The ear is made up of three major parts: the outer, middle, and inner ear. All of these various areas are essential for hearing, and when there is an abnormality in one area, it can affect hearing adversely. The outer ear consists of the pinna (the rigid cartilage covered by bone that we can see) and the auditory canal (a short tube from the pinna to the eardrum, or tympanic membrane). The middle ear contains the eardrum (tympanic membrane), and a small air-filled cavity behind it which contains three tiny bones, known as ossicles. These ossicles transmit sound to the inner ear, or the organ of hearing (cochlea), which will then transmit impulses via a major nerve (acoustic nerve) to the brain, which completes the hearing loop.
The middle ear periodically becomes swollen (inflamed) and fluid accumulates in the air-filled region behind the eardrum. This condition is called otitis media with effusion (or middle ear fluid). Viral and bacterial infections are the most common cause of middle ear infections and the subsequent middle ear fluid that may accumulate. Children are more prone to infections and fluid buildup due to a variety of factors, including frequent exposure to others with illness, poor Eustachian tube function, or an immature immune system.
Often, this middle ear fluid will result in a “blocked ear” feeling with decreased hearing. Under acute and more severe circumstances, patients will experience a localized ear pain, fever, irritability, and upper respiratory symptoms. Children with chronic middle ear fluid or recurrent ear infections may present with hearing deficits, poor attention, and even speech and language delays.
Middle ear fluid can be diagnosed through a variety of methods. This includes use of a pneumatic otoscope (a small device that visualizes the ear canal and blows air towards the eardrum), a tympanogram (a test to evaluate eardrum mobility), and a specialized hearing test.
Treatment options depend on the duration or frequency of ear symptoms. For patients experiencing their first ear infection, antibiotics and ibuprofen are usually the treatment of choice. If there are nasal or allergy symptoms occurring with the ear issues, it would be helpful to evaluate and treat these potential triggers. If a patient experiences recurrent ear infections or chronic middle ear fluid, ventilation ear tube insertion may be considered (ear tubes). These microscopic tubes are placed to remove ear fluid, reduce or eliminate ear infections, and restore the ability to equalize pressure between the middle ear and outside atmosphere (for example: no ear pressure when flying). Placing ear tubes is a short and painless procedure which can sometimes be done in the office setting but other times may require anesthesia in the hospital.
Tonsils are paired glands that are located in the back of the throat. Your tonsils are filled with nooks and crannies where bacteria, viruses, and other materials, dead cells, food particles and mucus, can become trapped. When this happens, the debris can become concentrated in white formations that occur in the pockets, known as tonsil stones (Tonsilloliths).
Tonsilloliths are formed when this trapped debris hardens, or calcifies. This tends to happen most often in people who have chronic swelling (inflammation) in their tonsils or repeated bouts of tonsil infections (tonsillitis). Usually tonsil stones form in adults and at times teenagers.
Often tonsilloliths do not cause any symptoms are simply a visible white, grey or discolored lump adjacent to the tonsil. Other times, one will develop irritation and redness at the site, and sometimes have a sensation of a lump in the back of the throat. Other symptoms include chronic sore throat, repeated infections, bad breath, and difficulty swallowing.
One of the most common remedies is gargling with salt water, which can dislodge these tonsil stones in many cases. Waterpick type of devices can “power wash” the tonsil stones away. In situations where the tonsil stones are causing more severe discomfort or continue to recur, one should speak with an Otolaryngology-Ear Nose Throat specialist about whether a course of oral antibiotics or surgical removal of the tonsils (tonsillectomy) is indicated.
Opinions expressed here are those of myself, Dr. Daryl Colden. They are not intended as medical advice and cannot substitute for the advice of your personal physician.
