Ear Disorders
Vertigo & Dizziness
Benign Paroxysmal Positional Vertigo
What Is Benign Paroxysmal Positional Vertigo (BPPV)?
The dizziness, or vertigo, you experience is called Benign Paroxysmal Positional Vertigo. It is actually one of the more common causes of vertigo. The vertigo is often described as a spinning or whirling sensation, when everything seems to be moving. The spinning sensation can lead to nausea, sweating, even vomiting. The vertigo occurs when your head is in a certain position, such as looking up, turning your head to one side when looking over your shoulder, or when you roll over in bed. The actual spinning sensation lasts for seconds to minutes, but often you feel off balance for several days, then it all goes away. It is not uncommon for this to resolve completely and then return months or)years later. What is actually happening?
This disorder originates in the inner ear balance system The normal inner ear receives sound for hearing, but also is the heart of the balance and coordination system for the body. The inner ear balance system (labyrinth) has three canals (semicircular canals) that detect head movements. This is done by the fluid in these canals pushing against specialized nerve endings in the inner ear which then sends messages to the brain and eyes. In BPPV, there are some crystals, or particles, in the fluid of the inner ear balance canals, that should not be there. These crystals then float, or sink, in the fluid, and therefore trigger the nerve endings of the inner ear to send wrong messages to the brain and eyes.
Cerumen Impaction (Ear Wax Removal)
Ear wax, or cerumen, is made by the glands in the skin of the ear canal. If it is made in excess or is very dry, a blockage or impaction may result. Q-Tips™ are usually not advised for ear cleaning. Instead, try the following: turn your head to one side and gently fill the ear canal with baby oil or mineral oil, using an eye dropper. Allow the oil to soak in for a minute or two before turning over and placing the oil in the opposite ear. Do this once or twice a day for three or four days. This will allow the wax to soften. For the next three or four days, gently fill the ear canals with 3% hydrogen peroxide in the same manner that you instilled the oil. Peroxide is available at your pharmacy or market and will usually bubble out the ear wax once it has become soft. If you have ventilating tubes in your ears, dilute the peroxide in half with water; discontinue it if you have any discomfort, dizziness or drainage.
For stubborn ear impactions, it may be necessary to continue the oil and peroxide for a few weeks or have it removed by your doctor. People who are frequently troubled by wax impactions may want to use the oil and peroxide on a monthly basis.
If you have any further questions, do not hesitate to ask us.
Download PDF document on Cerumen Impaction
Tinnitus
Is the Ringing in My Ears Normal?
Not at all. Tinnitus is the name for these head noises, and they are very common. Nearly 36 million Americans suffer from this discomfort. Tinnitus may come and go, or you may be aware of a continuous sound. It can vary in pitch from a low roar to a high squeal or whine, and you may hear it in one or both ears. When the ringing is constant, it can be annoying and distracting. More than seven million people are afflicted so severely that they cannot lead normal lives.
Can Other People Hear the Noise in My Ears?
Not usually, but sometimes they are able to hear a certain type of tinnitus. This is called "objective tinnitus," and it caused either by abnormalities in blood vessels around the outside of the ear or by muscle spasms, which may sound like clicks or crackling inside the middle ear.
What Causes Tinnitus?
Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. The health of these nerve endings is important for acute hearing, and injury to them brings on hearing loss and often tinnitus. If you are older, advancing age is generally accompanied by a certain amount of hearing nerve impairment and tinnitus. If you are younger, exposure to loud noise is probably the leading cause of tinnitus, and often damages hearing as well.
There are many causes for "subjective tinnitus," the noise only you can hear. Some causes are not serious (a small plug of wax in the ear canal might cause temporary tinnitus). Tinnitus can also be a symptom of stiffening of the middle ear bones (otosclerosis).
Tinnitus may also be caused by allergy, high or low blood pressure (blood circulation problems), a tumor, diabetes, thyroid problems, injury to the head or neck, and a variety of other causes including medications such as anti-inflammatories, antibiotics, sedatives, antidepressants, and aspirin. If you take aspirin and your ears ring, talk to your doctor about dosage in relation to your size.
Treatment will be quite different in each case of tinnitus. It is important to see an otolaryngologist to investigate the cause of your tinnitus so that the best treatment can be determined.
What Is the Treatment?
In most cases, there is no specific treatment for ear and head noise. If your otolaryngologist finds a specific cause of your tinnitus, he or she may be able to eliminate the noise. But, this determination may require extensive testing including X-rays, balance tests, and laboratory work. However, most causes cannot be identified. Occasionally, medicine may help the noise. The medications used are varied, and several may be tried to see if they help.
The following list of DOs and DON'Ts can help lessen the severity of tinnitus:
- Avoid exposure to loud sounds and noises.
- Get your blood pressure checked. If it is high, get your doctor's help to control it.
- Decrease your intake of salt. Salt impairs blood circulation.
- Avoid stimulants such as coffee, tea, cola, and tobacco.
- Avoid alcohol and other depressants.
- Avoid routine or excessive use of aspirin and non-steroidal anti-inflammatory agents such as Ibuprofen.
- Exercise daily to improve your circulation.
- Get adequate rest and avoid fatigue and stress.
- Stop worrying about the noise. Recognize your head noise as an annoyance and learn to ignore it as much as possible.
What Can Help Me Cope with Tinnitus?
Concentration and relaxation exercises can help to control muscle groups and circulation throughout the body. The increased relaxation and circulation achieved by these exercises can reduce the intensity of tinnitus in some patients.
Masking. Tinnitus is usually more bothersome in quiet surroundings. A competing sound at a constant low level, such as a ticking clock, radio static (white noise), or a fan may mask the tinnitus and make it less noticeable. Products that generate white noise are also available through catalogs and specialty stores.
Hearing Aids. If you have a hearing loss, a hearing aid(s) may reduce head noise while you are wearing it and sometimes cause it to go away temporarily. It is important not to set the hearing aid at excessively loud levels, as this can worsen the tinnitus in some cases. However, a thorough trial before purchase of a hearing aid is advisable if your primary purpose is the relief of tinnitus.
Tinnitus maskers can be combined within hearing aids. They emit a competitive but pleasant sound that can distract you from head noise. Some people find that a tinnitus masker may even suppress the head noise for several hours after it is used, but this is not true for all users.
Herbal Remedies: Some studies have shown that certain substances may help improve tinnitus.
These include:
- Ginko Biloba (~ 480 mg/day)
- Zinc (~ 30 mg/day)
- Niacin (~ 250 mg/day)
- Thiamine = Vit B1 (~ 1.1 mg/day)
- Odorless Garlic (~ 600 mg/day)
. Download PDF on Tinnitus
Eustachian Tube Dysfunction
The sinuses are air-filled spaces surrounding the nose. The eustachian tube is a narrow tube that connects the ear to the back of the throat behind the nose. The nose, sinuses, and eustachian tube are all lined by mucosa which can become thick and inflamed during colds, sinus infections, allergies or exposure to smoke and irritants. When the eustachian tube becomes swollen or plugged, there may be a feeling of fullness or popping of the ear and hearing may decrease.
If an infection is present, your doctor may prescribe an antibiotic. Many times, however, the problem is simply swelling and dryness of the mucus rather than a true infection. Under these circumstances, the following tips may be helpful:
- Make sure your environment is well humidified. In addition, try boiling water and inhaling the steam through your nose and mouth three times a day. Furthermore, a salt-water (saline) spray can be helpful. Use two sprays in each nostril three to four times a day.
- Decongestant tablets such as Sudafed or Entex may be helpful. These medications and antihistamines may sometimes worsen the problem by thickening and drying mucus which may result in plugging. A nasal decongestant spray may be recommended but should rarely be used for more than 3 days because congestion can actually become worse when using these sprays for long periods of time.
- If you have eustachian tube problems related to flying, please refer to our handout on "Air Travel and Eustachian Tube Dysfunction."
If you have high blood pressure or other medical problems, contact your primary doctor first. Follow the instructions and precautions on the package of any medications you take.
We hope this information is helpful. Should you have any questions do not hesitate to contact us.
Download PDF on Eustachian Tube Dysfunction
Post Operative Instructions Myringotomy and Ventilation Tube Placement
Diet
resume your previous diet as tolerated.
Physical Activities
No restrictions.
Bathing
As a general rule, try to prevent water from entering the ears. You may smear Vasoline™ on a cotton ball and place that in the ears during showering or bathing. Children who wish to swim should have ear molds made or use ear putty to plug the ears. The use of a head band or bathing cap for swimming will help keep the plugs in place.
Work or School
You may return the day following surgery.
Incision Care
If cotton has been placed in the ears, it can be removed latter on the day of surgery. It is not uncommon to have some bleeding from the ears for one or two days following surgery.
Medications
In some instances, ear drops should be used for several days following surgery. If you were given drops in the hospital or a prescription, use them as directed. Pain following surgery is usually minimal and can be relieved by Tylenol ™.
Follow - Up Care
You should be seen in the office about two weeks after surgery. You should be evaluated by your doctor at least every three months while the tubes are in place.
Additional Instructions
If you develop drainage from the ear(s) call your doctor to be evaluated. Possible causes include water contamination, infection or reaction to the material of the tube. If you have any questions or concerns, please do not hesitate to call Hudson Valley Otolaryngology.
Post Operative Instructions Chronic Ear, Middle Ear or Stapes Surgery
Diet
You may resume your regular diet as tolerated. Due to the combination of anesthesia and manipulating the ear during surgery, it is not unusual to have an upset stomach for the first day or so.
Work or School
You may return when you feel ready. However, please note the physical activity limitations described below.
Physical Activity
- Keep your head elevated as much as possible. Sleep or rest on two or three pillows if possible for the first week.
- Do not blow nose forcefully for three weeks following surgery. If you sneeze or cough, do so with your mouth open.
- Avoid any heavy lifting (over 10 lbs.), straining or bending for three weeks following surgery.
- Avoid travel by air for three weeks following surgery.
Bathing
Do not get water in your ear. If showering or washing hair, place a piece of cotton coated with Vasoline ™ in the ear canal to seal it. If there is a separate incision behind the ear, keep this dry for four days by placing a dry wash cloth over it while in the shower.
Medications
- If given a prescription for ear drops, take as directed daily until seen in the office and told to discontinue. Remove the cotton ball and place the drops directly on the underlying packing. If the sponge packing falls out, continue to place the drops into the ear as directed.
- An antibiotic is often prescribed as a preventative measure. Take as directed until the medication is finished.
- You will also receive a prescription for a pain medication. Use this as needed. If your pain is mild to moderate regular Tylenol™ will suffice.
Additional Instructions
- You may have had a sponge packing placed in your ear canal deep to the cotton ball. Place the ear drops directly on this cylindrical sponge packing. the packing may fall out prior to being seen in the office. In this case continue to place the drops as directed in the ear canal.
- If you wear glasses either remove the arm on the operated side or make certain that it does not rest on the incision behind your ear for one week.
- Beginning one day after surgery, try to leave the cotton out of your ear as much as possible unless there is significant drainage.
- Some drainage from your ear canal after surgery is expected. If there is a separate incision, some drainage may occur from this area also. If the drainage is profuse or develops a foul odor, call Hudson Valley Otolaryngology.
- Popping sounds, a plugged sensation, ringing or fluctuating hearing is expected in the ear during healing and can last for up to 6 weeks.
- If you should notice any swelling, redness or excessive pain please call Hudson Valley Otolaryngology.
- Some dizziness may occur after surgery. If it becomes severe or is associated with nausea or vomiting call Hudson Valley Otolaryngology.
Follow-Up Care
- Please call Hudson Valley Otolaryngology to make an appointment to be seen 7-10 days after the time of your surgery unless stated otherwise by your physician.
- Should any problems or questions arise, please call Hudson Valley Otolaryngology 24 hours a day (845) 471-4986 .
Common Questions About Ear Disorders
Balance
Ears
Hearing
Nearly 30 million Americans have impaired hearing. The most common cause of hearing loss in children is otitis media. For the elderly-the largest group affected-excessive noise, drugs, toxins, and heredity are the most frequent contributing factors.
Hearing loss is a medical disorder. In a limited number of patients, it can be surgically corrected; medical devices and rehabilitation can substantially reduce hearing loss in the vast majority of patients who cannot be helped by surgery. The medical specialists who diagnose and treat hearing disorders are called otolaryngologist-head and neck surgeons, or more commonly, "ear, nose and throat doctors."
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