ENT
Hearing Loss: Types, Causes, Testing and Treatment
Hearing loss may develop gradually or suddenly and may affect one or both ears. The main types are conductive hearing loss, caused by problems in the outer or middle ear; sensorineural hearing loss, caused by damage in the inner ear or hearing nerve; and mixed hearing loss, which combines both.
Conductive causes include earwax blockage, fluid behind the eardrum, ear infection, a perforated eardrum and problems with the small middle-ear bones. Sensorineural causes include ageing, repeated loud-noise exposure, certain medicines, genetic conditions, head injury and inner-ear disorders.
Signs include difficulty following conversation, asking people to repeat themselves, increasing television volume, struggling in noisy places, tinnitus, delayed speech in children or reduced response to sound. Hearing loss that develops suddenly over hours or a few days requires urgent ENT assessment because early treatment may improve the chance of recovery in selected cases.
Evaluation usually includes an ear examination and a formal hearing test performed by an audiologist. Tests help identify the degree and type of hearing loss. Additional tests or imaging may be requested depending on the pattern and associated symptoms.
Treatment depends on the cause. Wax, infection or middle-ear fluid may be managed medically or procedurally. Permanent hearing loss may be supported with hearing aids, assistive devices, communication strategies or implantable hearing devices in selected patients. Children should be assessed promptly because hearing is important for speech, language and learning.
Protecting hearing includes using suitable hearing protection around loud sound, keeping personal audio at safe levels and obtaining testing when changes are noticed.
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Tinnitus: Causes, Evaluation and Ways to Manage Ringing in the Ears
Tinnitus is the perception of sound without an external source. It may be heard as ringing, buzzing, humming, clicking or roaring and can affect one or both ears. It is a symptom rather than a disease.
Common associations include age-related hearing loss, noise exposure, earwax blockage, middle-ear problems and certain medicines. Sometimes no single cause is identified. Pulsatile tinnitus, which seems to beat in time with the pulse, is different and may require additional investigation.
Assessment starts with a medical history, ear examination and usually a hearing test when tinnitus is persistent, one-sided or associated with hearing changes. Imaging is not required for every patient, but may be considered when tinnitus is pulsatile, one-sided with asymmetric hearing loss or accompanied by neurological signs.
Treatment focuses on identifying reversible causes and reducing the effect on daily life. Removing impacted wax or treating an ear condition may help when these are responsible. Hearing aids may reduce tinnitus awareness in people with hearing loss. Background sound, sound therapy, sleep strategies and cognitive behavioural therapy can help some people manage distress. No single medicine or supplement reliably cures tinnitus, and products making guaranteed claims should be viewed cautiously.
Seek prompt assessment for tinnitus with sudden hearing loss, severe dizziness, facial weakness, neurological symptoms or a sound that follows the heartbeat. Persistent tinnitus that affects sleep, concentration, mood or quality of life should also be discussed with an ENT specialist or audiologist.
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Ear Infections: Types, Symptoms and Treatment
Ear infections can affect the ear canal, middle ear or, less commonly, inner ear. Outer-ear infection, often called swimmer’s ear, affects the canal and may cause pain when the outer ear is touched, itching, swelling and discharge. Middle-ear infection occurs behind the eardrum and is especially common in children after colds. It may cause ear pain, fever, irritability, reduced hearing or fluid leaking if the eardrum perforates.
Diagnosis requires examination of the ear. Treatment depends on the location, cause, age and severity. Outer-ear infections are commonly treated with prescribed ear drops and keeping the ear dry. Middle-ear infections may improve without antibiotics in selected cases, while antibiotics are recommended when clinical criteria indicate bacterial infection or increased risk. Pain relief and hydration remain important.
Do not insert cotton buds, oils or unprescribed drops into a painful or draining ear. Drops may be unsafe if the eardrum is perforated, unless specifically selected by a clinician.
Medical assessment is recommended for severe pain, persistent fever, discharge, swelling behind the ear, dizziness, facial weakness or significant hearing reduction. Infants, people with diabetes, immune suppression or previous ear surgery may need earlier assessment. Repeated infections or persistent middle-ear fluid can affect hearing and may require ENT and audiology review.
Prevention includes avoiding trauma from ear cleaning, drying the outer ear gently after swimming and keeping vaccinations up to date. Children exposed to tobacco smoke have a higher risk of middle-ear problems.
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