1. Impacted Ear Wax and Blocked Ears
Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.
In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.
Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.
2. External Ear Canal Itch and Pain
Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.
Treatment: Do not try to remove ear wax from your ear.
3. Middle Ear Infections
Cause: Spread of infection during attacks of flu, sinusitis and adeno-tonsillitis, from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in infants and children as their Eustachian tubes are not yet fully developed.
If the eardrum is perforated, bacterial infection can enter from external sources.
Treatment: Treat symptoms of upper respiratory infections and allergies early. Patients with eardrum perforations should keep the ear clean and dry, and have the perforation closed surgically if it fails to heal spontaneously.
4. Sensorineural Hearing Loss
Cause: After age 55, the average ear may gradually start to decline in its ability to hear the high-frequency range by about one decibel a year. Hearing loss can also be caused by exposure to loud noise. This can either be from chronic exposure to loud noise or sudden exposure to extremely loud noise (such as an explosion).
Treatment: Protect ears from exposure to loud noise and infections at all times. Ear mufflers and ear plugs are effective. Protect the ears if there is prolonged exposure to noise above 85 decibels or even short-term exposure to noise above 100 decibels.
5. Tinnitus or Subjective Noise In The Ears
Cause: Tinnitus is where one hears ‘noise’ in the ear when there is none. This happens to about 15% of the population. Occasional brief episodes are common and usually ignored. Possible causes of tinnitus include post-viral infection, blood flow disturbance, nerve damage by loud noise, ototoxic drugs, infections in the ears, or a tumour in the brain, nose or ear. If no cause can be definitively diagnosed, such cases are termed “idiopathic” and are most likely due to a previous viral infection or minor vascular event. When the ear doctor can reassure the patient and exclude any sinister underlying causes, most patients learn to adapt.
Treatment: Treat the cause of the tinnitus, if it is treatable. Avoid exposure to loud noise and certain eartoxic drugs. As tinnitus is often idiopathic, sometimes there’s not much that can be done other than to reassure the patient and, when appropriate, try medication to improve blood flow or vitamin B.