Dr. Manish Prakash
  • +91- 9999469769
  • drmanish@mayomhospital.com

Frequently Asked Questions


Q.  How Does the Ear Work?

The Pinna collects sounds and transmits it through the Ear Canal onto the Eardrum, setting it into vibration. The bones of hearing (Ossicles) connect the ear drum to the hearing organ (Cochlea) and transmit the vibrations. The hearing organanals and Vestibule) located in the inner ear serve to maintain balance.
For the eardrum to vibrate freely air is present in the middle ear. This air is naturally replaced during yawning and swallowing which open the tube connecting the Ear to the back of the nose (Eustachian tube). This tube works like a Natural Ventilation tube of the ear.

Q.  My Ears Hurt during Air Travel?

Some people develop ear pain when descending to land during an airplane journey. It is caused by pressure difference that develops on either side of the eardrum as the plane descends. This pressure can be released by a normally working Eustachian tube.
If due to cold or sinus infection the ventilating tube does not work well it can cause severe pain due to intense pressure even resulting in ear bleeding and eardrum perforation known as Severe Barotrauma.
Sucking sweets and gently blowing against a closed nose and mouth will usually push air into the middle ear, equalize the pressure and ease the pain. People with Narrow Eustachian Tubes or Sino nasal problems are more prone to this problem and may require to take antihistamines or decongestants during the flight to prevent Ear Pain.
To Diagnose the Cause and Effect of Ear Pain during Flying EAR VIDEO ENDOSCOPY is available along with NASAL ENDOSCOPY to visualize both ends of the Eustachian Tube and Nasal passage. Ask Your Doctor Whether you can Fly during a Cold?

Q.  What is Ear Wax?Is Ear Wax Normal and Hygienic? Should I Clean My Ears?

Earwax is secreted by glands in the outer Ear canal and is healthy in normal amounts. It serves like a temporary water repellent. The absence of earwax may result in dry, itchy ears.
Usually the ear canals are self cleansing. Old earwax spirals out of the ear canal to the ear opening where it usually dries, flakes, and falls out.
Under ideal circumstances, you should never have to clean your ear canals. But people having Dry wax or narrow ear canals can get wax blockage with pain and decreased hearing. If you want to clean your ears, you can wipe the external ear with a cloth over a finger.
DO NOT INSERT Ear bud into ear canal as it can further push the wax inside leading to complete blockage of the ear canal.


Most cases of ear wax especially if dry, hard and impacted will need softening to decrease pain and facilitate removal. Wax can be softened by Ceruminolytic drops. DO NOT PUT hot oil with garlic inside the ear as it may do more harm.
Wax may be removed from the Ear Canal using either Suction Removal Syringing ie. Flushing the Ear canal with Antiseptic solution (Ocassionally forceful syringing on a weakened ear drum can cause a hole).

Q.  My Child has an Ear Ache?

Common causes of Earache in children are:

In infants and toddlers earache may present as pulling or scratching at the ear with excessive crying, irritability.
The above causes of Earache can be differentiated confidently using Ear Video Endoscopy and can be appropriately treated.

Q.  What is Middle Ear Infection?What is the cause and remedy?

Otitis media means inflammation of the middle ear. It is the most common cause of earache in children and of hearing loss. It occurs most commonly in the winter months and may also be accompanied by cold which has often been ignored.
Otitis media is serious because of the associated severe ear pain and hearing loss it can lead to. Hearing loss, especially in children, may decrease learning ability and even cause speech delay.
Blockage of the natural ventilation tube (Eustachian tube) during a cold, allergy, or upper respiratory infection can lead to accumulation of pus and mucus behind the eardrum. This is called Acute Otitis Media and presents with ear pain due to the pressure of the pus in the middle ear. The ear drum looks red and inflamed on Ear Endoscopy. The eardrum cannot vibrate properly resulting in decreased Hearing.
Sometimes the eardrum ruptures, and pus flows out of the ear through a small hole. A course of antibiotics, decongestants, analgesics would be required for about 7 to 10 days to clear the infection. In case of severe pain not responding to medicines, pus may need to be drained out by a Myringotomy.

Q.  What are causes of Recurrent Ear Infections?

Enlarged and Infected Adenoids may cause repeated episodes of Otitis media. They may also be accompanied by persistent Glue ear with impaired hearing along with mouth breathing especially evident at night. In repeated cases an X ray of the Nasopharynx is required to assess the adenoid size along with an Audiogram and Tympanogram.
Audiogram/ PTA - This tests if hearing loss has occurred by presenting tones at various pitches.
Tympanogram - This measures the air pressure in the middle ear to see how well the eustachian tube is working and how well the eardrum can move.
If medicines do not improve the situation removal of Adenoids and insertion of Ventilation tube or grommet may be required.

Q.  I Hear a Ringing Noise which disturbs me?

    Common causes are
  • Ear Canal Blockage by Wax
  • Glue Ear or Ear Drum Perforation
  • Post Noise Exposure/ Noise Induced Hearing Loss
  • Meniere’s Disease
  • Hearing Nerve Weakness
  • Ototoxic Medications
  • Ototoxic Medications

These causes can be differentiated by an OTO VIDEO ENDOSCOPY and Audiometric testing and appropriate remedy can be suggested.
Do you know: Smoking/ Nicotine, Caffeine, Stress and Fatigue can worsen tinnitus.

Q.  How loud is too loud?

We measure the loudness of sound in decibels (dB). Most experts recommend that you use earplugs when exposed to 85 dB and above. But what does 85 dB mean? The following chart shows common sounds and their associated sound levels.

    Many common sounds may be louder than you think
  • A typical conversation occurs at 60 dB - not loud enough to cause damage.
  • A bulldozer that is idling (note that this is idling, not actively bulldozing) is loud enough at 85 dB that it can cause permanent damage after only 1 work day (8 hours).
  • When listening to music on earphones at a standard volume level 5, the sound generated reaches a level of 100 dB, loud enough to cause permanent damage after just 15 minutes per day!
  • A clap of thunder from a nearby storm (120 dB) or a gunshot (140-190 dB, depending on weapon), can both cause immediate damage.Workers and others in loud environments should not be exposed to sounds over 85 dB over an eight-hour period.

Q.  What is Noise Induced Hearing Loss?

Noise-induced hearing loss can be caused by a one-time exposure to a loud sound or by repeated exposure to sounds over an extended period of time. You cannot "toughen up" your hearing by regularly listening to loud noises.
Healthy hearing habits can help prevent hearing loss and tinnitus. However, the effects of loud noises can worsen existing tinnitus and further degrade hearing. If you already have one or both of these conditions, protect your ears from further damage. Sounds of less than 80 dB, even after long exposure, are unlikely to cause hearing loss.
Exposure to a one-time-only or continuous noise over 85 Db can cause temporary hearing loss. If hearing recovers, this temporary loss is called temporary threshold shift, which hearing recovers in about 16 to 48 hours after exposure. Hearing loss can also be permanent if loud sounds damage or destroy the delicate ear cells in your inner ear called cilia. Once these cells are damaged or destroyed, they cannot be repaired.
Use earplugs, earmuffs or other protection devices when exposed to sounds above 85 dB. Earplugs cut out just 15-20 dB so you'll still be able to hear sound at a rock concert or auditorium. But we do not know the sound intensity of the noise for this in general, if you are standing three feet away from some one and cannot hear what they are saying the noise level can be damaging to your hearing. Listening to loud music on MP3 player or iPOD using earphones can damage hearing.

Q.  My hearing has gone down with age. Do I need a hearing aid?

Hearing impairment with advancing age is termed as Presbyacusis. It is generally caused by a reduction in the number of   cochlear outer hair cells or  auditory nerve fibres due to senile degeneration, which may be accelerated by noise and ototoxic medicines exposure. Usually it starts from the    higher hearing frequencies which manifests as decreased speech discrimination and intelligibility and the patients complain to have heard the voice but  not understood it and may ask it to be repeated again with more problems in a noisy enviorment.
An Audiogram (Pure Tone and Speech) is recommended to assess the pattern (high and /or low frequency), severity (loss in decibels) functional impairment (Speech Discrimination Score). At a loss of more than 35 to 40 Db a Hearing Aid is generally recommended.

Q.  What is a hearing aid?

A hearing aid is an electronic, battery-operated device that amplifies sound for improved hearing. Hearing aids receive sound through a microphone, which then converts the sound waves to electrical signals. The amplifier increases the loudness of the signals and then sends the sound to the ear through a speaker. What are the different kinds of hearing aids? There are There are four basic styles of hearing aids. Each type offers different advantages, depending on its design, levels of amplification, and size.

Q.  What are the different kinds of hearing aids?

There are There are four basic styles of hearing aids. Each type offers different advantages, depending on its design, levels of amplification, and size.

Q.  What are Digital Hearing Aids,Do you need one?

Latest hearing aids use Digital technology for sound processing which allows them to provide amplification tailor made to your hearing loss. Variable Hearing Loss at different frequencies are benefited by Digital hearing Aids which are fine tuned through a computer.

Q.  Are two hearing aids better than one?

Yes it is better to have two hearing aids. Wearing two (binaural) hearing aids allows more information to reach your brain and makes it easier to hear speech against background noise.

Q.  How do cochlear implants work?

A Cochlear Implant has a microphone (works like Pinna), external microprocessor (works like middle ear and Cochlea) which receive the speech and sound convert it into electrical signal and transfer it magnetically into the implant within the ear. These signals further travel to the brain through the normal hearing nerve.

Q.  Who can benefit from an implant?

Patients with Severe or Profound Hearing Loss who do not benefit from a hearing aid can benefit. Children born deaf can and should be implanted as early as 2 years of age. An ENT and Hearing evaluation is a must to ascertain suitability for Implant.

Q.  How much benefit Cochlear Implants do?

Cochlear implants do not restore normal hearing and benefit varies depending on severity and duration of the deafness along with the patients motivation level. To know more see your Doctor.

Q.  What is Cochlear Implant?

A cochlear implant is an electronic device which can be implanted in deaf children and adults to restore hearing. It is recommended for deaf patients who do not get adequate benefit from a hearing aid as their hearing organ (Cochlea) is severely damaged. The Cochlear implant works as a bypass for the damaged cochlea and directly feeds sound impulse to the hearing nerve.