You should read this leaflet if you want to know about:

If you are at all worried about your hearing or balance, you should see your GP.

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How your ears work

Your ears are your organs of hearing and balance. They have three sections: the outer ear, the middle ear and the inner ear.

The outer ear

Sounds enter our outer ear (the pinna and external ear canal) and travel down the canal until they reach our eardrum. Once the sound reaches our eardrum, it vibrates, and is passed into the middle ear.

The middle ear

Our middle ear is an air-filled cavity that links the outer ear with the inner ear. It is also connected to the back of the throat by a small passage called the Eustachian tube.

Within the middle ear there are three tiny bones stretching from the eardrum to the cochlea (our hearing organ within the inner ear). It is these three bones that mechanically conduct the soundwave through the middle ear to the inner ear.

The inner ear

The inner ear has two parts:

The cochlea

The cochlea is a fluid-filled chamber that looks a bit like a snail shell. When the sound vibrations enter the cochlea, the fluid moves and hair-like nerve cells trigger an electrical pulse in the auditory nerve. Different hair cells pick up different frequencies of sound depending on where they are positioned in the cochlea. The auditory nerve then passes electrical impulses to your brain, which recognises them as sound.

The vestibular system

The vestibular system is also filled with fluid and has five small sections. Each of these sections detects head movement in a different direction. When you move your head, the fluid within these sections moves. In a similar way to the hair-like cells in the cochlea, they turn the mechanical movement into an electrical signal and send the information to your brain. This information is used with your vision and sensors in your joints to help you maintain your balance. 

Common ear problems

In the outer ear

Blockages in the external ear canal may affect your hearing. They are usually caused by wax. Your ear makes wax in order to clean itself. The wax normally comes out of the ear on its own. If it builds up too much, it can cause a blockage and you may need to visit your GP to have it removed.

Don't try to remove wax from your ears yourself. Never push cotton buds, fingers or anything else into your ears, as you could push any wax there is onto your eardrum. This could cause pain, infection and deafness. Ask your GP to check your ears if you think wax has built up.

Otitis externa

Otitis externa is when the skin of the ear canal becomes inflamed. This may happen if you have scratched your ear or if you have a skin condition such as eczema. Otitis externa may be painful and give you a watery discharge. There is usually little or no hearing loss. See your GP to get ear drops and don't get your ear wet or scratch it.

In the middle ear

Otitis media

Otitis media is an infection or inflammation of the middle ear usually caused by a viral or bacterial infection. This can stop the eustachian tube from opening as it should, preventing air from reaching the middle ear. When this happens, the middle ear can fill up with fluid that can become thick, like glue. This problem is called glue ear or otitis media with effusion.

The build-up of fluid in the middle ear reduces the movement of the eardrum and ossicles, and so causes a loss of hearing. The changes in pressure caused by the build-up of fluid can be painful.

Due to anatomical differences, children are more likely than adults to get glue ear. Most will get better without treatment and their hearing will return to normal. But get advice from your GP in any case. If your child has glue ear and it does not get better, an ENT (ear, nose and throat) surgeon may recommend an operation called a myringotomy where a tiny ventilation tube called a grommet is inserted temporarily into the eardrum. This allows air into the middle ear and prevents a build-up of fluid.

For more information, see our factsheet "Glue ear".

Otosclerosis

Otosclerosis affects more women than men. It can run in families and often begins around the age of 30. It is caused by a bony overgrowth of the stapes - one of the three tiny bones (ossicles) that stretch across the middle ear. The stapes becomes rigid and sound vibrations cannot pass freely through the ossicles. People with otosclerosis gradually become more deaf.

Hearing aids are very useful if you have otosclerosis. Most people can have an operation - a stapedectomy or stapedotomy. A tiny peg replaces the stapes so that sound can travel to the inner ear. This operation has a high success rate.

For more information, see our factsheet "Middle ear conditions".

Damaged ossicles

The ossicles are tiny bones in the middle ear. Serious infections and head injuries can damage them, and occasionally babies are born with malformed ossicles.

Ossicles can be repaired or replaced by having an operation called an ossiculoplasty.

Perforated eardrums

Perforated eardrums can be caused by untreated otitis media, other serious ear infections, head injuries, explosions, or poking things in your ear. They normally heal by themselves and any hearing loss is only temporary. More serious damage can be treated by an operation called a myringoplasty, where a tissue graft is used to seal up the hole.

In the inner ear

Sensorineural deafness

This is most often the result of damage to tiny hair cells in your cochlea. These hair cells can’t be replaced and hearing loss is permanent. This damage may happen:

Sensorineural deafness from birth may also be genetic. It is also common for members of the same family to have the same pattern of hearing loss as they get older.

For more information, see our factsheet "Genetics and deafness."

People with sensorineural deafness usually find hearing aids very helpful. A cochlear implant may be an option for people who have become profoundly deaf through sensorineural deafness and who cannot get much help from hearing aids, or for children who are born deaf.

For more information, see our factsheet "Cochlear implants."

Presbyacusis

Presbyacusis is the hearing loss that affects many people as they grow older. The tiny hair-like cells in the cochlea deteriorate over the years and are unable to vibrate as well as they should. This means quiet sounds cannot be heard as well as they could before. 

If you have presbyacusis, you probably find that people may appear to mumble and you often find it difficult to understand what they are saying, especially in noisy places. There are two reasons for this.

First, high frequency sounds (which are important for understanding speech) are more likely to be affected than low frequency sounds.

Second, your ear loses its ability to tell the difference between very similar sounds.

Hearing aids will usually be very helpful. Your GP can refer you for a full hearing assessment and advice.

For more information, see our leaflets "Is your hearing going?" and "Getting a hearing aid".

Balance problems

There are many medical conditions that may make you feel dizzy. Few of them are serious, but it is a good idea to get the specific cause of your dizziness diagnosed and treated. Balance problems and dizziness can be treated in several ways, such as taking a course of prescribed drugs, or using a set of balance retraining exercises.

Even when a balance problem is taking a long time to improve, there is almost always a course of treatment that will help.

For more information, see our factsheet "Dizziness and balance problems."

Some common balance problems are described below.

Migraine

Migraine is thought to be a very common cause of dizziness, particularly in children, but it is also quite common in adults. Often the dizziness is severe and is accompanied by vomiting.
It is important to understand that a migraine may make you feel dizzy whether or not you have a headache.

Benign paroxysmal positional vertigo

This is a specific balance disorder that can give you severe, short spells of dizziness, especially if you tip your head backwards – for example, if you look up at the sky, or when you first lie down in bed.

It is thought that this condition is caused when small crystals become dislodged and float around in the fluid in the vestibular system. Your specialist can alleviate some if not all of the symptoms by using a particle repositioning procedure known as the Epley or Semont manoeuvre. The movements reposition the crystals into another part of the vestibular system where they do not cause the same symptoms.

Ménière’s disease

Ménière’s disease is thought to be caused by change in the pressure of the fluid in the inner ear, which leads to sudden attacks of severe dizziness. The attacks last between 30 minutes and several hours and are usually accompanied by nausea and vomiting, as well as hearing loss and tinnitus.

Ménière's develops differently over time and between people. There are many different treatments for Ménière's disease and most people can find one that works for them.

See our factsheet "Ménière’s disease" for more information.

Viral infections

Your balance can also be affected by a simple viral infection in  your inner ear or in the nerve that takes information from your ear to your brain. Although your immune system removes the virus in a short period of time, your balance organs may have been damaged while you had the infection. You may feel dizzy until your brain can compensate for the damage. This sort of balance problem is usually helped by vestibular rehabilitation physiotherapy, which includes head and balance exercises.

Tinnitus

Tinnitus is the word for noises that some people hear in the ears or in the head - buzzing, ringing, whistling, hissing and other sounds. There are many different causes of tinnitus. It can be linked to exposure to loud noise, hearing loss, injuries to the ear or head, some diseases of the ear or emotional stress. It can also be a side effect of medication, or a combination of all these causes. Many people with tinnitus have never had any of these and don't have a hearing loss.

Although there is no cure for tinnitus yet, there are many things you can do to help you manage and live with it. We sell a range of equipment and CDs featuring music and relaxation techniques that can help.

For more information, see our leaflet "Tune out tinnitus".

Or for confidential advice, contact our Tinnitus Helpline
Telephone 0808 808 6666 (freephone)
Textphone 0808 808 0007 (freephone)
Fax 020 7296 8199
tinnitushelpline@rnid.org.uk

How to look after your ears

Never poke anything in your ears

If you think that you have an infection or blockage in one of your ears, see your GP. Unless your GP or ear specialist has prescribed eardrops, or you are using earplugs or a hearing aid, you should never put anything in your ear canal. This includes:

Only use a flannel to clean the surface of your pinna (the outside part of your ear). If you poke cotton buds into your ear canal, you may push wax down onto your eardrum where it can cause damage. In extreme cases, this may cause acute pain and deafness. By using cotton wool buds you may actually increase the amount of wax your ears produce. Cotton wool buds also leave tiny filaments in the ear canal and these can irritate the skin of your ear. The best thing is to leave the wax alone - it helps to keep your ears clean and healthy.

Be aware of the damaging effects of noise

Loud noises can damage your hearing. Unfortunately, the damage usually happens without you realising it. You may not notice any changes to your hearing until years later.

The louder the noise is and the longer you are exposed to it, the greater the risk of damage to your hearing. If you have to be in a very noisy situation, always protect your ears with ear protectors - earplugs or earmuffs - and get away from the noise as quickly or as often as you can.

Wherever you are, loud sounds can damage your hearing, especially if you listen to them for hours at a time. Try to avoid them at home, at work or when you go out. Loud noise is a feature of everyday life, so you will not be able to cut it out completely, but you can do some things to reduce the risk of noise damage:

For more information, see our factsheet "Noise exposure."

Read about our Don’t lose the music campaign (external link, opens new browser window).