Treatment of conductive hearing loss (CHL)

Conductive hearing loss CHL can be caused by acute or chronic conditions.

Acute causes for CHL are fluid in the middle ear from colds, acute ear infections (otitis media- an infection in which accumulation of fluid interfers with the movement of the ear drum and the ossicles), infection in the outer ear canal (otitis externa), perforated ear drum or a foreign body in the outer ear canal.

 Chronic causes for CHL are malformations of the outer ear, outer ear canal, or middle ear structures, poor Eustachian tube function, perforated ear drum, impacted ear wax (cerumen obturans) and otosclerosis. Otosclerosis is a condition caused by abnormal bone remodeling in the middle ear. Otosclerosis compromises and finally disrupts the ability of sound to travel from the middle ear to the inner ear.

Treatment of acute conductive hearing loss

1. Acute middle ear infection (Acute otitis media)

Acute middle ear infections can be either caused by bacterias or by viruses.

Bacterias:
Streptococcus pneumoniae, Hemophilus influenzae, Staphylococcus aureus and Moraxella catarrhalis

Viruses:
Herpes virus
Infuenza virus

Symptoms:
Sharp pain in the ear
Muffled hearing
Fever
Fatigue

Untreated otitis media can cause mastoiditis. Mastoiditis is a serious bacterial infection that effects the mastoid bone behind the ear. Prolonged high fever, vomitting, swelling of the mastoid are alarming signals and an ENT-specialist should be consulted immidiately.

Antibiotic treatment

Acute otitis media is usually being treated by beta-lactam-antibiotics, such as penicillin V, amoxicillin (in combination with clavulanic acid) and cefuroxim or by macrolid antibiotics such as erythromycin, roxithromycin, clarithromycin and azithromycin. The antibiotic treatment should be taken over a period of 7 days in a weight appropriate dosage. Impending or already present complications should be treated with an i.v. (intravenious) antibiotic. Antibiotic treatment always needs to be ordered by a physician.

Additional treatment
Over-the-counter painkillers (Paracetamol, Ibuprofen)
Decongestant nose spray (Otrivine, Afrin)
Bed rest
Hot-water bottle (hottie)

In rare cases a tympanostomy for pressure and infected middle ear fluid release might be necessary and performed by an ENT-specialist as an in-office procedure under local anesthesia.

2. Acute outer ear canal infection (Otitis externa)

Acute outer ear canal infection is often referred to as „swimmer’s ear“ because repeated exposure to salt water can make the ear canal more vulnerable to inflammation. But also self-cleaning of outer ear canal with cotton buds or other things (including fingers) can trigger a bacterial or fungus infection. Diabetes and other disease causing immune deficiency are risk factors for developing an otitis externa.

Symptoms:
Ear pain, which can be severe
Itchiness in the ear canal
A discharge of smelly liquid or pus from ear
Temporary hearing loss

Treatment:
A careful cleaning of the affected outer ear canal (OEC) by an ENT-specialist under the microscope is recommended in order to remove debris from the ear and to evaluate the tympanic membrane for eventual infection (myringitis). Ear drop medication or antifungal creme usually improves the symptoms within a few days but they all tend to be used twice a day for about 7 days.

Medication for OEC
Disinfection drops (dequalinium chloride)
Antibiotic drops (ciprofloxacin, dexamethasone)
Antifungal creme (clotrimazole)

3. Perforated ear drum

A perforated ear drum is a hole or tear in the ear drum. It can be caused by a middle ear infection, injury to the ear drum (poking an object such as a cotton bud deep into the ear, slap in the face, sudden loud noise or changes in air pressure , such as pressure changes when flying at high altitude or when scuba diving).

Symptoms
Earache or discomfort
Hearing loss
A high temperature
Ringing or buzzing inthe ear (tinnitus)

Treatment
Consultation with an ENT-specialist
Over-the -counter (OTC) painkillers (Paracetamol, Ibuprofen)
Oral antibiotics if perforated ear drum was caused by a middle ear infection (see antibiotic treatment for acute otitis media)
Avoidance of any fluid in the affected OEC (e.g. water, hydroxyperoxide, baby oil, ear candles)

Usually, perforated ear drums are healing within days if no infection occurs. In some cases a surgical intervention in order to close the perforation is required. Myringoplasty and tympanoplasty are such procedures and are performed either in local or general anesthesia, depending on the extent of the injury and the patient’s age. Therefore, any case of acute perforated ear drum should be evaluated by a ENT-specialist.

4. Earwax (Cerumen obturans)/ foreign body

Earwax is a waxy oil which protects the ear from foreign particles, dust and microorganisms not belonging to the normal flora in the outer ear canal (OEC). When earwax gets more produced by little glands in the OEC, it may get hard and block the ear. Any attempt to clean the ears, can push the earwax deeper, causing a blockage. Earwax buildup is a common reason for temporary conductive hearing loss.

It should take great caution when trying to treat earwax buildup at home. If the problem persists a doctor’s visit is required who is able to provide quick treatment, and hearing can be restored.

Causes of earwax buildup
Some people are prone to produce too much earwax
At-home removal of earwax can cause even more earwax buildup
Using cotton swabs, bobby pins etc. in the ear can push earwax deeper, creating a blockage

Symptoms of earwax
Sudden or partial hearing loss
Tinnitus (ringing, buzzing tone in the ear)
A feeling of fullnes in the ear
Earache

An ENT-specialist should be consulted if the following symptoms are Severe pain in the ear experienced:
Severe pain in the ear that does not subside
Fever
Dizziness
Persisting hearing loss
An odor coming from the ear

If a patient is unable to clear the earwax or if the ear becomes more irritated, a physician should be consulted. It’s important that other conditions, which may cause earwax buildup, can be ruled out by an ENT-specialist. Our team at ENTinCayman may use irrigation, suction, and a curette (a curved instrument) to remove the ear wax from the outer ear canal. Most patients do well after earwax removal. However, some people are prone to produce too much earwax and will face the problem again.

Foreign body in outer ear canal

The presence of a foreign body in the outer ear canal has to be dealt with as an emergency. In adults, insects (e.g. cockroaches, moths, flies) and broken cotton buds are the foreign bodies most commonly found in the ear. Some persons from Mexico and Central America reportedly insert leaves and other plant material into their ears as a form of native remedy (BresslerK, Shelton C. Ear foreign-body removal: a review of 98 consecutive cases. Laryngoscope. 1993 Apr. 103(4 Pt 1) 367-70).

The removal of a foreign body from the outer ear canal is indicated whenever a visualized foreign body is identified and an uncomplicated first attempt is anticipated.

If button batteries or hearing aid batteries are involved, emergent ENT consultation is always warranted because time-sensitive liquification necrosis may lead to subsequent tympanic membrane perforation and further complications. In fact, irrigation should never be attempted in such cases, as it accelerates the necrotic process. (McRae D et al. Button batteries in the ear, nose and cervical esophagus: a destructive foreign body. J Otolaryngol. 1989 Oct. 18(6): 317-9.)