The ear (inner, middle and outer) is responsible both for the sense of hearing and for equilibrium. The outer and middle ear transfers sound waves to the inner ear. The vestibulocochlear organ in the inner ear is involved with reception of sound as well as maintaining balance (equilibrium).
Therefore, conditions affecting the inner ear can present with symptoms related to hearing as well balance. However, most disorders involving the middle and outer ear may only impair hearing, although in severe cases, pain impulses may disrupt the sensory input from the vestibulocochlear organ.
Most ear problems will present with one or more of the following :
- Functional disturbances – hearing and/or balance
Ear Disorders Signs and Symptoms
Otalgia is the medical term for ear pain or earache. It is usually when the pain stems from the outer and middle ear that it is described as an earache by a patient. Most people associate a painful condition of the inner ear with a headache.
Causes and Symptoms
Inflammation of the middle and outer ear, otitis media and otitis externa respectively, are often due to infections or trauma. Infectious causes tend to present with additional symptoms like an ear discharge, which is usually purulent and often presenting with an offensive odor. When affected, the outer ear becomes red and swollen. Allergic causes, especially in cases of ear piercings and earrings made of certain metals, need to be excluded.
Most cases of otitis externa and media are acute. However, recurrent cases, particularly in children may lead to more long term effects such as impairing the hearing or even extend to the inner ear and disrupt the sense of balance.
Inflammation and infection of the outer ear, particularly the ear canal, is known as swimmer’s ear or otitis externa. This tends to result in an itchy ear as well as swelling and redness of the pinna of the ear may also be present. Discharge is more frequently seen in infections.
Causes and Symptoms
Itching (pruritis) of the ear due to otitis externa is caused primarily by irritation with foreign objects like a cotton ear swabs, hair pins, pens/pencils and matchsticks. The accumulation of water, dust or dirt, sand and other foreign particles that can enter the ear may also be responsible. An allergic reaction may occur or an infection may arise. Certain itchy skin conditions like psoriasis and eczema may also be responsible for itching of the ear canal.
Acute infections are mainly due to bacteria but persistent ear itching may be related to a fungal infection. This is known as otomycosis and most cases are due to the Aspergillus spp of fungi, with the Candida spp causing a minority of fungal ear infections. Ear discharge (purulent) with pain, swelling and redness tends to occur in bacterial infections along with the itching. With fungal infections, a persistent itch and watery discharge (serous), which is often referred to as ‘water in the ears’, are more frequently present.
Ear discharge (otorrhea) may be due to a number of infectious and non-infectious causes. The nature of the discharge may help to indicate the cause.
Watery or serous discharge may be due to local inflammation and sometimes due to fungal infections. More purulent discharge, which is often yellow to brown with an offensive odor, may arise with bacterial infections. A more sticky, mucoid discharge is seen with a CSF leak and perforated eardrum. Blood-tinged discharge may be seen in more severe infections and injury.
The causes of ear secretions and associated symptoms are discussed further under Ear Discharge.
Disorders affecting the hearing may either present as partial or complete hearing loss (deafness) or tinnitus.
Causes of Hearing Loss
Most cases of hearing loss are due to conductive disturbances. The passage of sounds waves are either obstructed within the ear canal or the transmission across the middle ear is impaired. Depending on the cause, the appropriate treatment may allow for a complete restoration of the hearing ability. The buildup and impaction of earwax, trauma, infections (acute or chronic) and fluid build up in the middle ear (effusion) are more common causes of conductive hearing loss.
Sensorineural causes of hearing loss involve the inner ear or brain and are usually, but not always, permanent. Implants and more invasive procedures may help to restore hearing. Birth defects (prenatal infection, injury during childbirth, and genetic disorders), infections particularly in childhood and age-related degeneration (presbycusis / presbyacusis) are more frequent causes of this type of hearing loss. Sudden, unilateral hearing loss may be related to conditions like a stroke.
Causes of Tinnitus
Tinnitus is a subject sensory perception of sound which is typically ringing or ‘swooshing’ in nature in the absence of any auditory stimulus. It may be accompanied by hearing loss. The causes of tinnitus are discussed further under Ringing Sounds in the Ears.
Dizziness and Vertigo
Differentiating between vertigo and dizziness (lightheadedness) is often difficult and it is not uncommon for patients to use the terms synonymously.
Causes of Vertigo
Vertigo is the subjective sensation of the surroundings moving or spinning. It is a symptom of inner ear disease (peripheral) or disorders associated with the brain (central). The cause of many cases of vertigo are unknown (idiopathic) although peripheral vertigo may be related to infection, trauma or chemical irritation of the semicircular canals. Central vertigo may be seen in conditions like multiple sclerosis or strokes.
Causes of Dizziness
Dizziness usually refers to feeling lightheaded where the patient feels unsteady similar to the sensation felt before fainting. The causes of dizziness may be due to a wide range of conditions, many of which do not involve the ear, example : low blood sugar, sudden drop in blood pressure, alcohol and certain drugs. However, many of the causes of peripheral vertigo may result in a lightheaded feeling without the typical vertigo sensation, especially in milder cases.