What doctors wish patients knew about proper ear care

AMA News Wire

What doctors wish patients knew about proper ear care

Oct 20, 2023

People may overlook their ears and take for granted the ability to hear. It is essential, though, to not to wait until an issue arises before giving your ears the attention they deserve. That means caring for them proactively today. Engaging in proper ear care is instrumental in maintaining optimal ear health, as it can reduce the risk of ear infections and prevent hearing loss. But it can be difficult to know where to start when it comes to improving your ear health.

The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines.

In this installment, two physicians took time to discuss what patients need to know about taking care of their ears. They are:

• Jacob B. Hunter, MD, an otolaryngologist and division chief of otology and neurotology at Thomas Jefferson University Hospital in Philadelphia.
• Shawn C. Jones, MD, an otolaryngologist in Paducah, Kentucky at Baptist Health Medical Group—a member of the AMA Health System Program. He is also an alternate delegate for the Kentucky Medical Association.

“In short, you can improve your ear health the same way you take care of the rest of your body,” Dr. Jones said. That can be done through “hygiene, lifestyle choices, appropriate medical consultations.”

It is also important to make “sure that you identify issues and get treated or looked at for what you might think are minor issues before they escalate into bigger problems,” he said.

“One of the most important things—because of the prevalence of hearing loss—is making sure you protect your ears from excessive noise,” Dr. Jones said. “We all live in an industrialized society, so make sure that you’re not exposed to loud noises or even moderate noises for prolonged periods of time, which can also cause hearing loss.”

“Most people can recall going to a concert when they're younger and they come out of the concert and their hearing is muffled or clouded,” Dr. Hunter said, noting “And when that gets better, that's called a temporary threshold shift.”

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“We want to protect our ears so that we can avoid something like that because that is an indicator of damage to the cochlea,” he said.

“There’s a free phone app where you can measure the decibel level and if you can keep it below 70 decibels, it’s really a great idea,” Dr. Jones said. “So, wearing hearing protection at a concert is a great idea, but even leaf blowing, lawn mowing and hair dryers because of the proximity a lot of times can cause hearing loss.”

“And if you’ve already experienced hearing loss for whatever reason, then your ears can be more sensitive to loud noises,” he said. “Obviously jet engines and those kinds of industrial noises most people are aware of, but the more common everyday activities can also over a period of time give you hearing loss.”

“Vitamin A, C and E, along with some minerals like zinc have been touted for their potential benefits in maintaining ear health,” Dr. Jones said. “But in general, all antioxidants are healthy, particularly for vascular health.”

“And probably the most significant related to the ear is vascular health next to making sure that you protect your hearing from noise exposure,” he said. That includes “things like drinking green tea and eating blueberries, broccoli and other things that would also promote an anti-inflammatory diet that is rich in antioxidants and flavonoids and those nutritional components.

“We know that combats all types of inflammatory disease and would be good for your ears as well,” Dr. Jones added.

“For most people, the ear canals do a great job of cleaning themselves. You can consider it like a self-cleaning oven,” Dr. Jones said. “You really don’t need to do anything, even push a button. It just happens.”

“The skin in your ear canals, like the skin on the rest of your body, sheds. And given the ear anatomy, he ears have a coordinated dance, if you will, that allows the skin to come out of the ear canal on its own,” Dr. Hunter said. “That skin in your ear is like a bucket and if it doesn’t have a coordinated fashion of getting out, that bucket will fill up.”

“We know there’s a natural skin migration in the ear canal and that helps remove skin that had shed,” he said, noting it’s “a combination of dead skin and wax that constitutes what comes out of our ears.”

“So, for most patients the ears clean themselves as long as they get water in there. As long as they don’t baby the ears—they don’t protect the ears from a water perspective—they should help,” Dr. Hunter said, noting that some people have narrow ear canals or “the outer portion of the ear canal might not line up with the inner portion, and that could prevent the wax from coming out naturally.”

“In those situations, we do recommend patients come in to get it cleaned out. But generally, if you leave it be, your ears will be OK,” he said.

“There’s an interesting article in The Washington Post that was published in 2016 that talked about the history of Q-tips,” Dr. Hunter said, noting that since the  1970s “there’s actually been a warning label on the Q-tip package to not place them in your ears because of all the issues and injuries that physicians like myself have encountered over the years.”

“The problem is if you’ve ever looked at an 18th or 19th century cannon and watched them load that, they do it with what looks like a big Q-tip when you tamp the gunpowder down and put the ball or the projectile in the cannon,” Dr. Jones explained. “You think you’re getting a lot of wax out and you may get some up, but your inclination is to actually push the wax down beyond the outer third of the ear canal where the hair is.

“And if you get it beyond that hair, then there’s no real mechanism for the ear to get the cerumen out and you get plugged up with wax,” he added. “That tends to reinforce the idea that I need to clean my ears up because I’ve gotten more plugged up a couple times when in actuality, you’re causing it rather than treating it.”

With that, “you can clean the outside of the ear, but when you start going down in the ear canal, that’s when you run into potential difficulties,” Dr. Jones said.

“Generally, peroxide is pretty safe for the ear, even the middle ear,” Dr. Jones said. “For example, if you’ve not had previous ear surgery, you don’t have a perforation in your eardrum and it’s to get wax dislodged, it’s not completely out of bounds.”

“There are some over-the-counter ear products like Debrox that some people use to get rid of ear wax and that’s generally what peroxide will do,” he said. “Sometimes, though, people use it for things that wouldn’t make sense. For example, if your ears are itching and dry then peroxide is actually going to make that worse because it tends to dry the ear out as well.”

“Any upper respiratory infection that causes inflammation in the nose can cause swelling and lead to a fullness sensation in the ears. This can cause fluid deposition, which can potentiallycause an ear infection,” Dr. Hunter said. “But almost all viruses could potentially affect the ear. Whether that’s fluid buildup, or inflammation in the inner ear causing a hearing loss or a balance impairment, there’s no way of predicting who is and is not susceptible.”

For example, “you can get the flu and that can affect your ears,” he said, noting “we always ask about a precipitating illness when patients present with a hearing loss—whether they had a cold exposure recently—because we recognize a viral infection can lead to sudden hearing loss or hearing loss, as well as dizziness.”

“There’s a colloquial expression that as the nose goes, so goes the ears. So, if you are congested or you have some allergies, you have a little bit of thickened posterior nasal drainage that goes by the eustachian tube on its way to the lower parts of the throat,” Dr. Jones said. “It can cause a little bit of inflammation or swelling at the origin of the eustachian tube and give you a feeling of fullness or pressure.”

“If it gets bad enough, you could even get middle ear fluid from that type of drainage or a bad sinus infection. It depends on how significant your underlying eustachian tube dysfunction is. But it certainly can lead to that,” he said. “As far as the itching ears, in my experience that tends to be more related to dry ear canals where perhaps you may have a tendency toward atopic dermatitis or seborrheic dermatitis and you can get those changes in the ear canal just like you can anywhere on your skin—your elbows, your knees, et cetera.

“That’s usually treated more with topical medications like a liquid topical steroid or something like that to stop the itching,” Dr. Jones added.

“From an ear fullness perspective … the most common diagnosis is a eustachian tube dysfunction—the tube that essentially connects the ears to the nose is generally closed,” Dr. Hunter said. “That’s why when we fly, and the cabin is pressurized at a higher altitude than sea level, we have to pop our ears. What we’re doing is opening that tube to allow the cabin pressure to come into the middle ear so that the pressure between the middle ear and outside the eardrum is the same.

“If people have inflammation in the back of the nose from a recent cold or allergies, that can make it difficult for that tube to open and that can lead to that perception of fullness—a negative pressure in the ear,” he added. “That’s how middle ear infections develop because that pressure is negative, and it pulls in fluid from the surrounding tissue that bacteria can potentially  b overpopulate in that fluid creating an ear infection.”

“If you notice you’re turning the TV up and everyone else around you is wondering why you’re turning the TV up or you’re having to ask people repeatedly to go over what they just said, it can be an indication you’ve got some hearing loss,” Dr. Jones said, noting that “ringing in your ears could also be an indication.”

“For a lot of people, hearing loss is so subtle because it occurs outside the range of speech,” he said. “It may be a low frequency hearing loss or a high frequency hearing loss where your ability to discriminate speech and normal conversation is not affected significantly.

“Sometimes in those cases, a feeling of fullness or pressure or the ringing in the ears is your best sign that you may need to get your ears checked,” Dr. Jones added.

“Culturally we need to recognize hearing loss is a part of aging, but it is something that we can potentially control and manage. Maybe not perfectly, but better than what we thought in the past,” Dr. Hunter said. “I always applaud patients for coming in to have that discussion with us.”

“I recognize some solutions aren’t perfect, but many patients and families report great benefit from hearing aids,” he said. “We’ve demonstrated that with quality of life and decreased caregiver burden, just improving the hearing not only helps the patient, but it helps the family and the loved ones as well.”