The ear is the organ of hearing and balance. The outer ear protrudes away from the head and is shaped like a cup to direct sounds toward the tympanic membrane, which transmits vibrations to the inner ear through a series of small bones in the middle ear called the malleus, incus and stapes.

The inner ear, or cochlea, is a spiral-shaped chamber covered internally by nerve fibers that react to the vibrations and transmit impulses to the brain via the auditory nerve. The brain combines the input of our two ears to determine the direction and distance of sounds.

Wax in the ear

Self cleaning mechanism of ear

The ear is normally a self-cleaning mechanism. Wax acts in a protective manner, catching particles that may land in the ear. Fine hairs inside the ear canal constantly move wax and sloughed skin out of the canal. Wax and skin can build up inside the ear canal. If the canal is not clean, the eardrum can become completely blocked, greatly reducing hearing and eventually cause permanent damage.

One cause of excessive wax buildup is the use of cotton bud.. Sometimes, when you use a cotton bud to clean your ear, you can push wax deeper into the ear canal and partially or completely block it.

Do not try and remove ear wax with cotton swabs, hair pins, or other hard objects. You can damage your ear canal or eardrum.

1-Wax removal

The purpose of this natural wax is to protect the ear from damage and infections. Normally, a small amount of wax accumulates and then dries up and falls out of the ear canal, carrying with it unwanted dust or sand particles.

Ear wax is helpful to coat the skin of the ear canal where it acts as a temporary water repellent. The absence of ear wax may result in dry, itchy ears, and even infection.

When wax has accumulated so much that it blocks the ear canal (and interferes with hearing), See an ENT doctor , he may have to wash it out (syringing) or suctioning it, or remove it with special instruments. Alternatively, he may prescribe ear drops that are designed to soften the wax like otorex, or sodium bicarbonate ear drops or simple baby olive oil.

2-Cleaning Baby’s ears

Never insert a cotton bud or anything else into your baby’s ear canal; you could easily puncture the eardrum. Earwax is nature’s protection for the ear canal, and there’s usually no reason to try to get it out of your baby’s ears.

If you’re concerned about a buildup of earwax, ask your baby’s doctor, better an ENT doctor, about it. If there’s so much wax that the doctor can’t see the eardrum, doctor will remove it. Otherwise, it will come out on its own eventually, and sticking a cotton swab in there is likely to push it in farther.

Instead, simply clean the outer part of your baby’s ears with a cotton swab moistened with oil or a washcloth moistened with warm water.

Things to remember while giving bath to babies-

Use boiled and clean water, only clean the out side ear, don’t use any cotton buds to clean the ear canal. Use a washcloth to wipe the outer part of your baby’s ears, but not inside. Check behind each ear, and wipe away any dirt or debris.

Fungus infection is very common in new born, if special care is not taken while giving bath. If fungus in the ear, baby may be keep pulling the ear, irritable and may cry with pain.

Only an ENT doctor can clean the tiny ear canal with special instruments using otoscope or microscope. Make sure the baby is “mummified” in a towel to keep the baby immobile while cleaning.

3-Ear piercing

Ear piercing is a religious and cultural tradition practiced extensively in our country. Traditionally, a baby’s ears are pierced in the first year itself. It can be done once the ear lobe is well formed. It is best to avoid people who do not have proper equipment or staff trained to pierce your baby’s ears. It is important that the piercing is done in hygienic conditions. Ear piercing guns are popular and commonly used. The piercing is done at centre of the ear lobe, avoiding the nerve and cartilage. The studs can be removed after 2 weeks and gold stud can be put. Use antibiotic ointment on the ear lobe before and after bath.

4-Insects in the ear

First of all, DO NOT use putting cotton bud, tweezers, bobby pin, or any other such “tools” in your ear. That would be like asking for something much worse to happen to you.

Put several drops of hydrogen peroxide in the ear, let it stay till it does the bubbling thing, and then drain on a folded solid color washcloth, preferably a white or light color. Check washcloth to see if insect came out. You may have to do this several times.

If needed, follow this with a few drops of mineral oil or baby oil, using same procedure as with h. peroxide.

Repeat the process in 30 minutes if you did not have success first time.

If still not successful go to the doctor.

5. Ear infection-

Although ear infection is more common in all age groups. Otitis media is the most commonly seen ear infection. It is also known as middle ear infection. It causes an inflammation of the middle ear. When the bacterial or viral infections causing colds, sore throat and other breathing or respiratory problems spread to the middle ear, it results in the ear inflammation of middle ear.

Fungus in the ear

Fungus in the ear also known a swimmer’s ear or outer ear infection is another type of ear infection found in adults. It is common after swimming in chlorinated water. It causes severe itching and pain.

Avoid water getting in the ear and use ear plugs while swimming

6. Avoiding ear ache before flying

Don’t fly with a cold.

Pain in one or both ears at times can be severe. Feeling of pressure in the ears

Hearing loss, Sensation of fullness or stuffiness in the ears and dizziness

Nosebleed also can occur.

Nasal decongestants or antihistamines may be used before flying. Try to avoid altitude changes during upper respiratory infections or attacks of allergies.

Use decongestant Nasal drops half an hour before take off and landing. A decongestant tablet taken before flying also help.

7. Vertigo

The inner ear is and brain dysfunction can cause vertigo

Vertigo (giddiness or dizziness) is the feeling that you or your environment is moving or spinning. When you feel as if you yourself are moving, it’s called subjective vertigo, and the perception that your surroundings are moving is called objective vertigo.

Common causes of vertigo

• Benign paroxysmal positional vertigo (BPPV)

• inflammation within the inner ear -labyrinthitis,

• Meniere’s disease

• Acoustic neuroma is a type of tumor on the 8th cranial nerve-rare

• brain hemorrhage.

• Migraine, a severe form of headache, may also cause vertigo.

If symptoms persist, it should be investigated, after detailed medical history, full ENT, Neurological examination followed by Audiogram CT scan or MRI is needed.

8. Noises in the ear

Tinnitus is a ringing, swishing, or other type of noise that seems to originate in the ear or head.

Tinnitus has sometimes been described as ‘the sound of silence’ because all people, if they are seated in a completely quiet soundproofed room, will hear a type of rushing or hissing sound. Usually this noise is masked by environmental sounds. Hearing words, songs or voices is not included in the definition of tinnitus.

One of the most common causes of tinnitus is damage to the microscopic endings of the hearing nerve in the inner ear. Advancing age is generally accompanied by a certain amount of hearing nerve impairment, and consequently tinnitus.

These days loud noise exposure is a very common cause of tinnitus, and it often damages hearing as well. Unfortunately, many people are unconcerned about the harmful effects of excessively loud noise, firearms, and high intensity music, mobile phones etc.

Some medications like aspirin and other diseases of the inner ear Meniere’s syndrome can cause tinnitus. Tinnitus can in very rare situations be a symptom of such serious problems as an aneurysm or a brain tumor (Acoustic Neuroma).

9. Hearing loss-remedies

If any treatable cause like wax removal, surgery to repair the ear drum and removing infections from middle ear can restore hearing.

But if it is nerve deafness, the best things currently available are hearing aids, and cochlear implants.

Do a hearing test in kids if they had Common childhood diseases such as mumps, measles, scarlet fever, whooping cough, or any high fever which can leave permanent hearing impairment. Always have your child’s hearing tested if he/she has had any of these conditions in addition to regular ear care.

10. Hazards of mobile phones

People using mobile phones for long periods are at risk of developing hearing loss particularly at higher speech frequencies. This hearing loss will be more in the dominant ear Presence of fullness in the ears, ear warmth, strange noises(tinnitus) in the ear are warning signals which should not be ignored

High frequency hearing loss is characterized by the loss of ability to hear consonants such as s, f, t, and z, even though vowels can be heard normally. Consequently, people hear sounds but cannot make out what is being said. red.

The dangers are more in youngsters who use the cellphone many hrs a day.

“Use cell phones when absolutely necessary.”

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Jubilee Hospital, Trivandrum

Medical Tourists-Are you looking for an ENT Clinic in Trivandrum?

Ear, Nose, and Throat (ENT) clinic Jubilee Hospital, Trivandrum.

ENT is a much-needed service used by all ages. So many people have problems with their ears, nose and throat, and most people are unable to find a good ENT surgeon in town.

Now you don’t have to go any where, please visit the ENT clinic headed by Dr.K.O.Paulose FRCS DLO (Fellow of the Royal College of Surgeons England) with more than 33 years experience in this field all over the world.

The ENT clinic in Jubilee Hospital, Trivandrum, offers good quality affordable service at affordable cost to the average patients. It is a charitable, non corporate hospital and is run by the Arch Diocese of Trivandrum, under the guidance of Most Rev.Soosapakyam, the arch Bishop of Trivandrum.

ENT Surgeons (Otorhinolaryngologists) specialize in disorders of the head and neck, especially those related to the ear, nose, and throat (hence the common abbreviation “ENT”). ENT surgeon also sub specialize in more than a dozen areas including otology, neurotology (the study of the nerves within the ear), surgery of the head and neck, nasal and sinus disorders, voice and swallowing problems, audiology, and upper airway obstruction.

ENT surgeons routinely handle cases such as adenoidectomies, tonsillectomies, nose bleeds, infected mastoids, sinus disease, snoring and sleep disorders, and breathing problems.

ENT specialist has 3 of the 5 special senses, namely Hearing, Smell and Taste under its care. The 6th newly included special Sense of Balance is also related to the ear.

Care of hearing, taste, smell, voice and balance care come under ENT. Jubilee Hospital in Trivandrum offer top quality ENT services in friendly set up.

Facilities

As one can see from the pictures, the Clinic itself is well equipped with Operating microscope, ENT Examination Unit, ENT examination chair, Flexible and Rigid Endoscopy with CCD camera and Monitor, Fibre optic headlight etc..

Most of the simple ENT procedures are done in the clinic itself eg-

Full Ear Nose Throat Examination

Ear – Wax removal, Ear cleaning infected ears, Fungus infections

Ear piercing

Endoscopy procedures

Cautery for Epistaxis

Hearing Evaluation

Clinic hours: 8AM -1 PM Mon-Wed-Friday

(Operation Days Tue-Thu-and Saturdays)

Patient can be seen on operation days with prior appointment from 2-4PM.

For Appointment- call 0471-2334561/62/63/64, 6452020,407822 Fax-0471-2330925

Email: jubileehospital@hotmail.com

Clinic hours: 8AM -1 PM Mon-Wed-Friday

(Operation Days Tue-Thu-and Saturdays)

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Normal inner ear

It is highly useful to get three-dimensional (3D) reconstruction of computed tomography (CT) images which will help in determining the anatomy and topographic relationship between various important structures in the temporal bone. 3D reconstruction based on the image data from spiral high-resolution CT using special software, is performed by segmentation, volume-rendering and surface-rendering algorithms on a personal computer. 3D CT is a valuable source of supplementary information on inner ear disease and ossicular chain discontinuity.

A 3D reconstruction of temporal bone CT might be useful not only for education and increasing understanding of the anatomical structures of the temporal bone but can be extremely useful in making better diagnosis of inner ear and middle ear diseases.

I have compared a small number of 3D CT images of temporal bones of normal individuals and those having clinically diagnosed ossicular chain discontinuity, Meniers disease (Labyrinthine Hydrops) and Benign positional vertigo(Otolith) cases, and I found amazing pictures confirming my clinical diagnosis. It was found that 3D-CT was useful in observing the minute structure of the inner ear in that it could ascertain spatial relationships and minute constrictions and protrusions that could not be detected by 2D analysis

“Rosary bead” (Paulo sign) appearance of Semicircular canal.

Among many patients diagnosed as Benign Positional vertigo who under went 3D Ct imaging, two interesting findings were reported by the radiologist. The typical findings are of a Rosary bead appearance of one of the semicircular canals. Clinically these two patients had vertigo on moving the neck to that particular orientation of the semicircular canal.

Both cases were slow to response when given betahistine and cinnarzine.One patient improved her symptoms when given a course of Deflazacort.

Those who are investigating cases of vertigo, a 3D CT may reveal newer findings like this and this area needs more studies.

(I haven’t heard anyone reported similar findings anywhere, hence the term –Rosary bead-Paulo sign)

*Courtesy to Dr Asha FRCR, Mr G.S.Vergin, Travancore Scans, Trivandrum.

*Copying the above pictures without permission is immoral. I will oblige to give more pictures for further study and research, on request.

Please visit Gallery for pictures-http://www.drpaulose.com/about/gallery

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Cochlear Implant is a surgically implanted electronic device that helps provide hearing to a person with severe to profound sensorineural hearing loss. This sensorineural hearing loss is caused by damage or a defect in the inner ear. Cochlear implants bypass damaged hair cells in the inner ear and directly stimulate the auditory nerve to send information to the brain.

Cochlear implants provide a better hearing for adults and children with profound hearing loss. They are designed for people whose hearing does not improve with other surgical procedures or with use of a hearing aid.

In our country, cost factor is the most important problem which does not allow the needy or ideal patient to undergo such surgery frequently, multichannel cochlear implant cost several lakhs, and seem beyond the reach of average Indian patients.

We are hoping to provide Cochlear implants at affordable price to the needy.

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For Appointment please follow the link-

For Appointment- call 04712334564, 6452020,407822 Fax-0471-2330925

Email: jubileehospital@hotmail.com

Web: http://www.jubileehospital.org/

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BERA (Brainstem evoked response audiometry), ABR (Auditory brain stem response), BAER (Brainstem auditory evoked response audiometry).

BERA is an electro-physiological test procedure which studies the electrical potential generated at the various levels of the auditory system starting from cochlea to cortex. This investigation was first described by Jewett and Williston in 1971.

Procedure: The stimulus either in the form of click or tone pips is transmitted to the ear via a transducer placed in the insert ear phone or head phone. The waves of impulses generated at the level of brain stem are recorded by the placement of electrodes over the scalp.

Electrode placement: Since the electrodes should be placed over the head, the hair must be oil free. The patient should be instructed to have shampoo bath before coming for investigation. The standard electrode configuration for BERA involves placing a non inverting electrode over the vertex of the head, and inverting electrodes placed over the ear lobe or mastoid prominence. One more earthing electrode is placed over the forehead. This earthing electrode is important for proper functioning of preamplifier.

BERA is resistant to the effects of sleep, sedation, sleep and anesthesia. Its threshold has been found to be within 10dB as elicited by conventional audiometry.

The waves detected in BERA tests

1. Auditory nerve

2. Cochlear nucleus

3. Superior olivary complex

4. Lateral lemniscus

5. Inferior colliculus

6 and 7. Medical geniculate body

Uses of BERA:

1. It is an effective screening tool for evaluating cases of deafness due to retrocochlear pathology i.e. (Acoustic schwannoma). An abnormal BERA is an indication for MRI scan. The BERA test helps us not only in identifying lesions in the 8th cranial nerve, but also the lesions in the brainstem region which affect the auditory pathway. The BERA response obtained in a particular case will depend upon the nature, location, and size of the lesion; e.g. if there is a small unilateral intracanalicular acoustic neuroma the BERA response will be of a particular type (increase in wave I and wave III interpeak latency). If there is a large acoustic neuroma in the CP angle region pressing upon the brainstem there is an increase in wave III and V latency on the contra lateral side, etc.

2. Used in screening newborns for deafness

3. Used for intraoperative monitoring of central and peripheral nervous system

4. Monitoting patients in intensive care units

5. Diagnosing suspected demyelination disorders

BERA findings suggestive of retrocochlear pathology:

1. Latency differences between interaural waves 5 (prolonged in cases of retrocochlear pathology)

2. Waves I – V interaural latency differences – prolonged

3. Absolute latency of wave V – prolonged

4. Absence of brain stem response in the affected ear

BERA has 90% sensitivity and 80% specificity in identifying cases of acoustic schwannoma. The sensitivity increases in proportion to the size of the tumor.

Criteria for screening newborn babies using BERA:

1. Parental concern about hearing levels in their child

2. Family history of hearing loss

3. Pre and post natal infections

4. Low birth weight babies

5. Hyperbilirubinemia

6. Cranio facial deformities

7. Head injury

8. Persistent otitis media

9. Exposure to ototoxic drugs

Limitation

1. All waves are absent in severe hearing loss as well as in a large acoustic neuroma.

2. A normal BERA response virtually rules out an acoustic neuroma; but doesn’t at all rule out intrinsic brainstem lesion or even non-acoustic tumor of the CP angle e.g. Meningioma.

There are many electrophysiological tests available, for localizing the site of the pathology in sensori-neural lesion; but none of these tests are foolproof. A detailed history, thorough clinical examination with the battery of audiometric tests available, help a clinician to come to a correct diagnosis.

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