Hearing is a very complex function. Our ability to hear sounds, to perceive and understand speech, and to appreciate the music depends on various features of the outer, middle and inner ear and the hearing center in the brain. The inner ear is also responsible for the balance. There are several situations that can affect the ear and cause hearing loss and balance problems:
Ear wax ( “cerumen”)
Cerumen is a common problem. It may cause a feeling of blockage or irritation of the ear with synchronous pain. A thin layer of wax in the ear is normal. The large amount of wax may cause the above problems. The wax is cleaned by suction and otological tools through microscopic inspection. This is a simple process and in most cases causes minor discomfort to the patient.
Otitis (infection of the outer or middle ear)
Ear infections are common and can affect the outer ear (ear canal) or the middle ear. Proper diagnosis and treatment are achieved through the medical history and thorough physical examination with appropriate equipment. In rare cases you may have a culture of the ear taken, to demonstrate the pathogen causing the infection.
Ear drum perforation (hole in the eardrum)
The drum perforations may occur from recurrent infections or trauma. Most perforations heal conservatively, but some patients may need surgery to close the perforation. When the perforation of the ear drum does not heal, it can cause recurrent ear infections, and hearing loss. Surgery to close the perforation of the ear drum is called “tympanoplasty”. The operation is performed under general anaesthesia and lasts about one hour (depending on the size of the perforation).
Hearing loss may be due to different causes, but more often in elderly due to the degeneration of the hair cells of the inner ear. This is called presbyacusis. The hearing can most often be improved by using hearing aids. A loud noise can also lead to sudden hearing loss. The prolonged exposure to loud noise could also be detrimental to hearing. The hearing test or tone audiogram shows the extent of hearing loss. In patients with asymmetric sensoneural hearing loss, loss of balance and tinnitus further radiological control by MRI is necessary, to exclude the possibility of an acoustic neurinoma (intracranial benign tumour).
Tinnitus is a common condition. Nearly 10% of people have experienced tinnitus at some stage of their lives. The most common form is a high frequency sound. In some patients, the tinnitus is in a “pulsed” form. In these patients a possible cause of vascular disease should be excluded.
Disorders of balance and dizziness
Dizziness and vertigo may be due to ear problems. The inner ear is a complex balance instrument that detects the position of the head and any of the movements. Dizziness is in some cases a problem of the inner ear and causes rotary vertigo. This is usually associated with nausea and vomiting. There are many common causes of vertigo from the inner ear. These include benign paroxysmal positioning vertigo (BPPV), Meniere’s disease, vestibular neuronitis and viral labyrinthitis.
Dysfunction of eustachian tube
The eustachian tube is a tube that connects the middle ear with the pharynx. Dysfunction of the Eustachian tube can lead to recurrent ear infections and glue ear. The Eustachian tube can be expanded using a balloon after the successful catheterization through the nose. The surgery is performed under general anaesthesia and takes about 15 minutes.