Ear's anatomy elegant, but delicate

<p>Warm weather and swim season can bring ear problems to people of all ages. And although the ear seems a very simple part of our anatomy, it really is quite intricate and elegant in its design. Knowing the structure of the ear helps with understanding painful ear problems.</p><p>The part of the ear we see on the outside is called the pinna -- the large part that captures sound waves. In the center of the pinna is the ear canal that leads to the eardrum, a thin and fragile structure also called the tympanic membrane. This exquisitely sensitive membrane vibrates in response to the motion of sound waves, transferring the waves into the middle ear. There, three tiny bones linked together transfer the sound to the deepest inner ear.</p><p>The middle ear is open to the back of the nose and throat through a tiny channel called the eustachian tube. This tube allows the pressure on both sides of the eardrum to equalize when the outside air pressure changes. It is also at risk of being obstructed any time the nose is congested, causing problems with equalization and hearing.</p><p>Ear infections usually occur in either the external or the middle ear. External otitis, like swimmer's ear, is an infection in the ear canal that causes swelling and pain. The lining of the ear canal is thin and fragile, easily damaged by over-aggressive scratching and cleaning. Pain in the canal can be caused by trauma, by infection with bacteria or fungus, or by chronic irritation. When water gets into the canal, it can bring contamination into an environment that is perfect for growth: warm and moist.</p><p>If your doctor wants to look at your ears to evaluate a possible infection this may be the reason -- to see if the problem is in the canal or deeper in the middle ear. The treatment is different depending on the location of the infection.</p><p>Wax blocking the canal is a common problem and some people just seem to make more wax than others. Wax, called cerumen, is protective, but when it builds up and blocks the eardrum it can be painful and prevent you from hearing well. Excessive ear wax that does not respond to gentle home remedies can be safely and easily removed at your doctor's office. But digging wax out with any homemade tool is NOT advised as this can damage the tender ear canal or the eardrum, leading to more serious problems.</p><p>Although people of any age can get a middle ear infection, children are particularly susceptible. This may be because a child's tiny eustachian tube does not drain as effectively as it will later in life. If the middle ear can't drain, fluid collects, creating a prime location for infection. Suckling and the natural positioning of breast-feeding babies are part of nature's way to keep the middle ear open. Risks for eustachian tube dysfunction include exposure to secondhand smoke and other irritants that can easily inflame and block these tiny tubes, causing hearing loss and possible infections. Remember that the tubes drain to the back of the nose, so once a child is 2 or 3 years old, gentle saline nose washes can help keep the ears healthy too.</p><p>Middle ear infections should be watched carefully; if left untreated, they can lead to an infection in the bones around the ears and further into the brain. This does not mean that every single infection needs antibiotics, but every infection should be monitored for signs of improvement.</p><p>Allergies, swimming, summer colds and travel can all cause ear troubles. Many of these are avoidable if you practice some basic preventive care, but if there is pain or persistent loss of hearing, you may want to see your doctor.</p><p>The ear is so much more than an ornament or a simple hole in the side of your head, and it deserves to be protected and treated well.</p><p>Dr. Stacey Kerr, a longtime Sonoma County family physician, graduated from UC Davis Medical School and is certified in her specialty by the American Board of Family Medicine. Her columns are not intended as a substitute for hands-on medical advice or treatment. Consult your health care provider before adhering to any recommendations in this column. E-mail comments to </p><p>drkerr@the-doctors-inn.com.</p>