EAR INFECTIONS - Full extract 

Ear infections cause severe pain, especially in children and often in the middle of the night. The earache can be unremitting, a pain that you just cannot get away from. Some years ago I asked a young girl which of her ears was hurting. She looked up sadly and replied, " All of them. " 

Some basic anatomy makes ear infections a little easier to understand. Inside the outer opening of the ear is a small canal that comes to a blind end at the eardrum. In this external canal are a few hairs and a varying amount of wax. Next is the middle ear space where three tiny bones or ossicles pick up the vibrations of the eardrum caused by sound waves, and then conduct them to the auditory nerve in the inner part of the ear. The middle ear is also connected via the rather narrow eustachian tube to the back of the throat. This is why the hearing feels muffled and woolly whenever the eustachian tube becomes blocked with a cold or when flying in a plane. 

Infections sometimes occur in the oil glands and hair follicles in the external canal. These small boils or pimples are called furuncles. They are really no different to boils elsewhere, but because of their position they can be extremely painful. The ear can be very tender to touch, and sometimes the furuncle will discharge into the external canal. Local ointment and oral antibiotics are occasionally required. Usually they settle without any treatment at all. 

We also see viral infections of the inner ear, causing severe dizziness and vomiting. These infections can sometimes be very distressing and often take several weeks to fully clear. 

By far the most common ear infections are those that affect the outer and middle ear.... 

Outer ear infection ( otitis externa or swimmer's ear ). This infection occurs in the external canal and causes considerable itchiness and irritation. The ear may be sore and quite tender to touch. Although these infections typically occur after swimming in an unclean pool, anything that allows moisture to get into the ears can cause them, for instance bathing and showering. Some people pick and scratch their ears with cotton buds and matchsticks, a practice that should be avoided. As well as the risk of injuring the canal or the eardrum, is the likelihood of introducing further infection. 

A certain amount of wax is normally present in the external canal; as well its waterproofing effect it also helps to clean the ears. With an outer ear infection a slight discharge may also occur. When the ear is examined with an auriscope, the outer canal is seen to be reddened and swollen. Frequently a lot of fluffy white debris is seen, especially when a fungal infection is causing the infection. This may make the ear feel quite blocked. The treatment involves the doctor mopping out as much of the debris as possible, followed by several days of antibiotic drops. Keeping the ears dry is important, both initially and later on to prevent recurrences. A subsequent check that the infection has been cleared is advisable. 

Middle ear infection ( otitis media ). This infection occurs in the middle ear space and causes a persistent severe earache. It is often preceded by a cold. There may also be a fever and vomiting. Sometimes the pain builds to a peak as the eardrum bulges. If the drum perforates, fluid seeps from the ear and the pain subsides. Although a rather disturbing sight when it occurs, it is usually of no great concern; most perforations heal very promptly. 

The treatment of middle ear infections involves adequate analgesics and a full course of antibiotics. Decongestant preparations may also help by keeping the eustachian tube more open and taking some pressure off the eardrum. If a perforation has occurred, a follow-up check is advised to see that it has healed. Because pressure changes can damage the eardrum it is better to check with your doctor before any type of flying. 

Recurrent middle ear infections in young children can be associated with fluid accumulation in the middle ear space, a condition referred to as "glue ears". Because hearing can be affected, referral to an ENT (ear, nose and throat) specialist is usually arranged. The insertion of tiny grommet tubes in the eardrums may be required to ensure that hearing is not affected. 

Sometimes milder intermittent earache can occur. This may be due to eustachian tube blockage without actual infection. Often this responds to decongestants and exercises to inflate the middle ear...like pinching the nose and "popping the ears" or, in younger children, blowing up balloons. 

Complications from ear infections are very unusual these days. Up to a few decades ago it was common for people to develop abscesses, chronic discharge and hearing loss from what we regard today as fairly minor infections. 

Health Tip:
* If a baby is very upset and distressed, think of the possibility of an ear infection.

* The old advice " put nothing in your ear smaller than your elbow " is just as true as it ever was.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001