The ear is divided into three parts, with each part serving different functions. The outer ear consists of the pinna or auricle (the external part of our ear that we can see), the external auditory canal and the outer part of our eardrum.

The middle ear is that part of our ear behind the eardrum that contains the three small bones (malleus, incus and stapes). These transmit sound waves from the eardrum to the inner ear.

The inner ear is also called the labyrinth. It consists of the cochlea and the semicircular canals. The cochlea is a snail-like structure with hair cells inside it that transform sound waves into electrical nerve impulses. These impulses are transmitted to our brain to perceive sound as we hear it.

The semicircular canals are part of our inner ear responsible for our balance.

Ear wax

Ear wax is made up of mainly dead skin cells and dust that enter from the outside environment.

It also contains a special liquid that is secreted from two different gland types, ceruminous and pilosebaceous glands. These glands are found deep in the skin of the external auditory canals. Their liquid helps trap dust and bacteria.

Most of us do not realise that the skin of our ear canal has the ability to expel ear wax and other small foreign substances. The habit of cleaning our ears with cotton buds, hairpins or ear canal scrapers causes more harm than good.

Once the special migratory epithelium is damaged, ear wax remains inside. In some instances, this wax is being pushed deeper in and the glands become blocked. Cotton buds may also encourage the growth of fungus and bacteria and by sticking these into our ear canals, we unknowingly introduce infection into our ears.

Quite often, cotton buds or other objects are pushed too far in, causing traumatic ear drum perforation. Impacted ear wax gives rise to hearing loss, pain and sometimes noise in the ear (tinnitus).

Olive oil and almond oil can be used to lubricate ear wax so that it may be expelled out. This should not be applied if one has eardrum perforation. It is best that one consult a specialist to have ear wax removed.

Ear syringing by squirting warm water into the ear canal is not recommended as it carries a high risk of infection, perforated ear drum and tinnitus. It is also very unpleasant as it gives rise to dizziness, pain and nausea during the procedure.

The best way to remove impacted ear wax is by micro-suctioning, a technique used by most ear, nose and throat specialists.

By visualising the impacted ear wax under the microscope, the specialist uses a suction tip attached to a machine that sucks out the wax without traumatising the skin or ear drum.

Ear piercing

Ear piercing is very common today. It may look pretty but if it gets infected, it looks extremely ugly and can be very painful. Pierced ears need good care. Hands need to be washed thoroughly before inserting or removing the ear rings. Alcohol should be applied on the hole to keep germs away. If the sites become red or swollen, one should seek expert advice before the infection spreads.

Water or foreign objects in the ear

Water routinely enters our ear canals when we take a bath or shower. Most of the time, it dries up on its own. We can shake our heads to get rid of this water but it may not work.

You can use loose cotton to soak up the water without traumatising the skin, or a hair dryer to dry the ear canal while drying one’s hair. To prevent water from entering, use ear plugs or cotton wool soaked with olive oil. As oil and water do not mix, shampooed water does not get to enter the ear canal.

If an insect enters the ear canal, you can apply warm olive oil to kill and flush it out. If this fails, you should seek professional help to have it removed under the microscope. Other sharp or blunt objects that are stuck in the ear canal are best removed by an ENT specialist.

Middle ear fluid

This condition is also called glue ear. It is more common in countries with temperate climate. It gives rise to hearing loss and a blocked feeling.

In children, parents may not realise that this is the cause of poor attention and sometimes behavioural problems. The child may turn the television volume up loud and does not respond when he or she is called.

Middle ear fluid is due to the build-up of mucous that is normally secreted by the middle ear mucosa but not drained adequately via the Eustachian tube. Studies have shown that children who are exposed to cigarette smoke are more prone. It may resolve without any intervention. Antibiotics may help to clear this. If it persists, grommet insertion (inserting a small plastic ventilating tube onto the ear drum) is the only way to drain the fluid and help the child to hear. This tube expels out on its own after several months.

Adults with middle ear fluid must have their noses and sinuses inspected to rule out nasopharyngeal cancer and sinusitis.

Middle ear infection

Infection that arises in the middle ear mucosal lining gives rise to pain, hearing loss and sometimes tinnitus and ear discharge. It is more common in children as their Eustachian tubes are not as well developed. It can only be diagnosed by visualising the ear drum using otoscope.

It can be treated with antibiotics, but if persistent, requires grommet insertion. Again, it has been shown that children exposed to cigarette smoke are more prone.

Noise-induced hearing loss

If one is continuously exposed to loud noise, you can develop noise-induced hearing loss. Loud walkmans, discotheques and loud factory machines have all been implicated in damaging the inner ear hair cells. This damage is irreversible so the best treatment is still prevention. In some countries, ear mufflers are compulsory for factory workers exposed to persistent noise.

If you would like to know more, please consult your doctor or ENT specialist. The following websites provide useful additional information.

- www.entnet.org

- www.tchain.com/otoneurology/disorders/hearing/wax2.html

- www.deafnessresearch.org.uk

- www.medinfo.co.uk/conditions/earwax.html

- www.netdoctor.co.uk/ate/ent/ 202868.html

- www.patient.co.uk/showdoc/23068727

- www.kidsource.com/kidsource/content/mef.html.

- This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public.

The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Assoc Prof Khoo Ee Ming, primary care physician. For more information, e-mail starhealth@thestar.com.my

The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care.

The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.

By Dr. Ong Chun Chiang
http://thestar.com.my/health/story.asp?file=/2006/5/28/health/14340793&sec=health