Ears and Hearing Conditions

Ear surgery is usually well tolerated, and can be performed as a ‘day case’. Post-operative pain is minimal in most cases. You will usually be prescribed simple analgesics, such as Paracetamol and Ibuprofen to take regularly (with food), as well as a short course of stronger pain-relievers to offset any moderate to stronger pain. Most patients find they do not require the stronger pain relief if they are careful to take their simple analgesics on a regular schedule. We recommend drawing up a schedule to attach to the fridge, or setting alarms on your phone to help you remember – like all things, after an operation ‘life’ can get in the way, and the most common cause of pain following an ear operation is having forgotten to take your analgesics!

It is normal after ear surgery to experience some bloody discharge from the ear canal – depending on your condition and surgery type, this can be expected to continue for a full week. Simply change the cotton ball in your outer ear when and as required, and replace it with a fresh one. You may be prescribed some antibiotic eardrops to commence at a certain point following surgery, or some ointment to apply to your suture-line. You may have tapes covering your suture line, or some packing in the outer ear – occasionally, these reach their end of their natural lifespan and become dry and fall off or out. Don’t be alarmed – your skin is sutured in multiple layers underneath, and is quite safe; your ear canal is packed all the way down to the eardrum, and only the outermost piece of packing will have come loose.

If you have had surgery involving your inner ear, you may feel off balance or dizzy for a period following your operation. If you feel severe spinning dizziness that is unexpected, please contact us at Evolve so we may support you. Feeling mildly off-balance is common following ear surgery and can last some weeks. Please take care of your physical safety – avoid wearing high-heeled shoes, be mindful of ‘irregular’ or low light surfaces (such as staircases, rocky driveways and unsealed roads), and avoid driving, operating heavy machinery, using sedating medications, drugs or alcohol, or undertaking dangerous activities where an increased falls risk may be important (such as climbing ladders or clearing rooftop gutters).

Grommets fall out according to their own timeline, and this depends on a number of factors including the type of grommet used and the state of the ear-drum and middle ear. Some families find their child’s grommets are easier to look after when kept dry. Others find they can bathe and swim freely, with no increase in ear infections. If your child does better with ‘water precautions’, here are a few handy hints for keeping the ears dry.

As long as grommets remain in place, it is important to keep the ears as dry as possible. Grommets fall out according to their own timeline, and this depends on a number of factors including the type of grommet used and the state of the ear-drum and middle ear.

KEEPING YOUR EARS DRY:

• For bathing:
  • A shower cap over the ears can be used if not washing the hair
  • A prune-sized wad of blu-tak moulded into the outer ear is useful for showers, or bath-time play. Vaseline on a cotton ball can also be used
• For swimming:
  • Special “sized” ear plugs, a headband and a bathing cap provide “three layer” protection for patients prone to water-borne infections
  • We recommend fitted Doc’s Pro-Plugs or custom-made plugs for a snug fit – these can be obtained from Attune Audiology Kawana, or Neurosensory Unit Buderim
• If the ear gets wet:
  • Shake out the excess water with the head on tilt
  • Dry mop the outer ear
  • A hair dryer on cool setting held at arms length can be helpful
• If the ear discharges:
  • A little clear or blood-stained discharge is normal after your grommets are put in. Simply twist a corner of a tissue into a ‘spear’ and wipe the canal clear as required. This may need to be done every couple of hours for the first day
  • If the ear develops smelly or copious discharge that does not settle with dry mopping over a couple of days, please see your GP for Ciproxin HC ear drops 5-7 days. These are safe to be used with grommets.

DO I REALLY NEED WATER PRECAUTIONS?

Around the world, there are different recommendations regarding whether ‘water precautions’ (keeping water out of the ears) are really necessary in patients with grommets. There is increasing international evidence that water exposure may make no difference to the number of times grommets become infected or discharge. However, whether this finding applies to Queensland patients – with our uniquely water-loving lifestyle, and humid client – has not been explored in the research.

At Evolve, our position is patient focused. We know that water precautions can be challenging – especially with young children. We also know that some patients keep their ears scrupulously dry, yet experience occasional infections; others experience infections only after they wet their ears, and others still swim frequently, use no water precautions, and never experience an infection.

At Evolve, we customise our advice depending on the needs and experience of our individual patient and their family. For each, we discuss the pros, cons and possible outcomes, then give you the knowledge and tools to conduct your own ‘experiment’ at home. Working with you, we will establish a regime that works specifically for you – to help you maintain good hearing, minimal ear discharge and optimal grommet health over time.

FOLLOW-UP

• An early “grommet check” will be performed around two weeks after your surgery
• You will then be reviewed on roughly six-monthly intervals – sometimes with a hearing test – until the grommet is out, the ear has healed and your condition has stabilised
• Most people require only a single set of grommets. However, some people require treatment and follow-up over several years. Your Evolve ENT will guide you as to what you require to maintain your best ear health

When it comes to pain within the Head and Neck, the humble ear is ‘the great masquerade’. While, to the unsuspecting patient, pain in the ear is obvious in its location (and its intensity!), the ear receives nerve signals from a variety of sites within the head and neck. Thus, solving the riddle of ear pain often takes significant effort and expertise, and finding the source of ‘ear pain’ is often essential to unmask potentially serious disease distant to the ear itself.

Your ear pain consultation is likely to include a thorough evaluation of the middle ear, ear drum, ear canal and outer ear, under the microscope. You may require a painless telescopic examination of the inner surfaces of the head and neck (including the nasal cavity and sinus openings, post-nasal space and Eustachian ‘ear ventilation’ tube openings, tonsils, throat and gullet), which is performed under local anaesthetic in the clinic. You may also undergo a comprehensive evaluation of all lining surfaces of the oral cavity, and assessment of jaw joint mobility and function.

Depending on your overall health, you may be required to have some imaging studies and blood tests as part of your assessment, and your Evolve ENT can guide you on the investigations required for your personal situation.

Birth defects of the outer, middle and inner ear frequently arise together – thus, an unusual shaped outer ear can be a useful indicator of problems of hearing and balance due to middle and inner ear malformation.

Abnormally shaped or excessively projected ears carry significant social stigma, and patients with even mildly abnormal ears frequently desire a more ‘normal looking’ ear, and will often benefit from specialist opinion.

Babies born with abnormal outer ears should have a thorough assessment by a specialist ENT surgeon to ensure there no accompanying problems with middle or inner ear function. This is best performed early, when the cartilage of the ear remains pliable, and non-surgical interventions remain available.

Earwax (also called ‘cerumen’) is a healthy and useful by-product of the normal ear. However, a variety of factors (including ear canal shape, wax consistency, age, canal hair and hearing aid use) can all contribute to problematic earwax ‘impaction’. Patients who experience earwax impaction may suffer discomfort, pain, skin inflammation and infection, difficulty with their hearing aids, and – when severe – even hearing loss.

There are several methods of treating earwax build-up should it become problematic. Some of these can be performed at home or in your community general practice, and some require specialist techniques available with your Evolve ENT surgeon. Your GP will be able to assess your earwax and recommend the best option for your situation.

Cholesteatoma is a complex disease characterised by the build-up of skin (‘squame’) within the middle ear and mastoid. Once trapped within these spaces, squamous skin continues to grow, expand and shed its skin cells. It often becomes infected, resulting in a painful, smelly and discharging ear. If left unattended, it can erode important structures, leading to permanent deafness, severe dizziness, facial nerve palsy, meningitis and brain abscess.

Although the word ‘cholesteatoma’ suggests a kind of tumour, the disease is not cancerous. It does, however, tend to recur and as a result, it is common for sufferers to require a series of operations staged over a number of years as the ear is stabilised. Cholesteatoma management, and the rehabilitation of hearing, during the years of disease stabilisation, presents a challenge for patients and surgeons alike. At Evolve ENT, your expert team can assess your ear, and support you through the process.

Hearing loss, even when it is mild, can devastate a person’s ability to fit in at work, school and socially. At Evolve, our experts can ensure you know your hearing status, and your options. A fuller, brighter and more connected future may be just around the corner.

I am worried I have hearing loss. When should I get tested or treated?

Many people live with some degree of hearing loss, so it is hard to know when to take the first steps to improve things. An esteemed Evolve mentor would often say ‘the time to address your hearing loss is when others begin to think you are rude, ignorant, or stupid’. What he meant was, hearing loss causes problems for people – for their work, their social interactions, and within their relationships.

Because we are often too embarrassed to admit we have a hearing loss, to ask for instructions to be repeated, or to admit we didn’t hear, individuals with hearing loss often live lives plagued with misunderstandings. Missed instructions at work, crossed lines during dinner parties, and missed cues during important conversations with loved ones can all contribute to the hearing impaired person feeling frustrated, less capable, and isolated. Among older persons, hearing loss is strongly associated with anxiety and depression, and is known to exacerbate disorders of cognition, such as dementia.

Surely hearing loss as we age is normal?

It is a mistake to consider hearing loss as a normal part of aging. Hearing loss – at any age – is a disability, a loss of normal and critical function. It should not be ignored, endured or dismissed as inevitable. Depending on the kind of hearing loss (conductive, sensorineural or mixed) a wide variety of surgical and non-surgical options exist for rehabilitating and optimising your hearing. From hearing aids, middle ear prostheses, bone-anchored hearing aids, active middle ear implants and cochlear implants, your Evolve ENT can provide expert advice on the best way to return you to the hearing world.

I am worried my child has hearing loss. What should I do?

For children, the answer is simple. As soon as you notice your child is lagging behind in speech or pronouciation compared with siblings or peers, we recommend discussing a paediatric hearing test with your GP.

It is true that many children with hearing problems will eventually get better without treatment. However, at Evolve we know that just as many children will improve with time, a significant number will not. And of those children who do, eventually, return to normal, a significant number will have spent a large or recurring part of each year unable to hear properly.

A child’s early years are vital for learning – but just as normal hearing is critical to learning speech, reading, writing and arithmatic, hearing clearly also determines whether your child is able to pay attention, behave well, communicate their needs and understand in a group environment. Early performance at kindy and school shapes your child’s idea of where they belong in their class pecking order. At Evolve, we believe every child should be able to reach their personal potential and reach for the stars in school and life – without the struggle of hearing impairment.

Hearing testing in children. Where should I go?

It’s essential that parents understand obtaining an accurate hearing test in children is not easy. Audiologists who specialise in diagnostics (hearing testing) are highly trained specialists. Testing children’s hearing requires special equipment, a custom-made test environment and more importantly, an audiologist with paediatric training and experience (not to mention endless patience!). At Evolve, we recommend Attune or the Neurosensory Unit.

Paediatric hearing tests involve interesting sounds, puppets, play and noisemakers! The sesions are often fun and interesting for children. However, their amount of time needed is variable – some children adapt quickly to a single task and the test is quick and straight-forward. Other times, the audiologist may need to trial a number of different approaches to gain your child’s attention and trust, or may need to use a series of different tests to establish their hearing level with confidence.

Patience is essential – we recommend you allow adequate time in your schedule, and pack a snack and drink to ensure you and your child are fed, happy and up to the task.

My child has hearing loss. What now?

At Evolve, we’re committed to keeping healthy kids healthy, as well as in identifying those who are struggling so we can help them rediscover ‘normal’ and excel in life, school and at home.

Obtaining a reliable paediatric hearing test is the first essential step. Next, an in-person consultation with your Evolve ENT will help you determine which, if any, treatment is required. Often, close surveillance of a child’s hearing loss over time is all that is required, and in this setting your Evolve ENT will observe serial hearing tests closely to ensure ‘mother nature’ does her job in a timely fashion. However, if your child’s hearing loss is severe or prolonged, or where speech and learning are delayed, we may recommend hearing surgery or rehabilitation via hearing aids.

Tinnitus is often described by patients as ‘ringing in the ears’ but can also take the form of buzzing, mechanical distortion of sound, or pulsation. Tinnitus may be subjective (only able to be heard by you), or objective (able to be heard by your doctor, as well). For many, tinnitus is highly distressing. Intrusive tinnitus may interrupt sleep, and frequently evokes feelings of anxiety, panic, frustration and depression.

Depending on the kind of tinnitus, there are some important serious causes that may need to be excluded (for example, narrowing of a large artery within the neck, abnormal tissue in the middle ear or skull base, a tumour of the hearing nerve). Usually, however, tinnitus is a ‘brain-generated’ noise created in response to hearing loss. In this situation, rehabilitating the hearing, and undergoing specific tinnitus training can help sufferers manage their tinnitus, and are often highly effective. Although tinnitus is a challenging problem for sufferers, Evolve ENT can help determine the best way forward for improving your symptom control and enhancing your quality of life.

“Dizziness” is a broad term which encompasses many different complaints, including light-headedness caused by standing up too quickly, ‘brain fog’ related to sedative or blood-pressure medication, imbalance caused by disease within the blood vessels, brain, muscles and nerves, and also the general ‘unsteadiness’ or fear of falling that often accompanies the aging process – failing vision, impaired sensation in the hands and feet seen commonly in diseases like diabetes, and the general slowing of the responsiveness of our joints, limbs, spine and muscles as we get older.

By contrast, “vertigo” is a very specific symptom involving a powerful and false sense of movement. Patients with true vertigo will report the room is spinning wildly, swinging, tilting or dropping out from beneath them. Because new vertigo can indicate an early or evolving stroke, it is important that patients consult their GP or local emergency department, who can assess and/or test for stroke, and treat affected patients urgently. Often, however, vertigo represents a malfunction of the inner ear.

The first time one experiences vertigo, it is typically an alarming event. Patients report violent spinning of the world around them, are frequently unable to stand, and often feel nauseated and vomit. The most common cause is a condition called “BPPV – Benign Paroxysmal Positional Vertigo”, a harmless and temporary (but often frightening!) malfunction of the inner ear related to changes in head position. BPPV is typically brought on when an individual tilts their head back and to the side, such as when hanging clothes on the line, or rolling over in bed. Fortunately, BPPV is not dangerous. It can usually be readily diagnosed by your GP using an in-clinic test called the Dix-Hall-Pike. It can also be effectively treated in clinic or at home using a series of simple exercises. These can be repeated as and when required should your BPPV return in the future.

Your Vertigo Appointment at Evolve

If your GP feels they require additional clarification around the diagnosis, or if your vertigo is persistent, severe or accompanied by other hearing or balance symptoms, your GP may refer you to an Evolve ENT for further evaluation. You can expect a thorough history (so please bring a list of medical conditions and medications if you have trouble remembering), an examination of your ears and a balance or “dizzy” examination, which tests your brain, inner ears, head and eye movements and gait. Occasionally, balance testing brings on vertigo, and you may feel dizzy or sick afterward – so please bring a support person on the day of your appointment to help with transport and to accompany you home.

Depending on your problem and needs, your Evolve ENT may arrange specialised hearing and balance testing, imaging studies of the brain or skull base, or blood tests, or we may refer you for consultation with a Neurologist, medical physician, vestibular physiotherapist or occupational therapist.