Falls, blows to the head, sports injuries, and even listening to loud music can cause ear damage, which can affect hearing and balance. That's because the ear not only helps us hear, but also keeps 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 their ability to speak and understand language, while problems with balance can influence how they're able to move and how well they feel.

How the Ear Works

To understand ear injuries, it's helpful to review the ins and outs of the ears. Basically, the ear is made up of three parts — the outer ear, middle ear, and inner ear.

Hearing begins when sound waves that travel through the air reach the outer ear, or pinna (the visible part of the ear). The outer ear captures the sound vibration and sends it through the ear canal to the middle ear, which contains the eardrum (a thin layer of tissue) and three tiny bones (called ossicles). The sound causes the eardrum to vibrate. The ossicles amplify these vibrations and carry them to the inner ear.

The inner ear is made up of a snail-shaped chamber (the cochlea), which is filled with fluid and lined with four rows of tiny hair cells. When the vibrations move through this fluid, the outer hair cells contract back and forth and amplify the sound.

When the vibrations are big enough, the inner hair cells translate them into electrical nerve impulses in the vestibulocochlear nerve (also called the auditory nerve, acoustic nerve, or eighth cranial nerve), which sends signals to the brain to be interpreted as sound. The vestibulocochlear nerve also helps with balance.

Types of Ear Injuries

Hearing loss and balance problems can happen when there's damage to key parts of the ear, like the eardrum, ear canal, ossicles, cochlea, or the vestibular nerve.

Here's a look at the most common causes of ear injuries and how they can affect kids:

Cuts, scrapes, burns, or frostbite. When there's an injury (even minor) to the outer ear or ear canal, bleeding and infection 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, or damage the inner ear. Wrestlers, boxers, and other athletes who endure repeated forceful hits to the outer ear can develop severe bruising or blood clots that block blood flow to the cartilage of the outer ear and damage its shape and structure (known as cauliflower ear).

Loud noise. Kids can have significant or permanent hearing loss when they're exposed to really loud noises daily or over a long period of time. This is called acoustic trauma or noise-induced hearing loss.

When this happens, the tiny hairs in the cochlea become damaged. Loud sounds (like a gunshot, firecracker, or explosion) can cause it, as can noises that are repeated over time (like lawn mowers, power tools, farm equipment, noise from sporting events, band or shop classes, motorbikes, even movie theaters). But for kids and teens, listening to loud music (at concerts, in the car, through headphones) is one of the chief causes of this type of preventable hearing loss.

Sudden, significant change in air pressure. When we fly or scuba dive, air pressure decreases as we go higher and increases as we go lower. If the pressure isn't equalized, the higher air pressure pushes on one side of the eardrum and causes pain and sometimes partial hearing loss, called barotrauma.

Normally, the eustachian tube (a passageway that leads from the middle ear to the back of the throat behind the nose) equalizes the air pressure in the middle ear to the outside air pressure by opening and letting air reach the middle ear. When your ears "pop" while yawning or swallowing, your eustachian tubes are adjusting the air pressure in your middle ears.

But in kids, the relatively narrow eustachian tubes may not work as well, especially if they're clogged by inflammation and mucus from an ear infection or cold, or blocked by enlarged or swollen adenoids. Any pain or hearing problems are usually minor and temporary, though — they usually go away within minutes and don't cause any lasting damage. 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.

Signs of Hearing Loss or Balance Problems

Ear injuries can affect kids differently. Some may have partial hearing loss, with symptoms like:

• trouble hearing when there's background noise
• difficulty 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
• turning up the TV
• difficulty paying attention or keeping up in school
• complaining that the ears feel "full"
• trouble talking (with poor, limited, or no speech)
• talking loudly
• failing to turn toward loud noises or respond to conversation-level speech
• answering inappropriately

In other cases, kids may have complete hearing loss or deafness (when they can't hear anything at all).

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
• dizziness or lightheadedness
• vision problems (like bouncing eyesight or blurriness, called oscillopsia)
• trouble going up stairs or standing up without falling
• problems walking (inability to walk without staggering, walking with legs too far apart, or trouble walking in the dark or over uneven areas)
• nausea or vomiting
• headaches
• major fatigue

Preventing Ear Injuries

You can't protect children from getting hurt all the time — accidents and injuries are par for the course with raising kids. But you can keep prevent some ear injuries 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 uncomfortable, potentially damaging 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 it can be bought separately).
• Wear ear protection at concerts, especially when sitting near the stage or speakers (they'll still be able to hear with earplugs — it just won't be as deafening), mowing the lawn or using machinery (like in metal or wood shop at school), or playing a loud instrument (like the drums).
• Always put on a snug-fitting helmet whenever they ride bikes or scooters, skateboard, or inline skate.
• Don the right kind of protective equipment every time they practice or play sports — helmets for baseball, softball, hockey, and football; headgear or ear guards for wrestling, rugby, and boxing.

Seeking Treatment

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, and how severe it is. While minor injuries usually cause temporary problems, serious injuries may cause permanent hearing loss or balance problems.

Vestibular therapy may help kids with balance problems. And some with significant hearing loss may need a hearing aid, an FM system or auditory trainer (specialized devices that block out background noise), or a cochlear implant (a surgically implanted device that helps overcome problems in the inner ear, or cochlea). They also might need listening therapy with an audiologist (hearing specialist).

Make sure to 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 can refer you to an ear, nose, and throat specialist and possibly an audiologist to figure out the next step to take.

Reviewed by: Robert C. O'Reilly, MD
Date reviewed: March 2012