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Ear, nose and throat

Consultants

Otology

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Otology is the ENT subspeciality dealing with the anatomy, physiology and diseases of the ear.

 

These conditions can cause infections, hearing loss, hypersensitivity to “normal” environmental sounds…
 
Among the most frequent problems are:

 

  • Tinnitus (ringing in the ears)
  • Otitis
  • Hearing loss

 
 

 
 

Tinnitus (noises in the ear)

This is a buzzing or ringing sound in the ears.

 
 

Risk Factors
  • Hearing loss
  • Ear infections
  • Exposure to loud noises
  • Earwax plugs
  • Tumours
  • Ototoxic medication (some antibiotics, quinine, aspirin)
  • Head injury with associated fracture
  • Hypertension, temporomandibular joint dysfunction

 
 

Symptoms
  • Patients describe this as hearing noises in their ear.
  • It can be perceived as a humming sound, beeping or a sensation of noise coming from the electricity mains.
  • It sometimes interferes with sleep at night and may limit quality of life. Patients with tinnitus often have hyperacusis (every day sounds are annoying and seem much louder than they should).
  • Loud noises and stress often worsen symptoms.

 
 

Diagnosis
  • Diagnosis is clinical with a complete examination of the ear ruling out other associated conditions.
  • If it is in only one ear and the noise is pulsatile, an imaging test such as MRI of the ears is required to rule out a tumour in the auditory nerve, or a CT scan in the case of a history of trauma prior to the tinnitus.

 
 

Treatment
  • There is no effective drug treatment.
  • Management of tinnitus is aimed at improving the impact on the patient’s quality of life. Avoiding quiet environments by using background music, television or radio are some of the measures which may be effective.
  • If there is no associated hearing loss, sound generators may be used, small electronic devices with white noise that are placed in the ears for 6-8 hours.

Otitis

Otitis is an inflammation of the ear, most of the time it is as a result of infection. It may only be in the outermost part (external auditory canal) or the middle ear.

 
 

otitis externa aguda

Acute Otitis Externa (swimmer’s ear)

This is an infection of the skin of the external auditory canal, germs enter from outside. It is quite common in children during the summer months due to water entering whilst swimming in the pool or the sea increasing humidity and the proliferation of bacteria, the most common one being Pseudomonas aeruginosa.
 

  • Spring-summer months
  • Swimming in the pool
  • Excessive and aggressive cleaning of the ear (earwax protects and prevents the growth of bacteria)

 

otitis media

Acute Otitis Media

This is a frequent complication of colds, so more common in winter.

The bacteria come from inside the nose or mouth, the most common being Streptococcus pneumoniae and Haemophilus influenzae, less common being Branhamella catarrhalis, Streptococcus group A and Staphylococcus aureus. Viruses such as Respiratory Syncytial Virus, rhinovirus and adenovirus (all responsible for the common cold) or the influenza virus (flu) may also be involved.

When starting with a cold, mucus accumulates in the middle ear, facilitating the growth of bacteria.

If a lot of mucus builds up, due to high pressure, the eardrum becomes perforated and mucus escapes to the outside (Suppurative Otitis Media).
 

Risk Factors
  • Age < 2
  • Nursery attendance
  • No breastfeeding
  • Exposure to tobacco smoke
  • Winter months
  • History of respiratory infections
  • Genetics, immunodeficiencies

 
 

Symptoms
  • Pain
  • Itching
  • Fever
  • Otorrhea (discharge)
  • Hearing loss
  • Inconsolable crying and irritability in infants

 
 

Diagnosis
  • Clinical history and otoscope examination of the external auditory canal and tympanic membrane.
  • Audiometry may be useful in assessing the level of associated hearing loss.

 
 

Treatment
  • The usual treatment for otitis is oral antibiotics for 10 or 14 days in cases of acute otitis media. Symptoms improve significantly within 48 hours. Nasal decongestants and mucolytic decongestants are sometimes added to antibiotic treatment.

    •  

  • Any patient with recurrent otitis media (at least 3 episodes in 6 months or 4 in 1 year) should be assessed by an ENT specialist to evaluate the need for drainage (tympanostomy tubes) through the tympanic membrane so that mucus accumulated in the middle ear can escape.

    •  

  • In cases of otitis externa, treatment is topical antibiotics (drops) for 7-10 days and anti-inflammatory medication for the pain. It is also important to prevent water entering the ear by using ear plugs whilst in the bath during the acute phase and in a preventative way when there is recurrent otitis externa.

Hearing loss

Hearing loss is a particularly frequent problem, especially in the elderly, with a significant impact on the patient’s quality of life. A late diagnosis can have serious consequences such as social isolation and progressive deterioration of the patient’s general health. In childhood, delayed diagnosis causes developmental problems.

 

Degrees of hearing loss:
Mild: difficulty hearing soft sounds and following conversations with a lot of background noise.

Moderate. Difficulty hearing loud, and soft sounds. When there is background noise, it is hard to understand the conversations.

Severe: To follow a conversation, speech must be very loud.

Profound: Communication is impossible without the help of a hearing aid or implant.
 

There are three types of hearing loss:

  • Conductive: Hearing loss occurs when damage to the outer or middle ear blocks sound vibrations to the inner ear, or the cochlea (for example, by a plug of earwax). With this type of hearing loss, your ears may feel blocked and speech may sound muffled, especially if there is a lot of background noise.
  • Sensorineural: Sensorineural hearing loss occurs when the inner ear (cochlea) or auditory nerve is damaged or not functioning properly. With sensorineural hearing loss, sounds are not only muffled, but are also difficult to understand, especially when there is noise. An example of this type of hearing loss would be presbycusis, the hearing loss caused by age-related degenerative changes.
  • Mixed: This is a combination of the above. This means that there may be damage to either the outer ear, middle ear and/or inner ear.

 
 

Risk Factors
  • Age: >65.
  • Noise. Chronic exposure to loud noises can lead to hearing loss.
  • Hereditary factors
  • Untreated infections such as otitis
  • Otosclerosis (disease that affects the mobility of the bones in the middle ear, reducing efficiency in transmission of vibrations)
  • Ototoxic agents (some medications, alcohol, and tobacco can damage the ear)

 
 

Symptoms
  • Perceiving sounds to be too loud when in reality they are not
  • Difficulty following conversations when two or more people are talking or there is background noise
  • Difficulty differentiating high pitched sounds from each other
  • Dizziness or loss of balance
  • A feeling of pressure in the ear
  • Constant buzzing
  • Asking others to speak louder
  • Not participating in conversations
  • Needing to turn up the radio or TV volume

 
 

Diagnosis
  • The longer it takes to diagnose, the greater the hearing loss usually is and the more difficult it is to slow it down and adapt to hearing aids or auditory implants, hence the importance of an early diagnosis. Diagnosis is made using medical history, examination and hearing tests such as audiometry and impedanciometry.

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  • Audiometry: This is a written record of hearing levels. It measures the quietest sounds that the patient can hear in decibels at different frequencies (from a low of 500 HZ to a high of  8000 HZ). It requires active patient participation.

    •  

  • Impedanciometry: This test is performed to evaluate how the middle ear functions in response to sound stimulation, the mobility and integrity of the tympanic membrane and the continuity of the bone chain of the middle ear (hammer, stapes, and anvil). It is carried out using a probe which is inserted into the outer ear, active patient involvement is not required unlike audiometry.

 
 

Treatment
  • Depending on the type of hearing loss, treatment may be a hearing aid, surgery or auditory implants.

Aesthetic surgery of the ear (otoplasty)

This procedure is performed on an outpatient basis or in a hospital. It can be performed under local anaesthetic in less than 2 hours. In children it should be done from the age of 5 or 6, when the ear has almost finished growing.

 

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