The National Institute on Deafness and Other Communication Disorders reports approximately 28 million Americans have lost some or all of their hearing, including 17 in 1,000 children under age 18. Noise exposure is increasingly common in the age of iPods and other personal music players. Overexposure to noise can cause both temporary and permanent hearing loss.

Loudness of common sounds

30 decibels (dBa)         Whisper
60 decibels                     Normal Conversation
60 – 80 decibels             Cars to a close observer
Above 85 decibels        Can cause permanent hearing loss

Although 10 million Americans suffer irreversible noise-induced hearing loss, with 30 million more exposed to dangerous noise levels each day, very little has been reported on the risk of such hearing loss in children.

How does noise exposure cause hearing loss?

Very loud sounds damage the inner ear by damaging the hair cells of the cochlea. When loud sounds are exposed to the ear for a short time, one may experience what’s called a temporary threshold shift, or a temporary hearing loss. This hearing loss may be accompanied by tinnitus (a ringing in the ears). One may recover from the temporary loss. But if the ear is exposed to loud sounds over longer periods of time, the hair cells can be permanently damaged, causing permanent sensorineural hearing loss.

Should MP3 player use be limited?

The maximum sound from an iPod Shuffle has been measured at 115 decibels, a level that can cause hearing loss to listeners of all ages. A survey sponsored by the Australian government found that about 25 percent of people using portable stereos had daily noise exposures high enough to cause hearing damage. Further research from the Netherlands reports that 90 percent of adolescents listened to music through earphones on MP3 players, almost half used high-volume settings, and only 7 percent used a noise limiter. Researchers at Boston Children’s Hospital determined that listening to a portable music player with headphones at 60 percent of their potential volume for one hour a day is relatively safe. The maximum volume limit is adjustable on many current MP3 players.

Why earplugs are important at concerts

Parents should be aware that various medical studies have found sound levels at rock concerts often to be significantly higher than 85 dBA, with some reports suggesting that sound intensity may reach 90 dBA to as high as 122 dBA.

To experience 85 dBA, listen to an electric shaver or a busy urban street. If levels are maintained at values greater than 85 dBA for long periods of time, this may lead to a significant noise exposure. Frequent concertgoers may experience some potentially irreversible hearing loss from their experience.

A research study, “Incidence of spontaneous hearing threshold shifts during modern concert performances” (Opperman, Reifman, Schlauch, Levine; Otol-HNS 2006, 134:4: 667-673), examined sound intensity throughout a well known concert venue, and the effectiveness of earplugs. The findings stated that sound pressure levels appeared equally hazardous in all parts of the concert hall, regardless of the type of music played. Accordingly, you should use earplugs at every type of musical concert, regardless of your distance to the stage.

A good rule of thumb: When a child accompanies a parent to any activity or location with excessive noise, ear protection should be worn by the entire family.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

As the parent of a child with newly diagnosed hearing loss, you will have many questions and concerns regarding the nature of this problem, its effects on your child’s future, treatment options and resources. This brief guide will give you necessary initial information, and provide guidance about the availability of resources and the respective roles of different care providers.

It is always difficult for parents to receive bad news about any aspect of their child’s health. Reacting with anger, grief and even guilt are not unusual when finding out that your child is hearing-impaired. These feelings are best managed by discussing them with a family member, close friend, clergy or mental health professional. At times, the feeling may also result in a degree of denial. Feel free to seek a second opinion, but it is unadvisable to delay further recommended diagnostic evaluations for your child. The best treatment for hearing loss of any degree is appropriate early intervention. Significant delays may result in irreversible harm to your child’s hearing, speech, language and eventual educational development.

You will come into contact with many healthcare and rehabilitation specialists during the long-term management of your child’s hearing loss. Some of them will be involved early in the journey and again at intervals. Others may step in later on. The following are professionals you will encounter and the role each of them will play in managing your child’s hearing loss.

The Audiologist

The audiologist is likely to be the first professional you encounter, and possibly the one who gives you the initial news regarding your child’s hearing loss. The audiologist will carry out behavioral or objective testing (such as auditory brainstem responses) or a combination of these approaches to determine the degree and type of hearing loss. The audiologist will also eventually recommend appropriate amplification, following a medical consultation. The audiologist will also provide your child with well-fitting ear molds along with the hearing aids, as he or she grows. The audiologist may also be the professional who provides you with information and referral to an early intervention program. Over time, the audiologist will provide periodic follow-ups to chart your child’s progress and to monitor his or her hearing loss.

Otologist, Otolaryngologist or Pediatric Otolaryngologist (ENT Physician)

Upon diagnosis of hearing loss, your child will be referred to an ear, nose and throat specialist (otolaryngologist), or one who specializes in childhood ear and hearing problems. This physician’s initial role is to determine the specific nature of the underlying problem that may be at least partially causing the hearing loss. Additionally, the physician will also determine if the problem is medically or surgically treatable, and if so, provide the necessary medical or surgical treatment. Such treatments could include something relatively simple, like the placement of eardrum ventilation tubes, or more complex surgical procedures. The ENT specialist may also refer your child for additional diagnostic procedures such as imaging studies (X-rays, CT-scans, MRI scans) to further define the type and source of hearing loss. The doctor will also provide clearance for hearing aid fitting, after determining if no other intervention is indicated. If it is determined that your child needs a cochlear implant, the otolaryngologist, along with the audiologist, will carry out further tests and examinations, and will carry out the implant surgery.

Primary Care Physician: Pediatrician or Family Practitioner

Your child’s primary care physician may be either a pediatrician or a family practice doctor. If your child is not diagnosed with a hearing loss in the newborn period but develops hearing loss later in life, it is the responsibility of this doctor to make appropriate referrals to an ear, nose and throat specialist and an audiologist to rule out or diagnose hearing loss. Your child’s primary care doctor may also participate in the treatment of ear infections if they appear, or refer them to an otolaryngologist for treatment. The primary care physician or the otolaryngologist may also provide a referral to a doctor who specializes in medical genetics, to find out if your child’s hearing loss may be hereditary. That may help you determine if a similar hearing loss could occur in your other children.

Early Intervention Specialist

This professional is typically is someone with an education background. He or she can help you find resources in your community, define family members’ roles in early intervention and management of the hearing loss, and can help you deal with questions regarding future educational placement. This specialist will also help you deal with your observations and concerns about your child and give you information and support regarding your child’s educational needs in the future.

Speech/ Language Pathologist (SLP)

This professional will evaluate the impact of your child’s hearing loss on speech/language development, and monitor his/her progress, noting if progress with that development is falling behind. If this happens, the SLP may refer back to the audiologist or otolaryngologist to determine if any changes have occurred in your child’s hearing. The SLP will also help your child to learn proper speech production, including correct articulation of speech sounds. If you choose oral communication for your child, in addition to the speech language pathologist your child may also be treated by an auditory-verbal therapist, who can help your child acquire the full range of speech sounds and guide the family to additional medical or audiological treatments. The auditory-verbal therapist will also help the child’s family become familiar with appropriate speech/language, auditory and cognitive developmental milestones you may expect for a child with hearing loss.

Finally, many other people can provide additional assistance for your hard-of-hearing child. Parents of older hard-of-hearing children and hard-of-hearing adults can share their experiences with you and may have suggestions for educational and recreational resources in the community.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery


Más de 50 millones de estadounidenses han sentido tinitus en algún momento en su vida. El tinitus es la percepción de un sonido en la ausencia de sonidos externos. Aproximadamente una de cada cinco personas con tinitus son impactadas negativamente. Estas personas requieren intervención médica. El tinitus puede aparecer o desaparecer o usted puede sentirlo en forma permanente. También puede ocurrir en un solo oído o en los dos. Puede tener muchos ruidos diferentes con tonos similares. Cuando dura más de 6 meses, el tinitus es considerado persistente. Antes de comenzar cualquier tratamiento, es importante visitar a un médico otorrinolaringólogo (ORL o ENT en inglés) y un audiólogo para obtener un examen completo. Entender lo que es el tinitus y sus causas es una importante parte del tratamiento.


El tinitus no es una enfermedad, sino un síntoma común relacionado con el sistema de audición. De hecho, varias partes del sistema de audición incluyendo el oído interno pueden estar defectuosas y causar el tinitus. En la mayoría de los casos la exacta causa del tinitus no se puede identificar y es relacionado con pérdida de audición. Este tipo de zumbido se llama tinitus primario. El tinitus secundario ocurre cuando existe una causa específica que no involucra pérdida de audición. Su doctor le podrá decir si su tinitus es primario o secundario.

En la mayoría de los casos, el tinitus solo lo puede escuchar Ud. (tinitus subjetivo). En casos muy raros lo puede escuchar su doctor (tinitus objetivo).

Varias partes del sistema de audición pueden estar involucradas. Por ejemplo, en el oído externo, demasiada cera puede resultar en tinitus. Igualmente, pelo suelto en el conducto auditivo puede tocar el tímpano y causar tinitus. Infecciones del oído medio o endurecimiento de los pequeños huesos que se encuentran en esta región (otosclerosis) también pueden resultar en tinitus.

Para todas las edades: La mayoría de los zumbidos provienen de un daño en las terminaciones nerviosas microscópicas en el oído interno. La salud de éstas es importante para mantener una excelente audición, y su daño trae disminución auditiva y, en muchos casos, el tinitus.

Si usted es de edad avanzada: La edad avanzada generalmente se acompaña de cierto grado de pérdida nerviosa de la audición y el zumbido.

Si Ud. es joven: La exposición a los intensos ruidos es probablemente la causa más importante y en muchos casos también daña la audición. Esto también es una de las causas prevenibles del tinitus y hay que reconocer que el zumbido también puede señalar el principio de pérdida de audición.

Algunas medicinas como el acetaminofén, antibióticos, y diuréticos para bajar la presión alta también pueden causar pérdida de audición y tinitus.

Raramente, porciones del cerebro dedicadas al sistema auditivo pueden ser afectadas por lesiones o tumores y causar tinitus. El tinitus pulsátil es una categoría especial de zumbido que suena como el latido cardíaco o pulso. Este tipo de tinitus también es raro y puede indicar la presencia de enfermedades cardiovasculares que requieren consultas con su médico tan pronto como sea posible.

Diferentes enfermedades sistémicas y estilos de vida pueden afectar directamente el tinitus. Por ejemplo, artralgia de la articulación temporomandibular (TMJ en inglés), insomnio, depresión, ansiedad, y estrés muscular con fatiga pueden causar zumbido o empeorar aquel que ya existe. Igualmente, una dieta deficiente, el consumo excesivo de cafeína, falta de hidratación, y falta de ejercicio también puede causar o exacerbar el zumbido.


Es importante que su doctor obtenga una historia completa, incluyendo posibles factores causales, y que haga un buen examen físico. Si el tinitus es unilateral, asociado con pérdida auditiva, o persistente, debe obtenerse un audiograma (audiometría). En cualquier caso, usted puede optar por un audiograma. No hay ninguna necesidad de obtener pruebas radiológicas (radiografías, tomografías computarizadas o los exámenes de MRI) a menos que el zumbido sea unilateral, pulsátil o asociado con pérdida auditiva asimétrica, o anormalidades neurológicas. Su médico tratará de determinar cuánto le afecta su zumbido con preguntas específicas o cuestionarios de autoevaluación.


Aunque no existe una ‘cura’ para el tinitus, hay varias opciones disponibles. Si le acaba de empezar su zumbido puede tener confianza de que esto se le quite en menos de 6 meses sin tratamiento. Esto es porque la mayoría de las personas no terminan con zumbido persistente. Al principio de sus síntomas debe de modificar su estilo de vida: evitar ruidos altos, reducir el consumo de cafeína, hidratar y liberar la tensión muscular en el cuello y la mandíbula.

Si su otorrinolaringólogo encuentra una causa específica de su zumbido, él o ella podrá ofrecerle un tratamiento específico para eliminar el ruido. Esto puede incluir limpieza de su conducto auditivo externo para remover la cera o algún pelo suelto, tratamientos para líquido acumulado en el oído medio o para artralgia temporomandibular, etc.

Un sonido competitivo constante, como un reloj con tictac o la estática de una radio (ruido blanco), puede tapar el zumbido y hacerlo menos evidente. Se venden aparatos que generan ruido blanco. Emiten un sonido competitivo pero agradable que puede distraer al paciente y quitarle la atención del ruido. Este fenómeno se llama enmascaramiento y es una forma de tratar el tinitus. Si Ud. tiene una pérdida auditiva, usar audífonos le puede reducir el zumbido y a veces lo elimina provisionalmente.

El tinitus puede ser tan desagradable para un paciente que le puede hasta provocar ansiedad o depresión. En aquella persona que ya por si sufre de ansiedad o depresión le puede ser muy difícil soportar la carga adicional del tinitus. En estos casos es importante consultar con un psiquiatra o psicólogo para recibir tratamientos dirigidos a estos problemas específicos. Además, hay buena evidencia de que terapia conductual cognitiva (TCC o CBT en inglés) es beneficioso en el alivio del zumbido.

La prescripción de medicamentos como antidepresivos, anticonvulsivos, ansiolíticos o inyecciones intratimpánicas de medicamentos no se recomienda para el tratamiento del tinitus, a no ser que exista otro problema médico que pueda beneficiarse de dicho tratamiento.

Suplementos dietéticos abundan en el internet y por la televisión y radio. No hay ninguna evidencia de que alguno de estos suplementos, incluyendo el ginkgo biloba, melatonina, zinc, etc., es beneficioso para el tinitus. La acupuntura puede o no puede ser útil en el tratamiento del tinitus; No hay suficientes estudios de calidad sobre este tema. La estimulación magnética transcraneal es una nueva modalidad, pero todavía no es recomendada para el tinitus en este momento.


Generalmente no. En casos raros de “tinitus objetivo”, su doctor puede escuchar su zumbido usando instrumentos como el estetoscopio.


El zumbido es una percepción fantasma que es ‘enmascarada’ por sonidos ambientales como el ruido de una oficina o el tráfico, TV o radio, etc. También no se percibe cuando el cerebro está ocupado – como cuando uno está en el trabajo. Por esta razón el zumbido es más molesto en los ambientes silenciosos como en la noche y cuando el cerebro no está enfocado en otra cosa. En general, uso de un generador de sonido en la noche puede ayudar con este problema. Si su tinitus está interfiriendo con el sueño, debe informar a su médico.


Es relativamente raro ver pacientes menores de 18 años que tengan tinitus. Sin embargo, es posible que este síntoma no se descubra eficientemente en estos pacientes porque los niños pequeños pueden tener dificultad para describir esta molestia. Además, en los niños que nacen con pérdida auditiva y tinitus, este síntoma puede ser inadvertido porque es algo que es constante en sus vidas. De hecho, ellos pueden aprender a ignorar este sonido interno. En pre-adolescentes y adolescentes, el mayor riesgo para el desarrollo de tinitus es la exposición a sonidos de alta intensidad, específicamente escuchando música. Por lo tanto, es importante enseñarles a los niños como proteger sus oídos de ruidos fuertes.


  • Evite la exposición a ruidos y sonidos fuertes.
  • Controle su presión arterial con su médico si esta alta.
  • Hidrátese adecuadamente.
  • Evite estimulantes como la cafeína, el té, la cola y el tabaco.
  • Haga ejercicio diario para mejorar su circulación.
  • Descanse adecuadamente y evite la fatiga.
  • Use máquinas de sonido y técnicas mentales para empujar la percepción del tinitus al fondo; cuanto más piense en el tinitus, peor será. Si no puede hacerlo por su cuenta, busque ayuda

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

What is Tinnitus?

Over 50 million Americans have experienced tinnitus or head noises, which is the perception of sound without an external source being present. About one in five people with tinnitus have bothersome tinnitus, which distresses them and negatively affects their quality of life and/or functional health status. Those individuals with persistent and bothersome tinnitus will often seek medical care. Tinnitus may be an intermittent or continuous sound in one or both ears. Its pitch can go from a low roar to a high squeal or whine or it can have many sounds. Persistent tinnitus is tinnitus that lasts more than six months. Prior to any treatment, it is important to undergo a thorough examination and evaluation by your otolaryngologist (ENT doctor) and audiologist. An essential part of the treatment will be your understanding of tinnitus and its causes.

What causes tinnitus?

Tinnitus is commonly defined as hearing a sound in the absence of external sounds. Tinnitus is not a disease in itself but a common symptom, and because it involves the perception of sound or sounds, it is commonly associated with the hearing system. In fact, various parts of the hearing system, including the inner ear, are often responsible for this symptom. At times, it is relatively easy to associate the symptom of tinnitus with specific problems affecting the hearing system; at other times, the connection is less clear. Most tinnitus is primary tinnitus, where no cause can be identified aside from hearing loss. Secondary tinnitus is associated with a specific underlying cause that may be treatable. Your doctor will help you distinguish whether your tinnitus is primary or secondary.

Most of the time, the tinnitus is subjective—that is, the tinnitus is heard only by the individual. Rarely, tinnitus is “objective,” meaning that the examiner can actually listen and hear the sounds the patient hears.

Tinnitus may be caused by different parts of the hearing system. The outer ear (pinna and ear canal) may be involved. Excessive ear wax, especially if the wax touches the ear drum, causing pressure and changing how the ear drum vibrates, can result in tinnitus.

Middle ear problems that cause hearing problems can also cause tinnitus. These include common entities such as middle ear infection and uncommon ones such as otosclerosis, which hardens the tiny ear bones or ossicles. Another, rare, cause of tinnitus from the middle ear that does not result in hearing loss is muscle spasms of one of the two tiny muscles in the ear. In this case, the tinnitus can be intermittent and at times, the examiner can also hear the sounds.

Most subjective tinnitus associated with the hearing system originates in the inner ear. Damage and loss of the tiny sensory hair cells in the inner ear (that can be caused by different factors such as noise damage, medications, and age) may be commonly associated with the presence of tinnitus.

One of the preventable causes of tinnitus is excessive noise exposure. In some instances of noise exposure, tinnitus can be noticed even before hearing loss develops, so it should be considered a warning sign and an indication of the need for hearing protection in noisy environments. Medications can also damage inner ear hair cells and cause tinnitus. These include both non-prescription medications such as aspirin and acetaminophen, when taken in high doses, and prescription medication including certain diuretics and antibiotics. As we age, the incidence of tinnitus increases.

Tinnitus may also originate from lesions on or in the vicinity of the hearing portion of the brain. These include a variety of uncommon disorders including vestibular schwannoma (acoustic neuroma) and damage from head trauma.

A special category is tinnitus that sounds like one’s heartbeat or pulse, also known as pulsatile tinnitus. Infrequently, pulsatile tinnitus may signal the presence of cardiovascular disease or a vascular tumor in the head and neck or the ear. If experiencing this type of tinnitus, it is advisable to consult a physician as soon as possible for evaluation.

There are a number of non-auditory conditions and lifestyle factors that are associated with tinnitus. Medical conditions such as temporomandibular joint arthralgia (TMJ), depression, anxiety, insomnia, and muscular stress and fatigue may cause tinnitus, or can contribute to worsening of existing tinnitus.

What testing do I need?

When you are evaluated for tinnitus, the first thing the doctor will do is obtain a complete history, investigating potential causative factors, and perform a thorough, targeted physical examination. If the tinnitus is one-sided (unilateral), associated with hearing loss, or persistent, an audiogram (hearing test) should be obtained early in the evaluation. You may opt for an audiogram in any case. There is no need for radiologic testing (X-rays, CT scans or MRI scans) unless your tinnitus is unilateral, pulsatile, or associated with asymmetric hearing loss or neurological abnormalities. Your doctor will try to determine how bothersome your tinnitus is, by asking certain questions or having you complete a self-assessment questionnaire.

How is tinnitus treated?

Although there is no one ‘cure’ for tinnitus, there are several options available that can help patients with tinnitus. If you are in the ‘new onset’ period of tinnitus (less than 6 months), you can be reassured that, for many, the natural course of tinnitus is to improve over time and most people do not go on to have persistent, bothersome tinnitus.

If the otolaryngologist finds a specific cause for your tinnitus, he or she may be able to offer specific treatment to eliminate the noise. This may include removal of wax or hair from the ear canal, treatment of middle ear fluid, treatment of arthritis in the jaw joint, etc.

Some patients with hearing loss and tinnitus have a modest improvement in coping with the tinnitus using hearing aids with or without built-in ear-level maskers. Sound therapies that involve simple things like background music or noise or specialized ear level maskers may be a reasonable treatment option. The effects of tinnitus on quality of life may be improved by a course of counseling with cognitive behavioral therapy (CBT), which usually involves a series of weekly sessions led by a trained professional.

Tinnitus can be so bothersome that it causes depression or anxiety; additionally, in a patient with depression and/or anxiety, it may be very difficult to tolerate the additional burden of tinnitus. Consultation with a psychiatrist or psychologist with treatment directed to the underlying condition can be beneficial.

Routine prescription of medications including antidepressants, anticonvulsants, anxiolytics, or intratympanic injection of medications, is not recommended for treating tinnitus without an underlying or associated medical problem that may benefit from such treatment.

Dietary supplements for tinnitus treatment are frequently advertised on the internet, television and radio. There is no evidence that any of these supplements, including ginkgo biloba, melatonin, zinc, lipoflavonoids, or vitamin supplements are beneficial for tinnitus.

Acupuncture may or may not be helpful in tinnitus; there are not enough quality studies of this treatment for tinnitus to make a recommendation.

Transcranial magnetic stimulation is a new modality but it cannot be recommended for tinnitus at this time, as long-term benefits are not proven.

Can other people hear the noise in my ears?

Not usually. In rare cases of “objective tinnitus,” others may be able to use a special in-the-ear microphone to hear your tinnitus.

Why is my tinnutis so loud at night?

Tinnitus is a sound that is ‘masked’ by external sounds such as office or traffic noise, TV or radio, etc. It is also not perceived when the brain is busy elsewhere – such as at work. At night, when external sounds are minimal and the brain is not focused on something else, tinnitus often sounds much louder and becomes more bothersome. In general, use of a sound generator at night is very helpful in decreasing the disturbance of tinnitus. If tinnitus is interfering with sleep, you should inform your doctor.

Can children be at risk for tinnitus?

It is relatively rare but not unheard of for patients under 18 years old to have tinnitus as a primary complaint. However, it is possible that tinnitus in children is significantly under-reported, in part because young children may not be able to express this complaint. Also, in children with congenital sensorineural hearing loss that may be accompanied by tinnitus, this symptom may be unnoticed because it is something that is constant in their lives. In fact, they may habituate to it; the brain may learn to ignore this internal sound. In pre-teens and teens, the highest risk for developing tinnitus is associated with exposure to high intensity sounds, specifically listening to music. In particular, virtually all teenagers use personal MP3 devices and nearly all hand-held electronic games are equipped with ear buds. It is difficult for a parent to monitor the level of sound exposure to children using these devices. Therefore, the best and most effective mode of prevention of tinnitus in children is proper education on the risks of excessive sound exposure in combination with proper monitoring by parents or other caregivers. Limits on the maximum volume output can be programmed into many electronic devices.

Tips to lessen the severity of tinnitus

  • Avoid exposure to loud sounds and noises.
  • Get your blood pressure checked. If it is high, get your doctor’s help to control it.
  • Exercise daily to improve your circulation.
  • Get adequate rest and avoid fatigue.
  • Use physical (sound machine) and mental techniques to push the perception of tinnitus to the background; the more you think about the tinnitus, the louder it will seem. If you cannot do this on your own, seek help as outlined above.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Affecting the outer ear, swimmer’s ear (also called acute otitis externa) is a painful condition resulting from inflammation, irritation or infection. These symptoms often occur after water gets trapped in your ear, with subsequent spread of bacteria or fungal organisms. Because this condition commonly affects swimmers, it is known as swimmer’s ear. Swimmer’s ear often affects children and teenagers, but can also affect those with eczema (a condition that causes the skin to itch) or excess earwax. Your doctor will prescribe treatment to reduce your pain and to treat the infection.

What causes swimmer’s ear?

A common source of the infection is increased moisture trapped in the ear canal from baths, showers, swimming or moist environments. When water is trapped in the ear canal, bacteria that normally inhabit the skin and ear canal multiply, causing infection of the ear canal. Swimmer’s ear needs to be treated to reduce pain and eliminate any effect it may have on your hearing, as well as to prevent the spread of infection.

Other factors that may contribute to swimmer’s ear include:

  • Contact with excessive bacteria that may be present in hot tubs or polluted water
  • Excessive cleaning of the ear canal with cotton swabs or anything else
  • Contact with certain chemicals such as hair spray or hair dye (avoid this by placing cotton balls in your ears when using these products)
  • Damage to the skin of the ear canal following water irrigation to remove wax
  • A cut in the skin of the ear canal
  • Other skin conditions affecting the ear canal, such as eczema or seborrhea.

What are the signs and symptoms?

The most common symptoms of swimmer’s ear are itching inside the ear and pain that gets worse when you tug on the auricle (outer ear). Other signs and symptoms may include any of the following:

  • Sensation that the ear is blocked or full
  • Drainage
  • Fever
  • Decreased hearing
  • Intense pain that may radiate to the neck, face or side of the head
  • Swollen lymph nodes around the ear or in the upper neck. Redness and swelling of the skin around the ear

If left untreated, complications resulting from swimmer’s ear may include:

Hearing loss. When the infection clears up, hearing usually returns to normal.

Recurring ear infections (chronic otitis externa). Without treatment, infection can continue.

Bone and cartilage damage (malignant otitis externa). Ear infections when not treated can spread to the base of your skull, brain or cranial nerves. Diabetics and older adults are at higher risk for such dangerous complications.

To evaluate you for swimmer’s ear, your doctor will look for redness and swelling in your ear canal. Your doctor also may take a sample of any abnormal fluid or discharge in your ear to test for the presence of bacteria or fungus (ear culture) if you have recurrent or severe infections.

How is swimmer’s ear treated?

Treatment for the early stages of swimmer’s ear includes careful cleaning of the ear canal and use of eardrops that inhibit bacterial or fungal growth and reduce inflammation. Mildly acidic solutions containing boric or acetic acid are effective for early infections.

How should ear drops be applied?

  • Drops are more easily administered if done by someone other than the patient.
  • The patient should lie down with the affected ear facing upwards.
  • Drops should be placed in the ear until the ear is full.
  • After drops are administered, the patient should remain lying down for a few minutes so the drops can be absorbed.

If you do not have a perforated eardrum (an eardrum with a hole in it) or a tympanostomy tube in your eardrum, you can make your own eardrops using rubbing alcohol or a mixture of half alcohol and half vinegar. These eardrops will evaporate excess water and keep your ears dry.

Before using any drops in the ear, it is important to be sure you do not have a perforated eardrum. Check with your otolaryngologist if you have ever had a perforated, punctured or injured eardrum, or if you have had ear surgery.

For more severe infections, your doctor may prescribe antibiotics to be applied directly to the ear. If the ear canal is swollen shut, a sponge or wick may be placed in the canal so the antibiotic drops will enter the swollen canal more effectively. Pain medication may also be prescribed. If you have tubes in your eardrum, a non oto-toxic (does not affect your hearing) topical treatment should be used. Topical antibiotics are effective for infection limited to the ear canal. Oral antibiotics may also be prescribed if the infection goes beyond the skin of the ear canal.

Follow-up appointments are very important to monitor improvement or worsening, to clean the ear again, and to replace the ear wick as needed. Your otolaryngologist has specialized equipment and expertise to effectively clean the ear canal and treat swimmer’s ear. With proper treatment, most infections should clear up in 7-10 days.

Why do ears itch?

An itchy ear may be caused by a fungus or allergy, but more often from chronic dermatitis (skin inflammation) of the ear canal. Otolaryngologists also treat allergies, and they can often prescribe an eardrop, cream or ointment to treat the problem.

Tips for prevention

  • A dry ear is unlikely to become infected, so it is important to keep the ears free of moisture during swimming or bathing.
  • Use ear plugs when swimming
  • Use a dry towel or hair dryer to dry your ears
  • Have your ears cleaned periodically by an otolaryngologist if you have itchy, flaky or scaly ears, or extensive earwax
  • Don’t use cotton swabs to remove ear wax. They may pack ear wax and dirt deeper into the ear canal, remove the layer of earwax that protects your ear, and irritate the thin skin of the ear canal.
  • This creates an ideal environment for infection.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Un orificio o ruptura en el tímpano, una delgada membrana que separa el canal auditivo y el oído medio es llamada perforación timpánica. El oído medio está conectado con la nariz por la trompa de Eustaquio, que equipara las presiones en el oído medio.

Una perforación timpánica es generalmente acompañada por una disminución en la audición y eventual supuración. El dolor no suele ser persistente.

¿Cual es la causa de la perforación?

Las causas de perforación timpánica son generalmente debidas a traumas o infecciones. Una perforación por trauma puede ocurrir:

  • Si el oído es injuriado directamente
  • Con una fractura de cráneo
  • Luego de una explosión repentina
  • Si un objeto (como hisopo, varilla) es empujado muy dentro del canal auditivo
  • Como resultado de ácido o agua hirviendo entrando en el canal auditivo

Las infecciones de oído medio pueden causar dolor, pérdida auditiva y ruptura espontánea de la membrana del tímpano, resultando en una perforación. En este caso puede haber supuración infectada o sanguinolenta en el oído. El término médico para esto es otitis media con perforación. Los síntomas de otitis media incluyen una sensación de oído lleno, audición disminuida, dolor y fiebre.

En algunas raras ocasiones un pequeño orificio puede persistir en la membrana luego de la colocación de un tubo de ventilación que se cae o es removido por el médico.

La mayoría de las perforaciones curan por si solas en semanas aunque algunas pueden tomar varios meses en curar. Durante este proceso el oído debe protegerse del agua y los traumas. Las perforaciones que no curan por si solas necesitarán cirugía.

¿Cómo se afecta la audición en un tímpano perforado?

Por lo general el tamaño de la perforación determina el nivel de pérdida auditiva – un orificio más grande causará una mayor pérdida que uno más pequeño. El lugar de la perforación también afecta el grado de hipoacusia. Si un trauma severo (como una fractura de cráneo) disloca los huesos del oído medio que transmiten el sonido o lastima estructuras del oído interno, la pérdida auditiva puede ser severa. Si la perforación es causada por un evento súbito traumático o una explosión, la pérdida auditiva puede ser importante y los acúfenos (zumbido en el oído) tener relevancia. En este caso, la audición se recupera parcialmente y el zumbido disminuye en algunos días. La infección crónica como resultado de la perforación puede causar una pérdida de la audición persistente o progresiva.

¿Cómo se trata la perforación timpánica?

Antes de realizar la corrección de la perforación se debe realizar un examen de audición. Los beneficios de cerrar una perforación incluyen la prevención de la entrada de agua al oído durante la ducha, el baño o la natación (que pueden causar infecciones de oído), mejorarán la audición y disminuirá los zumbidos. También puede prevenir el desarrollo de colesteatomas (quistes de piel en el oído medio) que pueden causar infección crónica y destrucción de las estructuras del oído.

Si la perforación es muy pequeña, un otorrinolaringólogo puede optar por realizar un seguimiento de la perforación en el tiempo para ver si cierra espontáneamente. Se puede intentar cerrar la perforación en el consultorio. Trabajando con un microscopio, el médico toca los bordes del tímpano con un químico para estimular el crecimiento y luego coloca un delgado parche de papel sobre el tímpano. Generalmente al cerrar la perforación la audición mejora. Muchas aplicaciones de este parche (hasta tres o cuatro) pueden necesitarse antes de que la perforación cierre completamente. Si el médico piensa que este parche de papel no llevará a un adecuado cierre de la perforación o si no tiene buenos resultados se necesitará cirugía.

Hay diferentes técnicas quirúrgicas pero la mayoría incluye en colocar tejido de la piel a través de la perforación para permitir la cura. El nombre de este procedimiento es timpanoplastia. La cirugía es muy exitosa en reparar la perforación, restaurando o mejorando la audición y generalmente se realiza en forma ambulatoria.

Su médico le recomendará acerca del manejo apropiado de un tímpano perforado.

Más información acerca del oído

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

A hole or rupture in the eardrum, the thin membrane that separates the ear canal from the middle ear, is called a perforated eardrum. The medical term for eardrum is tympanic membrane. The middle ear is connected to the nose by the Eustachian tube, which regulates pressure in the middle ear. A perforated eardrum is often accompanied by decreased hearing and sometimes liquid drainage. The perforation may be accompanied by pain, if it is caused by an injury or infection.

What causes eardrum perforation?

The causes of an eardrum hole are usually from injury, infection or chronic Eustachian tube disorders. A perforated eardrum from trauma can occur:

  • If the ear is struck directly
  • With a skull fracture
  • After a sudden explosion
  • If an object (such as a bobby pin, Q-tip or stick) is pushed too far into the ear canal

Middle ear infections may cause pain, hearing loss and spontaneous rupture of the eardrum, resulting in a perforation. In this case, there may be infected or bloody drainage from the ear. Infections can cause a hole in the eardrum as a side effect of otitis media. Symptoms of acute otitis media (middle ear fluid with signs of infection) include a sense of fullness in the ear, some hearing loss, pain and fever.

In patients with chronic Eustachian tube problems the ear drum may become weakened and open up.

On rare occasions a small hole may remain in the eardrum after a previously placed pressure-equalizing (PE) tube falls out or is removed by a physician.

Most eardrum holes resulting from injury or an acute ear infection heal on their own within weeks of opening, although some may take several months to heal. During the healing process the ear must be protected from water and trauma. Eardrum perforations that do not heal on their own may require surgery.

How is hearing affected by a perforated eardrum?

Usually the size of the perforation determines the level of hearing loss—a larger hole will cause greater hearing loss than a smaller hole. The location of the perforation also affects the degree of hearing loss. If severe injury (e.g., skull fracture) moves the bones in the middle ear that send out sound out of place, or injures the inner ear, hearing loss may be serious.

If the perforated eardrum is caused by a sudden traumatic or violent event, the loss of hearing can be great, and tinnitus (ringing in the ear) may occur. Chronic infection as a result of the perforation can cause longer lasting or worsening hearing loss.

How is a perforated eardrum treated?

Before attempting any correction of the perforation, a hearing test should be performed. The benefits of closing a perforation include prevention of water entering the middle ear while showering, bathing, or swimming (which could cause ear infection), improved hearing, and lessened tinnitus. It also may prevent the development of cholesteatoma (skin cyst in the middle ear), which can cause chronic infection and destruction of ear structures.

If the perforation is very small, an otolaryngologist (your ear, nose and throat physician) may choose to observe the perforation over time to see if it will close on its own. He or she might try to patch a patient’s eardrum in the office. Working with a microscope, your doctor may touch the edges of the eardrum with a chemical to stimulate growth and then place a thin paper patch on the eardrum.

Usually, with closure of the eardrum, hearing is improved. Several patches may be required before the perforation closes completely. If your physician feels that a paper patch will not provide prompt or complete closure of the hole in the eardrum, or if paper patching does not help, surgery may be required.

There are a variety of options for treatment, but most involve placing a patch across the perforation to allow healing. The name of this procedure is tympanoplasty. Surgery is typically quite successful in repairing the perforation, bringing back or improving hearing, and is often done in the physician’s office.

Your doctor will advise you regarding the proper care of a hole in the eardrum.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Noise-Induced Hearing Loss

A Q & A with AAO-HNS Member Expert Barry E. Hirsch, MD, Professor, Department of Otolaryngology and Communication Sciences and Disorders, and Neurological Surgery, University of Pittsburgh School of Medicine; Director, Division of Otology; and Chair, AAO-HNS Hearing Committee.

Q. What is noise-induced hearing loss?

A. Human ears are exposed to noises and sounds every day and in many ways. Usually, the noises we hear are helpful to us, allowing us to engage in conversations, listen to music and avoid dangerous situations. However, when we are exposed to harmful noises – sounds that are too loud, or loud sounds that last a long time – sensitive structures in the inner ear can be damaged, causing noise-induced hearing loss. These sensitive structures, called hair cells, are small sensory cells that convert sound energy into electrical signals that travel to the brain, where the brain converts them into meaningful sounds. Once damaged, hair cells cannot grow back and lose the ability to conduct sound.

Q. What are the symptoms of noise-induced hearing loss?

A. The symptoms of noise-induced hearing loss are subtle in the early stages. Hearing loss tends to occur first for high-pitched (frequency) sounds only. Consequently, the volume of sound heard may be unchanged but the quality of it lessens. Over time, speech may be heard but not completely understood. The presence of background noise can make speech hard to understand. Noise-induced hearing loss can also be accompanied by a ringing in the ears (tinnitus).

Q. When is noise dangerous?

A. Sound is measured in units called decibels (dB). On the decibel scale, an increase of 3 dB means that a sound is two times more intense, or powerful. To your ears, it sounds almost twice as loud. The humming of a refrigerator is 45 decibels, normal conversation is approximately 60 decibels, and the noise from heavy city traffic can reach 85 decibels.

Noise can be dangerous through a one-time exposure to an intense impulse sound, such as an explosion, or by continuous exposure to loud sounds over an extended period of time, such as noise generated in a woodworking shop, fabricating plant or by loud engines.

Sources of noise that can cause noise-induced hearing loss include motorcycles, firecrackers and firearms, all of which can emit sounds from 120 to 150 decibels. Long or repeated exposure to sounds at or above 85 decibels can cause hearing loss. The louder the sound, the shorter the time period before NIHL can occur. Sounds of less than 75 decibels, even after long exposure, are unlikely to cause hearing loss.

Here are some basic rules to follow if you are concerned about dangerous noise:

  • If it is necessary to shout to hear yourself or someone else over noise, the level of the sound can be damaging.
  • Should ringing in the ears occur after exposure to a loud sound, damage has been done and that sound should be avoided or ear protection used in the future.
  • If diminished hearing or a sense of fullness in the ears is experienced after noise exposure, the level of that noise is damaging.

Q. How can I protect my hearing?

A. Some helpful tips:

  • If you work in noisy places or commute to work in noisy traffic or construction, choose quiet leisure activities instead of noisy ones.
  • Develop the habit of wearing earplugs or ear muffs when you know you will be exposed to loud or prolonged noise.
  • Earplugs and/or ear muffs can effectively reduce sound energy hitting your ears by about 25 dB and can mean the difference between dangerous and safe levels of noise.
  • Try not to use several noisy machines at the same time.
  • Keep personal music players (mp3 players) and personal gaming device headsets, television sets and stereos on a low volume.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

What is otitis media and ear infection?

Otitis media refers to inflammation of the middle ear. When an abrupt infection occurs, the condition is called “acute otitis media.” Acute otitis media occurs when a cold, allergy, and the presence of bacteria or viruses lead to the accumulation of pus and mucus behind the eardrum, blocking the Eustachian tube. This can cause earache and fever.

When fluid sits in the middle ear for weeks, the condition is known as “otitis media with effusion.” This occurs in a recovering ear infection. Fluid can remain in the ear for weeks to many months. If not treated, chronic ear infections have potentially serious consequences such as temporary hearing loss.

Why do children have more ear infections than adults?

To understand earaches and ear infections, you must first know about the Eustachian tube, a narrow channel connecting the inside of the ear to the back of the throat, just above the soft palate and uvula. The tube allows drainage of fluid from the middle ear, which prevents it from building up and bursting the thin ear drum. In a healthy ear, the fluid drains down the tube, assisted by tiny hair cells, and is swallowed.

The tube maintains middle ear pressure equal to the air outside the ear, enabling free eardrum movement. Normally, the tube is collapsed most of the time in order to prevent the many germs residing in the nose and mouth from entering the middle ear. Infection occurs when the Eustachian tube fails to do its job. When the tube becomes partially blocked, fluid accumulates in the middle ear, trapping bacteria already present, which then multiply. Additionally, as the air in the middle ear space escapes into the bloodstream, a partial vacuum is formed that absorbs more bacteria from the nose and mouth into the ear.

Children have Eustachian tubes that are shorter, more horizontal, and straighter than those of adults. These factors make the journey for the bacteria quick and relatively easy. It also makes it harder for the ears to clear the fluid, since it cannot drain with the help of gravity. A child’s tube is also floppier, with a smaller opening that easily clogs.

How does otitis media affect hearing?

Most people with middle ear infection or fluid have some degree of hearing loss. The average hearing loss in ears with fluid is 24 decibels – equivalent to wearing ear plugs. (Twenty-four decibels is about the level of the very softest of whispers.) Thicker fluid can cause much more loss, up to 45 decibels (the range of conversational speech).

Suspect hearing loss if one is unable to understand certain words and speaks louder than normal.

Types of hearing loss

Conductive hearing loss is a form of hearing impairment where the transmission of sound from the environment to the inner ear is impaired, usually from an abnormality of the external auditory canal or middle ear. This form of hearing loss can be temporary or permanent. Untreated chronic ear infections can lead to conductive hearing loss. If fluid is filling the middle ear, hearing loss can be treated by draining the middle ear and inserting a tympanostomy tube. The other form of hearing loss is sensorineural hearing loss, hearing loss due to abnormalities of the inner ear or the auditory division of the 8th cranial nerve. Historically, this condition can occur at all ages, and is usually permanent.

When should a hearing test be performed related to frequent infections or fluid?

A hearing test should be performed for children who have frequent ear infections, hearing loss that lasts more than six weeks, or fluid in the middle ear for more than three months. There are a wide range of medical devices now available to test a child’s hearing, Eustachian tube function and flexibility of the ear drum. They include the otoscopy, tympanometer and audiometer.

Do people lose their hearing for reasons other than chronic otitis media?

Children and adults can incur temporary hearing loss for other reasons than chronic middle ear infection and Eustachian tube dysfunction. They include:

  • Cerumen impaction (compressed earwax)
    Otitis externa: Inflammation of the external auditory canal, also called swimmer’s ear.
  • Cholesteatoma: A mass of horn-shaped squamous cell epithelium and cholesterol in the middle ear, usually resulting from chronic otitis media.
  • Otosclerosis: This is a disease of the otic capsule (bony labyrinth) in the ear, which is more prevalent in adults and characterized by formation of soft, vascular bone leading to progressive conductive hearing loss. It occurs due to fixation of the stapes (bones in the ear). Sensorineural hearing loss may result because of involvement of the cochlear duct.
  • Trauma: A trauma to the ear or head may cause temporary or permanent hearing loss.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

You may have hearing loss and not even be aware of it. People of all ages experience gradual hearing loss, often due to the natural aging process or long exposure to loud noise. Other causes of hearing loss include viruses or bacteria, heart conditions or stroke, head injuries, tumors and certain medications. Treatment for hearing loss will depend on your diagnosis.

How Does the Hearing Sense Work?

Hearing is a complex and intricate process.The ear is made up of three sections: the outer ear, the middle ear and the inner ear. These parts work together so you can hear and process sounds. The outer ear, or pinna (the part you can see), picks up sound waves and directs them into the outer ear canal.

These sound waves travel down the ear canal and hit the eardrum, which causes the eardrum to vibrate. When the eardrum vibrates, it moves three tiny bones in your middle ear. The middle ear is a small air-filled space between the eardrum and the inner ear. These bones form a chain and are called the hammer (or malleus), anvil (or incus) and stirrup (or stapes). The movement of these bones transmits and amplifies the sound waves toward the inner ear.

The third bone in the chain, the stapes, interfaces with fluid which fills the hearing portion of the inner ear – the cochlea. The cochlea is lined with cells that have thousands of tiny hairs on their surfaces. As the fluid wave travels through the cochlea, it causes the tiny hairs to move. The hairs change the mechanical wave into nerve signals. The nerve signals are then transmitted to your brain, which interprets the sound.

Test Your Hearing

To get an idea of how well you hear, answer the following questions and then calculate your score. To calculate your score, give yourself 3 points for every “Almost always” answer, 2 points for every “Half the time” answer, 1 point for every “Occasionally” answer, and 0 for every “Never”. Please note: If hearing loss runs in your family, add an additional 3 points to your overall score.
The American Academy of Otolaryngology – Head and Neck Surgery recommends the following:

0-5 points­ Your hearing is fine. No action is required.
6-9 points Suggest you see an ear, nose and throat (ENT) specialist.
10+ points Strongly recommend you see an ear, nose and throat (ENT) specialist.
I have a problem hearing over the telephone.

  • Almost always
  • Half the time
  • Occasionally
  • Never

I have trouble following the conversation when two or more people are talking at the same time.

Almost always
Half the time

People complain that I turn the TV volume too high.

  • Almost always
  • Half the time
  • Occasionally
  • Never

I have to strain to understand conversations.

  • Almost always
  • Half the time
  • Occasionally
  • Never

I miss hearing some common sounds like the phone or doorbell ring.

  • Almost always
  • Half the time
  • Occasionally
  • Never

I have trouble hearing conversations in a noisy background, such as at a party.

  • Almost always
  • Half the time
  • Occasionally
  • Never

I get confused about where sounds come from.

  • Almost always
  • Half the time
  • Occasionally
  • Never

I misunderstand some words in a sentence and need to ask people to repeat themselves.

  • Almost always
  • Half the time
  • Occasionally
  • Never

I especially have trouble understanding the speech of women and children.

  • Almost always
  • Half the time
  • Occasionally
  • Never

I have worked in noisy environments (such as assembly lines, construction sites or near jet engines).

  • Almost always
  • Half the time
  • Occasionally
  • Never

Many people I talk to seem to mumble, or don’t speak clearly.


  • Almost always
  • Half the time
  • Occasionally
  • Never

People get annoyed because I misunderstand what they say.

  • Almost always
  • Half the time
  • Occasionally
  • Never

I misunderstand what others are saying and make inappropriate responses.

  • Almost always
  • Half the time
  • Occasionally
  • Never

I avoid social activities because I cannot hear well and fear I’ll make improper replies.

  • Almost always
  • Half the time
  • Occasionally
  • Never

Ask a family member or friend to answer this question: Do you think this person has a hearing loss?

  • Almost always
  • Half the time
  • Occasionally
  • Never

What can I do to improve my hearing?

  • Eliminate or lower unnecessary noises around you.
  • Let friends and family know about your hearing loss and ask them to speak slowly and more clearly.
  • Ask people to face you when they are speaking to you, so you can watch their faces and see their expressions.
  • Use sound amplifying devices on phones.
  • Use personal listening systems to reduce background noise.

Tips to maintain hearing health

  • If you work in noisy places or commute to work in noisy traffic or construction, choose quiet leisure activities instead of noisy ones.
  • Develop the habit of wearing earplugs when you know you will be exposed to noise for a long time.
  • Earplugs can reduce the volume of sound reaching the ear to a safer level.
  • Try not to use several noisy machines at the same time.
  • Try to keep television sets, stereos and headsets low in volume.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery