The ear - key to maintaining balance

The Ear – Key to maintaining balance by Linda Pope

The ear is a fascinating and complex organ.  Not only is it responsible for allowing you to hear and detect sounds, but also plays a key role in maintaining one’s balance.  For anyone who participates in any sport that requires balance, a healthy knowledge of the ear is paramount.

This article has a lot of detail about the ear and how it functions, so it is a detailed read, but when you realise how important the ear is, it is certainly worth the effort in understanding its’ complexities and what you need to do to look after it.

Overview

Although the size of each person’s ears varies, both ears on an individual are usually of the same shape and size. The ear is made up of three components; a) the outer ear, b) the middle ear, and c) the inner ear.

The Outer Ears

• The outer ear comprises of the pinna (auricle) and the external auditory canal.
• The pinna is the skin-covered flappy cartilage of the ear, visible on both sides of the head (which is what most people relate to when the ear is mentioned).
• The pinna helps collect sound waves and directs them to the ear drum, through the ear canal (however one will still hear almost normally without the pinna).
• The external auditory canal (or meatus) is lined with thicker skin in the outer part which contains glands secreting ear wax (cerumen) and much thinner skin tightly bound to the bone in the deep canal.
• The wax in your ears usually makes its own way out when not being pushed back in by ‘cotton buds’.  Its’ purpose is to trap dust, and it also has a protective role.

The Middle Ear

• The middle ear refers to the hollow air-filled bony space (tympanic cavity) in the temporal bone of the skull behind the ear drum. It is separated from the outer ear by the ear drum.  There are three tiny bones (Ossicles) in the tympanic cavity that vibrate when exposed to sound; a) malleus (the hammer), b) incus (anvil), c) stapes (the stirrup). The stapes is the smallest bone in the human body.
• These bones form a chain in the middle ear and extend from the ear drum to the oval window of the inner ear.  Their main function is to amplify the sound.  There are two tiny muscles attached to these bones that help to dampen loud sounds to protect the inner ear.
• The middle ear also connects to the back of the nose through the Eustachian tube (which opens and closes when we yawn and swallow), helping in equalising middle ear pressures to the atmospheric pressure.

The Inner Ear

• The inner ear is the most complex component.
• It is located in a tiny space in the temporal bone and is inaccessible to direct examination.
• The inner ear comprises of intimately related structures; a) the cochlea, and, b) the vestibule (the organ of balance comprising of the semi-circular canals and the otolithic organ).

 Hearing and Balance – How it works

• For hearing, the sound waves (mechanical energy) are helped towards the ear drum by the pinna through the external auditory canal.
• The ear drum begins to vibrate as the sound waves strike.
• These vibrations then pass through the three ossicles of the middle ear (the hammer, anvil, and stirrup) where they amplify to reach the oval window.
• The vibrations (still mechanical energy) then pass through the inner fluids (perilymph and endolymph) to reach the outer and inner air cells in the cochlea, where it is finally transformed into electrical energy.  These cause nerve impulses to travel through the auditory nerve to the temporal lobe of the cortex via the auditory pathway.
• The other important function of the ear is to help maintain balance.
• Oriented at right angles to each other are three semi circular canals in the inner ear on each side which are responsible for detecting rotational movements whenever the head is turned or changes position.  The resulting movement of the fluids within these canals help the brain to identify or detect the extent of movement and position of the head.
• The otolitic organ comprising of the sacule and utricle are responsible for detecting linear acceleration, with the utricular signals eliciting eye movements and the saccular signals projecting to the muscles which control posture.  The vestibule, along with the eyes, also plays an important role in focusing on an object during head movement through the vestibular occular reflex (VOR).  The vestibule also works closely with the cerebellum (the lower part of the brain) in maintaining balance and posture.

I suffer with Meniere’s disease and BBPV, meaning that I have debilitating episodes of dizziness, nausea and very unsettled equilibrium (balance problems).  To help maintain my balance and hearing I have had operations, steroid injections when needed and medications along with vestibular rehabilitation, and a salt restricted diet.  After being diagnosed, I realised just how important the ear and its’ functions are to our everyday living.  In my case, these two conditions have been life changing.

To find out more on this interesting organ, I spoke to my ENT surgeon, Mr S Singam, who is based at Torbay Hospital.  He has been an ENT Surgeon for 20 years, training in India, the Republic of Ireland and the UK.  Singam’s special interests are bone anchored hearing aid surgery (BAHA), snoring, & obstructive sleep apnoea, Meniere’s disease, acupuncture and lots of GOLF (not too extreme).
 
Interview with Mr S Singam

L Pope: What is a healthy ear?

S Singram: One that looks normal and is free from infections with normal hearing and normal balance.
 

LP: How should we look after our ears?

SS: There are various things we can do:

• Avoid trying to clean the ears with cotton buds, match sticks etc, which in turn causes infection and injury.
• Avoid high levels of noise exposure as this can lead to noise induced hearing loss.
• Protect the ear from very cold water going in frequently (as is common in water sports) by using simple ear plugs.  In some patients, cold water causes bony bumps to form in the external auditory canal (exostosis).
• Avoid sudden extreme pressure changes as can sometime happen in diving (duringdescent or ascent.)

LP: How important are ears in extreme sports?

SS: In extreme sports, your sense of balance is of utmost importance.  It helps in righting oneself from various positions, to maintain stability and to progress to the next move.  For example, if you were sky diving with a dysfunctional balance, it would be nearly impossible to do it safely, as you would completely lose orientation during the dive.  Other senses like hearing, vision, and touch are also essential in extreme sports.

LP: What things can go wrong with the ears?

SS: Many things can go wrong, starting with infection (acute and chronic external ear and middle ear infections).  Direct trauma (ruptured tympanic membrane, skull base fractures), barotrauma (from sudden extreme pressure changes).  Hearing problems (from any of the above, and noise exposure).  Balance problems (benign paroxysmal positional vertigo, BPPV, Meniere’s disease, labyrinthitis, vestibular neuronitis) and very rarely tumours - to name but a few.

LP: What symptoms are common of ear problems?

SS: With infections, it’s itching and discharge. With hearing problems, one tends to start missing conversations, turning the television up loud, and experiencing ringing in the ears (tinnitus).  With regards to the organ of balance, one starts getting vertigo.  These are typically associated with a sense of rotation, nausea, vomiting, and sometimes associated hearing problems.  Pain in the ear is another symptom that should not be ignored.  The pain may be from the ear, or may be coming from elsewhere (referred pain).  Therefore, it’s important to get this checked.

LP: If someone does suffer with ear problems can they still participate in extreme sports?

SS: The simple answer to that is ‘yes’, they can, as long as the organ of balance is working well.  Generally one can still manage a lot of extreme sports with associated hearing problems or chronic infections although it tends to be a nuisance.  
 

LP: Any advice you would give concerning the ears and sport?

SS: Some of the following are things we have already touched upon.  Take water sports for example, using ear plugs on a regular basis would help prevent recurrent infections, exostosis, etc.  Avoid diving when suffering with a bad cold, as the ear becomes more sensitive to little changes in pressure because of malfunctioning Eustachian tubes.  Obviously going down or resurfacing too quickly causes nitrous oxide to be released in the inner ear - known as ‘the bends’.  If you are shooting for example, always use good ear defenders.

In general, if one notices problems pain, discharge, hearing problems, or a spell of vertigo, it would be advisable to consult your GP sooner rather than later as a lot of the problems are simple to treat in the early stages. 

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