Deafness is a frustrating symptom. In children it creates educational difficulties and parental worry. In adults, everyday life is fraught with difficulties, and there may be stigmatisation. Three million adults in the UK suffer some degree of persistent deafness. Congenital causes acquired in utero are not included here.
This is often seen in swimmers and returned tropical travellers. It is frequently a sequel to water trapped behind earwax in the ear canal, which swells and encourages stasis and subsequent infection. The vast majority of cases seen settle with simple treatment, but be wary of rarer serious causes.
This the commonest reason for an out-of-hours concern for a child. Parental distress is often as great as the child’s, and appropriate advice can do much to relieve this – even over the telephone. Causes in adults are far more varied than for children and can originate in the pinna, ear canal, middle ear and from neighbouring structures (referred pain).
This means noises heard (nearly always subjectively) in the ears or head. They are often described as being like a whistling kettle, an engine, or in time with the heartbeat. As a short-lived phenomenon, it is very common (often with URTIs) – such cases do not usually present to the general practice. More serious, persistent tinnitus occurs in up to 2% of the population. It is very distressing and can cause secondary depression and insomnia. Objective tinnitus is very rare.