As you may well know, earplugs fulfill the demand of occluding the ear from water, foreign bodies, and noise.  Although earplugs are imperative to protect the eardrums and ear canals from damage, there are certain dangers of wearing earplugs that are often overlooked.  

We all know of the benefits of wearing earplugs, for example a teenage concert junkie can protect their hearing with the help of earplugs. The decibel of sound entering their ear will be lowered with the assistance of the earplugs, preventing long-term hearing damage.  They are also useful at preventing water from going into the ear canal while swimming, preventing ear infections.

However, as a lifeguard at a community pool, I began to recognize a hidden danger of wearing earplugs. The other day a young camper, who was wearing a pair of earplugs, was playing water volleyball in the pool with her friends. She was talking to a friend, not paying attention to the game when the ball hit her right ear lodging her earplug deep into her ear canal. She came to me with overwhelming fear and pain regarding her ear, urging me to remove the stuck earplug. After seeing the damage to her ear, I knew I could not help her. We had to call for an ambulance, and she had to go to the ER immediately. Later, I found out that she suffered from eardrum perforation, which can cause permanent damage to the ear if not treated by a professional.

Scenarios similar to this young camper’s injury happen everyday, and many individuals have no idea what the correct action is to take when faced with similar dilemmas. For example, an individual may try to remove the lodged earplug from the ear canal, which can ironically lead to severe ear damage. Most individuals do not understand the anatomy of the human ear and the irreversible damages that can occur in not seeking medical attention.

In addition to ear perforation, earplugs can cause impacted earwax, which includes tinnitus (ringing in the ear), discharge, pain, and infection. It is also known to muffle your hearing causing a temporary conductive hearing loss. This can be caused by not properly cleaning your earplugs allowing bacteria to develop on the plug.

Preventive measures to take:

–       When wearing earplugs you should be cautious of your surroundings. The environment in which you surround yourself with while wearing earplugs will have an impact on the damages that can occur to your ears.

–       Do not leave earplugs in your ear for an extensive period of time, because it can cause a temporary hearing handicap by muffling sound. This is dangerous while driving, walking alongside a busy road, riding a bike, and etc. In addition to this, it may cause pain and irritation by trapping air in the ear canal.

–       Properly and fully insert earplugs.

–       Do not sleep with a pair of disposable earplugs in your ears because it may lead to minor infections.

A guide to picking out the right earplugs:  http://site.earplugstore.com/reusable_consumer_plugs.htm


Everyday I think about how important our senses are. Especially hearing. Imagine a world without sound. It would be so dead and dull. No jamming out to your favorite song. No whistling. I’d never hear the sound of my Mustang starting or my best friend’s contagious laughter. I can’t even begin to imagine living in a world and not being able to hear, but there are people out there who live with that reality everyday.

Some people are born deaf. Some people lose their hearing through injury and sometimes the ability to hear fades away with age.

But in today’s world through the help of modern medicine, many people are fortunate enough to be able to regain their hearing and some are even able to gain the ability, which they never possessed to begin with.

This reminds me of a video I saw once (video below) of a 29 year-old woman who had received an ear implant and finally heard herself for the first time. The sound of my own voice is something I never really think about. And this woman was brought to tears by it. I found the experience extremely moving and it revitalized my passion in someday helping people with their hearing disabilities as well.

I imagine people who experience traumatic hearing loss have the hardest times coping with their deafness. They know what they are missing out on. Like soldiers who lose their hearing after being too close to a bomb explosion. I imagine their experiences to be much like the time my sister accidentally kicked me in the ear while we were horsing around in the pool. My vision went blurry for a few moments and it felt like my ear canal was vibrating. I could not hear my sister apologizing or my mom telling me to get out of the pool. Their mouths were moving and all I could hear was a steady ringing. I panicked when I thought I might be like that forever. Luckily, after shaking the water out and letting a few minutes pass my hearing returned and my panic dissipated.

To continue research on traumatic hearing loss, please visit: http://www.dmrti.army.mil/documents/Acoustic%20Trauma%20and%20Hearing%20Loss%20Information%20Paper%2021%20Jul%2007.pdf

This also makes me think of Ms. Dotty. She’s 93 years-old and very hard of hearing. She has a hearing aid, which she’s only remembered to wear about fifty percent of the times I’ve visited with her. Even though her memory isn’t the sharpest (though I can’t say the same about all her witty remarks) I’m so grateful for our ability to communicate which would be almost impossible without the assistance of her hearing aid and my hearing. Being able to still tell Ms. Dotty how my job and my studies are doing and seeing her be proud of me after telling her about my classes reinforces my commitment to learning more about the ear with hopes of one day being able to benefit others who have lost their hearing due to old age.

I just hope that people realize how important of a sense hearing truly is and how complex and fragile the human ear can be.

Function of the Middle Ear:

The middle ear works as an energy transducer and must be present to address the impedance mismatch that exists between air and water. Essentially, the middle ear acts as a middle man in the hearing process. The action of the middle ear is to convert acoustical energy from the outer ear into mechanical energy, which stimulates the structures of the inner ear. If no middle ear was present only, 0.01% of the acoustic wave energy traveling through air would enter the fluid filled cochlea and 99.99% would be reflected. In addition, the middle ear provides protection from loud sounds and is a pressure equalizer.

Anatomy of the Middle Ear:

The malleus (hammer), incus (anvil), and stapes (stir up) are three tiny bones found in the middle ear, known as the ossicles. The area ratio, lever action, membrane buckling of these bones contribute to the impedance matching mechanisms, and serve to increase sound pressure level by about 33 dB from the tympanic membrane to the oval window.

  • Malleus: Shaped like a hammer and transmits the vibration from the eardrum and to the incus.
  • Incus: Shaped like a anvil and transmits sound vibration from the malleus to the stapes.
  • Stapes: Shaped like a stirrup and transmits sound vibration from the incus to the membrane of inner ear inside the oval window. The stapes is the smallest and lightest bone in the human body.

Middle ear muscles: stapedius and tensor tympani muscles. They are normally activated by loud sounds (>70 dB SPL) to protect the ear from damage.

The Eustachain Tube provides air and drainage for the middle ear. At rest, the tube is normally closed. If tube fails to open properly, it can lead to a build up of negative pressure in the middle ear functions as a pressure equalizer.

Disorder of the Middle Ear: Otitis Media (OM):

Otitis media is an inflammation of the middle ear, or a middle ear infection. It develops when viruses and bacteria get into the ear and multiply. Otitis Media occurs between the tympanic membrane and the inner ear, including the Eustachian tube.

Signs and Symptoms:

  • Intense pain, caused by the build up of pressure behind the ear drum
  • Drainage from the ear (May appear as blood, colorless fluid, pus, or as a dry crust on the outer portion of the ear after sleeping.)
  • Fever
  • Hearing loss
  • Disturbed sleep
  • Chills
  • Irritability
  • Some children show no symptoms

Risk Factors:

  • 75% of young children will get an ear infection before their third birthday
  •  Age: Children between 6 months and 6 years old are prone to ear infections because of their shorter and straighter Eustachian tubes
  • Upper respiratory infection
  • Exposure to groups of children
  • Exposure to smoke
  • Allergies and asthma


The goals of treatment are to eliminate the infection and prevent hearing loss and other complications.

  • Medication: Antibiotics to clear infection, if present. About 80% usually show improvement in 48-72 hours
  • Myringotomy (“Tubes”): A small incision is made in the tympanic membrane and tube is inserted to drain fluid. This step is taken if the child is non-responsive to medication.

Impact on Hearing:

All children with Otitis Media will have a slight degree of hearing loss. The equivalent to a child wearing ear plugs. A child experiencing hearing loss due to an infection will hear muffled sounds and speak loudly. In noisy environments, such as a classroom, the child may misinterpret speech leading to a delay in learning important  language skills. Conductive hearing loss due to an infection is temporary and once treated hearing will return to normal.


If otitis media is treated in a timely manor a child’s hearing will not be negatively impacted, and the infection and symptoms will go away quickly. Opting to not treat an infection can have adverse effects on a child’s learning development. The long lasting accumulation of fluid within the middle ear is a risk for both hearing and speech disorders and for the repeated development of infections.

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Those funny looking flaps on the side of your head are more than an accessory piece for holding earrings or holding your eye glasses in place. Those flaps are referred to as the outer ear, also known as the auricle or pinna, and are a vital role in the hearing process. The outer ear picks up sound and then funnels it down the ear canal. The next time a friend calls your name from across the room remember to thank your pinna for recognizing the sound.

The outer ear can suffer from a multitude of disorders. It is a site for trauma, impacted cerumen, and foreign bodies. It is commonly subjected to inflammation. Malformations of the outer ear are prevalent, which can lead to hearing problems. The good news is most of these disorders are manageable and treatable.

Anatomy of the Outer Ear:

  • Helix: fold surrounding the auricle.
  • Scapha: hollow at the end of the helix.
  • Concha: deep fossa of the external ear.
  • External Auditory Meatus: mouth of the canal of the temporal bone that carries sounds to the eardrum.
  • Tragus: prominence over and in front of the acoustic meatus.
  • Lobe: fleshy part at the base of the ear.
  • Navicular Fossa: boat-shaped fold of the ear.
  • Antihelix: curved ridge in front of the helix.

Impacted Cerumen:

Cerumen is a waxy substance found in the ear, that functions to lubricate, clean, and protect the ear. Impacted cerumen is an accumulation of wax in the ear canal that interferes with the flow of sound to the eardrum often causing itching and ear pain. Impacted cerumen occurs naturally in some patients. It is also the fate of many Q-tip-wielding patients who inadvertently pack cerumen farther back into the ear canal in an ironic attempt to clean their ears. To treat impacted cerumen one must remove the excessive cerumen with treatment by a doctor or audiologists.

Inflammatory Disorders:

1. Acute External Otits (swimmer’s ear):

  • Diffuse bacterial infection of the ear canal
  • The presence of germs that can infect the skin and an impairment in the skin of the ear canal that allow infection can lead to Acute External Otitis
  • Known as an ‘earache’
  • Occurs rapidly and worsens quickly
  • Symptoms: pain, itching, pressure, and hearing loss
  • Ear canal is red and swollen, and simply touching the outer ear causes pain
  • The combination of wax in the ear canal and swelling of the skin occlude the canal to block sound from entering the eardrum, causing a temporary conductive hearing loss
  • Causes: swimming in polluted water, water trapped in the ear canal after a shower
  • Treatment: antibiotic ear drops and avoidance of water; oral antibiotics given in severe of resistant cases
  • Prevention: the use of ear plugs when swimming, avoid polluted water, avoid inserting (cotton swabs) into the ear canal

Congenital Malformations:

1. Microtia:

  • Deformity present at birth where the pinna/auricle is small, abnormally-shaped or absent
  • Divided into four separate division:
  1. Anotia: no ear, most severe
  2. Grade 1 Micortia: the ear is smaller than normal and most of the features of a normal ear present
  3. Grade 2 Microtia: missing normal features of the ear
  4. Grade 3 Microtia: the ear has a vertical skin appendage with a malformed lobule of the lower end
  • Can be unilateral (90%) or bilateral; in unilateral cases the right ear is more commonly affected
  • More common in males
  • Generally occurs in isolation but associated with Treacher-Collins Syndrome
  • Occurs in every 1 out of 8,000- 10,000 births
  • A conductive hearing loss is associated with microtia, caused by an inefficient conduction of sound to the inner ear
  • Negative psychological effects
  • Normal intelligence
  • Treatment: Reconstructive surgery can be preformed to construct a normal outer ear, generally recommended after the age six. Conventional hearing aids and bone anchored hearing aids may be needed for improving one’s hearing.
  • Celebrities with Microtia: Paul Stanely of KISS,

In the same way, I may not hear music the way other people hear it, but I have nothing else to compare it to, or didn’t for most of my life. I haven’t felt at a loss for anything. I have no sense of the direction of sound, yet I have no trouble mixing a stereo album. I hear the expanse or width of sound but I can’t necessarily tell you where it’s coming from.

2. Atresia:

  • Closure of the external auditory canal
  • Unilateral about 70%
  • Males about 60%
  • Right Ear about 57%
  • Conductive hearing loss
  • Often accompanied by microtia and proportional middle ear malformations
  • Normal intelligence
  • Treatment: Must begin with early identification and discussion of the development and education issues specific to the child. If the hearing is affected, surgery can open the ear canals.  Cosmetic surgery can be performed to create a normal looking ear. Cosmetic surgery is usually done when a child’s face  is completely grown. The age varies from child to child and is done with consultation of a plastic surgeon. Placement of hearing aids is necessary for normal language development of the child.
  • For more information visit: http://emedicine.medscape.com/article/878218-overview

Hearing is one of the five senses; it has a powerful role in the communication process. Hearing enables people to experience the world around them through sound. Remember the last conversation you had, the emotions and information exchanged, now imagine how that conversation would be like without the power of hearing. For many individuals suffering from a hearing loss is a reality.

Prevalence Of Hearing Loss:

  • Affects all ages;
  • 3 in 10 people over age 60 have hearing loss;
  • 65% of people with hearing loss are younger than 65;
  • 3 in 3,000 infants are born with severe to profound hearing loss;
  • At least 1.4 million children (18 or younger) have hearing problems;
  • The presence of hearing loss has doubled in the past 30 years


How We Hear:

The ear is made up of the inner, middle, and outer ear; and central auditory pathway. The process of hearing begins with the outer ear. The pinna or auricle collects sound energy and directs it down the ear canal into the eardrum. The incoming sound vibrations cause the eardrum to vibrate, setting into motion the malleus, incus, and stapes making up the ossicular chain of the middle ear. The stapes bone of the middle ear vibrates up against the oval window of the fluid filled inner ear. Fluids within the spiral shaped cochlea of the inner ear are set into motion, stimulating the hair cells of the Organ of Corti. When the hair cells respond, they activate neurons of the auditory nerve. The signal is now in the form of a neural code that can be processed by the nervous system.

Outer Ear Anatomy

  • Pinna
  • External Auditory Meatus (eardrum)
  • Tympanic Membrane

Middle Ear Anatomy

  • Tympanic Membrane
  • Ossicular Chain: Malleus Bone, Incus Bone, and Stapes Bone (smallest bones in the body)
  • Muscles: Tensor Tympani Muscle, Stapedius Muscle
  • Eustachian Tube

Inner Ear Anatomy

  • Cochlea
  • Inner and Outer Hair Cells

Center Auditory Pathways

  • 8th cranial nerve



Types of Hearing Loss:

Hearing loss is categorized by which part of the auditory system is damaged.

  • Three Basic Types:
  1. Conductive Hearing Loss: problem in the outer or middle ear
  2. Sensorinueral Hearing Loss: problem located in the inner ear or central auditory pathway
  3. Mixed Hearing Loss: refers to a conductive and sensorinueral hearing loss occurring at the same time
  • Causes:
  1. Conductive Hearing Loss: wax in the ear canal, a perforation the in the eardrum, or fluid in the middle ear
  2. Sensorinueral Hearing Loss: aging, infection or other disease, noise exposure, or related to a genetic disorder
  3. Mixed Hearing Loss


Degree Of Hearing Loss:

The degree of hearing loss refers to the severity of the loss.

  • Normal: -10 to 15 dB HL
  • Slight: 16 to 25 dB HL
  • Mild: 26 to 40 dB HL
  • Moderate: 41 to 55 dB HL
  • Moderately Severe: 56 to 70 dB HL
  • Severe: 71 to 90 dB HL
  • Profound: 91+ dB HL


The Audiometer and Test Environment:

The audiometer is the principle tool used in the process of evaluating a patient’s auditory functioning. It is an electronic device that produces and delivers sounds to the patient. It produces a audible threshold graph called an Audiogram that is interpreted by an audiologist when diagnosing a hearing disorder. To meet the need for an appropriately quiet environment, audiological testing is performed in specially constructed, sound-isolated rooms.


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