Ear Injuries

Ear injuries can affect hearing and balance. That's because our ears not only help us hear, but also keep us steady on our feet.

Kids need to hear well to develop and use their speech, social, and listening skills. Even mild or partial hearing loss can affect how well they speak and understand language. Problems with balance can affect how they move and how they feel.

How Do Ear Injuries Happen?

Falls, blows to the head, sports injuries, and even listening to loud music can hurt the ears. Damage to key parts of the ear, like the eardrum, ear canal, ossicles, cochlea, or the vestibular nerve can lead to hearing loss and balance problems.

Here are some common causes of ear injuries and how they can affect kids:

Cuts, scrapes, burns, or frostbite. Even minor injuries to the outer ear or ear canal can lead to bleeding and infection that can affect other parts of the ear.

Inserting something into the ear. Things like a cotton swab, fingernail, or pencil can scratch the ear canal or cause a tear or hole in the eardrum (called a ruptured eardrum).

Direct blows to the ear or head. Falls, car accidents, sports injuries, or fights may tear the eardrum, dislocate the ossicles (tiny ear bones), or damage the inner ear. Wrestlers, boxers, and other athletes often get repeated forceful hits to the outer ear. Severe bruising or blood clots then can block blood flow to the cartilage of the outer ear. This damages its shape and structure (known as cauliflower ear).

Loud noise. Kids and teens can have serious or permanent hearing loss (called acoustic trauma or noise-induced hearing loss) if they:

• are exposed to very loud noises, like a gunshot, firecracker, or explosion
• are around loud noise for a long time, like lawn mowers, power tools, farm equipment, loud sporting events, etc.
• listen to loud music at concerts, in the car, or through headphones. This is one of the chief causes of this type of preventable hearing loss.

Sudden air pressure changes. Usually, the air pressure in the middle ear and the pressure in the environment are in balance. But things like flying or scuba diving can cause a sudden change in pressure. If it's not equalized, the higher air pressure pushes on one side of the eardrum. This leads to pain and sometimes partial hearing loss, called barotrauma. It usually goes away quickly. In some cases, a child can have pain for several hours if the ears don't "pop." Occasionally, extreme pressure changes can fill the middle ear with fluid or blood or cause the eardrum to burst.

What Are the Signs & Symptoms of Hearing Loss?

Ear injuries can affect kids in different ways. Signs of hearing loss can include:

• trouble hearing when there's background noise
• trouble hearing high-pitched sounds or music notes
• hearing only certain or muffled sounds
• ringing in the ears or other strange sounds like hissing, buzzing, humming, or roaring
• trouble paying attention or keeping up in school
• complaining that the ears feel "full"
• trouble talking (with poor, limited, or no speech)
• talking loudly
• not turning toward loud noises or respond to conversation-level speech
• not answering questions, or answering inappropriately
• turning up the volume on the TV or stereo

What Are the Signs & Symptoms of Balance Problems?

Depending on whether they hurt one or both ears, kids with ear injuries that affect balance may have symptoms like:

• falling or stumbling a lot (clumsiness)
• vertigo (a sudden feeling of spinning or whirling that feels like moving while sitting or standing)
• feeling unsteady, "woozy," or disoriented
• feeling dizzy or lightheaded
• vision problems like bouncing eyesight or blurriness (called oscillopsia [ah-sih-LOP-see-uh])
• trouble going up stairs or standing up without falling
• problems walking (staggering while walking, walking with legs too far apart, or trouble walking in the dark or over uneven areas)
• nausea or vomiting
• headaches
• extreme tiredness

How Are Ear Injuries Treated?

How long hearing or balance problems last and how they're treated will depend on:

• what part of the ear was hurt
• what caused the injury
• how severe it is

Minor injuries usually cause temporary problems. But serious injuries may cause permanent hearing loss or balance problems.

Kids who have trauma to the outside of the ear with swelling and bruising need to see a doctor right away. If blood collects and blocks flow to the cartilage, doctors must do surgery to drain it to prevent scarring (cauliflower ear).

Most traumatic eardrum injuries eventually heal on their own. But all should be checked by an otolaryngologist (ear, nose, and throat specialist, or ENT). Sometimes, eardrum injuries don't heal with time and need to be patched surgically (tympanoplasty).

Vestibular therapy can help kids who have balance problems. This special type of physical therapy uses exercises to help kids with balance skills and coordination.

Kids with significant hearing loss may need:

• listening therapy with an audiologist (hearing specialist)
• a hearing aid. These can fit inside or behind the ear and make sounds louder. An audiologist adjusts them so that the sound coming in is amplified enough to let a child hear it well.
• an FM system or auditory trainer to reduce background noise. Some classrooms have these to improve hearing in group or noisy environments.
• surgical exploration of the ear and, possibly, reconstruction

When Should I Call the Doctor?

Call your doctor if your child has:

• had any type of ear or head injury, even if it seems minor
• any signs of problems with balance or hearing
• severe ear pain
• blood or fluid draining from the ear (that doesn't look like earwax)

If there's a concern, your doctor might refer you to an ENT or an audiologist to figure out what's going on.

Can Ear Injuries Be Prevented?

Not every ear injury is avoidable. But you can keep prevent some by encouraging kids to:

• Never stick anything in their ears, not even cotton swabs or their fingers. Regular bathing should be enough to keep earwax at normal levels. If your child complains of ear discomfort and you see earwax in the ear, it's OK to wipe the outside of the ear with a washcloth. If earwax interferes with hearing or causes pain or discomfort, talk to your doctor about having the earwax removed in the office.
• Steer clear of situations with loud noise. If you or your kids have to shout to be heard from 3 feet away, that's far too loud.
• Turn down the volume when listening to music, especially while wearing headphones or riding in the car. Also look for portable media or music players with "volume limiters" (they may come with the device or you can buy one).
• Wear ear protection at concerts, especially when sitting near the stage or speakers. They'll still hear with earplugs, but without damage. They also should wear it while mowing the lawn or using machinery (like in metal or wood shop at school), or playing a loud instrument (like the drums).
• Always wear a snug-fitting helmet on bikes, scooters, and skateboards, or when inline skating.
• Use the right protective equipment every time they practice or play sports, such as:
  • helmets for baseball, softball, hockey, and football
  • headgear or ear guards for wrestling, rugby, and boxing