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The Not So Normal Ear
    by Gordon Whitehead, B.S., MA., Aud(C), Audiologist

    This paper has been recommended by Digital Recordings as suggested reading for their AUDIO-CD product.


Ear Problems

The marvellous human ear that functions so well for so many people throughout their lives, also has the potential of not working well, particularly if it is abused by a significant number of damaging agents. Let's consider some of the problems that can be encountered in the not so normal ear. Some problems related to the ear:

  • Hearing loss. This is the situation in which the listener is not able to hear until the intensity of sound has been increased beyond that which is normally required. Hearing loss can be temporary or permanent. Hearing loss can involve the mechanical, or "conductive" portion of the outer and/or middle ears, or the "sensori- neural," or electrical portion of the inner ear, the eighth nerve or the brain. Hearing losses can be mild, moderate, severe, or profound in nature.

  • Speech discrimination (word recognition) difficulties. Some types of damage to the ear may cause not only hearing loss, but also a problem in understanding what is heard, even when it is loud enough to hear comfortably. This problem is usually, but not always, associated with sensorineural hearing loss where the malfunction is in the inner ear, the eighth nerve, or the brain.

  • Recruitment. Recruitment is a narne that describes a significant problem in tolerating louder sounds. A person with a hearing loss may have such a severe tolerance problem, that once sound has been amplified just enough to overcome their hearing loss, they found it too loud to tolerate. This problem is usually, but not always, associated with sensorineural hearing loss where the malfunction is in the inner ear.

  • Tinnitus. Tinnitus is the presence of a noise that is perceived as being in the head or in the ears, even when no noise is actually present. Tinnitus can be ever- present, or transient in nature. It can be very quiet, or extremely loud. It may sound like a whistle, hum, buzz, wind, or have other characteristics. This problem is usually, but not always, associated with sensorineural hearing loss, especially with the malfunction in the inner ear. Excessive exposure to intense noise is the most common causal factor. Tinnitus may just be a nuisance, or it can be quite distracting, or it can routinely interfere with sleep, or it can lead to suicide ...

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Some Causes and "Cures" of Ear Problems

The Outer Ear

Most of the problems encountered with the outer ear are transient in nature, and frequently relate to mechanical blockage of the ear canal. The ear canal can be blocked, or occluded, by such things as excessive accumulation of cerwnen (earwax), swelling of the lining of the ear canal from a skin infection or space occupying lesion such as a cyst, or the presence of a foreign object.

Sometimes a child is born without normal outer ear structures, even though the nerve function of the ear may be normal.

In all cases, a problem in the outer ear requires medical attention, preferably from a good ear specialist (usually called an otologist, or ENT doctor). The physical structures of the ear can be easily (and permanently) damaged; home remedies should be avoided. This is particularly true of the removal of excessive ear wax. It is extremely common for clinics to see patients who have attempted to clean their ears improperly, frequently with cotton swabs. Your grandmother was right; never put anything smaller than your elbow (or at the very least, your finger) in your ear canal.

Most of the conductive hearing problems in the outer ear can be corrected with the appropriate medical and/or surgical attention.

The Middle Ear

Middle ear problems can be of varied causes, but the two most commonly experienced are middle ear "Infections," and abnormalities of the bone structure in the middle ear.

It is common for the Eustachian tube to block. Many people have experienced a "muffled" sensation when they sniff hard when their nose is runny. Usually the Eustachian tube pops open in a few minutes, and everything is back to normal. This can also occur when flying, especially when landing. If the Eustachian tube does not open, fluid begins to collect in the middle ear space; once fluid is against the back of the eardrum, it cannot move well, and temporary hearing loss occurs. The fluid can be quite benign, or it can become infected. These conditions should be treated medically and/or surgically by a good ear specialist.

Diseases of the bones, the ossicles, in the middle ear are not uncommon. The best known is otosclerosis, where bony growth fuses the three bones together, or to the wall of the middle ear so that mobility is impaired.

Most of the conductive hearing problems in the middle ear can be corrected with the appropriate medical and/or surgical attention.

The Inner Ear

The performance of the inner ear can be affected by numerous malfunctions. By far the most common cause of permanent hearing loss where the damage is in the inner ear, is excessive exposure to intense noise. We live in a very noisy world. We abuse our ears unmercifully, both in the work enviromnent, and at home or with recreational pursuits. Loud music, power tools, snowmobiles, firearms, chainsaws, motorcycles, monster trucks ... The list of ways to abuse our ears is constantly growing, and many of us are not intelligent enough to recognize the fact that we are causing irreparable damage to our hearing. If you fit in this category, enjoy yourself, because you will soon no longer be able to enjoy activities that require hearing.

Excessive exposure to intense noise can, and will, cause permanent sensorineural hearing loss, and probably tinnitus. The sad fact is that this permanent type of hearing loss is 99.9% preventable, if we use the appropriate kind of ear protection for the noise encountered!

You use seat belts. You use eye protection. You use safety shoes. You use a hardhat. You use gloves. Why not ear protection?? Ask your audiologist for a specific recommendation for the type of noise you encounter.

There is no medical or surgical correction for this sensorineural hearing loss. A hearing aid might help somewhat. You blew it! You live with it! No longer enjoy music. No longer enjoy hearing birds. No longer enjoy hearing streams or brooks. No longer enjoy hearing nature sounds. No longer easily hearing firiends talking. Or your kids or grandkids. Or the telephone. Or the telephone ring. Or television without blasting everyone else out of the house. No longer do your job? ...

The inner ear can also be damaged by head injury, and disease processes such as Meniere's disease. These require medical/surgical attention.

The Eight Nerve

Eighth nerve problems, though not rare, are also not that common. They can be serious, or even life-threatening. The two most common problems that can affect the functioning of the eighth nerve are head injury, and tumours along the nerve. If diagnosed early, medical/surgical attention can be quite effective. If hearing loss, and/or speech discrimination problems, and/or balance problems are noted, seek help from an audiologist and an ear doctor.

The Brain

There are many types of head injuries and disease processes that can affect brain function. Some are more successfully treatable than others. If hearing loss, and/or speech discrimination problems, and/or balance problems, and/or headaches, and/or auditory processing problems are evident, seek medical attention.

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Closing Remarks

There are many "causes" and "cures" for problems related to the ear. The above material is a simple, elementary review of the most common causes and cures. The reader who has specific, or more technical questions, or wants to delve more deeply into these aspects of the auditory system, may contact us for more detailed information. If you suspect that you or someone you know is experiencing what may be one of these problems, do not delay seeking a professional opinion from an audiologist and an ear doctor.

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