Ear Disorders: Overview

Ear disorders are disorders that affect the outer, middle, or inner ear. Ear disorders can be caused by infections, congenital damage, or injuries. They can cause pain or hearing loss.

Malcolm's Story

Malcolm is a 79-year-old retired Air Force pilot. When he goes to his healthcare provider for his annual physical examination, Malcolm is asked about his hearing. He says he has a constant buzzing in his ears, and that when people are talking to him, they keep mumbling and need to speak more clearly. His wife complains that Malcolm turns up the volume on the television and radio too high. At the same time, Malcolm says he won't go to the movies because the sound system is too loud. Malcolm's doctor refers him to a specialist in hearing disorders called an otolaryngologist * . The doctor diagnoses presbycusis (PREZ-bee-KEW-sis) and tinnitus (tin-NIGH-tus).

What Are Ear Disorders?

The ear is the major organ responsible for hearing and balance in humans. There are three main parts to the ear: outer, middle, and inner. Disorders such as infection can result in problems with hearing and balance.

Hearing is one of the five senses (hearing, sight, smell, taste, and touch) that are important in understanding and interacting with the environment. Several disorders of hearing can create barriers between a person and his or her environment. These disorders include deafness and tinnitus. Presbycusis is a common hearing disorder in older adults that results in hearing loss.

Anatomy of the ear.

Anatomy of the ear.
Illustration by Frank Forney. © 2016 Cengage Learning®.

The ear is also responsible for a person's sense of balance. Problems in the inner ear can affect balance and may result in falls or injury.

A common ear-related disorder, especially in swimmers and children, is ear infection. An infection is an inflammation—in this case, inflammation of the ear. There are two types of ear infection: otitis externa * (o-TItis ex-TER-na), an infection of the outer ear, and otitis media * (o-TI-tis ME-di-yuh), an infection of the middle ear.

How Common Are Ear Disorders?

According to the American Hearing Research Foundation, approximately 10 percent of people living in the United States have some degree of hearing loss, or deafness. Hearing loss is primarily a problem of older adults. More than one-third of people 65 years and older, and more than one-half of people older than 75 years have hearing loss.


Earbuds, more formally known as headphones, are used by almost all young people in the 2010s to listen to their favorite music while reading, using computers, walking or jogging outside, or doing household chores. Earbuds are designed to cover only the ear canal. There are two basic types of earbuds as of 2016: those that rest against the ear canal but are not designed to fit inside it, and those that fit directly within the ear canal itself. The second type is often called an in-ear monitor or IEM.

Both types of earbuds are associated with problems that concern safety experts as well as doctors. The type of earbud that rests against the outside of the ear canal has been linked to an increased rate of hearing loss among teens. According to the American Osteopathic Association, the rate of hearing loss among teenagers in 2016 is 30 percent higher than it was in the 1990s. The reason for the increase is that earbuds that only cover the ear canal are not very effective in shutting out other sounds, which typically leads the user to turn up the volume of the music he or she is listening to. The high volume leads eventually to hearing loss. Hearing experts recommend that people using this type of earbud should never turn the sound on their device higher than 60 percent of maximum volume, and should use the devices for no more than an hour a day.

While IEMs do a better job of shutting out environmental noise, they carry the additional danger of lowering the user's awareness of his or her surroundings when outdoors. A 2011 television program noted that safety experts and law enforcement are increasingly concerned about joggers or cyclists distracted by their music who collide with pedestrians or fail to see approaching motor vehicles until it is too late. Titled “Deaf to Danger?,” the program also noted that “tuning out” the outside environment through music while exercising outdoors makes users more vulnerable to criminals as well as colliding with people or other objects along their street or bike path.

Tinnitus is a common disorder, especially in older adults. According to the American Speech-Language-Hearing Association, almost everyone at one time or another has experienced brief periods of mild ringing or other sounds in the ear. Women going through menopause and women who are postmenopausal may experience tinnitus. People in occupations in which they are exposed frequently to loud noises—including construction workers, pilots, and airline personnel—and people who play in or attend music concerts with loud or highly amplified sound are at risk of tinnitus.

Ménière's disease is not common. According to the American Hearing Research Foundation, Ménière's disease affects approximately 0.2 percent of the population. Ménière's disease affects men and women equally, with typical age at onset between 20 and 50 years.

Perforated Eardrum

The eardrum, also called the tympanic (tim-PAN-ik) membrane, is a thin cone-shaped structure that separates the outer ear in humans from the middle ear. Its function is to convey sound waves from the outer ear to the structures in the middle ear.

The eardrum can be ruptured or perforated by direct trauma to the ear (often resulting from the use of hairpins or cotton swabs to remove earwax); by blast injuries; by a blow to the head; or during such sports as scuba diving, martial arts, and swimming. The eardrum can also be perforated when an infection builds up in the middle ear (otitis media). In some cases, the eardrum ruptures as the result of air travel with a severe cold; the changes in air pressure as the plane is taking off or landing lead to the perforation of the traveler's eardrum.

Symptoms of a perforated eardrum may include temporary mild hearing loss, tinnitus, earache, or a discharge of mucus from the ear.

Perforated eardrums are fairly common in the general population, although exact figures are not kept because the condition heals by itself in many cases. If the patient develops an ear infection or other complications of the perforated eardrum (ongoing hearing loss or discharge from the ear), an otolaryngologist can treat the ear with antibiotic drops; a patch applied directly to the eardrum; or a surgical procedure in which a graft of the patient's own skin is used to close the hole in the eardrum.

Ear infections, specifically otitis media, are common in infants and young children because the tubes inside the ear (called Eustachian tubes) become blocked with fluid and mucus. According to the American Academy of Otolaryngology, nearly 100 percent of children in the United States have at least one episode of ear infection by the age of five years. Swimmers are also at increased risk of ear infections.

What Are the Causes of Ear Disorders?

Deafness and hearing loss

The most common causes of hearing loss are an accumulation of earwax (cerumen) in the outer ear canal, long-term exposure to loud noise, ear infections, and aging. Hearing loss can be present at birth (congenital), and it also may be related to genetic factors—that is, it runs in the family. Or it may be caused by a disease, such as German measles (rubella), acquired by the mother during pregnancy.

Acquired hearing loss can be caused by damage to the ear related to an ear infection or to long-term exposure to loud noise. Acquired hearing loss may be genetic or familial, but it may not appear until later in life. Acquired hearing loss may be associated with the use of earbuds on such personal devices as iPods and smartphones when a person listens to music with the volume turned up too high.

Temporary hearing loss may be related to something that creates a barrier to the transmission of sound to the inner ear, such as an accumulation of earwax in the outer ear canal. Tumors in the brain affecting the auditory nerve may cause hearing loss. Medications with the side effect of ear damage can also be a cause of hearing loss.


It is difficult to determine whether the cause of agerelated hearing loss is a unique problem or is associated with such other causes of hearing loss as long-term exposure to loud noises. It may be associated with health conditions common in the elderly, including high blood pressure and diabetes. It may also be a side effect of medications, such as some chemotherapy drugs. Less commonly, presbycusis may be associated with functional changes in the eardrum (tympanic membrane) or the three tiny bones in the middle ear (the stapes, incus, and malleus) that carry sound waves to the cochlea (KOKE-lee-uh) in the inner ear.


The exact cause of tinnitus is not known; however, several factors are associated with tinnitus, including exposure to loud noises, infections of the ears or sinuses, Ménière's disease, thyroid problems, hormonal changes in women, problems in the cardiovascular system * , and brain tumors. Tinnitus can also be a side effect of some medications.

Ménière's disease

The exact cause of Ménière's disease is unknown; however, it is believed to be related to excessive fluid in the inner ear.

Ear infections * and bronchi * ). In older children and adults who are swimmers, ear infections occur because the ears are not cleaned or dried properly after leaving the water. Bacteria or fungi in the water can then cause infections, particularly if there is a break in the skin of the outer ear.

Earwax is removed by flushing the ear canal with warm fluid.

Earwax is removed by flushing the ear canal with warm fluid.
Illustration by Argosy, Inc. © 2016 Cengage Learning®.

How Do People Know They Have an Ear Disorder?

Deafness and hearing loss

Signs of hearing loss include difficulty hearing people speak; difficulty hearing in noisy or crowded environments; difficulty hearing people with high-pitched voices; ringing in the ears; the perception that some sounds are too loud; and difficulty distinguishing certain sounds. Sometimes people who have hearing loss are believed to be confused or have dementia because they may misunderstand directions, shout at people, or behave in other ways that seem abnormal but are really the consequences of hearing loss.


Decreased hearing in both ears, particularly higher-frequency sounds. Some people with presbycusis also experience vertigo (VUR-tih-go), or dizziness. Signs of presbycusis are similar to the signs of hearing loss.


Ringing, buzzing, hissing, and roaring sounds are the primary signs of tinnitus.

Ménière's disease Ear infections

Signs of ear infections include fluid draining from the ears, fever, problems with hearing, difficulty with balance, and difficulty sleeping. Children, and especially infants, may cry more than usual and tug at their ears.

How Do Doctors Diagnose and Treat Ear Disorders?


The doctor obtains a health history from the patient or, in the case of infants and children, from the parent. Examination of the ear is done with an instrument called an otoscope * . If hearing loss is suspected, the doctor may recommend auditory testing to determine the extent of the hearing loss and whether it affects one or both ears. If the patient is having difficulty with balance, balance testing is conducted. Other tests may be performed depending on what is thought to be the cause of the problem. For example, if the cause is thought to be a tumor, a brain scan may be done. A primary care doctor may refer the patient to an otolaryngologist, who is a doctor with specialized knowledge and experience in caring for people with hearing and ear disorders.


Treatment of hearing loss depends on the cause of the problem. If the cause is something that can be corrected, such as an accumulation of earwax in the ear canal, the corrective treatment is provided. If the cause cannot be corrected, then the doctor prescribes or recommends various interventions to improve the patient's hearing. These interventions may include the use of such devices as electronic hearing aids, cochlear implants * , assistive listening devices, and instruction in lip reading.


Treatment of presbycusis includes many of the treatments used for deafness, including interventions or the use of devices to assist or improve hearing. These include electronic hearing aids, cochlear implants, assistive listening devices, and instruction in lip reading.


Treatment for tinnitus depends on the cause. It may include cleaning the ears of earwax and hair; treatment of fluid trapped in the middle ear; the use of hearing aids or sound-masking devices; avoidance of medicines that have tinnitus as a side effect; and learning how to cope with the problem (for example, avoiding situations involving loud or repetitive background noise).


Ear infections in older children and adults frequently clear up without treatment; infants and children under the age of 5 with suspected ear infections, however, should be seen by a healthcare professional. Over-the-counter pain medications—specifically acetaminophen (uh-SEH-teh-MIH-noh-fen)—may be recommended for pain. (Note: Aspirin should never be given to infants and children.) If the infection is severe, the doctor may prescribe antibiotics. Surgery may be recommended for children who get frequent ear infections. The surgeon places tubes in the ear to relieve pressure.

Can Ear Disorders Be Prevented?

Deafness and hearing loss

People can lower their risk of deafness or reduce the extent of hearing loss by avoiding exposure to loud noise and by wearing ear protectors when working in occupations or participating in activities that involve repeated exposure to loud sounds. There are no preventive measures for congenital or age-related hearing loss.


Presbycusis is an age-related disorder that cannot be prevented according to the National Institute on Deafness and Other Communication Disorders in 2016. There is also some evidence that genetic factors increase some people's susceptibility to presbycusis.


People can lower their risk of tinnitus by avoiding exposure to loud noises. Those who work in occupations that expose them to high noise levels should wear ear protectors or sound-masking earphones. Avoiding medications that have tinnitus as a side effect can prevent or minimize tinnitus. Other preventive measures include getting adequate sleep and rest, maintaining cardiovascular health by getting adequate exercise, and monitoring blood pressure to prevent or decrease tinnitus. Tinnitus as a by-product of aging is not preventable.

Ménière's disease

Ménière's disease as such cannot be prevented because its cause was still unknown as of 2016.

Ear infections

Vaccination * against pneumococcal (NOO-moh-KOK-al) bacteria * can be helpful in preventing ear infections and their complications, because these bacteria are a common cause of ear infections. To prevent swimmer's ear * , people should dry their ears completely with a clean cloth after getting out of the water from swimming or bathing. Special over-the-counter eardrops are available at pharmacies for swimmers to put in the ear after swimming to help to dry the ear.

See also Aging • Bacterial Infections • Deafness and Hearing Loss • Disability • Ear Infections (Otitis) • Fungal Infections • Sinusitis • Sore Throat/Strep Throat • Tinnitus • Vertigo


Books and Articles

Faulkner, Nicholas, and Josepha, Sherman. The Ear in 3D. New York: Rosen Publishing, 2016.

Tamparo, Carol D. Diseases of the Human Body. 6th ed. Philadelphia, PA: F.A. Davis, 2016.


American Academy of Otolaryngology–Head and Neck Surgery. “EarInfection and Vaccines.” http://www.entnet.org/?q=node/1307 (accessed April 22, 2016).

American Academy of Otolaryngology–Head and Neck Surgery. “Ménière's Disease.” http://www.entnet.org/content/menieres-disease (accessed April 22, 2016).

American Academy of Otolaryngology–Head and Neck Surgery. “Tinnitus.” http://www.entnet.org/?q=node/1324 (accessed April 22, 2016).

American Speech-Language-Hearing Association. “Tinnitus.” http://www.asha.org/public/hearing/Tinnitus/ (accessed April 22, 2016).

MedicineNet.com . “Hearing Loss (Deafness).” http://www.medicinenet.com/deafness/article.htm#what_are_forms_of_hearing_loss (accessed April 22, 2016).

MedlinePlus. “Age-Related Hearing Loss.” U.S. National Library of Medicine, National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/001045.htm (accessed April 22, 2016).

MedlinePlus. “Ear Infections.” U.S. National Library of Medicine, National Institutes of Health. http://www.nlm.nih.gov/medlineplus/earinfections.html (accessed April 22, 2016).

MedlinePlus. “Ménière's Disease.” U.S. National Library of Medicine, National Institutes of Health. http://www.nlm.nih.gov/medlineplus/menieresdisease.html (accessed April 22, 2016).

MedlinePlus. “Tinnitus.” U.S. National Library of Medicine, National Institutes of Health. http://www.nlm.nih.gov/medlineplus/tinnitus.html (accessed April 22, 2016).

Merck Manual, Consumer Version. “Hearing Loss.” http://www.merckmanuals.com/home/ear-nose-and-throat-disorders/hearing-loss-and-deafness/hearing-loss (April 22, 2016).

National Institute on Deafness and Other Communication Disorders. “Ear Infections in Children.” (accessed April 22, 2016).


American Academy of Otolaryngology–Head and Neck Surgery. 1650 Diagonal Road, Alexandria, NA 22314-2857. Telephone: 703-836-4444. Website: www.entnet.org (accessed April 22, 2016).

American Hearing Research Foundation. 275 N York St., Suite 401, Elmhurst, IL 60126. Telephone 630-617-5079. Website: www.american-hearing.org (accessed April 28, 2016).

American Speech-Language-Hearing Association. 2200 Research Boulevard, Rockville, MD 20850-3289. Telephone: 301-296-5700. Website: www.asha.org (accessed April 22, 2016).

American Tinnitus Association. 522 SW 5th Ave., Portland, OR 97204. Toll-free: 800-634-8978. Website: www.ata.org (accessed April 22, 2016).

National Institute on Deafness and Other Communication Disorders. 31 Center Dr., MSC 2320, Bethesda, MD 20892-2320. Toll-free: 800-241-1044. Website: www.nidcd.nih.gov (accessed April 22, 2016).

* otolaryngologist (OH-to-LAH-rinGOL-o-jist) is a doctor who has specialized knowledge of and experience in treating people with diseases of the ears.

* otitis externa is an infection in the outer ear.

* otitis media is an infection in the middle ear.

* cardiovascular system (KARdee-o-VAS-kulur SIS-tum) is the heart and blood vessels.

* larynx (LAIR-inks) is the voice box (which contains the vocal cords) and is located between the base of the tongue and the top of the windpipe.

* bronchi (BRONG-kye) are the larger tubelike vessels that carry air in and out of the lungs. The singular form is bronchus (BRONG-kus).

* otoscope is an instrument used to examine the inside of the ear visually.

* cochlear (KOKE-lee-er) implants are surgically implanted electronic devices that provide a sense of sound to a person who is profoundly deaf or severely hard of hearing; the implants may help provide hearing in patients who are deaf because of damage to sensory hair cells in the cochlea.

* vaccination (VAK-sih-NAY-shun) given usually by an injection, is a preparation of killed or weakened germs, or a part of a germ or product it produces, to prevent or lessen the severity of the disease caused by that germ. Also called immunization.

* pneumococcal bacteria is a class of bacteria that can cause infection resulting in pneumonia, infection of the blood (bacteremia/sepsis), middle-ear infection (otitis media), or bacterial meningitis.

* swimmer's ear is an ear infection commonly seen in swimmers and people who do not dry their ears adequately after being in water.

Disclaimer:   This information is not a tool for self-diagnosis or a substitute for professional care.

(MLA 8th Edition)