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Ear Conditions

Ear problems range from condtions of the outer, middle and inner ear. They can affect your hearing and sometimes your balance as well. These ear conditions can even negatively impact your quality of life and the way you interact with people and the world around you.

Dr Pieter Naudé specialises in the treament of a variety of ear conditions, including hearing loss, perforated eardrums, vertigo, ear infections, glue ear and cholesteatoma

Hearing Loss

Hearing loss is a condition that is more common than many people realize. The World Health Organization (WHO) estimates that there are 360 million people in the world with disabling hearing loss. This is 5.3% of the world’s population!

Hearing loss can be devided into conductive hearing loss and sensori-neural hearing loss. Anything that causes a blockage or a reduction of sound getting through to your inner ear is a conductive loss. If the cochlea in the inner ear or the ear nerve is damaged, it is called a sensori-neural hearing loss.

Causes of a conductive hearing loss:

  • Wax impaction
  • Outer ear infections / Otitis Externa
  • Perforated eardrum
  • Middle ear infections
  • "Glue ear" / fluid in the middle ear
  • Hearing bones (ossicles) problems

Outer ear infections / Otits Externa

Infections of the skin of the ear canal are usually caused by exposure to water. This is why it is often called "swimmer's ear". It can also be caused by scratching deep inside your ear canal and damging the thin skin of the canal.

This condition is very painful. The skin of the canal swells up, causing a conductive hearing loss and a blocked feeling. There will also be a watery, pus-like discharge from the ear.

Otitis externa is treated by an ENT, who will carefully clean the ear and prescribe antibiotic eardrops.

Some skin conditions like eczema can also affect the skin of the ear canal and predispose you to outer ear infections. Eczema of the ear canal usually causes a dry, itchy skin, just like eczema in other areas of the body.

Perforated Eardrums

A perforated eardrum is quite a common ear condition and it refers to a tear or a hole in the eardrum. The eardrum is a thin membrane that separates the middle ear from the outer ear canal. This membrane needs to move as sound enters the ear, just like the membrane of a speaker moves when sound is played though it. The movement of the membrane moves the hearing bones which takes the sound to the cochlea in your inner ear.

There are many causes of perforated eardrums, including infection and injury. If there is an infection, this will be treated first. Once the infection has resolved your physician may order a hearing test to measure the amount of conductive hearing loss caused by the perforation.

Your physician may monitor your condition to see if the perforation closes by itself over time, or they may choose to perform a tympanoplasty. This involves placing a "patch" on the perforation to allow for healing.

Middle Ear Infections

Middle ear infections are also known as otitis media. This is a very common condition, and children are more likely to develop middle ear infections than adults. It is estimated that 5 out of 6 children will have had an ear infection by the time they are 3 years old. They are caused by viral or bacterial infections that affect the middle ear, the area behind the eardrum. Middle ear infections can be quite painful due to inflammation and the build-up of pus or fluid in the middle ear. This fluid or pus will also be a conductive hearing loss.

Since these ear problems often clear up on their own, treatment may vary. An ear infection can resolve spontaneously without antibiotics. Most of the time it is only pain and fever medicine that is needed. However, in severe cases, antibiotics are often prescribed as well. There are certain long term problems that can occur due to ear infections, like persistent fluid in the ear (glue ear) with hearing problems. That is why it is important to make an appointment with an ENT specialist like Dr Naudé who can assess the condition and advise you on the appropriate course of action to take.

Hearing Bones Problems

The hearing bones are 3 littles bones forming a chain that stretches from your eardrum to your cochlea. The chain runs in your middle ear. Theses bones are the smallest in your body, and are called the malleus (hammer or mallet), the incus (anvil) and the stapes (stirrup). Some diseases like otosclerosis can cause these hearing bones to get stuck, or trauma can cause the chain to dislocate. This will then cause a conductive hearing loss. Luckily this can be fixed with a very delicate ear operation.


Cholesteatoma is a condition where the skin of the eardrum grows inwards, into the middle ear and beyond instead of gradually growing outwards like it normally should. This skin in the middle ear then causes a long term infection that can have some serious complications. People with this condition will complain of a constant ear discharge, hearing loss and sometimes even dizziness.

Cholesteatomas can be left alone if they are very mild, but most of the time the disease progresses and needs an operation. The aim of the operation will be to remove the skin, recontruct the eardrum and restore the hearing as much as possible.

Wax Impaction

Wax impaction has many causes, but it generally refers to the build-up of ear wax in the ear canal. This can produce different symptoms, including a feeling of "fullness" in the ear, ear pain, an itchy feeling, hearing loss, funny noises in the ear, dizziness or a discharge from the ear.

Wax impaction can be seen in people of all ages and it can be treated by cleaning the ears, rinsing the ear canal with saline or water, and removing wax manually using specific instruments. Your physician can accurately assess these ear problems and make a recommendation as to what your treatment should be.

"Glue ear" / Otitis Media with Effusion (OME)

When a middle ear infection clears up, some fluid stays behind. This fluid can be very sticky, like glue, and will reduce the movement of the eardrum and hearing bones and therfore cause a conductive hearing loss. There is usually some discomfort as well, as one gets when your ears are blocked. Babies and children often don’t know how to convey these symptoms, and the parents will often report that the child does not respond well, or constantly pulls on the ear.

Sometimes there is no ear infection before a glue ear, but a bad cold or sinus infection damages the Eustachian tube. This tube runs from the back of your nose to your ear and is responsible for ventilating your middle ear and constantly equalising the air pressure. If the tube is damaged, fluid can build up in the middle ear and cause the same symptoms as mentioned above.

If the fluid in the ear is persistent and causes hearing loss, a grommet or ventilation tube can be inserted in the eardrum.

Glue ear in children

Ringing Ears

Ringing ears, also known as tinnitus, is an ear condition where you hear a sound that is not produced by your surroundings. Most people experience ringing in their ears at some point, ususally after exposure to loud noise. If the situation does not go away, it can lead to an irritating problem.

These sounds can be ringing or "roaring"-like, and it might even keep time with your heartbeat or your breathing. There are many different causes of tinnitus. These include:

  • Hearing loss
  • Earwax build-up
  • Medicines, like certain antibiotics or aspirin
  • Excessive consumption of alcohol or caffeine
  • Eardrum ruptures or ear infections
  • Head injuries
  • A sudden change in environmental pressure

Ringing ears cannot always be cured, but it’s best to talk to your ENT specialist to find out what the cause of your tinnitus may be, and how to best manage your condition.


Vertigo is a specific symptom caused by conditions that affect the balance organ of your inner ear. Some people call it dizziness, but vertigo is not the same as a feeling of "wanting to faint" or light-headedness. Vertigo is a feeling of the world spinning around you, like if you were sitting in a wound-up swing. This usually causes nausea and vomitting as well, and can be a very debilitating symptom.

The most common condition that causes vertigo is Benign Paroxsysmal Positional Vertigo, or BPPV. This is sometimes described as a "loose crystal floating in you inner ear". BPPV produces brief episodes of vertigo and nausea, usually when turning around in bed. The condition can be cured by a small procedure done by dr Naudé in his rooms called the Epley maneuver.

The other condition that can cause vertigo is Vestibular Neuritis. This is caused by an infection, usually viral, than inflames the balance part of the hearing nerve. If the hearing is also affected it is called a Labyrinthitis, where both the hearing and the balance parts of the nerve are affected.

Méniér's Disease is a rare condition where brief spells of vertigo are accompanied by tinnitis (ringing ears), a feeling of fullness in the ear and brief hearing loss in the same ear.

For more information about the various ear conditions, contact Dr Pieter Naudé today for expert medical advice.