1. Hearing loss

This can be due to a problem anywhere along the pathway that sound takes when going from the outside world right into the brain. So, for example:

  • Outer ear
    • Wax
    • Foreign body
    • Otitis externa (infection)
  • Middle Ear
    • Glue ear
    • Otitis media (infection)
    • Cholesteatoma (rare, benign lesion)
  • Inner ear
    • Sensorineural hearing loss due to age (presbyacusis)
    • Traumatic injury
    • Noise induced damage
    • Inner ear infection
  • Brain
    • Benign cyst or tumour of nerve (extremely rare)
    • Stroke or TIA (rare, usually with other symptoms)

The hearing loss may occur gradually (eg. age related, glue ear in children or cholesteatoma), over a short to intermediate time frame (eg. otitis externa or media) or suddenly, such as when due to an inner ear infection. Treatment is directed at the cause.

2. Ear discharge

This can be caused by an outer ear infection (otitis externa), or a problem with the middle ear, such as infection (otitis media) in association with a perforated ear drum). Cholesteatoma is a much more rare cause of ear discharge, is usually also associated with a gradual hearing loss and unlike the infective conditions above is not usually painful.

3. Tinnitus

This refers to a buzzing noise which usually only the patient can hear (although there are certain rarer causes of tinnitus such as caused by a fluttering middle ear muscle or contraction of a muscle of the soft palate which can occasionally also be heard by others). This usually occurs in both ears and is most commonly associated with a gradually progressive hearing loss due to advancing age (presbyacusis). If tinnitus is truly only one-sided then referral to an ENT surgeon is usually sensible to exclude other causes, such as impacted wax in the ears, middle ear fluid, or inner ear/central causes such as a lesion pressing on the hearing nerve.

4. Dizziness

This has a large number of possible causes. Dizziness (a feeling of imbalance, unsteadiness or ‘whooziness’) must be distinguished from vertigo, which refers to an intense rotatory sensation in which the room or the patient spins round and round. It is more common for inner ear disorders to cause vertigo rather than dizziness. If dizziness is the main symptom, then other causes need to be considered.

Causes of vertigo:

  • Meniere’s disease
  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Labyrinthitis (usually viral)

Causes of dizziness:

  • Cardiovascular causes eg. anaemia, abnormal heart rhythms
  • Diabetic neuropathy (reduced sensation in feet)
  • Visual problems
  • Widespread arthritis causing unsteadiness
  • Musculoskeletal cervical neck problems

5. Ear pain (otalgia)

Any ear infection can cause ear pain, as can an injury to the ear. It is common however for pain felt in the ear to originate from a problem outside of the ear. This is known as referred pain.

Causes of referred otalgia:

  • Dental problems
  • Pain in the jaw joint (temporomandibular dysfunction)
  • Musculoskeletal neck stiffness / arthritis / spondylosis
  • Severe sore throat

If someone is suffering with ear pain and a comprehensive examination by an ENT surgeon has shown that there is no abnormality of the ear, then other ‘referred’ causes need to be considered.