Ears, hearing and balance:
Abnormal sensations in the ears:
The feeling of having a “clogged ear” can have very different causes. Most often, the ears are clogged with ear wax (cerumen obturans). This problem can be solved quickly and easily with ear cleaning. Sometimes, however, the symptoms also arise because the pressure balance between the nasal cavity/nasopharynx and the middle ear does not function properly (tubal ventilation disorder) or the air-filled space in the middle ear is restricted (for example due to fluid of a middle ear tube catarrh). Feelings of pressure may also be associated with hearing disorders (acute hearing loss) or in combination with vertigo in Ménière’s disease.
Itching is a very common symptom and is often due to very dry ear canal skin, sometimes ear canal eczema, a fungal infection or an allergy. In most cases, itching is easy to treat.
Earache is the leading symptom of all inflammatory diseases of the ear. These may be inflammations of the skin (e.g., an infected atheroma), the outer ear (perichondritis), the ear canal (otitis externa), or the middle ear (otitis media). All of these diseases are treatable with medication, be it by a local treatment or, more rarely, with tablets.
In some cases, there are no causes for the earache in the area of the ear. This is then referred to as secondary otalgia, that is to say pain radiating into the ear through the nerves, whose causes may be in the region of the neck, the area of the tooth/jaw (craniomandibular dysfunction, CMD) or the cervical spine. A detailed examination with appropriate therapy is also necessary in this case.
Tinnitus and noise hypersensitivity
Tinnitus is any kind of ear or head noises. Tinnitus is often perceived as whistling, rushing, hissing, humming or droning. It can be audible constantly or repeatedly, and also pulse synchronously. Tinnitus affects 15% of the Swiss population, usually only temporarily. The reasons for this are hearing problems, problems in the area of the jaw and cervical spine, but also internal or neurological disorders can be the cause. Tinnitus is often associated with negative stress or burnout. Any prolonged tinnitus should be examined by the ENT specialist to address a cause that can be treated or, in the case of chronic tinnitus, to offer supportive measures to help patients in their coping strategies.
Hyperacusis is a hypersensitivity to noise. Those affected experience normal environmental noises as unpleasantly loud, which are judged by the normal hearing as completely unproblematic. To be distinguished from the hyperacusis is phonophobia, a specific anxiety disorder against certain sounds.
The Hydrops cochleae is a special form of acute hearing impairment and there exists (unfortunately) no colloquial name. The patients notice a one-sided hearing loss (for example, finger rubbing is noticeably quieter on one side), sometimes associated with a feeling of fullness and buzzing in the affected ear or even dizziness. In the hearing test, a drop in the hearing threshold mainly shows in the low tones. It is assumed that during a hydrops (“dropsy”) it comes to a breach of the gossamer membrane (Reissner membrane) – by an increase of the liquid (endolymph) in the cochlea (cochlea) – which separates the helix (ductus cochlearis, endolymph) from the vestibular canal (scala vestibuli, perilymph) and leads thus to a mixing of the two fluids, whereby the functioning of the sensory cells in the cochlea can be impaired. The causes are to a great extent unclear, but stress and psychological distress seem to play a role in the development of a hydrops cochleae. Since the causes of the hydrops cochleae appear to be different from those of the classical acute hearing loss, the therapy is also different (betahistidine), but even without therapy the spontaneous recovery rate is very high (>70%). Some authors also recommend a reduction in salt intake and in any case, it is important to ensure that the vegetative nervous system is relieved (stress). Since the symptoms of a hydrops cochleae can also occur in other ear diseases, for example, in congested ears by lard or a malfunction of the Eustachian tube during a cold, a check-up at a specialist within 48–72 hours is recommended.
Very rarely, and only if the hearing loss is associated with severe rotary vertigo, the hydrops cochleae may be a first attack of a M. Menière.
Acute and chronic hearing loss, hearing aid expertise
Most often, hearing loss is increases slowly and bilaterally in the sense of a natural decrease in hearing during the course of life. If the moment is reached where the hearing performance affects the communication ability, it may be useful to think about the use of a hearing aid. As experts of the SVA, we are happy to carry out relevant diagnostic assessments and consultations and if necessary initiate the provision a hearing aid.
An ossification of the ossicular chain (otosclerosis) can also lead to a slowly increasing hearing loss.
Sometimes, hearing problems occur suddenly and usually on one side. In this case, we speak of an acute hearing loss. These are disorders of the inner ear and should be clarified within 24–72 hours and a therapy should be initiated. In some cases a clarification is necessary by means of blood sampling and/or imaging procedures (MRI, magnetic resonance recording).
Paroxysmal hearing loss with tinnitus and violent rotary vertigo, often accompanied by pressure in the ears, could be the first attack of Ménière’s disease, an inner ear disease that should be diagnosed and treated as soon as possible.
Discharge from the ear (otorrhoea)
“Running ears” can have many causes. In children, it most often occurs as part of a middle ear infection or if a foreign body remains unnoticed in the ear canal for a long time (“popular” are glass beads and small Lego parts). In adults, they are in most cases an expression of harmless changes in the external auditory canal, in particular painless inflammation by fungi (otitis externa mycotica), blocked ears (cerumen) and auditory canal eczema. Sometimes inflammation of the middle ear is the reason for it and special attention is required if the ear discharge has an unpleasant odour. Then a check-up should be carried out by the specialist, whether it is due to chronic bone suppuration (cholesteatoma) or, in very rare cases, to a tumour.
Vertigo is a common symptom and a challenge for the patient and the treating physician alike. The causes of dizziness can be very different and often lead to an odyssey from one specialist to another. This is often unavoidable and requires patience from the patient and good interdisciplinary collaboration from the specialists. We ENT specialists clarify whether the dizziness symptoms could have their causes in the balance organ of the ear (peripheral vestibular disorder). If we suspect a central vertigo (for example Parkinson’s disease, a cerebral infarction, a degenerative disease or multiple sclerosis), we refer the patient to the appropriate specialist. The key to a targeted examination lies in a detailed and exact anamnesis (interview and questionnaire), so that the sometimes elaborate and by medical-technical aids supported diagnostic assessments can be kept to a minimum.
The most common peripheral vestibular vertigo types are well treatable.
Most rewarding is benign positional vertigo (benign paroxysmal positional vertigo), which can often be clearly diagnosed and treated with a simple reduction manoeuvre. Another common type of vertigo is the so-called phobic staggering vertigo, a dizziness that can occur especially under stress and is counted in the broadest sense of the psychosomatic disorders or anxiety disorders. Other common types of peripheral vestibular vertigo include Ménière’s disease and vestibular migraine. Strong and persistent vertigo attacks lasting hours may arise from an inflammation of the vestibular nerve (neuropathia vestibularis) and short-term attacks indicate a neuralgia (vestibular paroxysmia) of the vestibular nerve.
Hearing loss in children
If you have the impression that your child is not hearing well and you are unsure whether it is “not being able to hear” or “not wanting to hear”, then we will carry out the appropriate hearing test as soon as the child is old enough (from approx. 4 years). In addition, the condition of the middle ear can be examined and, in the case of pre-school and school-age children, the likelihood of an auditory processing and perception syndrome AVWS can be determined in conversation and with validated questionnaires. In unclear situations, we collaborate with the Department of Paediatric Audiology of the University Hospital and the Children’s Hospital.
If hearing loss is determined, which is caused by an effusion in the tympanic cavity, which does not regress by itself (middle ear tube catarrh, Glue Ear), the operative insertion of tympanic tubes in the eardrum may be necessary.
We carry out diving fitness examinations and issue you a certificate according to SUHMS regulations. This service is not covered by statutory health insurance.