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How the Ear Works

The ear consists of three main parts: the outer, middle and inner ear. The outer ear (the part you can see) opens into the ear canal. The eardrum separates the ear canal from the middle ear. Small bones in the middle ear help transfer sound to the inner ear. The inner ear contains the auditory (hearing) nerve, which leads to the brain.

Any source of sound sends vibrations or sound waves into the air. These funnel through the ear opening, down the ear, canal, and strike your eardrum, causing it to vibrate. The vibrations are passed to the small bones of the middle ear, which transmit them to the hearing nerve in the inner ear. Here, the vibrations become nerve impulses and go directly to the brain, which interprets the impulses as sound (music, voice, a car horn, etc.).

Ear and parts of the ear

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Ear Related Problems

The following is a short description of some common ear related problems.


    A cholesteatoma is a skin growth that occurs in an abnormal location, the middle ear behind the eardrum. It is usually due to repeated infection, which causes an ingrowth of the skin of the eardrum. Cholesteatomas often take the form of a cyst or pouch that sheds layers of old skin that builds up inside the ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth.

    Cholesteatoma is a serious but treatable ear condition which can only be diagnosed by medical examination. Persisting earache, ear drainage, ear pressure, hearing loss, dizziness, or facial muscle weakness signals the need for evaluation by an otolaryngologist-head and neck surgeon.

    To learn more about Cholesteatoma, click here.

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    Otitis Media (Ear Infection/Ear Ache)

    Otitis media is the inflammation of the middle ear and occurs most commonly during the winter and early spring months. Inflammation occurs when the middle ear is infected. It can occur in one or both ears. Otitis media is the most frequent diagnosis recorded for children and is the most common cause of hearing loss in children. Although otitis media is most common among young children, it can also affect adults.

    Some of the symptoms of otitis media for children, adolescents and adults include:

    • hearache
    • feeling of fullness or pressure
    • hearing problems
    • dizziness, loss of balance
    • nausea, vomiting
    • ear drainage
    • fever

    In infants and toddlers, look for the pulling or scratching of the ear accompanied by:

    • hearing problems
    • crying, irritability
    • fever
    • vomiting
    • ear drainage

    Remember, without proper treatment, damage from an ear infection can cause chronic or permanent hearing loss.

    To learn more about Otitis Media, click here.

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    Impacted Cerumen (Earwax Buildup)

    The ear canal is shaped somewhat like an hourglass-narrowing part way down. The skin of the outer part of the canal has special glands that produce earwax. (he earwax is formed in the outer part of the canal.)This wax is supposed to trap dust and dirt particles to keep them from reaching the eardrum. Usually the wax accumulates a bit, dries out and then comes tumbling out of the ear, carrying dirt and dust with it. Or it may slowly migrate to the outside where it can be wiped off. The ear canal may be blocked by wax when attempts to clean the ear push wax deeper into the ear canal and cause a blockage. Wax blockage is one of the most common causes of hearing loss.

    Earwax is healthy in normal amounts and serves to coat the skin of the ear canal where it acts as a temporary water repellent. The absence of earwax may result in dry, itchy ears.

    Most of the time the ear canals are self-cleaning; that is, there is a slow and orderly migration of ear canal skin from the eardrum to the ear opening. Old earwax is constantly being transported from the ear canal to the ear opening where it usually dries, flakes, and falls out.

    Under ideal circumstances, you should never have to clean your ear canals. However, if you want to clean your ears, you can wash the external ear with a cloth over a finger, but do not insert anything into the ear canal.

    When cerumen is removed from the ear, the physician uses sucion, a cerumen spoon, or delicate forceps to do so. If no infection is present, the ear canal can be irrigated.

    For more information, click here.

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    Perforated Eardrum

    A perforated eardrum is a hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear. The medical term for eardrum is tympanic membrane. The middle ear is connected to the nose by the eustachian tube, which equalizes pressure in the middle ear. A perforated eardrum is often accompanied by decreased hearing and occasional discharge. Pain is usually not persistent.

    The causes of perforated eardrum are usually from trauma or infection. A perforated eardrum can occur:

    • If the ear is struck squarely with an open hand
    • With a skull fracture
    • After a sudden explosion
    • If an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the ear canal.
    • As a result of hot slag (from welding) or acid entering the ear canal

    Middle ear infections may cause pain, hearing loss, and spontaneous rupture (tear) of the ear-drum resulting in a perforation. In this circumstance, there maybe infected or bloody drainage from the ear. In medical terms, this is called otitis media with perforation.

    On rare occasions a small hole may remain in the eardrum after a previously placed PE tube (pressure equalizing) either falls out or is removed by the physician.

    Most eardrum perforations heal spontaneously within weeks after rupture, although some may take up to several months. During the healing process the ear must be protected from water and trauma. Those eardrum perforations which do not heal on their own may require surgery.

    For more information, click here.

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    Swimmer's Ear

    Swimmer’s ear is an infection of the outer ear structures. It typically occurs in swimmers, but the since the cause of the infection is water trapped in the ear canal, bathing or showering may also cause this common infection. When water is trapped in the ear canal, bacteria that normally inhabit the skin and ear canal multiply, causing infection and irritation of the ear canal. If the infection progresses it may involve the outer ear.

    The most common symptoms of swimmer’s ear are mild to moderate pain that is aggravated by tugging on the auricle and an itchy ear. Other symptoms may include any of the following:

    • Sensation that the ear is blocked or full
    • Drainage
    • Fever
    • Decreased hearing
    • Intense pain that may radiate to the neck, face, or side of the head
    • ·
    • The outer ear may appear to be pushed forward or away from the skull
    • Swollen lymph nodes

    WARNING: If you already have an ear infection, or if you have ever had a perforated or otherwise injured eardrum, or ear surgery, you should consult an ear, nose, and throat specialist before you go swimming and before you use any type of ear drops. If you do not know if you have or ever had a perforated, punctured, ruptured, or otherwise injured eardrum, ask your ear doctor.

    For more information, click here.

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Hearing Tests

The following are four commonly used hearing tests. The complete text of the information presented under this section can be found here.


    The basic hearing test or audiogram tests one's ability to hear pure tones in each ear. Best results are obtained by a trained audiologist in a special soundproof testing booth. Simple tests, such as ones done in many schools, may be useful for screening, but a careful audiogram is necessary for accurate diagnosis of most hearing problems.

    The results of audiograms are most often displayed in graph form. This graph shows the amount of hearing loss expressed in units called decibels at different sound frequencies (also called Hertz). High frequencies correspond to high tones, and low frequencies are low tones. Most audiograms go from around 250 hertz to 8000 hertz. A loss up to 20 decibels on this graph is considered "normal". Hearing losses over 20 decibels are considered abnormal.

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    The tympanogram is a test that measures how easily the eardrum vibrates back and forth and and what pressure the vibration is the easiest. The middle ear is normally filled with air at a pressure equal to the surrounding atmosphere. If the middle ear is filled with fluid, the eardrum will not vibrate properly and the tympanogram will be flat. If the middle ear is filled with air but at a higher or lower pressure than the surrounding atmosphere, the tympanogram will be shifted in its position.

    The tympanogram is a quick and easy test. A special probe is placed up against the ear canal, like an ear plug, and the equipment automatically makes the measurements.

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    ABR (Short for Auditory Brain Stem Response)

    The ABR is a special hearing test that can be used to track the nerve signals arising in the inner ear as they travel through the hearing nerve (called the auditory nerve) to the region of the brain responsible for hearing. The test is useful because it can tell us where along that path the hearing loss has occurred. For example, the ABR is often used for individuals with a sensorineural (nerve) loss in just one ear. This loss can sometimes be caused by a benign (non-cancerous) tumor on the auditory nerve. If the ABR is normal along that region of the path, the chances of having this tumor are quite small.

    The ABR can also be used on small infants since it requires no conscious response from the person being tested. A small speaker is placed near the ear which produces clicking sound. Special electrodes automatically record the nerve signal; the patient can even be asleep during the test.

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    The ENG (short for electronystagmogram) is actually not a hearing test but rather a special test of the balance mechanism of the inner ear. The test involves running a cool liquid and then a warm liquid through the ear canal (it is usually done through a small tube so the ear itself remains dry). This change in temperature stimulates the inner ear which in turn causes rapid reflex movements of the eyes. This movements are recorded, and from these we can get information about how well this balance mechanism is functioning.

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