Crackling in the ear

Among the many different symptoms (from Greek symptom - coincidence, sign), medical semiotics also includes tinnitus felt in the ears without an external sound source. One of the types of this symptom is crackling in the ear. [1]

Causes of the ear cod

That is, crackling in the right ear, crackling in the left ear, or crackling in both ears is a type of tinnitus, which occurs for a variety of reasons. [2] And the most common causes include:

• accumulation of earwax and the formation of a wax plug in the ear; [3]
• obstructive dysfunction or blockage of the mucous epithelium-lined auditory (eustachian) tubes, which connect the pharyngeal and middle ear cavities. As a result, air exchange and normal pressure in the inner and middle ear cannot be maintained, and crackling and ear noise can be heard. Crackling in the ears when swallowing is associated with inflammation of the eustachian tube - tubo-otitis;
• eardrum damage; [4]
• acute otitis media and/or exudative otitis media - with pain in the affected ear; [5]
• chronic purulent otitis media, more specifically, its complication in the form of epitympanitis, which affects the auditory ossicles of the tympanic cavity of the middle ear; [6]
• middle ear and mastoid cyst of the temporal bone - middle ear choleostomy. [7]

The inner ear houses the vestibular section and the balance organ (precordial organ), so crackling in the ear and dizziness are common symptoms of inner ear injuries, labyrinthitis (inflammation of the inner ear), [8] as well as Meniere's disease (endolymphatic swelling of the inner ear). [9]

Crackling in the ears when yawning indicates problems with the auditory tube, spasm of the tensor tympani muscle (which tenses the eardrum), or disorders of the temporomandibular joint (between the jaw and the rest of the skull). [10]

The most common cause of crackling in the ear at loud sounds is myoclonus of the middle ear - spasm or dysfunction of the already mentioned musculus tensor tympani and the stirrup muscle of the ear (musculus stapedius).

Persistent tinnitus crackling can be etiologically associated with both tympanic membrane perforation, chronic acoustic trauma, [11] and with scarring and degenerative changes in the middle ear - tympanosclerosis. [12]

Risk factors

Specialists refer to risk factors for crackling in the ears as:

• advanced age;
• middle ear infections;
• sinus infections - chronic sinusitis maxillary (maxillary) sinus (or maxillary sinusitis), in which viscous secretion from the paranasal sinuses (perinasal sinuses) can block the mouth of the eustachian tubes; [13]
• hypertrophy of the tubal tonsil (located near the nasopharyngeal opening of the auditory tube); [14]
• hypertrophy of the pharyngeal tonsils - adenoids (adenoid vegetations);
• prolonged exposure to loud noise;
• allergies;
• anomalies of the dentoalveolar system in the form of a bite disorder, in particular mandibular prognathism;
• cleft palate.

Pathogenesis

When the auditory tube is obstructed, tinnitus without pain is associated with impaired airflow and drainage. When the eustachian tube is dysfunctional (when it does not open or close properly), the negative pressure in the middle ear pulls the eardrum inward, bringing it closer to the auditory ossicles.

When the tympanic membrane is damaged and perforated, the auditory ossicles, particularly the stapes, can be affected, and the crackling in the ear is due to damage to the base of the stapedis.

In middle ear myoclonus, muscle spasm of the muscle tensing the tympanic membrane causes air to be pushed out, which is accompanied by crackling in the ear.

In patients with Meniere's disease, the pathogenesis of crackling in the ear is due to an increase in the volume of endolymph - the fluid between the bony and membranous labyrinths of the inner ear - and an increase in pressure within the labyrinth.

Diagnostics of the ear cod

Diagnosis of diseases and pathologic conditions accompanied by this symptom is based on patient history and ear examination.

First of all, instrumental diagnostics is used: otoscopy; hearing test (audiometry); determination of tympanic membrane mobility and conductivity of auditory ossicles - tympanometry; ECoG (electrocochleography); X-ray of ear and temporal bone; CT and MRI of inner ear; vestibulometry; rhinoscopy and X-ray of pananasal sinuses (sinuses).

Blood tests are taken: general clinical, for COE, for C-reactive protein, etc.

Differential diagnosis is necessary to identify the true cause of this type of tinnitus.

Treatment of the ear cod

Eliminating the causes of tinnitus crackling is the main goal of treatment.

If the cause is wax buildup in the ear canal, wax plug drops (to soften earwax) are applied and wax plug removal is performed.

On the treatment of middle ear inflammation in detail publications:

• Drops for otitis media
• Treatment of chronic otitis media
• Antibiotics for otitis media
• Physiotherapy for otitis media

For exudative otitis exudata, a tympanostomy (tympanic membrane shunt) may be performed, and for inner ear inflammation, a sanitizing procedure with drainage may be performed.

In cases of inflammation of the maxillary sinus, maxillary sinus drops are used. Read more - Acute sinusitis - Treatment

In case of hyperplasia of adenoid vegetations, they are removed and the middle ear choleostomy is also removed. The treatment of endolymphatic edema of the inner ear is surgical treatment of Meniere's disease.

Prevention

It is unlikely that the symptom can be prevented, it is necessary to prevent ENT diseases, primarily otitis media causing middle ear infections, as well as respiratory infections.

Forecast

The prognosis regarding the disappearance of crackling in the ear depends entirely on the etiologically related disease and its treatment (if any).