The ear is complex and delicate, containing the sensory organs for hearing, balance and motion. Conditions of the ear can range from rare conditions requiring specialist surgery or more widely seen conditions that can often be treated with a course of medication or simple surgical procedure.

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Child with problem of the ear


Mr Patel has an abundance of experience managing rare conditions of the ear and conditions more regularly seen, such as Glue ear; the commonest cause of partial deafness in children and estimated to affect one in four children.

Your first consultation with Mr Patel will include a thorough discussion around your medical history and may involve an investigative examination of your ears using an audiogram or tympanometry, ear microscopy or ear suction. All examinations are undertaken by Mr Patel himself, he is highly skilled in using these methods and particularly able at ensuring children feel at ease.

All cases are discussed with you in detail before any decision regarding a procedure is made.

Mr Patel works with an audiologist whom performs tympanometry testing on site for patients of all ages and pure tone audiometry from the age of 3.  Those under 3 may need to have paediatric audiometry testing at the Portland Hospital for women and children.

Where appropriate, Mr Patel can refer paediatric patients to experienced speech and language therapists to ensure that your child’s development is not severely impacted by their condition.

Conditions treated include

Glue ear

Glue ear (also known as secretory otitis media, otitis media with effusion, or serious otitis media) is a very common condition among children and can affect one or both ears. Glue ear occurs when the middle ear fills with a sticky, glue-like fluid instead of air. This fluid dampens the vibrations made by sound waves as they travel through the eardrum. It’s estimated that one in five children around the age of two will be affected by glue ear at any given time.

The main symptom of glue ear is some hearing loss in one or both ears. The two main treatment options for glue ear are hearing aids and grommets (a grommet is a very small tube that is inserted into the child’s ear during surgery).


Earache can present due to a variety of causes. Some of them affect the ear itself, others are from conditions affecting areas close to the ears.

Common reasons for earache include: Fluid building up deep inside the eardrum, Infection of the ear canal outside the eardrum, A boil or infected hair follicle in the ear canal, Eczema in the ear canal (seborrhoeic dermatitis) or Injury in the ear canal from objects poked inside, such as cotton buds or sharp objects.

Ear discharge

Ear discharge is any fluid that comes from the ear. It is also called otorrhea. Most of the time, the ears will discharge ear wax; an oil that the body naturally produces (UMMC). However, other conditions, such as a ruptured eardrum, can cause blood or other fluids to drain from your ear. This is a sign that the ear has been injured or infected and requires medical attention.

Eustachian tube dysfunction

The eustachian tubes are small passageways that connect the upper part of the throat (pharynx) to the middle ears. When you sneeze, swallow or yawn, your eustachian tubes open, allowing air to flow in and out. But sometimes a eustachian tube might get plugged.

This is called eustachian tube dysfunction. When this happens, sounds may be muffled and the ear may feel full or painful, there may be a popping or clicking sensation (children may say their “ear tickles”), there may hear ringing in the ears and sometimes difficulty keeping balance. The most common cause of eustachian tube dysfunction is excessive mucus and inflammation of the tube caused by a cold, the flu, a sinus infection or allergies. Children are at greater risk of eustachian tube dysfunction because their tubes are shorter and straighter than those of an adult.

Noises in ears

See tinnitus below.


Tinnitus is the perception of sound in the absence of any corresponding external sound. This noise may be heard in one ear, in both ears or in the middle of the head or it may be difficult to pinpoint its exact location. The noise may be low, medium or high‑pitched. There may be a single noise or two or more components, it can be continuous or it may come and go. Tinnitus is not a disease or an illness, it is a symptom generated within a person’s own auditory pathways.

Hearing loss

Hearing loss can occur suddenly, but usually develops gradually. It is estimated that there are more than 10 million (about 1 in 6) people in the UK with some degree of hearing impairment or deafness. General signs of hearing loss can include; Difficulty hearing other people clearly and misunderstanding what they say, Asking people to repeat themselves, Listening to music or watching television with the volume turned up higher than other people require. Hearing loss caused by a bacterial infection may be treatable with antibiotics. Surgery can be used to drain a fluid build-up, repair a perforated eardrum, or correct problems with the hearing bones.


Otosclerosis is a common cause of hearing loss in young adults, which results from abnormal bone growth inside the ear. There are three tiny bones (ossicles) deep inside the ear, which move back and forth when sound waves enter. These three bones transmit sound waves to the cochlea (inner ear), which converts them into nerve signals that are sent to the brain. In otosclerosis, the stapes (stirrup bone) begins to fuse with the surrounding bone, eventually becoming fixed so it cannot move.

Sound waves can no longer be efficiently transmitted into the inner ear. Rarely, otosclerosis can spread to the cochlea and the tiny hairs that turn sound waves into electrical signals can become damaged, resulting in greater hearing loss.


Dizziness is the feeling of being lightheaded, woozy, or unbalanced. It affects the sensory organs, specifically eyes and ears and can cause fainting. Dizziness is not a disease but a symptom of other disorders. Vertigo and disequilibrium may cause a feeling of dizziness. Vertigo is characterised by a feeling of spinning. Disequilibrium is a loss of balance or equilibrium. Dizziness is often a result of vertigo. It can also be caused by a problem in the inner ear, where balance is regulated. The most common cause of vertigo and vertigo-related dizziness is benign paroxysmal positional vertigo (BPPV).

Balance disorder

A balance disorder is a condition that leaves a person feeling unsteady or dizzy. If standing, sitting, or lying down, it might feel as if you are moving, spinning, or floating. If you are walking, you might suddenly feel as if you are tipping over. Balance disorders can be caused by certain health conditions, medications, or a problem in the inner ear or the brain. A balance disorder can profoundly impact daily activities and cause psychological and emotional hardship.

Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo; the sudden sensation of spinning. Benign paroxysmal positional vertigo is characterized by brief episodes of mild to intense dizziness. Symptoms of benign paroxysmal positional vertigo are triggered by specific changes in the position of the head, such as tipping the head up or down, and by lying down, turning over or sitting up in bed. Standing or walking may also feel unbalanced.

BPPV is often associated with a minor to severe blow to the head. Less common causes of BPPV include disorders that damage the inner ear or, rarely, damage that occurs during ear surgery. BPPV also has been associated with migraines. Treatment includes the Epley manoeuvre which involves performing four separate head movements to move the fragments that cause vertigo to a place where they no longer cause symptoms. Each head position is held for at least 30 seconds. A person may experience some vertigo during the movements. Symptoms should improve shortly after the Epley manoeuvre is performed, although it may take up to two weeks for a complete recovery.

Ear infection

Children in particular can often suffer with recurring ear infections. See Otitis externa, Otitis media and Acute otitis media for more information.

Otitis externa

Otitis externa is a condition that causes inflammation (redness and swelling) of the external ear canal, which is the tube between the outer ear and eardrum. Symptoms of otitis externa include; ear pain, which can be severe, itchiness in the ear canal, a discharge of liquid or pus from the ear and some degree of temporary hearing loss.

Usually only one ear is affected and although complications associated with otitis externa are uncommon, there is a small risk of further problems developing such as abscesses, narrowing of the ear canal inflamed or perforated eardrum or cellulitis. In some cases, otitis externa can spread to the outer ear and surrounding tissue, including the bones of the jaw and face. This infection is known as malignant otitis externa.

Otitis media

Otitis media is an infection of the middle ear that is particularly common in young children. Although anyone can develop a middle ear infection, the majority of cases occur in children under 10. Infants between 6 and 15 months old are most commonly affected. It’s estimated that around one in every four children will have had at least one middle ear infection by the time they are 10 years old. Very young children are still at risk of developing complications because their immune systems are still developing. Some of the main complications associated with middle ear infections are; Mastoiditis, Cholesteatoma and Labyrinthitis.

Acute or Chronic otitis media

Acute or Chronic otitis media is inflammation of the middle ear in which there is fluid in accompanied by signs or symptoms of ear infection such as a bulging eardrum usually accompanied by pain or a perforated eardrum, often with drainage of purulent material (pus). A perforated eardrum is a hole or tear in the eardrum. It can be uncomfortable, but usually heals within a few weeks or months provided the ear is kept dry and there’s no infection.

The eardrum, also known as the tympanic membrane, is a thin layer of tissue that separates the outer ear from the middle ear. A hole in the eardrum can be caused by: a middle ear infection, if pus builds up inside your ear and puts pressure on your eardrum, an injury to the eardrum, such as a severe blow to the ear or poking an object such as a cotton bud deep into the ear, a sudden loud noise, such as a loud explosion changes in air pressure, such as pressure changes while flying at high altitude or when scuba diving. The procedure used to repair a perforated eardrum is known as a myringoplasty.

Eardrum perforations

Eardrum perforations occur where there is a hole or tear in the eardrum. It can be uncomfortable, but usually heals within a few weeks or months provided the ear is kept dry and there is no infection. The eardrum, also known as the tympanic membrane, is a thin layer of tissue that separates the outer ear from the middle ear. A hole in the eardrum can be caused by; a middle ear infection or if pus builds up inside the ear and puts pressure on the eardrum. The procedure sometimes used to repair a perforated eardrum is known as a myringoplasty.

Acoustic neuroma

An acoustic neuroma is a benign (non-cancerous) growth, or tumour, in the brain. It’s also known as a vestibular schwannoma and the most common tumour of the Cerebellopontine angle. An acoustic neuroma grows on the vestibulocochlear nerve, which helps control hearing and balance. This nerve runs alongside the facial nerve, which carries information from the brain to the face muscles. Acoustic neuromas may grow about 1-2mm every year. However, there could be long periods when the tumour doesn’t grow at all. There are several different treatment options for an acoustic neuroma depending on age, overall health, and the size and position of the tumour.


Meningioma is a tumour that arises from the meninges, the membranes that surround the brain and spinal cord. Most meningiomas are noncancerous (benign), though rarely a meningioma may be cancerous (malignant). Some meningiomas are classified as atypical, meaning they’re neither benign nor malignant but, rather, something in between. Most people with a meningioma will have a tumour at only one site, but it also is possible to have several tumours growing simultaneously in different parts of the brain and spinal cord. When multiple meningiomas occur, more than one type of treatment may be necessary.


A cholesteatoma is an uncommon abnormal collection of skin cells inside the ear. Left untreated, it can continue to grow and damage the delicate structures deep inside the ear, such as the tiny bones and organs essential for hearing and balance.

A cholesteatoma can lead to; an ear infection, causing discharge from the ear, hearing loss, which can be permanent, vertigo, tinnitus or damage to the facial nerve, causing weakness in half of the face. In very rare cases, an infection can spread into the inner ear and brain, leading to a brain abscess or meningitis. Usually only one ear is affected by a cholesteatoma. The two most common symptoms are; persistent, often smelly, discharge from the affected ear and gradual loss of hearing in the affected ear.

Preauricular pits

Preauricular pits or sinuses are present in front of the ear. They are small skin lined tracks that lead from the skin surface, to deep within the tissues in front of the ear. Their track course can go into the cartilage or end in the skin tissue. A preauricular sinus or preauricular pit occurs as a result of faulty fusion in the development of the ear while the child is in the womb, a congenital condition present from birth. The presence of a preauricular sinus may be associated with other abnormalities of the outer ear and it is not possible for the preauricular sinus or pit to close by itself.


Labyrinthitis is an inner ear infection. It causes a delicate structure deep inside the ear called the labyrinth to become inflamed, affecting hearing and balance. The most common symptoms are dizziness, hearing loss (from mild to total loss of hearing) and vertigo. Around half of all cases of viral labyrinthitis are thought to be caused when a viral infection of the chest, nose, mouth and airways, such as the common cold or flu.

Vestibular neuritis

Vestibular neuritis (sometimes called vestibular neuronitis) means inflammation of the vestibular nerve. This is the nerve that comes from the inner ear and takes messages from the semicircular canals to the brain. The causes and symptoms of labyrinthitis and vestibular neuritis are similar. The main symptom is vertigo. Vestibular neuritis affects both adults and children but has a peak age of onset of 40 to 50 years.

Ménière's disease

Ménière’s disease is a rare disorder that affects the inner ear. It can cause vertigo, tinnitus, hearing loss, and a feeling of pressure deep inside the ear. People with Ménière’s disease usually experience some or all of these symptoms during sudden attacks, which typically last around two to three hours, although it can take a day or two for the symptoms to disappear completely.

Although the exact cause of Ménière’s disease is unknown, the following factors may increase the risk of developing the condition: autoimmunity; when the immune system attacks its own tissues and organs by mistake, genetic (inherited) factors; for example, a family history of the condition, a chemical imbalance in the fluid in the inner ear; as a result of too little or too much sodium or potassium in the body, a problem with the blood vessels; there’s a link between Ménière’s disease and migraines, which are thought to be caused by the narrowing and widening of blood vessels and some viral infections, such as meningitis.

Operations include

  • Grommet insertion (paediatric and adult)
  • Myringoplasty
  • Tympanoplasty
  • Mastoid Surgery
  • Surgery for Cholesteatoma
  • Ossiculoplasty
  • Stapedectomy
  • Bony and Soft Tissue Meatoplasty
  • Removal of Exostoses
  • Pre-auricular Sinus Excision
  • Osseous Labyrinthectomy
  • Chemical Labyrinthectomy
  • Intratympanic Steroid Injection
  • Endolymphatic Sac Surgery (surgery for Menieres Disease)
  • Complex Neuro-Otological Surgery such as for Acoustic Neuroma or other Cerebellopontine Angle Lesions


Mr Patel works with Consultant Anaesthetists Dr Richard Waddington and Dr Bernard Norman. Dr Richard and Dr Bernard both have sub speciality expertise in paediatric anaesthetics and also serve as lead paediatric / Obstetric anaesthetists in two NHS trusts in London.


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Boy sees ENT London Consultant - case study

Case Study: A 2 year old boy was struggling to hear

Alfie’s parents noticed that Alfie was sometimes struggling to hear them and he was suffering with recurring colds and ear aches. They approach Mr Patel for help.

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“My hearing test on my repaired ear was astounding, This was life changing for me and I just wanted to let Mr Patel know how pleased and grateful I am.”

Mr Howell, South London