DISEASE OF EAR

DISEASE OF EAR :

Importance of Ear Wax (Cerumen)

• Traps debris and microorganisms so they can migrate their way out of the ear canal
• Contains immunoglobulins important for immunity
• Provides moisture for the tympanic membrane, which helps keep it pliable.

Blockages in the external ear canal

Blockages in the external ear canal may affect hearing. They are usually caused by wax, although there may be rarer causes (see below under Otitis Externa). The ear makes wax in order to clean itself and keep the outer ear free from moisture. The wax normally falls out of the ear on its own. For copious wax flows, a doctor visit may be needed periodically to have it removed.

Basic rules for removing ear wax: Never push cotton buds, fingers or anything else into the ears. Why? You will push any wax there is onto the eardrum. This could cause pain, infection and loss of hearing. At worst you could burst the eardrum. It is best to ask the doctor to check the ears and clean them if you think you have a continual wax build-up.

PROBLEMS OF THE OUTER EAR :

· Otitis externa

Otitis externa occurs when the skin of the ear canal becomes inflamed. This may happen due to any of the following conditions:

ü The lining or the outer ear canal has been irritated by scratching or continual Q-tip (cotton bud) use

ü A skin condition such as eczema

ü A fungal infection is present

ü A bacterial infection is present

ü A viral infection is present

Otitis Externa is also associated with high humidity, warmer temperatures, swimming, local trauma, and hearing aid use or hearing protector use.

· Perforated ear drum

Perforated eardrums from internal causes (pressure pushing out on the ear drum) are caused by middle ear infections (viral or bacterial - otitis media) In most cases, a burst eardrum from a middle ear infection will heal on its own within about two months. However, if an item such as cotton bud, pencil, or sharp object caused the burst eardrum, a trip to your family doctor is mandatory. Your doctor will probably clean the ear carefully give you an antibiotic shot and antibiotic ear drops, then prescribe antibiotic tablets for a 10 day regimen. In severe cases, you may be referred to an ENT specialist (Ear, nose, Throat specialist).

PROBLEMS OF THE MIDDLE EAR :

· Otitis media

Otitis media is an infection or inflammation of the middle ear usually caused by a viral or bacterial infection.

Symptoms
Some of the symptoms of middle ear infection include:

ü Earache

ü Headache

ü Fever

ü Discharge from the ear

ü Mild deafness

ü Difficulties in sleeping

ü Loss of appetite

· Glue ear and burst eardrum in children

The medical term is otitis media with effusion - a condition in which a sticky glue-like fluid builds up in the middle ear chamber. It is a very common condition that affects mainly young children aged between two and five years. In most children, glue ear clears up on its own. However, up to 5% of children get persistent glue ear, which if left untreated, can cause long term hearing loss. Physicians call glue ear 'otitis media with effusion', 'secretory otitis media' or 'chronic secretory otitis media'.

· Burst eardrum in adults

An external cause for a burst eardrum is a head trauma such as a blow to the ear or an object penetrating the ear canal and penetrating the eardrum. An immediate trip to the emergency room is mandatory. The ER nurse or doctor will clean the ear carefully give you an antibiotic shot and antibiotic ear drops, then prescribe antibiotic tablets for a 10 day regimen. In severe cases, you may be referred to an ENT specialist (Ear, nose, Throat specialist).

· Mastoid infection

· Cholesteatoma

· Damaged ossicles

Trauma, serious infections and head injuries can damage one or all three of the bones that make up the ossicles. also babies are sometimes born with malformed ossicles. They can be repaired or replaced by having an operation called an ossiculoplasty.

· Otosclerosis

The last bone in the vibration chain in the middle ear is the stapes. It is attached to the cochlea at the oval window. Otosclerosis is a metabolic imbalance condition that causes new bone to grow over the end of the stapes, where it connects to the cochlea. This leads to a reduction in movement and eventually the bone becomes fixed as no vibration occurs, causing the elimination of transfer of sound to the inner ear and permanent hearing loss.

PROBLEMS OF THE INNER EAR :

· Sensorineural hard of hearing and nerve damage

Sensorineural hearing loss is most often the result of damage to tiny hair cells in the cochlea. These hair cells cannot be replaced. This damage may happen from the following causes:

ü Naturally, as you grow older (Presbyacusis). Hearing aids will be helpful in this situation.

ü If you have a disease such as mumps or meningitis.

ü If you have to take certain strong drugs - in particular aspirin in very high doses, or antibiotics called aminoglycosides (i.e. streptomycin and gentamycin)

ü If you are exposed to loud noise for a long time. (By law, if you work somewhere very noisy you must be provided with earplugs or muffs to protect the hearing)

ü If you have had a serious head injury with a skull fracture.

ü Before a baby is born - for example, if the mother has rubella (German measles) while she is pregnant.

ü If a baby is born prematurely or if the mother has a difficult labor.

ü Sensorineural hard of hearing from birth may also be genetic. It is common for people in one family to have the same pattern of hearing loss as they get older.

· Tinnitus

Another symptom that is sometimes associated with true vertigo is tinnitus. Tinnitus is noise in the ear that may be heard on and off, continuously or in a pulsation form. This noise may be buzzing, ringing, roaring, whistling or hissing. It often goes with many ear disorders, including Ménière's Disease (see below), infections such as an inflammation of the middle ear (otitis media), or inflammation of the internal ear (labrynthitis), eustachian tube obstruction or noise-induced hearing loss.

· Vertigo

The symptoms of true vertigo may include a very strong feeling that you are moving or spinning when you are actually still or that the room is moving about you. This illusion may make you feel like you are spinning and circling. This feeling may become worse when you move your head, and it may make you feel nauseated or even make you vomit. These episodes of vertigo usually come and go; and are not constant.

ü Sense of movement

ü An illusion of spinning and circling

ü Worsened with head movements

ü Nausea/vomiting

ü Episodes come and go

ü Rhythmic Eye Movement (Nystagmus)

· Menieres disease

Ménière's Disease is an inner ear disorder that brings spontaneous episodes of vertigo that can last minutes to hours. Along with the vertigo, there may be some hearing loss in the affected ear that comes and goes, as well as an increase in tinnitus and a sense of fullness in the Ménière's affected ear. Between episodes, you may have a persistent hearing loss and tinnitus in the affected ear. The vertigo associated with Ménière's Disease may happen suddenly, or may build in intensity over several hours and you may begin to experience nausea or vomiting.

· Vestibulopothy

Patients who suffer multiple episodes of severe vertigo without hearing loss likely have what is known as recurrent vestibulopathy. These attacks of vertigo come and go, and last from minutes to hours. This inner ear disorder is therefore similar to Ménière's Disease, but without any hearing loss or noise in the ear. There is no evidence of brain dysfunction with recurrent vestibulopathy, and it usually goes away over time. Some recurrent vestibulopathy may turn into Ménière's Disease or benign paroxysmal positional vertigo (BPPV).

· Benign paroxysmal positional vertigo or BPPV

BPPV causes vertigo due to free floating particles in the inner ear organ of balance or vestibule disrupting the fluids' normal flow thus causing disorientation. The vestibular system located in and around the ear controls our body's sense of balance. When your head moves, the vestibular system sends information to the organs inside the ear, and these organs then pass the information on to the brain.

· Labrynthitis (viral)

Viral labyrinthitis is a sudden disruption of the messages to the brain from within the inner ear as a result of a sudden viral infection. As a result of this virus, you may experience severe vertigo that usually comes on suddenly and can last from days to weeks, depending on the length of time the body builds up anti-bodies to the virus. There are no other symptoms related to the ear.

· Vestibular neuronitis

Vestibular neuronitis is an inflammation of the vestibular nerve that causes a disruption of the message sent by the vestibular nerve to the brain. The first attack of vertigo is usually severe, and is associated with nausea and vomiting, lasting days to weeks. People with vestibular neuronitis do not have hearing loss or tinnitus.

· Cochlear implants

If you were born hearing but have lost nearly all the hearing through sensorineural hard of hearing, and hearing aids are not powerful enough to help, a cochlea implant may be an option for you. A cochlea implant is a small electronic device consisting of:

o An external battery worn somewhere on the body or clothes

o A microphone/ sound processor usually placed behind the ear which translates sounds into electrical signals and then sends these to the internal part.

o A connecting system which is surgically implanted in the ear. It passes through the ear drum and the middle ear, bypassing the ossicles.

o A thin receptive wire that is threaded into the full length "snail shell" of the cochlea to transmit electrical impulses from the sound processor to the auditory nerves. The brain doesn't care where the signals originate, just that it can hear them and interpret them

A cochlea implant does not provide perfect hearing, but many people who have cochlea implants can understand speech and recognize different sounds around them. Some can even use the telephone. Children who are born deaf can also sometimes have cochlea implants. Better results are likely if this is done while they are still very young.

REFERENCES :

http://www.hearingaidscentral.com/hearingdiseasesanddisorders.asp

HOW MECHANISM EAR WORK

PHYSIOLOGY OF HEARING

The ear is made up of three different sections: the outer ear, the middle ear, and the inner ear. These parts work together so you can hear and process sounds. The outer ear, or pinna (the part you can see), picks up sound waves and the waves then travel through the outer ear canal.

When the sound waves hit the eardrum in the middle ear, the eardrum starts to vibrate. When the eardrum vibrates, it moves three tiny bones in your ear. These bones are called the hammer (or malleus), anvil (or incus), and stirrup (or stapes). They help sound move along on its journey into the inner ear.

The vibrations then travel to the cochlea, which is filled with liquid and lined with cells that have thousands of tiny hairs on their surfaces. There are two types of hair cells: the outer and inner cells. The sound vibrations make the tiny hairs move. The outer hair cells take the sound information, amplify it (make it louder), and tune it. The inner hair cells send the sound information to your hearing nerve, which then sends it to your brain, allowing you to hear.

The part of the ear that is dedicated to sensing balance and position also sends impulses through the eighth cranial nerve, the VIIIth nerve's Vestibular Portion. Those impulses are sent to the vestibular portion of the central nervous system. The human ear can generally hear sounds with frequencies between 20 Hz and 20 kHz (the audio range). Although the sensation of hearing requires an intact and functioning auditory portion of the central nervous system as well as a working ear, human deafness (extreme insensitivity to sound) most commonly occurs because of abnormalities of the inner ear, rather than the nerves or tracts of the central auditory system.

REFERENCES :

1. http://en.wikipedia.org/wiki/Ear, citied 23/07/2008; 13.07 wib;

2. http://kidshealth.org/kid/health_problems/sight/hearing_impairment.html , citied 22/07/2008 ; 08.30 wib

WHAT IS HEALTH EAR

DEFINITION OF HEALTH EAR :

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Therefore Health may be regarded as a balance of physical, mental and social aspects of life in a being.

Physical health is good bodily health, and is the result of regular exercise, proper diet and nutrition, and proper rest for physical recovery. Mental health refers to a human individual's emotional and psychological well-being. One way to think about mental health is by looking at how effectively and successfully a person functions. Feeling capable and competent; being able to handle normal levels of stress, maintain satisfying relationships, and lead an independent life; and being able to "bounce back," or recover from difficult situations, are all signs of mental health.

The health ear has three main parts: the outer, middle and inner ear. The outer ear (the part you can see) opens into the ear canal. The eardrum separates the ear canal from the middle ear. Small bones (maleus, incus and stapes) in the middle ear help transfer sound to the inner ear. The inner ear contains cochlea, vestibulae, semi-circular canals and the auditory (hearing) nerve, which leads to the brain.

The outer ear (pinna,ear canal, surface of ear drum)

The outer ear is the most external portion of the ear. The outer ear includes the pinna (also called auricle), the ear canal, and the very most superficial layer of the ear drum (also called the tympanic membrane). In humans, and almost all vertebrates, the only visible portion of the ear is the outer ear. Although the word "ear" may properly refer to the pinna (the flesh covered cartilage appendage on either side of the head), this portion of the ear is not vital for hearing. The outer ear does help get sound (and imposes filtering), but the ear canal is very important. Unless the canal is open, hearing will be dampened. Ear wax (medical name - cerumen) is produced by glands in the skin of the outer portion of the ear canal. This outer ear canal skin is applied to cartilage; the thinner skin of the deep canal lies on the bone of the skull. Only the thicker cerumen-producing ear canal skin has hairs. The outer ear ends at the most superficial layer of the tympanic membrane. The tympanic membrane is commonly called the ear drum. The pinna helps direct sound through the ear canal to the tympanic membrane (eardrum). The framework of the auricle consists of a single piece of yellow fibrocartilage with a complicated relief on the anterior, concave side and a fairly smooth configuration on the posterior, convex side. The Darwinian tubercle, which is present in some people, lies in the descending part of the helix and corresponds to the true ear tip of the long-eared mammals. The lobule merely contains subcutaneous tissue.In some animals with mobile pinnae (like the horse), each pinna can be aimed independently to better receive the sound. For these animals, the pinnae help localize the direction of the sound source. Human beings localize sound within the central nervous system, by comparing arrival-time differences and loudness from each ear, in brain circuits that are connected to both ears. This process is commonly referred to as EPS, or Echo Positioning System.

Middle ear

The middle ear, an air-filled cavity behind the ear drum (tympanic membrane), includes the three ear bones or ossicles: the malleus (or hammer), incus (or anvil), and stapes (or stirrup). The opening of the Eustachian tube is also within the middle ear. The malleus has a long process (the manubrium, or handle) that is attached to the mobile portion of the eardrum. The incus is the bridge between the malleus and stapes. The stapes is the smallest named bone in the human body. The three bones are arranged so that movement of the tympanic membrane causes movement of the malleus, which causes movement of the incus, which causes movement of the stapes. When the stapes footplate pushes on the oval window, it causes movement of fluid within the cochlea (a portion of the inner ear).

The arrangement of the tympanic membrane and ossicles works to efficiently couple the sound from the opening of the ear canal to the cochlea. There are several simple mechanisms that combine to increase the sound pressure. The first is the "hydraulic principle". The surface area of the tympanic membrane is many times that of the stapes footplate. Sound energy strikes the tympanic membrane and is concentrated to the smaller footplate. A second mechanism is the "lever principle". The dimensions of the articulating ear ossicles lead to an increase in the force applied to the stapes footplate compared with that applied to the malleus. A third mechanism channels the sound pressure to one end of the cochlea, and protects the other end from being struck by sound waves. In humans, this is called "round window protection", and will be more fully discussed in the next section.

Abnormalities such as impacted ear wax (occlusion of the external ear canal), fixed or missing ossicles, or holes in the tympanic membrane generally produce conductive hearing loss. Conductive hearing loss may also result from middle ear inflammation causing fluid build-up in the normally air-filled space. Tympanoplasty is the general name of the operation to repair the middle ear's tympanic membrane and ossicles. Grafts from muscle fascia are ordinarily used to rebuild an intact ear drum. Sometimes artificial ear bones are placed to substitute for damaged ones, or a disrupted ossicular chain is rebuilt in order to conduct sound effectively.

Inner ear : cochlea, vestibulae, and semi- circular canals

The inner ear includes both the organ of hearing (the cochlea) and a sense organ that is attuned to the effects of both gravity and motion (labyrinth or vestibular apparatus). The balance portion of the inner ear consists of three semi-circular canals and the vestibule. The inner ear is encased in the hardest bone of the body. Within this ivory hard bone, there are fluid-filled hollows. Within the cochlea are three fluid filled spaces: the tympanic canal, the vestibular canal, and the middle canal. The eighth cranial nerve comes from the brain stem to enter the inner ear. When sound strikes the ear drum, the movement is transferred to the footplate of the stapes, which presses into one of the fluid-filled ducts of the cochlea. The fluid inside this duct is moved, flowing against the receptor cells of the Organ of Corti, which fire. These stimulate the spiral ganglion, which sends information through the auditory portion of the eighth cranial nerve to the brain.

Hair cells are also the receptor cells involved in balance, although the hair cells of the auditory and vestibular systems of the ear are not identical. Vestibular hair cells are stimulated by movement of fluid in the semicircular canals and the utricle and saccule. Firing of vestibular hair cells stimulates the Vestibular portion of the eighth cranial nerve.

SOURCE :

1. http://en.wikipedia.org/wiki/Ear ; citied 23/07/2008; 13.07 wib