The Sixth Sense

Department of ENT
NHAK, Kohima 

“I praise you, for I am fearfully and wonderfully made” Psalms 139:14. This Bible verse is a befitting description of how God has designed the intricate mechanism of human hearing and its divine origin. Our ears grant us the ability to recognize sounds from every direction, naturally compelling us to turn our heads when the source remains unseen. Even during slumber, noise possesses the power to stir us awake. Of all the senses, hearing is the most immediate in seizing our focus, offering essential hints about whether a sound indicates security or peril, companion or opponent. It is also the final sense to fade under anesthesia and at the moment of death.

We hear sound as small cyclical pressure changes in the air which get funneled in by the pinna and reach the ear drum inside the ear. The small vibrations of the tympanic membrane are then transferred through tiny ossicle bones into the inner ear. These tiny ossicles not only transmit the vibration but they amplify the sound as it enter the inner ear. It is a wonder that these ossicles with just some few mm in size can have such intricate function. From the inner ear the vibrations electrify the 8^th Cranial nerve which is the Nerve for hearing, which in turn carry the signal to our brain where these signals are perceived. When we see the physics and dynamics of the hearing mechanism one cannot help but stay in awe of the intelligent power of God. No human could ever conceive of such an invention, nor could the body independently develop such extraordinary features.

The human ear serves as the primary organ for auditory perception while also playing a pivotal role in maintaining equilibrium. However, this secondary function remains relatively obscure to the general populace. The mechanism of controlling balance is at another level of complexity. The inner ear’s vestibular system, housed in the strongest bone in the body, controls balance by sensing head movement and gravity. The inner ear has a fluid in it which sloshes with each head movement. These movements stimulate the inner hair cells which in turn send these signals to the oldest part of the brain, the brainstem through the 8^th nerve. The brain in turn uses this information to pinpoint the body’s position and dens signals to the muscles to help you stay balanced. A narrow passage connects the middle ear to the upper part of the throat (Nasopharynx) called the Eustachian tube. This tube maintains the pressure inside the ear and helps drainage of fluid or mucus and also protects the ear from infections.

When we understand the function and mechanism of the ear we can relate to the symptoms of the diseased ear. Any pathology which disrupt the mechanism of hearing or balance or both can produce symptoms related to these two functions. Hearing related symptoms can be hearing loss, ringing or buzzing noise in the ear (tinnitus) or increased sensitivity to sound (hyperacusis). Balance related symptoms can be dizziness (Vertigo), unsteadiness, nausea or vomiting and uncontrolled eye movements (Nystagmus). Symptoms related to pressure regulation can be ear fullness (sensation of blocked ear), ear pain, popping or clicking sounds, fluid drainage or ear infections.

Proper ear care is essential for hearing, balance, and preventing infections. Here’s how you can take care of your ears effectively.

• Keep your ears clean

• Avoid inserting cotton swabs or sharp objects into the ear canal, as they can push wax deeper and cause damage.
• If you have excessive earwax buildup, use ear drops or see a doctor for professional cleaning.
• Gently clean the outer ear with a damp cloth

• Protect your ear from loud noise

• Use ear protection (earplugs or noise-canceling headphones) in loud environments (concerts, construction sites, or when using power tools)

• Prevent ear infections

• Dry your ears properly after swimming or bathing to prevent infections ("swimmer's ear").
• Avoid inserting fingers, earbuds, especially matchsticks and feathers into the ear.
• If you have a cold or allergies, manage them to prevent Eustachian tube blockage and ear infections.

• Take care of ear pressure

• When flying or diving, chew gum, swallow, or yawn to help equalize ear pressure.
• If you experience ear barotrauma (pressure-related discomfort), try the Valsalva maneuver (gently blowing while pinching your nose and keeping your mouth closed).
• Treat nasal congestion promptly to avoid pressure-related issues.

• Get regular ear checkups

• Visit an ear specialist (ENT) if you experience persistent ear pain, hearing loss, ringing (tinnitus), or dizziness.
• If you frequently experience ear infections, seek medical advice.
• Have your hearing tested regularly, especially if you are exposed to loud noises or have age-related hearing concerns.

According to WHO, by 2023 which is just 3yrs down the lane from now, over 500 million people are expected to have disabling hearing loss requiring rehabilitation. 

Hearing loss has traditionally been associated with aging due to the gradual degeneration of hair cells in the inner ear over time. This condition, known as presbycusis, typically begins around middle age or later. In our modern Reality Teens and young adults (10-35 years old) are now experiencing early signs of hearing loss. Causes include frequent exposure to high-volume audio (gaming, earbuds, concerts, social media). A study by the WHO estimates that 1 billion young people worldwide are at risk of noise-induced hearing loss. Why does this matter so much? Age related hearing loss is an inevitable degenerative process however to suffer from hearing loss at a young age  is a pressing issue as Hearing loss is irreversible in most cases. If younger generations are experiencing it now, they may suffer from more severe hearing loss earlier in life, affecting communication, mental health, and quality of life.

Tips to Protect Hearing for Young Gamers & Music Listeners

Follow the 60/60 Rule

• Keep volume below 60% of the maximum level.
• Limit listening through headphones to 60 minutes at a time, then take a break.

Use Noise-Canceling Headphones

• These help block background noise, so you don’t have to turn up the volume as much.
• Avoid cheap headphones that lack sound isolation, as they encourage higher volume use.

Choose Headphones Over Earbuds

• Over-ear headphones are better than in-ear earbuds because they don’t sit directly in the ear canal.
• If using earbuds, opt for those with volume-limiting features.

Enable Volume Limits on Devices

• Many smartphones, tablets, and gaming consoles allow you to set a maximum volume level in the settings.

Take Breaks & Give Ears Time to Recover

• Follow the 5-minute break rule – for every hour of gaming or music, take at least 5 minutes with no sound exposure.
• Try quiet time after long gaming/music sessions to let your ears rest.

Be Aware of Warning Signs

• If you notice ringing in your ears (tinnitus) after gaming or listening to music, it's a sign your ears need a break. Struggling to hear conversations clearly in noisy environments may indicate early hearing damage.

Use Safe Audio Features in Games

• Many modern games have audio settings to limit sudden loud sounds – enable these if available.
• Consider turning down explosions, gunshots, and other high-decibel effects in competitive games.

Get Regular Hearing Checkups

• If you game often or use headphones frequently, consider annual hearing tests to catch any early signs of damage.

Our ability to hear in the future depends on how well we safeguard our ears today, as many instances of hearing loss are preventable through mindful listening habits and proper auditory care. For individuals with hearing impairment, early diagnosis and prompt rehabilitation are vital for reaching their full potential. By taking proactive measures now, you can ensure lasting auditory health throughout life.

With the advent of World Hearing Week observed at this time of the year, this year’s theme builds upon the 2024 focus on changing mindsets towards ear and hearing care. We invite individuals of all ages to empower themselves to ensure healthy ears and hearing for themselves and others, with the theme, "Changing mindsets: empower yourself to make ear and hearing care a reality for all!"