Hearing loss is common and can affect people of any age. About 16% of adults in the UK have some degree of hearing loss. It is thought that half the general population above the age of 75 have some hearing loss. Children are the next most common group to be affected, usually due to fluid or infection in the middle ear but also due to congenital problems or viral illness during early childhood. Hearing loss can interfere with normal communication with others on a daily basis.

You should always seek medical attention urgently if you have a sudden hearing loss, as sometimes treatment for sudden deafness should be started within 48 hours of its onset.Hearing loss caused by a bacterial infection, and wax may be treatable with micro-suction and antibiotics. Surgery can be used to drain a fluid build-up, repair a perforated eardrum, or correct problems with the hearing bones. Hearing aid technology, particularly implantable hearing devices, is a rapidly growing area, and for some people provide excellent hearing when hearing aids are no longer effective.

Glue ear is common. Up to eight in every ten children (80%) will have a short episode of glue ear before they start primary school. The medical name for glue ear is ‘otitis media with effusion’.

Sometimes it follows after an ear infection, but many children with glue ear have never had an ear infection. Often, the hearing loss from glue ear is not enough to be noticed by the parents. It may be more noticeable that the child cannot hear that well in a group situation. Sometimes, in a younger child, the hearing does not seem to be a problem, but the child’s speech and language development is slower than his or her friends of the same age. Some children complain of earache because of the fluid in their ears. Some children have balance problems or poor attention as a result of glue ear. Sometimes, the only problem reported by parents or carers is behavioural problems. This is probably due to frustration on the part of the child who cannot hear properly.

For most children, the glue ear will get better with no treatment. Those children who have ongoing problems may be recommended surgical treatment. This may be grommet surgery or adenoidectomy and grommet surgery. Hearing aids may be a better first treatment for some children.

Otosclerosis is hearing loss caused by the stapes bone, which is the inner most ossicle of the middle ear fusing with the surrounding bone, which therefore prevents transmission of sound. It affects the ears only and not other parts of the body. Both ears are usually involved in some extent. However, in some individuals, only one ear is affected. It usually begins in young adults. It can be corrected with an operation called stapedectomy, or managed with a hearing aid or implantable hearing device.

Pain relating to the ear is notoriously often severe due to the numerous nerves that supply the ear. The medical name for ear pain is ‘otalgia’.

It may originate from inflammation in the ear due to wax or infection, or may be referred pain from inflammation of adjacent anatomical structures such as the jaw joint, or throat that are supplied by the same nerves, necessitating nasendoscopy to complete the assessment. Occasionally, the pain is caused by neuralgia, which originates in the pain carrying nerves themselves.

Conditions such as otitis externa, perforated ear drum, and cholesteatoma result in discharge from the ear. The medical name for ear discharge is ‘otorrhoea’. Discharge indicates that the ear has been injured or infected and requires medical attention.

See Otitis externa, Otitis media and Acute otitis media for more information.

Otitis external is inflammation and swelling of the skin from the earhole to the eardrum. It can be caused by dirty water, but most often occurs spontaneously. Symptoms of otitis externa include ear pain, which can be severe, itchiness in the ear canal, a discharge of liquid or pus from the ear and some degree of temporary hearing loss. It can be caused by dirty water, or trauma, but most cases are spontaneous infections. Recurrent episodes may need a regimen for prevention.

Otitis media is an infection of the middle ear. It is common in children, particularly aged under 2. The episodes are frequently associated with a cold and present with malaise, fever, pulling at the affected ear and sometimes discharge. If very severe, there is a risk of the infection spreading to cause complications such as mastoiditis (redness and swelling behind the ear), and brain abscess.

Ear drum perforations may be caused by trauma, or otitis media, which usually heal spontaneously over days or weeks if the ear is kept dry and there is no infection. Most persistent perforations form spontaneously and present with recurrent discharge form the ear and hearing loss. A persistent eardrum perforation can be repaired by an operation called myringoplasty.

Cholesteatoma is caused by a pocket of skin that grows from the eardrum into the middle ear, around the ossicles and into the mastoid. The pocket sheds dead skin cells which get trapped and cause erosion of the bone as it expands. It causes ear discharge and hearing loss, which can be permanent, vertigo, tinnitus or damage to the facial nerve, causing weakness in half of the face. In very rare cases, an infection can spread into the inner ear and brain, leading to a brain abscess or meningitis. The only effective way to get rid of this pocket of skin is surgery.

May be a sign of Eustachian tube dysfunction.

The middle ear and mastoid is an air filled cavity that contains the three little bones of the ear (the ossicles) that transmit sound. All air-filled cavities in nature need ventilation and drainage to function effectively. Each time we swallow (about a thousand times a day!), air gets pushed along a tube that connects the back of our nose with the middle ear to ventilate it, and microscopic hairs, called cilia, move mucous from the ear into our nose. Inflammation in the nose and ear, or anatomical differences, can impede the normal physiology, leading to pressurised-cabin type blockage, difficulty equalising pressure and popping and clicking symptoms. Some blockage and hearing loss is caused by microscopic inflammation in the inner ear fluids, called cochlear hydrops, or may be mediated through nerves that send signals to the ear called inner ear suppression.

Tinnitus is a sensation or awareness of sound that is not caused by a real external sound source. Although it is commonly assumed to be a ringing noise, tinnitus can take almost any form including hissing, whistling, humming and buzzing. Some people hear a single sound whereas others hear multiple noises. For some, the sound is constant: for others it is constantly changing. Although there is no simple pill or operation to cure the majority of cases of tinnitus, Mr Harris and his team of tinnitus therapists are very experienced in assessing and managing tinnitus and they will be able to advise you on the best approach for you, ranging from correction of associated hearing impairment, to advice regarding tinnitus devices and several tinnitus therapy strategies that are very helpful in ameliorating the condition. Single-sided tinnitus or pulsatile tinnitus need radiological investigation to exclude the rare possibility that there is a more serious cause.

Further information

Up to date advice is available from the British Tinnitus Association at www.tinnitus.org.uk

An acoustic neuroma is a benign growth of the hearing and balance nerve near to where it enters the brain. They typically present with hearing loss or tinnitus that is only on one side, or worse on one side, and can sometimes affect balance. They are slow growing and most do not need treatment. If left undiagnosed, rarely they can grow and cause serious complications.

Pre-auricular pits are commonly seen dimples just in front of the ear. The form when skin gets trapped as the ear forms in the womb. Most are shallow and will not cause any problems. Some are tracts going deep into the tissues in front of the ear and can become infected, requiring surgical excision to prevent recurrent infections and scarring. Occaionally, the presence of a preauricular sinus may be associated with other abnormalities of the outer ear.

Protruding ears in children can lead to a child being teased at school. It is due to a defect in part of the cartilage (gristle) of the ear, and one or both ears can be affected. An operation to correct the shape of the ears so that they protrude less can help the child become less self-conscious.Surgical correction can be carried out whenever the patient wishes, but not usually before the age of about six, because by this stage the cartilage in the ear is more mature.