimes you have to watch carefully. Your child may get an ear infection before he or she has learned how to talk. If your child is not old enough to say, "My ear hurts," you need to look for other signals that there is a problem.
Here are a few signs your child might show you if he or she has otitis media:
- Does she tug or pull at her ears?
- Does he cry more than usual?
- Do you see fluid draining out of her ears?
- Does he have trouble sleeping?
- Can she keep her balance?
- Does he have trouble hearing?
- Does she seem not to respond to quiet sounds?
A child with an ear infection may show you any of these signs. If you see any of them, call a doctor.
What will a doctor do?
Your doctor will examine your child's ear. The doctor can tell you for sure if your child has an ear infection. The doctor may also give your child medicine. Medicines called antibiotics are sometimes given for ear infections. It is important to know how they work. Antibiotics only work against organisms called bacteria, which can cause illness. Antibiotics are not effective against viruses, such as those associated with a cold. In order to be effective, antibiotics must be taken until they are finished. A few days after the medicine starts working, your child may stop pulling on his or her ear and appear to be feeling better. This does not mean the infection is gone. The medicine must still be taken. If not, the bacteria can come back. You need to follow the doctor's directions exactly.
Your doctor may also give your child pain relievers, such as acetaminophen. Medicines such as antihistamines and decongestants do not help in the prevention or treatment of otitis media.
Will my child need surgery?
Some children with otitis media need surgery. The most common surgical treatment involves having small tubes placed inside the ear. This surgery is called a myringotomy. It is recommended when fluids from an ear infection stay in the ear for several months. At that stage, fluid may cause hearing loss and speech problems. A doctor called an otolaryngologist (ear, nose, and throat surgeon) will help you through this process if your child needs an operation. The operation will require anesthesia.
In a myringotomy, a surgeon makes a small opening in the ear drum. Then a tube is placed in the opening. The tube works to relieve pressure in the clogged ear so that the child can hear again. Fluid cannot build up in the ear if the tube is venting it with fresh air.
After a few months, the tubes will fall out on their own. In rare cases, a child may need to have a myringotomy more than once.
Another kind of surgery removes the adenoids. This is called an adenoidectomy. Removing the adenoids has been shown to help some children with otitis media who are between the ages of 4 and 8. We know less about whether this can help children under age 4.
What about children in daycare, pre-school, or school?
Even before your child has an ear infection or needs to take medicine, ask the daycare program or school about their medication policy. Sometimes you will need a note from your doctor for the staff at the school. The note can tell the people at your child's school how and when to give your child medicine if it is needed during school hours. Some schools will not give children medicine. If this is the case at your child's school, ask your doctor how to schedule your child's medicine.
