Earwax or cerumen is a normal component of the ear canal. Most of the time cerumen will take care of itself and not require any intervention (nature designed the ears to be “self-cleaning”).
Cotton-tipped applicators or other tools should NEVER be used in the ears.
These will often pack the earwax down further into the ear canal, as well as to risk injury to the eardrum. The condition, called cerumen impaction, may cause a sensation of fullness or that the ear is plugged, partial hearing loss, ringing in the ears, itching and/or drainage.
Cleaning should be done with a cloth, washing the external part of the ear only. For most people home treatments with a few drops of hydrogen peroxide can aid in softening and removal of impacted earwax.
Cleaning can also be done by an otolaryngologist using miniature suction instruments and a microscope. Cerumen removal by an otolaryngologist is preferential for people with narrow ear canals, a perforated eardrum or a PE tube, or if other methods have failed, or for people with diabetes or weakened immune systems.
Itching in the ear is usually due to dryness or irritation of the ear canal. A few drops of mineral oil or baby oil can be used to moisturize the ear. The use of cotton-tipped applicators to clean the ears can cause irritation and itching. They should NOT be used in the ear canal. Itching can also arise from infection, so an exam by an otolaryngologist is warranted if the itching and irritation does not improve or if it progresses.
A perforation (hole) in the eardrum can be caused from an injury or infection. The eardrum (called the tympanic membrane) separates the ear canal from the middle ear. Decreased hearing and occasional discharge often accompany a perforated eardrum. It is generally not a painful condition but does require medical treatment. Many times the hole will heal on its own within a few weeks. During this time, precaution should be taken to keep water from entering the ear, which could cause infection.
Perforations that do not heal on their own may require outpatient surgery. The procedure, called a tympanoplasty, involves grafting skin tissue across the perforated eardrum to allow it to heal. This surgery is typically very successful in repairing the eardrum and improving hearing.
Ringing in the Ears (Tinnitus)
Tinnitus is a ringing, swishing, or other type of noise that seems to originate in the head or ears. The noises may be intermittent or an annoying continuous sound and the pitch can go from a low roar to a high squeal or whine. Tinnitus is defined as a subjective perception of sound by an individual. In most cases, tinnitus is not a serious problem but rather a nuisance that eventually resolves. However, in rare cases tinnitus can be associated with a serious health condition.
Tinnitus is not a disease but rather, a symptom of an underlying condition. Nearly 36 million Americans suffer from this disorder, which may be caused by different parts of the hearing system, the outer ear, the middle ear, the inner ear or by abnormalities in the brain. Excessive earwax, a foreign body in the external ear canal, fluid, infection or disease of the middle ear bones or eardrum can all cause tinnitus. One of the most common causes of tinnitus is due to damage to the microscopic hair cells of the hearing nerve in the inner ear. Prolonged loud noise exposure, some common medications (for example, aspirin) and the normal aging process are all associated with loss of and damage to these nerve endings. In very rare situations, tinnitus can be a symptom of a serious condition such as a brain aneurysm or a brain tumor (acoustic tumor).
Dizziness and Motion Sickness
“Dizziness” is a general term that refers to any problem with balance. The cause can be attributed to a wide variety of problems, including heart problems, blood flow issues, neurologic problems, and inner ear abnormalities. Aging and medications are also common causes of dizziness. In many cases, the ear is not the problem. In fact, inner ear issues represent only a small portion of the causes of dizziness. However, when the ear is involved, the patient will typically experience vertigo.
“Vertigo” is a term that refers to a sense of motion. This can also be referred to as “spinning”, and may be accompanied by nausea and vomiting. Often times, vertigo is caused by a problem of the inner ear or to poor compensation for head/body movement, (i.e., the eyes telling the brain where the body is in space). In many cases, hearing is unaffected. Vertigo usually improves by itself but sometimes therapy can help speed recovery along. Some diseases of the inner ear respond to medications but more often than not, the medications only offer symptomatic relief. In rare instances, benign growths on the balance or hearing nerves can cause vertigo.
A thorough workup for vertigo usually includes a hearing test to evaluate the hearing portion of the inner ear. In many cases, an electronystagmogram (ENG) or a video nystagmogram (VNG) may be ordered. These tests record and analyze a patient’s eye movements in response to various conditions via small electrodes placed on the skin around the eyes (ENG) or by using a video camera mounted inside goggles that the patient wears (VNG). Vertigo can also arise from problems of the brain, which can be attributed to nothing more than normal aging or benign processes, but can also represent issues that are more serious.