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Edward Chisholm – Otolaryngology ENT SpecialistEar infections- otitis media and otitis externa can cause painful and itchy ears. The skin can become so swollen that the ear canal closes, causing temporary deafness, and there can be a scanty discharge from the ear.
It can affect both ears and often keeps recurring, especially if you are otherwise rundown or stressed. Treatment for outer ear infections is generally in the form of antibiotic ear drops which are instilled into the ear canal for at least a week. Longer term problems can occur when such infections are frequent, because there can be damage to the eardrum, or perhaps persistent deafness due to fluid remaining behind the eardrum (glue ear).
A second but more serious form of middle ear infection is when it becomes chronic or long-lasting. Other significant symptoms such as tinnitus, weakness of the face or dizziness can occasionally occur.
Mastoid abscess behind the ear Infections of the inner ear are fortunately less common and are generally caused by viruses, although occasionally by secondary bacterial infection. The common cold virus is perhaps the most common cause of inner ear infections but many other viruses have also been associated with sudden deafness such as mumps, measles and herpes.
Glue Ear ( Secretory Otitis Media with effusion) is a build-up of fluid behind the eardrum, in the middle ear causing conductive hearing loss-deafness.
Common reasons for persistent glue ear in children are due to large adenoids at the back of the nose. Sometimes deafness is not suspected, but the child is thought to be inattentive, slow or lazy. The fluid frequently goes away by itself, so a policy of watchful waiting is usually advised.
Other medical treatments including antihistamines steroids, medicines to try and thin sticky mucus have all been used. It is very delicate and normally done under general anesthetic (patient fully asleep) the anesthetic is usually given by injection into a vein in the back of the hand, or by gas.
Children recover very rapidly from grommets insertion and should be able to return to school after a day or two. The hearing normally improves immediately, but don\’t worry if there is still some difficulty in the first weeks as it can take time in some cases.

There may be a very slight earache, treated easily with Calpol or paracetamol for older children.
Dr Paulose FRCS, DLO is a Consultant ENT Plastic & Laser Surgeon with over 38 years of world class experience in Ear, Nose, Throat and Laser Surgery treating patients across the world from UK, US, Middle East to Asia.
The clinical significance of cochlear otosclerosis has been in question for a long time and the exact relationship between cochlear otosclerosis and degeneration of cochlear structures remains controversial. It occurs commonly in people who suffer from skin problems such as eczema, psoriasis or dermatitis but also in people with narrow ear canals or who swim a great deal.
The most common is acute otitis media which is characterised by a severe earache and high temperature, generally in a child, with associated deafness.
Happily, the eardrum almost always heals once the infection settles and the hearing also returns to normal.
Generally, chronic middle ear disease is associated with a smelly ear discharge and deafness, but rarely with pain. In these cases referral to an ear nose and throat surgeon is very important as the treatment usually involves surgery to remove the infection from the middle ear and mastoid bone. It is much less common than in previous decades, but certainly still occurs, especially in toddlers, and it needs urgent treatment with antibiotics once the child is admitted to hospital. Blowing up balloons to try and force air up the Eustachian tube, may help but the published results are very short term and not many children will persist with this treatment.
The decision to operate is always individual, based on all the factors in that particular case. It is fitted through a small cut in the eardrum (myringotomy).The tension of the eardrum grips the grommet around its waist. To prevent the needle from hurting, a local anesthetic cream is applied about an hour beforehand. A small cut (myringotomy) is made in the eardrum, and the fluid in the middle ear is sucked out.
Many investigators have examined the relationship between degenerative changes in the cochlear structures and hearing loss associated with otosclerosis .
Generally, outer ear infections are caused by a bacterial infection of the skin of the canal, although occasionally it may be due to a fungus or yeast.

In severe cases referral to an ear nose and throat specialist is both necessary and appropriate for cleaning of the ear canal and more intensive treatment. Either way it stops the ear drum and ossicles vibrating easily, so quieter sounds are not heard. Occasionally glue ear is caused by flying with a cold a€“ the Eustachian tube is unable to equalize pressure during descent .Diving with a cold is very likely to cause glue ear. It is known that otosclerosis alone is not a certain reason to explain either the degeneration of cochlear structures or sensorineural hearing loss, though extensive cochlear otosclerosis has been associated with sensorineural hearing loss.
Removal of the adenoids may be recommended if the adenoids are enlarged, and where glue ear recurs after initial grommet insertion. It is important to understand that a grommet does not cure the underlying cause of glue ear. If the eardrum is badly thinned, stretched and damaged, it might not have the strength to hold a standard grommet in place.
Despite the fact that the round window is a common site for otosclerotic lesion, there are few studies which have focused on this site. Provided the grommet remains in position and is not blocked, the hearing returns to normal almost immediately. A grommet does provide highly effective and immediate relief of deafness and earaches, while it is in position and working. For hair washing, either use earplugs, or a piece of cotton wool dipped in Vaseline to provide a waterproof seal.
While they indicated no reaction or mild degeneration in the spiral ligament, they reported outer hair cell loss in these cases. The relationship between the extent and site of cochlear otosclerosis and damage to sites specific cochlear structures has yet to be examined.
We speculate that the effects on cochlear structures are different in otosclerotic lesions around the round window as compared with those around the oval window.

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