A Look at Your Ears, Nose, and Throat

Your ears, nose, and throat are all part of your upper respiratory system, explains Paul Jones, MD, director of pediatric otolaryngology at Rush University Medical Center in Chicago. They share anatomy and have similar mucous membrane linings, which means they get similar infections; an infection, an allergy, or another problem affecting one of them (from ear pressure pain and strep throat to problems with your sinuses and constant phlegm in the throat) may also affect the others. Understanding the anatomy of your ears, nose, and throat will help you know how to keep them in good health and free of infections.

The ear has three parts: the outer ear, the middle ear, and inner ear. The outer ear, or pinna — the part you can see — includes the ear canal (1), and the skin lining this canal makes ear wax, or cerumen. The canal leads into the slightly angled eardrum (2), also called the tympanic membrane — this transmits sound to the middle ear, which is behind the eardrum inside the skull. The middle ear includes the Eustachian tube (3), which connects to the throat, and the ossicles (tiny bones) (4), through which sound travels. The nerves that take sound to the brain are found in the inner ear.

Adults and children get ear infections for the same reasons. Otitis media, an ear infection of the middle ear, occurs when the mucosa (the lining of the upper respiratory tract that secretes mucus) swells because of a cold, respiratory infection, or allergy, and the Eustachian tube (3) gets blocked. Adults get fewer ear infections than kids because their Eustachian tubes are bigger and more angled. If you do get infections, you may have a Eustachian tube that genetically doesn’t work correctly, Dr. Jones says. Other types of ear infections include otitis externa (an outer ear infection, or swimmer’s ear) and otitis interna (an inner ear infection).

When left untreated, an ear infection can lead to a more serious infection, permanent hearing loss, and problems with speech and language development — so speak to your doctor right away if you think you or child have an ear infection. The doctor may prescribe an antibiotic to kill the bacteria and recommend pain medications or prescription ear drops.

Ear wax is a natural protector against infections, explains Jones, and you should never try to remove it or you may end up pushing the wax further in … and needing to have it removed by an ear, nose, and throat specialist. “I had 15 people in my office this morning, and four were here for impacted ear wax,” he says. Ear wax will come out naturally on its own, and constantly removing it can disturb the wax-producing glands.

However, in some cases, excessive ear wax can accumulate in the ear canal, possibly causing ear pain, a plugged sensation in the ear, itching, ear odor — even hearing loss. If you want a way to keep ear wax to a minimum, says Jones, you can try flushing your ears by putting a few drops of hydrogen peroxide in each ear once a week. The wax will then come out on its own. But, Jones warns, this advice is for patients who know their ears are healthy. “We don’t want someone with a perforation [of the ear drum] to do that."

When you feel your ears pop, you know your Eustachian tubes are opening properly. Their function is to equalize internal and external pressure — that’s why you experience ear-popping with elevation changes on airplanes. When the tubes don’t open properly, you can have ear pressure pain. On a normal day, the Eustachian tube opens about 100 times. But when it’s dysfunctional, such as when dust or allergies are irritating the lining, you may need to decongest it. A topical nasal spray can help. Very rarely, says Jones, a malfunctioning Eustachian tube could be a sign of blockage by head or neck cancer.

Like the ear, the nose is divided into sections. The septum divides it vertically (one external nostril on each side), but the nose is also separated into front and back parts. The front, visible part of the nose is called the anterior, which is made from cartilage; the section that leads into the throat is called the posterior. Surrounding the nose are the sinuses, normally air-filled pockets that can cause pain if they become mucus-filled or infected. There are four sinus cavities — frontal sinuses, maxillary sinuses, ethmoid sinuses, and sphenoid sinuses. Sinus tissue and your nasal passages are covered with cilia, microscopic hairs that capture dust and dirt so we don’t breathe in bacteria. The septum has many blood vessels near its surface, which is why the nose bleeds rather easily.

Infected sinuses, also known as sinusitis, can cause facial and headache pain. When yellow or green pus is trapped in sinus cavities — above and below the eyes and around the nose — your entire head aches, you may experience nasal congestion, and you could have a sore throat or fever. And a number of things could be to blame, such as a virus, bacteria, fungus, or allergies. What’s the best way to treat infected sinuses? Opening them up, Jones says. Using saltwater solutions and irrigating the nose helps; talk to your doctor about appropriate techniques. Viral infections generally resolve themselves, while bacterial infections are treated with antibiotics. As with a blocked Eustachian tube, tumors could mimic sinusitis symptoms, especially if symptoms are on one side.

Nosebleeds happen due to a number of different causes — dry air, allergies, colds, migraine headaches, even cocaine use. Sometimes a nosebleed can be due to blood clotting disorders or being on blood-thinning medication. To stop a nosebleed, sit and lean forward slightly. Don’t recline — keeping your head above your heart slows the bleeding and allows the blood to come out through your nose, instead of going down your throat. Squeeze the soft portion of your nose — between the tip and the bridge — with your index finger and thumb and hold until the bleeding stops. Seek medical help if the bleeding doesn't stop.

Constant phlegm in the throat — often called post-nasal drip — has many possible causes, including pollution, dust, or an anatomical obstruction. The nose produces a quart of mucus daily, and you will notice a change when there’s more of it or if it’s thicker. An increase in mucus production is usually due to an infection or an obstruction, which the body wants to flush out. If mucus is too thick, a medication like Mucinex can make the mucus thinner so that it’s more easily swallowed.

The throat, or pharynx, is divided into three parts. The nasopharynx (1) is located behind the nose. The oropharynx is behind the mouth (2). And the laryngopharynx (3), or lower section of the throat, is in front of the esophagus (4); this is where the larynx, or voice box, and the vocal cords are housed (5). The often-infected tonsils (6) and adenoids (7) are found in the naso- and oropharynx. A number of common problems can affect the throat: strep and other infections that cause sore throats, hoarseness, laryngitis, and tonsillitis are just a few.

Strep throat is an infection caused by a form of the Streptococcus bacteria, Jones says. Doctors test for strep when someone has a sore throat because of its dangerous complications, such as heart problems that can happen later if the strep is not treated. Strep throat is most common in children between the ages of 5 and 15, and symptoms of strep include sore throat, swollen tonsils, telltale white patches on the throat, fever, body aches, and even stomach pain. Strep throat should be treated with an antibiotic. Not all sore throats are strep throat; if your strep test is negative, your sore throat is probably due to a virus and won’t respond to antibiotics.

When you speak, air moving through your vocal cords (1) causes vibrations and results in sound. When all the working parts don’t come together properly, your voice can sound strained, raspy, or hoarse. Hoarseness happens for a number of reasons — your vocal cords can be swollen from a cold virus or laryngitis (which occurs when the vocal cords become inflamed or swollen, or simply because you’ve been yelling or overusing your voice). However, prolonged hoarseness can also indicate a serious problem, such as cancer, so see an ENT specialist if your symptoms don't go away.

Lifestyle choices are often to blame for a dry throat, Jones says — too much caffeine or alcohol, not enough water, and smoking cigarettes (menthol, too, can dry out the throat). Changing these habits may help, as can sucking on sugarless candy. While some factors, including age, can’t be changed — as we age, our mucous glands dry up — others can be soothed. For example, a dry throat could be a sign that you’re getting a cold, Jones says, so cold medications may help.