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
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
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
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
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
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
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)
failing to turn toward loud noises or respond to conversation-level speech
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
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.
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./p>