Nanavati Superspecialty Hospital

Hello friends,

I am Dr. Sanjay Bhatia, ENT specialist and Neurotologist. Today I am going to give you some information regarding blocked ear and decreased hearing. Most importantly we should understand how our ear is? Our ear is divided into 3 structures. Outer ear, middle ear and inner ear. So most commonly people think that my ear is blocked I can't hear well is wax. Wax in the ear is just basic secretion which is having antiseptic properties of the external auditory canal. It does cause the blockage of the ear and decreased hearing. One of the commonest cause of accumulation is a small canal or habitual use of earbuds. We do not educate used of earbud to remove the wax Because it tends to push the wax inwards towards the tympanic membrane. The best way to remove the wax is to meet your ENT surgeon If you think it is blocked. We do give wax solvents to make the wax soft and it can be removed by suction, irrigation or by probing.

The next other common things we see is the fungal infection or the discharge in the external auditory canal, which does form a film or pseudomembrane in front of the tympanic membrane and causes blockage of the ear. This can be removed by giving antifungal ear drops and then after a week or so it will come out with suction. Further down you have tympanic membrane which is a border between the outer ear and the middle ear space so tympanic membrane, If it has a perforation does cause decreased hearing or blocked the sensation of the ear. So it can be in different quadrants, you have perforated eardrums can be of acute onset or it can be a chronic eardrum perforation, if it is an acute perforated eardrum with active discharge going on, you can have the blockage feeling in the ear. Normally in the acute situations, we do observe, we give antibiotics, we give major decongestant usually these acute infections are ascending infections secondary to the nasal infections.

If it is a chronic perforated eardrum, the best thing is to get a test of hearing called pure tone audiometry done and prepare yourself for ear surgery called tympanoplasty. Tympanoplasty means the repair of the eardrum, inspection of the ear ossicles, these are the 3 ossicles which are situated behind your tympanic membrane and the middle ear space. Other conditions you can get a blocked ear or decreased hearing is a cold accumulated behind your eardrum, the eardrum may be intact so this fluid which is accumulated could be a sterile fluid we call it middle ear effusion or it could be purulent infected fluid usually common in children and they cause severe ear pain as well as decrease hearing.

The treatment is antibiotics, decongesting the nose where we have to do a small opening of the eardrum called myringotomy. Another condition where you have a decreased hearing and the block sensation of the ear is fixation or immobility or discontinuity of the ear bones or the ossicles. Depending on the various situations you can do the ossicular reconstruction if there is a discontinuity or aversion of the hearing bones. In case of the fixation of the bones of hearing you have to work on and around the ossicle usually it is the stapes, we do a stapedotomy procedure and we put an implant of telfon or gold implant or titanium prosthesis. The last concern is your inner ear space or organ of hearing called cochlea.

Usually, the hearing loss which is neural in origin is causing the blockage of the ear so you feel that I can not hear and my ear is blocked, the eardrum is normal, the middle ear spaces are normal, there is no infection, so what could be the cause? Get pure tone audiometry done it will show you in the document that we are now hearing and particular frequencies are going weak. In case the social life is not affected you can go on with your life, but if you think socially you are not hearing well please meet the otologist and get hearing tet done. Lastly, there are nerves of hearing which come in to the cochlea there can be some tumors called acoustic neuroma which can cause decreased hearing and other expected things are the acoustic traumas, the head injuries and the central hearing loss. So these are the few common causes of decrease hearing and the blocked ear.

Thank you very much.

Hello!

I am Dr. Sanjay Bhatia, ENT specialist and neuro-otologist. Today we are going to speak on nasal obstruction; the common cause what I see in my clinical practice. If we start, nasal obstruction most commonly seen in paediatric age group is nose block, mouth breathing and nasal discharge. These are predominantly seen with a small adenoid growth at the end of the nose. Deviated nasal septum, hypertrophic reactive turbinates or allergic colds are treated with medications. Adenoids usually do subside with medication but persistent and recurrent episodes of adenoiditis will require surgical management. As the age progresses, around teenage, adolescent ages we see buckling of the nasal septum called deviated nasal septum causing nasal obstruction. The correct age would be around 15, 16 to 18 years if there is a persistent nasal obstruction causing difficulty in breathing, mouth breathing, snoring.

So, the surgery for that is septum correction called septoplasty which can be done in a conventional way or an endoscopic septoplasty. As we go further, we have this constant environmental agent which causes sneezing, watery nose and persistent nasal discharge which chokes the nose causing nasal blockages. These are known as allergic rhinitis which can also have a resulting in nasal obstructions and frequent episodes of allergic rhinitis can lead to soreness of nasal lining leading to nasal polyposis. The early treatment is medication, nasal sprays and anti-allergic tablets. If the symptoms persist and there are nasal polyps which are not regressing in spite of good medications and systemic steroids one has to undergo sinus surgery to remove the nasal polyposis. Another factor for nasal obstructions can be recurrent rhino-sinusitis, bacterial infections and masses in the nostrils.

So this can be tumors, can be in adolescent ages in males we see is vascular masses called as angiofibromas, there can be other tumor factors in the nose which has to be addressed according to the lesion. How effective are the nasal surgeries for the above symptoms? This is a common question asked and discussed with my patients. Now depending on the etiology, the recurrence rates are known. If it is allergic symptoms, we do not control the allergies by surgery. Allergies are controlled by medications only. How severe is the response of your lining to the allergy will show us the recurrences of the symptoms? That's why most of the consultants will tell you nasal polyposis is just to clear the nostrils from the polyps, create a wide surface area for the medications to reach.

Regarding the removal of adenoids, there are various techniques today. Apart from the conventional curate technique, we have nasal endoscopic technique where it is visualized under the vision and shaver system and coblation is used to remove adenoids and the division. So it is no longer applying procedure so the success rate of removal of adenoids is much higher and better. Septoplasty we have already discussed. Sinus surgery for bacterial infections and infective causes is how well we open up the affected sinuses. You create a larger area of drainage and a good antibiotic serves the purposes. Regarding the tumor and other masses, it depends on the etiology and pathology of the tumor, how bad or good the disease is for the recurrence kind of thing. Thank you and you can go through the post and other things on the lybrate website.

Thank you.