Insight into voice changes
- What causes hoarseness?
- What can you do to treat it?
- When should you see an ENT?
- and more…
Abnormal changes in the voice are called “hoarseness.” When hoarse the voice may sound breathy raspy strained or show changes in volume or pitch (depending on how high or low the voice is). Voice changes are related to disorders in the sound-producing parts (vocal folds) of the voice box (larynx). While breathing the vocal folds remain apart. When speaking or singing they come together and as air leaves the lungs they vibrate producing sound. Swelling or lumps on the vocal folds hinder vibration altering voice quality volume and pitch.
What are the causes of hoarseness?
Acute Laryngitis: The most common cause is acute laryngitis—swelling of the vocal folds that occurs during a common cold upper respiratory tract viral infection or from voice strain. Serious injury to the vocal folds can result from strenuous voice use during an episode of acute laryngitis.
- Speaking in noisy situations
- Excessive use
- Telephone use with the handset cradled to the shoulder
- Using inappropriate pitch (too high or too low) when speaking
- Not using amplification when public speaking
Benign Vocal Cord Lesions: Prolonged hoarseness can occur when you use your voice too much or too loudly for extended periods of time. These habits can lead to nodules polyps and cysts. Vocal nodules (singers’ nodes) are callus-like growths of the vocal folds. Vocal fold polyps and cysts also occur in those who misuse their voice but can also occur in those who do not.
Vocal Hemorrhage: If you experience a sudden loss of voice following a yell or other strenuous vocal use you may have developed a vocal fold hemorrhage. Vocal fold hemorrhage occurs when one of the blood vessels on the surface of the vocal folds ruptures and the soft tissues fill with blood. It is considered a vocal emergency and should be treated with absolute voice rest and examination by an otolaryngologist (ear nose and throat doctor).
Gastroesophageal Reflux (GERD): A possible cause of hoarseness is gastro-esophageal reflux when stomach acid comes up the swallowing tube (esophagus) and irritates the vocal folds. Other typical symptoms of GERD include heartburn and regurgitation. Usually the voice is worse in the morning and improves during the day. These people may have a sensation of a lump or mucus in their throat and have an excessive desire to clear it.
Laryngopharyngeal Reflux (LPRD): If the reflux makes it all the way up through the upper sphincter and into the back of the throat it is called LPRD rather than GERD. The structures in the throat (pharynx larynx and lungs) are much more sensitive to stomach acid and digestive enzymes so smaller amounts of the reflux into this area can result in more damage. Many patients with LPRD do not have hearburn or other classic symptoms of GERD.
Smoking: Smoking is another cause of hoarseness. Because smoking is the major cause of throat cancer if smokers become hoarse they should see an otolaryngologist.
Neurological Diseases or Disorders: Hoarseness can also appear in those who have neurological diseases such as Parkinson’s or a stroke or may be a symptom of spasmodic dysphonia a rare neurological disorder that usually affects only the voice but sometimes affects breathing. A paralyzed vocal fold may be the cause of a weak breathy voice. If the hoarseness persists for more than three months and other causes have been ruled out a neurologist may be helpful for diagnosis.
Other Causes: These include allergies thyroid problems trauma to the voice box and occasionally menstruation. Very serious conditions such as laryngeal cancer can also cause hoarseness which is why it is important to have chronic hoarseness evaluated promptly by an otolaryngologist
How is hoarseness treated?
Hoarseness caused by a cold or flu may be evaluated by family physicians pediatricians and internists who have learned how to examine the larynx. Problems with the voice are often best managed by a team of professionals who know and understand how the voice functions. These professionals are otolaryngologists speech/language pathologists and teachers of singing acting and public speaking. Vocal nodules polyps and cysts are typically treated with a combination of microsurgery and voice therapy.
How is hoarseness evaluated?
Otolaryngologists will obtain a thorough history of a patient’s hoarseness and general health. They will then evaluate the voice and do a complete ear nose and throat exam. This includes examination of the vocal folds by laryngoscopy. Laryngoscopy may be suggested by the otolaryngologist at any time during an evaluation for hoarseness but if it persists beyond three weeks it should be evaluated and that evaluation should occur within a maximum of 3 months. The evaluation should be immediate if there is concern about a serious underlying cause is suspected.
Doctors usually look at the vocal folds either with a mirror placed in the back of the throat or with a very small lighted flexible tube (fiberoptic scope) that is passed through the nose to view the vocal folds. Videotaping or stroboscopy (slow-motion assessment) may also help with the analysis. These procedures are well tolerated by most patients. In some cases special tests designed to evaluate the voice may be recommended. These measure voice irregularities how the voice sounds airflow and other characteristics that are helpful in diagnosing and guiding treatment.
When should I see an otolaryngologist?
- If hoarseness lasts longer than three weeks especially if you smoke
- If you do not have a cold or flu
- If you are coughing up blood
- If you have difficulty swallowing
- If you feel a lump in the neck
- If you observe loss or severe changes in voice lasting longer than a few days
- If you experience pain when speaking or swallowing
- If difficulty breathing accompanies your voice change
- If your hoarseness interferes with your livelihood
- If you are a vocal performer and unable to perform
How are vocal disorders treated?
The treatment of hoarseness depends on the cause. Many common causes of hoarseness can be treated simply by resting the voice or modifying how it is used. An otolaryngologist may make some recommendations about voice use behavior refer the patient to other voice team members and in some instances recommend surgery if a lesion such as a polyp is identified. Not smoking and avoiding secondhand smoke is recommended to all patients. Drinking fluids and taking medications to thin out the mucus may help.
How to prevent hoarseness
Specialists in speech/language pathology (voice therapists) are trained to assist patients in behavior modification to help eliminate some voice disorders. Patients who have developed bad habits such as smoking or overusing their voice by yelling and screaming benefit most from this conservative approach. The speech/language pathologist may teach patients to alter their methods of speech production to improve the sound of the voice and to resolve problems such as vocal nodules. When a patient’s problem is specifically related to singing a singing teacher may help to improve the patients’ singing techniques.
- If you smoke quit.
- Avoid agents that dehydrate the body such as alcohol and caffeine.
- Avoid secondhand smoke.
- Stay hydrated—drink plenty of water.
- Humidify your home.
- Watch your diet—avoid spicy foods.
- Try not to use your voice too long or too loudly.
- Use a microphone if possible in situations where you need to project your voice.
- Seek professional voice training.
- Avoid speaking or singing when your voice is injured or hoarse.
Reference: American Academy of Otolaryngology. Head and Neck Surgery. http://www.entnet.org/HealthInformation/hoarseness.cfm
You may have hearing loss and not even be aware of it. People of all ages experience gradual hearing loss often due to the natural aging process or long exposure to loud noise. Other causes of hearing loss include viruses or bacteria heart conditions or stroke head injuries tumors and certain medications. Treatment for hearing loss will depend on your diagnosis.
How does the hearing sense work?
Hearing is a complex and intricate process. The ear is made up of three 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 directs them into the outer ear canal.
These sound waves travel down the ear canal and hit the eardrum which causes the eardrum to vibrate. When the eardrum vibrates it moves three tiny bones in your middle ear. The middle ear is a small air-filled space between the eardrum and the inner ear. These bones form a chain and are called the hammer (or malleus) anvil (or incus) and stirrup (or stapes). The movement of these bones transmits and amplifies the sound waves toward the inner ear.
The third bone in the chain the stapes interfaces with fluid which fills the hearing portion of the inner ear — the cochlea. The cochlea is lined with cells that have thousands of tiny hairs on their surfaces. As the fluid wave travels through the cochlea it causes the tiny hairs to move. The hairs change the mechanical wave into nerve signals. The nerve signals are then transmitted to your brain which interprets the sound.
Test your hearing
To get an idea of how well you hear answer the following questions and then calculate your score. To calculate your score give yourself 3 points for every “Almost always” answer 2 points for every “Half the time” answer 1 point for every “Occasionally” answer and 0 for every “Never.” Please note: If hearing loss runs in your family add an additional 3 points to your overall score.
The American Academy of Otolaryngology—Head and Neck Surgery recommends the following:
0-5 points—Your hearing is fine. No action is required.
6-9 points—Suggest you see an ear nose and throat (ENT) specialist.
10+ points—Strongly recommend you see an ear nose and throat (ENT) specialist.
I have a problem hearing over the telephone.
Half the time
I have trouble following the conversation when two or more people are talking at the same time.
Half the time
People complain that I turn the TV volume too high.
Half the time
I have to strain to understand conversations.
Half the time
I miss hearing some common sounds like the phone or doorbell ring.
Half the time
I have trouble hearing conversations in a noisy background such as a party.
Half the time
I get confused about where sounds come from.
Half the time
I misunderstand some words in a sentence and need to ask people to repeat themselves.
Half the time
I especially have trouble understanding the speech of women and children.
Half the time
I have worked in noisy environments (such as assembly lines contstruction sites or near jet engines).
Half the time
Many people I talk to seem to mumble or don’t speak clearly.
Half the time
People get annoyed because I misunderstand what they say.
Half the time
I misunderstand what others are saying and make inappropriate responses.
Half the time
I avoid social activities because I cannot hear well and fear I’ll make improper replies.
Half the time
Ask a family member or friend to answer this question: Do you think this person has a hearing loss?
Half the time
What can I do to improve my hearing?
- Eliminate or lower unnecessary noises around you.
- Let friends and family know about your hearing loss and ask them to speak slowly and more clearly.
- Ask people to face you when they are speaking to you so you can watch their faces and see their expressions.
- Utilize sound amplifying devices on phones.
- Use personal listening systems to reduce background noise.
Tips to maintain hearing health
- If you work in noisy places or commute to work in noisy traffic or construction choose quiet leisure activities instead of noisy ones.
- Develop the habit of wearing earplugs when you know you will be exposed to noise for a long time.
- Earplugs can reduce the volume of sound reaching the ear to a safer level.
- Try not to use several noisy machines at the
- Try to keep television sets stereos and headsets low in volume.
Reference: American Academy of Otolaryngology. Head and Neck Surgery. http://www.entnet.org/HealthInformation/Hearing-Loss.cfm
Certain foods are believed to be responsible for up to 30 percent of all headaches.
Tyramine content may vary among brand names available on the market because if preparation processing or storage. It is best to eat only freshly prepared foods and to avoid eating those that may have aged fermented pickled or marinated. Tenderizers monosodium glutamate nitrates of nitrate compounds are likely to be provoking agents. It is important to read the labels carefully when shopping and asking questions when eating out.
FOOD GROUPS FOODS ALLOWED:
- Decaffeinated coffee and colas. Caffeine sources to be limited to two (2) cups per day which includes coffee tea and colas
- Milk – Homogenized skim (2%)
- Cottage cheese cream cheese American and Velveeta Cheese or any synthetic cheese
- Yogurt in ½ cup portions or less
MEAT AND MEAT SUBSTITUTES:
- Freshly prepared meats eggs.
BREAD AND BREAD SUBSTITUTES:
- All except those on avoid list. Commercial breads.
FOODS TO AVOID:
- Alcoholic beverages wine beer
- Milk – chocolate buttermilk
- Aged and processed cheese including cheddar swiss mozzarella parmesan Romano brick Brie camembert gruyere gouda stilton provolone Roquefort blue and foods containing cheese (pizza macaroni and cheese)
- Yogurt and sour cream
MEAT AND MEAT SUBSTITUTES:
- Aged canned cured or processed meats and those containing nitrites or commercial meats extracts. Pickled or dried herring chicken livers sausage salami bologna pepperoni frankfurters pates peanuts and peanut butter marinated meats. Any meat prepared with tenderizers soy sauce or yeast extracts.
BREAD AND BREAD SUSTITUES:
- Homemade yeast breads fresh cake doughnuts yeast and yeast extracts sourdough breads.
- Breads or crackers containing cheese chocolate or nuts.
- Seven in 10 people have at least one headache a year
- The majority of headaches last for only a few hours but some can persist for weeks
- Forty-five million Americans suffer from chronic headaches
- Headaches cost billions of dollars in lost productivity every year
With a headache pain may occur in only one part of the head such as above the eyes or it may involve the entire head. The type of pain experienced varies; it may be constant and dull or sudden and sharp. And sometimes other symptoms such as nausea occur at the same time depending on the type of headache.
Three main types of headaches
Tension headaches typically feel like a tightening on both sides of the head. They can last for minutes or days and can happen frequently. Tension headaches are often the result of stress or bad posture which causes tightening of the muscles in the neck and the scalp. Tension headaches often worsen with noise and hot stuffy environments. This type of headache occurs mostly in women over age 20.
Migraine headaches are intense and throbbing often involve one side of the head and can make you sensitive to light or noise. Migraines last from hours up to three days and are more common in women. Some sufferers have an “aura” (a group of visual symptoms) just before an attack. In the U.S. each year about 25 million people experience a migraine. Migraine sufferers usually have their first attack before age 30 but they can also occur in children as young as age three. Migraines recur at intervals of varying length. Some people have attacks several times a month; others have less than one a year. Most people find that migraine attacks occur less frequently and become less severe as they get older. There are two types of migraine: migraine with an aura and migraine without aura. An aura is a group of symptoms that develop before the onset of the main headache.
Cluster headaches are non-throbbing and usually are felt on one side of the head behind an eye. Cluster headaches affect about 1 million people in the United States. More common in men they can happen over several days and usually last 30 to 45 minutes. They generally occur between one and four times a day. Like migraines cluster headaches are likely to be related to an increased blood flow as a result of the blood vessels in the brain widening.
What are the causes?
There are many possible causes of headache that determine the site and nature of the pain. About three in four of all headaches are caused by tension in the scalp and neck muscles. Very few headaches have serious underlying causes but those that do require urgent medical attention. For example a severe headache may be a sign of meningitis. In elderly people a headache with tenderness of the scalp or temple may be due to temporal ateritis in which blood vessels in the head become inflamed.
If you have a headache that lasts more than 24 hours and is severe or accompanied by other symptoms such as problems with vision or vomiting medical help should be sought immediately.
What might your doctor do?
Your doctor may do a physical examination if he/she suspects an underlying disorder causing your headache. You may require tests such as a CT scan or a MRI of your brain.Reference: American College of Physicians. http://www.acponline.org/patients_families/diseases_conditions/headaches/
Symptoms that persist for greater than two weeks and affect quality of life.
- Chronic Cough
- Chronic Hoarseness
- Nausea and Vomiting
- Alarm Symptoms
Symptoms that signal complications or alternative diagnosis.
Normally require immediate medical care and should not be treated at the self-care level.
- Frequent Vomiting
- GI Bleeding
- Unexplained Chest Pain
- Weight Loss
- Dietary changes
- Medication changes
- Elevate the head of bed
- Weight reduction
- Smoking cessation
- Avoid alcohol
- Avoid tight fitting clothing
- Avoid foods that decrease lower esophageal pressure (fats chocolate alcohol peppermint)
- Avoid direct irritant foods (spicy foods acidic juices coffee)
- Include protein-rich meals in diet (augments lower esophageal pressure)
- Eat small meals and avoid eating prior to sleeping
- Discontinue if possible medications that promote reflux (calcium channel blockers beta-blockers nitrates theophylline)
- Take direct irritant drugs with water if they cannot be avoided (tetracyclines quinidine potassium iron aspirin NSAIDs
Eustachian tube dysfunction (ETD) can cause dulled hearing. It is usually a temporary problem that lasts a week or so and most commonly occurs during and after a cold. There are various other causes and sometimes it lasts longer. Often no treatment is needed but decongestants antihistamines or a steroid nasal spray sometimes help.
What is the Eustachian tube and what does it do?
The Eustachian tube is a narrow tube that connects the middle ear with the back of the nose. In adults it is about 3-4 cm long. The middle ear space behind the eardrum is normally filled with air. The air in the middle ear is constantly being absorbed by the cells that line the middle ear. So fresh supplies of air are needed to get to the middle ear from time to time.
The Eustachian tube is normally closed but opens from time to time when we swallow yawn or chew. This allows air to flow into the middle ear and any mucus to flow out. This keeps the air pressure equal either side of the eardrum. Having equal air pressure on each side of the eardrum and the middle ear free of mucus enables the eardrum to work and vibrate properly which is needed to hear properly.
How do we hear?
Sound waves hit the eardrum. Vibrations of the eardrum pass on to tiny bones (the ossicles) in the middle ear. These bones transmit the vibrations to the cochlea in the inner ear. Sound signals are sent from the cochlea to the ear nerve and then on to the brain.
What is Eustachian tube dysfunction?
Eustachian tube dysfunction (ETD) means that the Eustachian tube is blocked or does not open properly. Air cannot then get into the middle ear. Therefore the air pressure on the outer side of the eardrum becomes greater than the air pressure in the middle ear. This pushes the eardrum inward. The eardrum becomes tense and does not vibrate so well when hit by sound waves.
What are the symptoms of Eustachian tube dysfunction?
The main symptom is muffled or dulled hearing. You may also have ear pain because the eardrum is tensed and stretched. Other symptoms that may also develop include: a feeling of fullness in the ear; tinnitus (ringing or buzzing in the ear); dizziness. One or both ears may be affected.
Symptoms can last from a few hours to several weeks or more. It depends on the cause. In most cases due to a cold (the common cause) the symptoms are likely to go within a week or so. As symptoms are easing you may get popping sensations or noises in the ear. Also the dulled hearing may come and go for a short time before getting fully back to normal.
What are the causes of Eustachian tube dysfunction?
ETD occurs if the Eustachian tube becomes blocked or if the lining of the tube becomes swollen or if the tube does not open as it should to allow air to travel to the middle ear.
Colds and other nose sinus ear or throat infections
This is the common cause of ETD. The blocked nose or thick mucus that develops during a cold or other infections may block the Eustachian tube. An infection may also cause the lining of the Eustachian tube to become inflamed and swollen. Most people will have had one or more episodes in their life when they have had a cold and find that they cannot hear so well due to ETD. The symptoms of ETD may persist for up to a week or so (sometimes longer) after the other symptoms of the infection have gone. This is because the trapped mucus and swelling may take a while to clear even when the infecting germ has long gone.
Sometimes the infection is very mild. Perhaps a mild cold with a mild bunged up nose. However ETD may still develop in some people for a while.
Glue ear is a condition where the middle ear fills with glue-like fluid. The Eustachian tube becomes congested and prevents the free flow of air into the middle ear causing the difference in air pressure mentioned above. The eardrum becomes tight reducing its ability to vibrate resulting in dulled hearing. The situation is made worse by the glue-like fluid damping down the vibrations of the drum even further. It is a common condition in children. It clears by itself in most cases but some children need an operation to solve the problem.
Allergies that affect the nose such as perennial rhinitis and hay fever can cause extra mucus and inflammation in and around the Eustachian tube and lead to ETD.
Anything that causes a blockage to the Eustachian tube can cause ETD. For example enlarged adenoids. Rarely ETD can be a symptom of rare tumours that sometimes develop at the back of the nose. These will usually cause other symptoms in addition to ETD.
Air travel and the Eustachian tube
Some people develop ear pain when descending to land during a plane journey. It is caused by unequal pressures that develop on either side of the eardrum as the plane descends. As a plane descends the air pressure becomes higher nearer the ground. This pushes the eardrum inwards which can be painful. In most people just normal swallowing and chewing quickly cause air to travel up the Eustachian tube to equalise the pressure.
Some airlines offer sweets to suck and eat when the plane is descending to encourage you to chew and swallow. However if you have a narrow Eustachian tube a cold or anything else that can cause blockage to the Eustachian tube then the pressure does not equalise very easily when the plane descends. This can cause severe ear pain.
What is the treatment for Eustachian tube dysfunction?
Treatment options depend on the cause and severity of the condition.
Often no treatment is needed
In many cases the ETD is mild and does not last longer than a few days or a week or so. For example this is common following a cold. No particular treatment is needed and the symptoms often soon go.
Try to get air to flow into the Eustachian tube
Air is more likely to flow in and out of the Eustachian tube if you swallow yawn or chew. Also try doing the following. Take a breath in. Then try to breathe out gently with your mouth closed and pinching your nose (the Valsalva manoeuvre). In this way no air is blown out but you are gently pushing air into the Eustachian tube. If you do this you may feel your ears go 'pop' as air is forced into the middle ear. This sometimes eases the problem. This is a particularly good thing to try if you get ear pain when descending to land in a plane.
Decongestant nasal sprays or drops
These may be advised by your doctor if you have a cold or other cause of nasal congestion. You can buy these from pharmacies. They may briefly relieve a blocked nose. However you should not use a decongestant spray or drops for more than 5-7 days at a time. If they are used longer than this they may cause a worse rebound congestion in the nose.
Antihistamine tablets or nasal sprays
These may be advised by your doctor if you have an allergy such as hay fever. In this situation they will help to ease nasal congestion and inflammation.
Steroid nasal spray
A steroid nasal spray may be advised if an allergy or other cause of persistent inflammation in the nose is suspected. It works by reducing inflammation in the nose. It takes several days for a steroid spray to build up to its full effect. Therefore you will not have an immediate relief of symptoms when you first start it. However if any inflammation is reduced in the back of the nose then the Eustachian tube is able to work better.
Referral to a specialist
If symptoms persist or the cause of the ETD is not clear then you may be referred to an ear specialist for assessment. Treatment options depend on any underlying cause that may be found.
Insight into the proper care of the ears
Why does the body produce earwax?
- What is the recommended method of ear cleaning?
- When should a doctor be consulted?
- and more…
Good intentions to keep ears clean may be risking the ability to hear. The ear is a delicate and intricate area including the skin of the ear canal and the eardrum. Therefore special care should be given to this part of the body. Start by discontinuing the use of cotton-tipped applicators and the habit of probing the ears.
Why does the body produce earwax?
Cerumen or earwax is healthy in normal amounts and serves as a self-cleaning agent with protective lubricating and antibacterial properties. The absence of earwax may result in dry itchy ears. Most of the time the ear canals are self-cleaning; that is there is a slow and orderly migration of earwax and skin cells from the eardrum to the ear opening. Old earwax is constantly being transported assisted by chewing and jaw motion from the ear canal to the ear opening where it usually dries flakes and falls out.
Earwax is not formed in the deep part of the ear canal near the eardrum but in the outer one-third of the ear canal. So when a patient has wax blockage against the eardrum it is often because he has been probing the ear with such things as cotton-tipped applicators bobby pins or twisted napkin corners. These objects only push the wax in deeper.
When should the ears be cleaned?
Under ideal circumstances the ear canals should never have to be cleaned. However that isn’t always the case. The ears should be cleaned when enough earwax accumulates to cause symptoms or to prevent a needed assessment of the ear by your doctor. This condition is call cerumen impaction and may cause one or more of the following symptoms:
- Earache fullness in the ear or a sensation the ear is plugged
- Partial hearing loss which may be progressive
- Tinnitus ringing or noises in the ear
- Itching odor or discharge
What is the recommended method of ear cleaning?
To clean the ears wash the external ear with a cloth but do not insert anything into the ear canal.
Most cases of ear wax blockage respond to home treatments used to soften wax. Patients can try placing a few drops of mineral oil baby oil glycerin or commercial drops in the ear. Detergent drops such as hydrogen peroxide or carbamide peroxide may also aid in the removal of wax.
Irrigation or ear syringing is commonly used for cleaning and can be performed by a physician or at home using a commercially available irrigation kit. Common solutions used for syringing include water and saline which should be warmed to body temperature to prevent dizziness. Ear syringing is most effective when water saline or wax dissolving drops are put in the ear canal 15 to 30 minutes before treatment. Caution is advised to avoid having your ears irrigated if you have diabetes a perforated eardrum tube in the eardrum or a weakened immune system.
Manual removal of earwax is also effective. This is most often performed by an otolaryngologist using suction special miniature instruments and a microscope to magnify the ear canal. Manual removal is preferred if your ear canal is narrow the eardrum has a perforation or tube other methods have failed or if you have diabetes or a weakened immune system.
Why shouldn't cotton swabs be used to clean earwax?
Wax blockage is one of the most common causes of hearing loss. This is often caused by attempts to clean the ear with cotton swabs. Most cleaning attempts merely push the wax deeper into the ear canal causing a blockage.
The outer ear is the funnel-like part of the ear that can be seen on the side of the head plus the ear canal (the hole which leads down to the eardrum). The ear canal is shaped somewhat like an hourglass—narrowing part way down. The skin of the outer part of the canal has special glands that produce earwax. This wax is supposed to trap dust and dirt particles to keep them from reaching the eardrum. Usually the wax accumulates a bit dries out and then comes tumbling out of the ear carrying dirt and dust with it. Or it may slowly migrate to the outside where it can be wiped off.
Are ear candles an option for removing wax build up?
No ear candles are not a safe option of wax removal as they may result in serious injury. Since users are instructed to insert the 10” to 15”-long cone-shaped hollow candles typically made of wax-impregnated cloth into the ear canal and light the exposed end some of the most common injuries are burns obstruction of the ear canal with wax of the candle or perforation of the membrane that separates the ear canal and the middle ear.
The U.S. Food and Drug Administration (FDA) became concerned about the safety issues with ear candles after receiving reports of patient injury caused by the ear candling procedure. There are no controlled studies or other scientific evidence that support the safety and effectiveness of these devices for any of the purported claims or intended uses as contained in the labeling.
Based on the growing concern associated with the manufacture marketing and use of ear candles the FDA has undertaken several successful regulatory actions including product seizures and injunctions since 1996. These actions were based in part upon violations of the Food Drug and Cosmetic Act that pose an imminent danger to health.
When should a doctor be consulted?
If the home treatments discussed in this leaflet are not satisfactory or if wax has accumulated so much that it blocks the ear canal (and hearing) a physician may prescribe eardrops designed to soften wax or he may wash or vacuum it out. Occasionally an otolaryngologist (ear nose and throat specialist) may need to remove the wax using microscopic visualization.
If there is a possibility of a hole (perforation or puncture) in the eardrum consult a physician prior to trying any over-the-counter remedies. Putting eardrops or other products in the ear with the presence of an eardrum perforation may cause pain or an infection. Certainly washing water through such a hole could start an infection.
What can I do to prevent excessive earwax?
There are no proven ways to prevent cerumen impaction but not inserting cotton-tipped swabs or other objects in the ear canal is strongly advised. If you are prone to repeated wax impaction or use hearing aids consider seeing your doctor every 6 to 12 months for a checkup and routine preventive cleaning.
Reference: American Academy of Otolaryngology. Head and Neck Surgery. http://www.entnet.org/HealthInformation/earwax.cfm
Earaches and Otitis Media
Otitis media means “inflammation of the middle ear ” as a result of a middle ear infection. It can occur in one or both ears. Otitis media is the most frequent diagnosis for children who visit physicians for illness. It is also the most common cause of hearing loss in children. Although otitis media is most common in young children it occasionally affects adults
Is it serious?
Yes because of the severe earache and hearing loss it can cause. Hearing loss especially in children may impair learning capacity and even delay speech development. However if it is treated promptly and effectively hearing can almost always be restored to normal. Otitis media is also serious because the infection can spread to nearby structures in the head especially the mastoid. (see the symptoms list) Immediate attention from your doctor is the best action.
How does the ear work?
The outer ear collects sounds. The middle ear is a pea-sized air-filled cavity separated from the outer ear by the paper-thin eardrum. Inside the middle ear are three tiny ear bones. When sound waves strike the eardrum it vibrates and sets the bones in motion that transmit to the inner ear. The inner ear converts vibrations to electrical signals and sends these signals to the brain. A healthy middle ear has the same atmospheric pressure as air outside of the ear allowing free vibration. Air enters the middle ear through the narrow eustachian tube that connects the back of the nose to the ear.
What causes otitis media?
Blockage of the eustachian tube during a cold allergy or upper respiratory infection and the presence of bacteria or viruses lead to a build-up of pus and mucusbehind the eardrum. This infection is called acute otitis media. The build-up of pressurized pus in the middle ear causes pain swelling and redness. Since the eardrum cannot vibrate properly hearing problems may occur. Sometimes the eardrum ruptures and pus drains out of the ear. More commonly however the pus and mucus remain in the middle ear due to the swollen and inflamed eustachian tube. This is called middle ear effusion or serous otitis media. Often after the acute infection has passed the effusion remains lasting for weeks months or even years. This condition allows frequent recurrences of the acute infection and may cause difficulty in hearing.
What will happen at the doctor’s office?
During an examination the doctor will use an otoscope to look at and assess the ear. The doctor checks for redness in the ear and/or fluid behind the eardrum and to see if the eardrum moves. These are the signs of an ear infection.
Two other tests may also be performed:
- Audiogram—Tests if hearing loss has occurred by presenting tones at various pitches.
- Tympanogram—Measures the air pressure in the middle ear to see how well the eustachian tube is working and how well the eardrum can move.
How should medication be taken?
It is important that all the medications be taken as directed and that you keep any follow-up visits. Often antibiotics to fight the infection will make the earache go away rapidly but the infection may need more time to clear up. Other medications that your doctor may prescribe include an antihistamine (for allergies) a decongestant (especially with a cold) or both. Sometimes the doctor may recommend a medication to reduce fever and/or pain. Special ear drops can ease the pain. Call your doctor if you have any questions about yours or your child’s medication or if symptoms do not clear.
What other treatment may be necessary?
If your child experiences multiple episodes of acute otitis media within a short time or hearing loss or chronic otitis media lasts for more than three months your physician may recommend referral to an otolaryngologist for placement of ventilation tubes also called pressure-equalization (PE) tubes. This is a short surgical procedure in which a small incision is made in the eardrum any fluid is suctioned out and a tube is placed in the eardrum. This tube eventually will fall out on its own and the eardrum heals. There is usually an improvement in hearing and a decrease in further infections with PE tube placement.
Otitis media may recur as a result of chronically infected adenoids and tonsils. If this becomes a problem your doctor may recommend removal of one or both. This can be done at the same time as ventilation tubes are inserted.
What are the symptoms?
In infants and toddlers look for: Pulling or scratching at the ear especially if accompanied by other symptoms; hearing problems; crying irritability; fever; ear drainage.
- In young children adolescents and adults look for: earache; feeling of fullness or pressure; hearing problems; dizziness; loss of balance nausea vomiting ear drainage and/or fever.
Remember without proper treatment damage from an ear infection can cause chronic or permanent hearing loss.
American Academy of Otolaryngology – Head and Neck Surgery. http://www.entnet.org/HealthInformation/Earaches.cfm