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Primary ear & hearing care

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Acute otitis media

An acute, suppurative infectious process of the middle ear characterised by accumulation of infected fluid behind the tympanic membrane. Often, it is precipitated by impaired function of the Eustachian tube. Otorrhoea may result if the tympanic membrane ruptures.
Antibiotic eardrops Fluoroquinolones (i.e., Ciprofloxacin or Ofloxacin) are often used as topical antibiotic drops for the treatment of ear infections. Glucocorticoids and aminoglycosides are also commonly prepared as topical ear drops in the treatment of other otologic conditions.
Audiologist A healthcare professional that specialises in the identification and assessment of disorders of hearing, using audiological tests and procedures.
Auditory nerve The eighth cranial nerve that connects the inner ear to the brainstem, transmitting sounds in the form of electrical impulses to be interpreted by the brain.
Batteries Button batteries are small, shiny objects that are attractive to children and pose a potential danger as foreign bodies. Patients often present with a compacted external auditory canal due to a lodged battery.
Bell’s Palsy Bell’s palsy is a condition that causes a temporary weakness or paralysis of the muscles in the face. It can occur due to inflammation and compression of the facial nerve. Patients present with unilateral weakness/paralysis on one side of their face, often causing a facial droop.
Bulb An ear bulb syringe should be used for aspiration or irrigation when one or both ears are impacted with wax. They are small rubber objects that will fill with water and allow the user to squirt the water gently into the ear to remove the earwax.
Cartilage Firm, flexible connective tissue. Typically found in structures of the external ear, larynx, respiratory tract, and in the articulating surfaces of joints.
Cholesteatoma A cholesteatoma is an abnormal growth of skin in the middle ear behind the eardrum. It can be congenital or more commonly it can occur as a complication of chronic ear infections. Negative pressure persists in the middle ear due to eustachian tube dysfunction, resulting in retraction of the tympanum. Clinical presentation includes a painless discharge from the ear, hearing loss, dizziness, a blocked and pressure-filled ear, and an accumulation of squamous debris within the ear.
Cochlea (hearing organ) Snail shaped structure in the inner ear that contains the organ responsible for hearing through the process of auditory transduction. It is here that sound waves are transduced into electrical impulses that are transmitted to the brain for further interpretation.
Cochlear implants An electronic device that stimulates the auditory nerve through electrodes placed in the cochlea of the inner ear, allowing some severely deaf people to perceive sounds.
Chronic suppurative otitis media A more chronic form of otitis media defined by a perforated tympanic membrane with persistent drainage from the middle ear for more than two to six weeks. Clinical features include persistent/recurrent otorrhea through a tympanic membrane perforation with associated conductive hearing loss of varying severity and otalgia.
Conditioned play audiometry Performed in children from the ages of two to five years old during their developmental years. It is a type of behavioural hearing test that directly follows visual reinforcement audiometry when the child becomes able to focus on a task.
Consanguinity A relationship or connection by lineage. It is when two or more individuals are related by a common ancestor.
Complaints associated with cholesteatoma Painless otorrhea (unremitting/recurrent) and hearing loss due to the accumulation of squamous debris in the middle ear reducing sound transmission. Less common complaints include vertigo or facial nerve palsy.
Deaf Impaired hearing ability usually due to inner ear or nerve damage.
Deformities of the pinnae Microtia (underdeveloped outer ear), cryptotia (ear cartilage buried under the skin), anotia (absence of ear), protruding ears (prominent, stick out more than 2cm), constricted ears (helical rim is folded over), ear tags (accessory tags consisting of skin or cartilage), cauliflower ear (bulky ears due to excessive collagen formation), ear keloids or haemangiomas.
Distraction test of hearing The distraction test is used for babies who are developmentally six to 24 months and assesses the ability of the baby to hear a sound then turn to locate it.
Dizziness Altered sense of balance and place. It can be described as a sensation of spinning, light-headedness or feeling faint.
Dry mopping A method used to clear pus, discharge, or any kind of fluid build-up in the ear. Done using a wick that is prepared by rolling a cotton over the end of a stick, allowing it to extend past the end for 2-3cm. The ear canal is cleaned using a twisting motion.
Dry perforation A perforation without the presence of a secondary watery, mucoid, or bloody substance. There will be no purulent otorrhea on the ruptured membrane and at the perforated edges (unlike a wet perforation where this is likely to occur).
Ear care Interventions used to keep the ears clean are essential in the minimisation or prevention of infection, hearing loss and waste accumulation in the ear. Ear care ranges from ear irrigation for the removal of excess cerumen/foreign materials in the ear to the protection of the ears from loud noises that could damage them.
Ear canal The tubular passage of the outer ear leading to the tympanic membrane. The lateral portion of the canal is about 8mm long and consists of cartilage, thick skin, hairs, and exocrine glands. The medial portion is about 16mm long consisting of bony, thin skin with no appendages.
Ear drum/tympanic membrane A thin membrane separating the middle ear from the inner part of the external auditory canal. It transmits sounds by vibrating in response to sound energy and converting it into mechanical vibrations that are transferred to the tiny bones in the middle ear.
Ear protection Refers to the preservation of hearing and ear health using devices to protect the ears from elements such as cold, water intrusion, debris, noise, or environmental conditions.
Early identification Crucial for effective rehabilitation. Regular monitoring and early identification are recommended for all children. Early identification of hearing problems can prevent children from further disabilities and from falling behind their peers in speech/language development, cognitive skills, and social skills
Early intervention A program that helps children with hearing loss to learn language and skills, as well as improve in their speech development. Intervention plans vary, but will usually include monitoring, follow ups and continued care.
Electrical signals Neurons carry messages in the body in the form of electrical signals called nerve impulses. To create a nerve impulse, your neurons must be excited. Stimuli such as light, sound, chemicals or pressure all excite neurons which in turn transmit these electrical signals to the brain where they are interpreted further.
External processor A cochlear implant is an electronic device that partially restores hearing. It is an external sound processor that fits behind the ear and captures sound signals and sends them to a receiver implanted under the skin behind the ear. The receiver sends the signals to electrodes implanted in the inner ear (cochlea).
Facial palsy This term refers to weakness of the facial muscles, resulting from temporary or permanent damage to the facial nerve. When the facial nerve isn't functioning properly, the muscles in the face do not receive the necessary signals. This results in paralysis of the affected part of the face, which can reduce movement of the eye(s), mouth or other areas.
Facial nerve The facial nerve is the seventh cranial nerve. It carries nerve fibres that control facial movement and expression. It also carries nerve fibres that are involved in taste to the anterior 2/3rd of the tongue, and it is involved in lacrimation (production of tears).
Foreign body in ear canal Common presentation or reason for visits to the doctor amongst children and can cause of harm if left untreated. A foreign object stuck or lodged in the outer ear canal can cause pain, inflammation, infection, and hearing loss.
Fungal otitis media Otomycosis is a fungal ear infection that predominantly affects the outer and middle ear. Common causative fungi include Candida and Aspergillus. Presenting complaints include hearing loss, otorrhea, tinnitus, discharge, and a feeling of fullness in the ear. Grey/yellow/white fungal spores may form in the ear canal.
Genetic causes Hereditary diseases may be passed down lineages in genetic material that is inherited from previous descendants. Certain genetic alterations may deem one more predisposed to specific medical conditions/diseases than others.
Glue ear Glue ear occurs when thick fluid builds up inside the middle ear space. It can cause temporary hearing loss, but this will usually resolve in 3 months. Glue ear tends to be more common in children due to their short and more horizontal positioned eustachian tube.
Haematoma of the pinna A collection of blood within the cartilaginous auricle (outer ear) which typically results from blunt trauma during injuries. The collection should be managed by drainage.
Hair cells Hair cells are specialized secondary sensory cells that mediate our senses of hearing, balance, linear acceleration, and angular acceleration. They are transducers that change mechanical energy of motion to electrical signals conveyed as vestibular nerve action potentials. These receptors can be found in both the auditory and vestibular system.
Hard of hearing Used to describe difficulty hearing that is of a lesser degree than complete deafness.
Headphones A pair of small loudspeaker earphones worn on or around the head, over the user's ears (or inside them). They are electroacoustic transducers that convert electrical signals to corresponding sounds.
Hearing related milestones Milestones correlate to general progression in speech development. Milestones include reacting to loud sounds, turning head towards a sound, watching your face when you speak, vocalizing pleasure and displeasure sounds (laughs, giggles, coos, cries, fusses), making noise when talked to.
HearWho app This app gives the public access to a hearing screener to check their hearing status and monitor it over time. It can also be used by health workers to screen people in the community for hearing loss and refer them for diagnostic testing if they fail the screening test.
Hearing loss prevention Reduce noise exposure, take a break from the noisy activities, increase the distance between you and the source of the noise, reduce your time in noisy areas, wear hearing protection in noisy areas, use foam plugs and ensure you are listening to music at a reasonable volume. Ear care is also important to keep ears functioning optimally. Clean regularly with appropriate methods to remove any waste/cerumen accumulation.
Infection of pinna Pinna perichondritis is an infection of the lining of the ear cartilage, usually caused by Pseudomonas aeruginosa or Staphylococcus aureus. Patients will present with an erythematous, swollen, hot external ear, with a collection of pus on the pinnae.
Injury of the pinna External ear injuries may be open or closed. Blunt ear trauma may cause a hematoma of the pinna. This may result in cartilage necrosis, chronic scarring or permanent deformity if left untreated (“cauliflower ear”). Open injuries include lacerations (with and without cartilage exposure) and avulsions.
Inner ear The inner ear or the labyrinth of the ear, contains the organs of hearing and equilibrium. The bony labyrinth, a cavity in the temporal bone, is divided into three sections; the vestibule, the semi-circular canals, and the cochlea. Within the bony labyrinth is a membranous labyrinth, which is divided into three parts; the semi-circular ducts, the saccule and utricle (located in the vestibule) and the cochlear duct, which is the part of the inner ear involved in hearing.
Levels of hearing loss Varying degrees of hearing impairment including the following grades in ascending order of severity: mild, moderate, moderate severe, severe, profound, complete, and unilateral.
Main symptoms of ear disease Hearing loss, otorrhea/discharge, otalgia, pressure-like sensation, fussiness in young infants or tugging at the ears for older children, tinnitus/ringing in the ears, fever, or headaches.
Mastoiditis An infection of the mastoid bone, located behind the ear. Usually caused by a middle ear infection that can result in damage to the mastoid bone and the formation of pus-filled cysts. Symptoms include redness, swelling and tenderness around the bone. Associated symptoms include fever, ear pain and discharge.
Meningitis/brain abscess Meningitis is inflammation of the meninges and subarachnoid space. It may result from bacterial, viral, or fungal infections. Severity of infection will vary from mild/moderate to severe. Findings typically include headache, fever, and nuchal rigidity. Diagnosis is by cerebrospinal fluid (CSF) analysis.
Middle ear The middle ear lies within the temporal bone and extends from the tympanic membrane to the lateral wall of the inner ear. The main function of the middle ear is to transmit vibrations from the tympanic membrane to the inner ear via the auditory ossicles.
Ossicles - malleus, incus, stapes These ossicles are small bones within the ear, connected in a chain-like manner. They link the tympanic membrane to the oval window of the internal ear. Sound vibrations cause a movement in the tympanic membrane which further stimulates movement, or oscillation, of the auditory ossicles. This movement helps to transmit the sound waves from the tympanic membrane of the external ear to the oval window of the internal ear.
Otalgia Term used to describe earache or pain originating from the ear.
Otitis externa Inflammation of the external ear, commonly involving the external auditory canal, the auricle or both. It is often caused by bacteria, viruses or fungi and is usually classified as either acute or chronic. Swimmer’s ear is an acute diffuse otitis externa, due to a bacterial infection of the external canal. Usually, it presents with pain, tenderness, otorrhea and conductive hearing loss due to a build of debris that narrows the lumen of the external canal. Other examples include furunculosis, impetigo of the pinnae or erysipelas of the soft tissue surrounding the ear.
Otitis media (OM) Infection of the middle ear with inflammation of the ear tissue including the ear drum and the tissue behind it. This causes fluid build-up in the middle ear, resulting in rupture of the tympanic membrane and a discharge of infective pus. OM may be classified as acute/chronic and with/without effusion. Acute OM is usually caused by a virus and has a rapid onset. It presents with pain, fever, and poor sleep. OM with effusion is often asymptomatic but there will be fluid accumulation in the middle ear with a sensation of fullness/pressure due to eustachian tube dysfunction. Persisting negative pressures will often require grommet insertion. Chronic suppurative OM is a complicated middle ear inflammation that results in a perforated tympanic membrane and often presents with hearing loss and may require tympanoplasty.
Otoacoustic emissions test A test to evaluate the functioning and health of the inner ear or cochlea. It assesses how good one's inner ear response to sound is. During the tests small probes are placed into the ear that is being evaluated to screen for the accuracy of sound detection.
Otorrhea Term to describe discharge/drainage of liquid from the ear, usually resulting from external ear canal pathology or tympanic membrane perforation.
Otoscope A medical device used to look inside patient’s ears. It has an attached light. It is used to examine the ear canal and tympanic membrane or eardrum.
Ototoxic medications NSAIDs (including aspirin, ibuprofen, and naproxen), aminoglycosides, diuretics, quinine-based medications, certain anticonvulsants, tricyclic antidepressants, anti-anxiety medications, antimalarial medications, blood pressure controlling medications, allergy medications, chemotherapy drugs. These can all cause ototoxicity.
Outer ear The external part of the ear consisting of the auricle, pinna and the ear canal. It gathers sound energy and focuses it on the eardrum (tympanic membrane).
Pinna The visible, projecting part of the external ear. The pinna consists of a skin flap attached to fibroelastic cartilage. It has comparatively little effect on the acuity of hearing. Also known as the auricle.
Perforation A hole in the tympanic membrane or the thin layers of tissue that separates the ear canal from the middle ear. A perforated eardrum may be caused by loud sounds, a foreign object in the ear, head trauma, a middle ear infection or rapid pressure changes.
Pre-auricular sinus Term used to describe small pits located around the external ear, that can become problematic if infected. These dimples are often found anteriorly in the ascending limb of the helix. If infected, they may develop into an abscess requiring incision and drainage.
Polyp A benign growth often located on the inside of a child's ear canal, may also be found in the middle ear, or attached to the tympanic membrane. Ear polyps may be caused by chronic ear infections or a cholesteatoma.
Pus Pus is an exudate or infective fluid that will be found discharging from a site of inflammation or held together in a collection known as an abscess. Usually, it appears yellow and may have an offensive odour.
Rehabilitation Rehabilitation is defined as a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions through interaction with their environment. 
Speech therapist Speech therapy is the assessment and treatment of communication problems and speech disorders. Speech therapy techniques are used to improve communication. These include articulation therapy, language intervention activities, and others depending on the type of speech or language disorder.
Speculum An instrument used to widen the opening of a nostril to achieve better visualisation of the nasal cavity.
Sound vibrations Sound can propagate through a medium such as air, water, and solids. The sound waves are generated by a sound source which creates vibrations in the surrounding medium. As the source continues to vibrate through the medium, the vibrations propagate away from the source at the speed of sound, thus forming a sound wave.
Sunken eardrum Retracted eardrums are caused by eustachian tube dysfunction. These tubes drain fluid to help maintain an even pressure inside and outside of the ears. When your eustachian tubes aren't working correctly, decreased pressure inside your ear can cause your eardrum to collapse inward, creating a retracted/sunken eardrum.
Tinnitus Ringing or buzzing noise in one or both ears that may be constant or come and go. It is often associated with hearing loss and can be because of normal compensatory changes in the hearing mechanism. It may be pulsatile/non-pulsatile, also classified as subjective (not heard by others) or objective (heard by others)
Tragus Small pointed eminence of the external ear, situated in front of the concha, and projecting backward over the meatus. Functions to collect sound.
Vestibular system (balance organ) The apparatus of the inner ear involved in balance. The vestibular system consists of two structures of bony labyrinth within the inner ear: the vestibule and the semi-circular canals. There is a membranous labyrinth contained within them.
Wax Earwax, also known by the medical term cerumen, is a brown, orange, red, yellowish or grey waxy substance secreted in the ear canal of humans and other mammals. It protects the skin of the human ear canal, assists in cleaning and lubrication, and provides protection against bacteria, fungi, and water.
Wicking Ear wicks are used particularly if the ear canal is very swollen and blocked. This is a piece of gauze soaked in treatment drops and pushed gently into the ear canal between the swollen walls to remove the blockage.
Whisper voice test A bedside estimate of hearing impairment in which the examiner stands two feet the patient's ear and whispers a number followed by a letter. An approximate 30 dB hearing loss is suggested by inability to hear numbers or letters.


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