Ear complaints can cause real anxiety and distress for sufferers, disturbing sleep, affecting social lives and even having an impact upon people’s mental health.

Mr Simon Browning, a Consultant Surgeon at HMT Sancta Maria Hospital, talks here about some of the common, yet often debilitating, ear complaints he sees, that can be treated or managed by him and the ENT team at HMT Sancta Maria.

 

“Many of the patients I see are dealing with problems that are considered fairly routine, such as ear infections or problems with ear wax build-up. They may be suffering from conditions that are quite common, like tinnitus or vertigo, but because of the effect these conditions can have on a person’s mental health and wellbeing, their social life, personal life, and sleep patterns, they can be debilitating.

 

A number of these conditions are treatable, and for those that aren’t curable, there are effective ways of managing them, so they encroach less, and so the patient feels in control of their life again.”

 

Benign ParoxysmalPositioning Vertigo (BPPV)

 

How does it feel?

This is the most common cause of vertigo, and it can be disconcerting and worrying for patients. They feel a sensation of spinning or swaying, as if the head is turning quickly from the inside. These episodes can be brief and mild, or severe and they are often provoked by rolling over in bed or lying back in a chair such as at the dentist or hairdresser.

 

What causes it?

We are all born with calcium particles in the ear that form a normal part of the balance mechanism. For some people these become loose perhaps through ageing or after a fall or a head injury. They get trapped in the wrong part of the balance organ and cannot get out. These misplaced particles cause us to feel a spinning sensation when we move.

 

How is it treated or managed?

Many patients can be treated effectively by using a very simple physical therapy, called the Epley Manoeuvre. This should be carried out in a controlled way by a medical professional but it can be learned by patients. It involves getting the patient to lie down, roll over onto their side, and then sitting them up again. This allows the particles to escape. The treatment can work remarkably swiftly and, as you can imagine, patients are often amazed that something so simple can be life-changing.

 

Tinnitus

 

What is tinnitus?

Tinnitus is an intermittent whistling, roaring or buzzing sound in the ear that can fluctuate in loudness and pitch. It is often most noticeable at night or during other quiet times. It is very common and, in the UK, about 1 in 10 people have it all of the time.

 

What causes it?

Tinnitus can arise when a patient has hearing loss perhaps as a result of aging or prolonged exposure to loud noise. Some drugs can cause it such as some painkillers, antibiotics or diuretics. In some cases, it is caused by a head or neck injury, an ear infection, problems with the jaw or a foreign body in the ear. Sometimes it just comes by itself.

For the majority of patients, tinnitus is annoying but it doesn’t change their lives. They can ignore it easily, they can sleep normally and live normally. For others, it is distressing causing sleeplessness, anxiety, isolation and even depression. They need help to manage the problem.

 

How is it managed?

If there is an underlying cause, such as an ear infection, or wax in the ear, this can be treated, and in those cases, the tinnitus will often disappear.

In other cases, where there is no clear cause for the tinnitus, the ENT department can offer investigation and support to help manage the condition. There are a number of tactics that can be used, including using a pillow speaker to create low level sounds at night, attention switching techniques, positive imagery, and even self-hypnosis type techniques. Often the treatment is about managing sleep, without the use of sleeping tablets, and managing a patient’s emotional response to the condition.

With the right support and intervention the majority of patients experience improvement in their tinnitus.

 

Surfer’s Ear

 

How does it feel?

This is a condition that affects the ears of surfers and other water-sport enthusiasts. It causes hearing difficulty, trapping of water and ear infections.

 

What causes it?

As you can guess from the name, this is seen most in surfers, who have prolonged periods of exposure to cold water and cold air. Surgeons in this part of the world, and in Devon and Cornwall see this often but there are surgeons in other inland parts of the UK who have never seen an instance of it. It occurs when cooling of the ear canal stimulates bone growth that narrows the canal and blocks the eardrum. This narrowing can trap water and wax in the canal.

 

How is it treated or managed?

The unwanted bone growth will be drilled out. Recovery takes, typically, around six weeks. One of the main problems with treating Surfer’s Ear is that you are treating surfers! While they tend to be fit and healthy, they are also keen not to have their lifestyles interrupted by medical procedures and recovery time, and it is hard to keep them out of the water. I’m trialling the use of a state-of-the-art piece of equipment, a piezoelectric drill, to carry out this procedure, which may cut that recovery time to four weeks and may allow us to operate on both ears during the same operation – something that is not currently feasible.

 

Ear infection

(Swimmers Ear, middle ear infection or fungal infection.)

 

What are they?

Ear infections vary from simple outer ear infections caused by swimming to very severe infections that can cause serious harm. They happen in the ear canal and behind the eardrum. Symptoms include earache, ear discharge and deafness. Tinnitus and dizziness may also occur.

 

What causes it?

Infections can be caused by an injury to the eardrum, an infection picked up when swimming or an issue caused by a cold or allergy. Swimmer’s Ear, middle ear infections and fungal infections are quite common. Of these issues, a cholesteatoma is the most worrisome to me. This is a skin cyst in the middle-ear made of trapped skin cells and debris.

 

How is it treated or managed?

A cholesteatoma is sometimes hard to diagnose for GPs so the problem can rumble on for years, in some cases. This can be problematic, as it can grow into other areas of the ear, including the balance mechanism. More seriously, it can turn into an infection in the inner ear and, in rare cases, in the brain. The best treatment for these serious infections is surgery but simpler infections respond well to ear cleaning and ear drops.

 

If you are experiencing ear problems and you would like to see an ENT specialist, contact HMT Sancta Maria here:

https://www.hmtsanctamaria.org/product-category/consultant/consultant-ent/or call 01792 479040.

 

Mr Simon Browning MA(Ed), MPhil, FRCS (ORL), MB BCh, is a Consultant Surgeon at HMT Sancta Maria and an Associate Professor at the University of Swansea Medical School.

He qualified in Medicine from Cardiff before training in Bristol, Oxford and Southampton Hospitals, taking up a higher training post in South Wales.  He has held roles in the Royal College of Surgeons, ENT UK and Regionally as the Chairman of the Surgical Training Committee.

His sub-specialist interests within ENT include: balance disorders, tinnitus, ear diseases including Surfer’s Ear, perforations and other chronic ear conditions. His paediatric expertise includes management of deaf children including bone anchored hearing aids, perforations and cholesteatoma, balance disorders, tonsillitis, sleep apnoea, and glue ear.