FURUNCLES
Furuncles—an infection of the hair follicles on the outer ear--begin as a small pimple and later develop into a large local infection. Typically caused by a staph-like infection or by other bacteria or fugal buildup possibly in a laceration of the skin, any movement of the pinna or pressure on the place of infection can be incredibly painful, and furuncles typically coincide with flu-like symptoms. They're a frequent issue in those with underlying illnesses such as diabetes or eczema, as the patients immune system may not be as well equipped to fight off infection. Clinicians will often check the patient's blood pressure levels once a furuncle is discovered to ensure that their other systems are properly functioning (Tolbecs). Pain will increase as the infection continues to develop, before coming to a head and eventually bursting, which often gives the individual instant relief. Discharge may also be secreted from the furuncle's location, sometimes seeping into the external auditor meatus, however, this can be easily treated with microsuction; the most commonly performed manual type of earwax removal used by doctors, during microsuction, a doctor uses a long, thin nozzle that fits in your ear to suction out the wax. Pain relief is typically the priority for treatment of the furuncle, however, an oral antibiotic may be prescribed to accelerate the healing process. The infection can spread to others, and on rare occasions, can even enter the patients bloodstream causing a host of other issues such as sepsis, an overall infection of the body, or MRSA, another form of bacterial infection that is resistant to antibiotics. Some furuncles may successfully burst without intervention, and will typically do so within a few days, typically fully healing without a scar within three weeks (Boils). Hearing loss isn't typically a massive concern in regards to furuncle symptoms, however, a temporary conductive hearing loss may occur during the infection's progression. The audiogram to the right depicts potential results of a hearing test performed on a patient with a furuncle obstructing their left external auditory meatus. Because of the infection's location, the transmission of sounds from the patient's outer ear to their eardrum would be highly impaired.
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IMPACTED CERUMEN
Cerumen, or, earwax, is a naturally occurring and self-cleaning agent of the ear canal, as it prevents foreign bodies such as dirt, bacteria, dead skin cells, and debris etc. from entering the external auditory meatus. Not only this, but this substance secreted from the sebacious and ceruminous glands acts as a a natural moisturizer, preventing the skin inside of the ear from becoming too dry. As cerumen is typically transported away from the medial portion of the ear canal, it can sometimes travel inwards, becoming impacted and creating a host of issues for a patient. This can occur if an individual has overactive gland that secretes a surplus of cerumen than travels to the medial portion of the ear canal, or due to the force of q-tips or other cleaning devices that a patient may use in an attempt to extract the wax at home (Musiek). Common symptoms of hard, impacted cerumen include, tinnitus (ringing), vertigo (dizziness), and external otitis (swimmers ear). As we discussed, the ear canal conveys sound to the eardrum in order for us to hear, so any blockage in the ear canal and its transmission of sound can result in conductive hearing loss. Sounds would not be able to bypass the outer and middle ear, preventing the transmission of sounds to be detected by the brain. Impacted cerumen is especially common in geriatric patients, and is typically treated using methods such as cerumenolytic agents, irrigation, and manual removal. In regards to the agents, a clinician will use a series of solutions that aid in thinning, softening, and breaking up the earwax, making it much easier to remove. Irrigation is a common method as well, as a syringe can be safely inserted into the ear canal, flushing out the unwanted cerumen into a basin held below the patient's ear. Often the most common, manual removal is known as the safest measure, as the ear is not being exposed to moisture in the removal process and is therefore less susceptible to infection (Sevy). Although we know that cerumen is a helpful agent in keeping our ears clean and safe from infection, it can create greater issues if not maintained. A patient may experience conductive hearing loss due to impacted cerumen, and as seen in the audiogram to the right, it depicts a normal bone conduction test and an impaired air conduction test, as the patient is experiencing an obstruction in the right ear canal which hinders sound transmission from the outer ear to the ear drum.
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PAROTID TUMORS
Parotid tumors manifest themselves in the salivary glands—specifically the parotid gland--and are caused by abnormal cells growing in said glands or in the tubes that drain them. Typically benign, or, noncancerous, a typical symptom of a parotid tumor is a painless mass visible either in front of the ears or below the chin. Swelling may progress quickly overtime, a typical a sign of the mass being benign, rather than the slow growth of a cancerous tumor. A more advanced and often cancerous sign of a parotid tumors is difficulty moving one side of the face, known as facial nerve palsy (Salivary). The cause of parotid tumors is unknown, however, cancers of the salivary gland do not usually run in families, so parotid tumors are not likely to be inherited from an individual's parents. Instead, the likely cause is some kind of DNA change during a person's lifetime, which may be a random event that occurs within the cells of the salivary gland or exposure to a cancer causing chemical, such as radiation or carcinogens (Do). Parotid tumors, both cancerous and noncancerous, can spread to the soft tissue around the salivary gland or to the skin, jawbone, ear canal, or facial nerve, and can be located by a clinician in a multitude of ways. They can be detected during an X-ray of the salivary gland (called a sialogram), ultrasound, MRI, or CT scan, etc. Courses of treatment of a parotid tumor may be surgical removal in order to prevent the spread of the tumor, or through radiation, and the progression of a parotid tumors is dependent on the grade of cancer or the lack thereof. A possible hearing loss attributed to such tumors is that of sensorineural hearing loss, as a result from exposure to radiation during treatment, and the audiogram to the left depicts a potential audiogram of a patient experiencing sensorineural hearing loss in both ears. Radiation therapy may cause damage to the inner ear, cochlea, or acoustic nerve, and the likelihood of sensorineural hearing loss in patients who have been treated with radiation is much higher than those who haven't (Bhandare).
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BACTERIAL OTITIS EXTERNA
Bacterial otitis externa, more commonly known as "swimmer's ear," is an infection that manifests itself in the external auditory meatus, or, ear canal. The perfect environment for fungus and bacteria to grow, the ear canal is dark, warm, and can hold water, so when water remains in the ear after swimming, for example, the moist canal will be prone to bacteria growth. Repeated exposure is not the only cause for the infection however; swimmer's ear can occur due to a loss of earwax—a natural ear protectant—from unnecessary removal, damage to the ear caused by foreign objects such as q-tips or fingers, and even polluted water sources (Swimmer's). During diagnosis, a clinician may ask about one's past health as well as the symptoms that they're experiencing, and will typically check both ears using an otoscope, which is a lighted tool allowing them to better examine the ear canal and the eardrum for abnormalities. Symptoms of swimmer's ear include otalgia (pain), erythema (redness) of the outer ear, otorrhea (discharge), pruritis (itching), edema (swelling), and muffled hearing or hearing loss. With proper treatment such as, antibiotic ear drops, pain medication, and keeping the ear canal as dry as possible, swimmer's ear is typically resolved within two weeks. If left untreated, it can result in reoccurring ear infections, damage to the bone or cartilage, worsening hearing loss, and risk of the infection spreading to nearby tissue, the skull, brain, or the nerves that innervate the brain (John's). A possible hearing loss attributed to swimmer's ear is that of conductive hearing loss, as the water left in the ear canal may obstruct the transmission of sound from the outer ear to the eardrum. The audiogram to the right depicts the potential results of a test conducted on a patient with conductive hearing loss due to swimmer's ear, as they have a normal bone conduction test and an abnormal air conduction test. It tells us that the patient has conductive mild sloping to moderately severe hearing loss in the right ear.
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