Complete Wellness

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The Ins and Outs of Ears

Ears are a very multifunctional and complicated apparatus. Let’s start from the outside and work our way in.

If you have pain, have lost the ability to hear, have a constant ringing in the ear, or have persistent dizziness, please go to a medical professional and have an appropriate examination and work up, as well as an adequate explanation of your symptoms.

The external parts of the ears are terribly useful for holding up your glasses, holding your hair back, or keeping your pencil, and can be an important part of your stylish look by their decoration with earrings.

If you have piercings, you have created a specific wound. You should receive specific instructions for care immediately after the piercing. Our bodies have an amazing ability to heal. In general, if the area is getting more painful, more red, or more swollen, it may be infected. As soon as you recognize this, help your body try to fix it by applying heat. Heat dilates blood vessels, which allows your body to bring in more blood, with white blood cells to fight infection. Rubbing alcohol can sting if put on your piercing, but will really kill germs well. Bactroban Ointment, by prescription, is also useful. Sometimes an infection can get to the point that it requires that you see your medical professional and get a prescription for antibiotics.

The ears, like all holes in the body, have specially protected skin surrounding them. Sometimes, it can look dirty behind the ear, but it’s just that protective wax and a little built up skin. It’s kind of like cradle cap that babies get on their scalps. Put a little baby oil or Vaseline on the area before bath time and gently scrub with a washcloth in the bath. It may take a few days to get it all off. Be gentle. Let the child do it him or herself.

If you have one of those irritating cracks behind the ear, try Vaseline or steroid/hydrocortisone (over the counter or prescription) cream. Don’t dry the area out too much by aggressive cleaning or tons of soap. The skin protects itself with that waxy material. If there seems to be too much of it, soften it with pretty much any ointment or Vaseline you have, leave it on for a while and then gently wipe with a washcloth. Take it easy on this delicate skin. Fortunately the head has fantastic blood flow and that means your body can fight infections there really well and heal quickly.

The ear canal, or external auditory canal, protects itself with wax too. Like most things in life, too much is not good. It is not uncommon for wax to build up and cause pain, fullness and decreased hearing. Sometimes you have no idea that your ear is completely clogged with wax. Q-tips or cotton swabs can smash wax in farther and make the problem worse. Wax softening drops are available in most drug stores and come with those rubber squirt bulbs. You can use regular hydrogen peroxide that’s in that brown bottle under your bathroom sink to do the same thing. What I end up doing in my office is mixing 1:1 hot water and peroxide and using that to flush the ears out. (Another general principle in life is not to do anything that hurts.) You should not do this if you have tubes in your ears or a perforated eardrum. You don’t want to put cold water or anything really hot into this sensitive area. Do not put paper clips or pen caps or anything hard or sharp in your ear, ever. Earwax is yellow to reddish-brown and can look like pus or even blood. Just dab gently, don’t panic, and wait

If you tend to be a waxy kind of person, it is fine to drop a few drops of peroxide into the ears once a week or so. The best time to do this is when you are heated up from exercise or bathing, or something, drop the peroxide into the ears, (you can just use the bottle cap) and then take your bath or shower. It’s OK to use q-tips, just be gentle. This skin has wax to protect it because it is delicate. Be nice. There is a process called ear candling during which a paper cone is placed outside the ear canal and lit on fire causing hot air to draw the wax out. Some people love this, but I’m not a huge fan of putting fire near the head and hair. Some doctors use a tiny vacuum to such the wax out or a special spoon to pull it out. Any of these methods can work but the gentler the better.

I’ve pulled live moths out of ear canals, flushed live spiders out and pulled chewing gum and tiny toys, too. The external auditory canal doesn’t go any farther than the eardrum. A bug can’t go into your brain

The ear canal frequently gets water in it. There’s a great trick to get it out if the usual hopping on one foot and smacking yourself in the head doesn’t work. A few drops of rubbing alcohol in the ear will decrease the surface tension in the trapped water and let it come right out. (It also make you shiver….Woo hoo!) Stores sell Swim-Ear and similar products to accomplish this, but they are no better than what you can make at home with alcohol and plain white kitchen vinegar. The alcohol dries and the vinegar creates and acidic environment to prevent growth of yeast. Keeping the ear canal dry, without stripping the wax completely, is an important way to prevent swimmers ear. After swimming, especially in natural water, I recommend a few drops of alcohol, with or without the vinegar, in the ears to keep them dry. If your ear canals are irritated or infected, the alcohol will burn a little. Sorry.
Swimmers ear is an infection in the ear canal and can be quite painful. It is one of the few circumstances in which makes doctors prescribe pain medications for children. It can be easily treated with antibiotic drops and doesn’t usually require them to be taken by mouth. If the infection has gotten really bad and has gotten into the soft tissues, causing pain behind the ear and fever, then oral antibiotics may be necessary. Before the age of antibiotics, this led to mastoiditis, an infection in the big heavy bone right behind the ear. Mastoiditis is a serious infection and might even need surgery to drain the infection from the bone. Fortunately, it is rare these days.

Deep in the ear canal is the eardrum or tympanic membrane. This is a minimally transparent membrane that vibrates with sound, which moves tiny bones, the smallest in the body, attached to nerves, which transmit signals to the brain that gets interpreted as words, music or whatever. When we speak of “ear infections” and usually mean infections of the middle ear. This is called otitis media. Otitis media is very common in children and gets less common as we get older as the Eustachian tube that drains the middle ear gets bigger and less likely to swell shut.

Ear infections in children usually resolve on their own. Children have tremendous immune systems and can fight off infection really well. Medical convention has changed over time from immediate treatment with antibiotics by mouth, to watchful waiting for a day or two, to trying not to treat at all. What is done depends in large part on how your child is doing. We might be more eager to give antibiotics to a child who is miserable with pain and fever. Eardrops don’t reach the middle ear so the medicine must be given by mouth.

Young children who are learning to speak need to be able to hear sound well. If a child has multiple recurrent infections or one that just won’t go away it can impact hearing during this critical time. Evaluation by an ENT, Ear, Nose and Throat doctor might be necessary to consider the possibility of tubes placed in the eardrum to allow drainage and resolution of the infection. In some cases, the fluid behind the eardrum can get thick and cause what is called a “glue ear”. You can imagine that the little bones that have to vibrate to send signals to the brain might not be able to do so if they are stuck in glue. Maybe your child is ignoring you and maybe he or she just can’t hear you.

Adults can get otitis media as well, and it is sometimes associated with sinus infections or even conjunctivitis, or pink eye. All these drainage tubes end up flowing into the same area behind the nose and mouth so it is easy for the infections to travel from one area to another. That also means, if you have conjunctivitis it is a good idea to have someone check your ears, especially if you are feeling sick.

Younger children don’t tend to get sinus infections because we are born without sinuses and those cavities or spaces develop as our skulls grow.

Adults can also have hearing problems with middle ear infections, just like kids. There are times when the fluid in the middle can become thickened and either prevent movement of the tiny bones or the little nerves that send signals to your brain. These hair cells each correspond to a specific vibration and kind of behave like the keys of an electronic keyboard. There are some viral infections that can cause a key on that keyboard to be stuck down, causing a constant tone. We call this a “ringing in the ear”, or tinnitus. This constant ringing can be quiet, but annoyingly insistent, or for others, it can be a major interference in life. For most, it is on the annoying end of the spectrum most of the time. The most difficult time is in the quiet of night when you’re trying to get to sleep. The most commonly recommended technique is to sleep with the non-ringing ear off the pillow, so it gets some noise input, to distract your brain from the ringing. Background noise, like a radio between stations or one of those environment sounds machines can be very helpful.

Sometimes, viral infections or other inflammatory processes can lead to hearing loss that doesn’t have anything to do with the fluid being thick. This can lead to a fairly abrupt, and usually irreversible loss of hearing. Thankfully, it is usually just in one ear, but still can be scary. If you lose hearing and it isn’t obviously associated with a wax plug or fluid in the middle ear, please see a medical professional ASAP. You should probably see a specialist before resigning yourself to permanent hearing loss

The inner ear is even deeper inside and is separated from the middle ear with another one of those membranes, kind of like the eardrum. The inner ear is responsible for balance. Have you ever been tumbled by a wave in the sea and couldn’t really tell which way was up when you stopped tumbling? That is because there are little grains of sand that float to the bottom of a small fluid filled sac in the inner ear and let you know which way is down. When you tilt your head the little grains shift in the sac to keep you oriented. It reminds me of a snow globe. Coming off of this sac are tunnels oriented at a couple of different angles to help with rotation. When you sit in one of those spinning chairs and spin around a few times, the fluid gets to spinning like the tea in a cup that you’ve stirred. When you stop spinning, it takes a few seconds for the fluid to stop, so your brain thinks you’re still moving and you can stand up and walk straight till the fluid stops.

Vertigo occurs when your inner ear is stimulated to signal your brain that there is rotational movement. Feeling lightheaded or woozy is not vertigo. Being a bit unsteady on your feet is not vertigo. Vertigo specifically means a sensation of you and or the room spinning. Sometimes this can happen due to an infection in the middle or inner ear or more usually, because on of those little gravity grains has gotten in the wrong place and ends up in the semicircular canal, that little tunnel, and is stimulating is to tell your brain that you are spinning. (I don’t think anyone understand why too much alcohol makes the room spin, but it is for sure that if that is happening you’ve drunk too much and have poisoned yourself a little bit.)

Usually vertigo is worse if you move, even sometimes just turning your head or rolling over in bed can set it off. You can imagine that if you have that little pebble just sitting still in the canal, it is not causing any signals to be sent, but when you rotate your head, even a little, it touches those sensitive nerves and fires off those nerves. Keeping still is the best way to stay comfortable. When your brains gets to spinning, it can make you miserable with nausea and vomiting.

There is a simple maneuver which can be very helpful if you are having this kind of vertigo. If you can lie on your side, the side that makes you most dizzy, and then roll slowly till you are face down, you can let the little grain of sand get to the mouth of the tunnel in which it is stuck. Then, slowly push yourself straight up, and let the grain fall back into the sac where it is supposed to be.
This is called the Eply maneuver. It is totally safe and can be done as often as you need. Generally, I recommend staying upright after doing this so that the sand grain doesn’t jut fall back into the tunnel. If it doesn’t work, see a doctor. In the meantime, keep still and try to make sure you don’t get dehydrated if you’re having trouble with nausea. (See “Dehydration”.)




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