Sense Organs; Hearing Pathologies

Question 1

Otitis Externa
(Swimmer’s ear)

Answer 1

• Inflammation of the outer ear.
  Otitis = ear inflammation, externa = outer part

Pathophysiology:
* 90% are associated with a bacterial infection and the remaining are fungal or allergic

Aetiology:
Risk factors;
* 5 X more common in swimmers
* More prevalent in humid climates
* Diabetes mellitus
* Immune suppression e.g. HIV
* Narrow auditory canal
* Ear wax (cerumen) contains lysozymes and oil that creates an acidic, lubricating coat. This inhibits bacterial and fungal growth so insufficient wax can predispose to infection.
* Excess wax (obstruction), water in the ear, frequent use of earplugs / headphones / hearing aids, acne, eczema, fungal infections following antibiotic use

Main signs and symptoms:
* Pain (esp. movement of pinna)
* Discharge (often purulent), swelling, red, swollen auditory canal
* Hearing deficit (inflammation)
* Can cause itching, fever, fever, lymphadenophy

Allopathic treatment:
* Hygiene
* Avoid water in ears
* Syringe ears – saline solution (GP)
* Topical antibiotics

Alternative treatment:
* Treat cause – herbs and nutritional support for the immune system, allergies, lymphatic drainage, inflammation (anti-inflammatories – quercetin, turmeric, diet)
* Homeopathy
* Acupuncture
* Garlic oil, nano silver

Question 2

Otitis Media

Answer 2

• Inflammation of the middle ear.
  Otitis = ear inflam¬mation, externa = outer part

Aetiology:
* Infectious organisms typically spread from nasopharynx (bacterial, viral)
* Allergy

Risk factors;
* Most common cause of earache in children (75 % = <10 yrs) – the Eustachian tube is more horizontal (common route of spread).
* Many have food or inhaled allergies (e.g. cow’s milk, wheat, egg)
* Fluid outs pressure on tympanic membrane

Main signs and symptoms:
* Ear ache / pain
* Mild hearing loss
* Malaise, fever, nausea
* Bulging of the tympanic membrane

Allopathic treatment:
* Rupture of the tympanic membrane – results in discharge from the ear canal and relief of pain
* Antibiotics

Alternative treatment:
* herbs and nutritional support for the immune system, allergies, lymphatic drainage, inflammation
* Homeopathy
* Acupuncture
* Pro-biotics – Lactobacillus
* Avoid allergens
* Garlic oil, colloidal silver drops in ear

Complications:
* Scar tissue on eardrum (with rupture of the tympanic membrane – loss of elasticity)

Question 3

Secretory Otitis Media
(Glue ear)

Answer 3

• An effusion of the middle ear resulting in incomplete resolution of acute Otitis media

Pathophysiology:
* Gluey fluid dampens the tympanic membrane and ossicle vibrations, which leads to hearing impairment

Aetiology:
* Incomplete resolution of acute Otitis media

Main signs and symptoms:
* hearing loss (difficult to determine in young children – listening to TV very loudly etc)
* Pressure in ear and mild intermittent ear pain

Allopathic treatment:
* Tympanostomy tube (Grommet): a tiny pipe inserted into eardrum under anesthetic and fluid is drained, air circulates in middle ear and hearing improves. Typically fall out within 6-12 months. Hole usually heals when grommet falls out
* Tonsils may be removed to improve Eustachian drainage (immune compromise).

Alternative treatment:
* Treat cause – herbs and nutritional support for the immune system, allergies, lymphatic drainage (gallium), inflammation, infection
* Homeopathy
* Acupuncture
* Colloidal silver

Question 4

Otitis Interna
(Labyrinthitis)

Answer 4

• A balance disorder, associated with inflammation of the membranous labyrinth
  Labyrinth = inner ear, it is = inflammation

Aetiology:
* Viral or bacterial - often following upper respiratory infection
* Following head injury, an allergy or reaction to medication

Main signs and symptoms:
* Sudden and severe vertigo (not triggered by movement unlike benign paroxysmal positional vertigo (BPPV)
* Sudden unilateral hearing loss (not in BPPV)
* Nausea and vomiting
* Tinnitus
Vertigo = illusion of movement

Allopathic treatment:
* Anti-emetics drugs (anti-sickness) – often viral cause meaning its hard to treat

Alternative treatment:
* Herbs and anti-inflammatory diet
* Homeopathy
* Acupuncture (conium – vertigo)
* Decrease stress
* Hydrate

Question 5

Meniere’s Disease

Answer 5

• A disorder of the inner ear, caused by a change in fluid volume in labyrinth, associated with progressive distention of the membranous labyrinth

Aetiology:
* Unknown; Genetics, viral, autoimmune links (RA, SLE)
* Links with food allergies

Main signs and symptoms:
* Vertigo, Tinnitus and Hearing loss (common triad)
* Nausea and vomiting
* Ear pressure
* Characterised by fluctuating patterns of symptoms (acute attacks typically last 2-3 hours every 1-2 months)

Allopathic treatment:
* No cure – symptom minimization (manage acute attacks)

Alternative treatment:
* Low salt – reduce fluid build-up in inner ear (esp. table salt)
* Regular exercise, stress reduction, smoking cessation
* Address fatigue; common trigger of episodes
* Food triggers –link between migraine & Meniere’s Similar triggers may contribute to come attacks of Meniere’s. Eliminate caffeine / alcohol
* Homeopathic; Conium maculatum 30C
* Acupuncture and herbs

Question 6

Tinnitus

Answer 6

• The perception of sound originating from within the head rather than outside

Aetiology:
* Two Categories:
* Objective; Pulsatile (carotid stenosis, valve disease), muscular (spasm of tympanic muscles)
* Subjective (no acoustic stimuli); Ear origin (Meniere’s ear infection, wax), Neurological (head injury, MS, tumour), infections (meningitis), drug related (NSAIDs, loop diuretics), TMJ (jaw) dysfunction

Alternative treatment:
* Treat underlying causes
* Very early stages; Ginkgo biloba (increases circulation up to ear)
* Avoiding loud noise and earwax build up
* Manual therapy to neck and jaw

Question 7

Hearing Impairment

Answer 7

Hearing loss;
Categorisation:
* Conductive: Ear canal obstructions, ossicle abnormalities, ruptured tympanic membrane
* Sensory: Poor hair cell function – can be due to a congenital condition, infection or noise trauma

Aetiology:
* Diseases: measles, meningitis, mumps (auditory nerve damage), Rubella, Chlamydia and Syphilis (complete loss in Foetus), premature birth (usually impaired, not lost)
* Head injuries can cause hearing loss through damage to the middle ear or auditory nerve
* ‘Shaken baby syndrome’

Risk factors;
* Long-term exposure to noises; e.g. living next to airport.
* 90 dB+ can cause temporary or permanent hearing loss

Main signs and symptoms:

Measured in the degree of loudness, in decibels (dB):
* Mild hearing loss = adults 25-40 dB
* Moderate hearing loss = 41-70 dB
* Severe hearing loss = 71-90 dB
* Profound hearing loss = 90 dB or greater

Allopathic treatment:
* Hearing aids (amplifier) – receives incoming sound and amplifies the volume
* Cochlear implant (sometimes called a bionic ear). This stimulates the auditory nerves by electrical impulses.