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Ear Infections

Diagram of the human ear: outer, inner and middle ear 

There are three different types of ear infections:

  • Outer Ear Infections
  • Middle Ear Infections
  • Inner Ear Infections

Treatment for each of these varies depending on the type and location of each infection.

Outer and middle ear infections are seen commonly. Inner ear infections are less common.

Outer Ear Infections

Outer ear infections are sometimes referred to as swimmer’s ear, because it can be caused by water or moisture in the ears. Although some outer ear infections may be caused by swimming, most are caused by a combination of heat, moisture (e.g., sweat) and local trauma (e.g., scratching the ear canal).  

Many outer ear infections actually start as a type of heat rash, starting with itching of the ear.  When the ear starts to hurt or feels blocked, typically you may try to clean the ear with cotton swabs (Q-tips) or irrigate it with solutions like hydrogen peroxide. Unfortunately, this tends to make the issue worse. As the swelling in the ear canal worsens, the pain may become severe. The ear becomes more tender to the touch and may become red and swollen. The ear canal swelling can lead to pain, drainage from the ear and sometimes trouble hearing.

Earwax serves a protective function and can actually help prevent outer ear infections. But beware, ear wax may build up and block hearing. If you attempt to remove it yourself, it may lead to infection, damage, or chronic dermatitis of the ear canals.

Treatment for Outer Ear Infections

Treatment of an outer ear infection requires a careful examination by a physician, a thorough and gentle cleaning of the ears, and usually some sort of ear drops. Antibiotics by mouth are occasionally required and severe cases may require hospitalization and medication through an IV. Although most cases of outer ear infections are caused by bacteria, some may be caused by fungi or viruses, such as H. Zoster (shingles). In these cases, your physician may suggest more specialized treatment.

Middle Ear Infections

A middle ear infection is an infection of the space behind the ear drum. This type of infection is very common in children.  However, middle ear infections can and do occur at any age.

Some middle ear infections may follow a cold or sinus infection, while others may follow a quick change in pressure that can happen, for example, when flying in an airplane. Severe middle ear infections usually cause quickly worsening ear pain and muffled hearing. The pain may worsen over just a few hours, and in some cases, the pressure may cause the eardrum to rupture or burst with sudden drainage from the ear, this may be pus or blood. Unlike outer ear infections, moving the ear itself (pulling on your ear) is not usually painful.

There is another type of middle ear infection that involves infection of fluid caught behind the ear drum (much like mucous trapped in a sinus). This condition may not cause pain, but you may experience a significant hearing loss and feeling of your ear being blocked. This is because the fluid prevents good movement of the eardrum and hearing bones, affecting your hearing.

Treatment for Middle Ear Infections

The number of ear infections and the number of children with repeated ear infections are both on the rise. Antibiotics have been the treatment of choice for middle ear infections, but bacterial resistance is increasing and has required longer courses of treatment and more potent antibiotics. Surgery, in the form of ear tubes, removal of the adenoids and or tonsils, are sometimes necessary. Untreated middle ear infections can result in temporary or permanent hearing loss and other complications. Medical evaluation, treatment, and monitoring are therefore necessary and appropriate. In children, exposure to smoking is an important risk factor that can lead to an increased number of infections. Parents and caretakers are strongly urged to quit smoking.

Inner Ear Infections

Inner ear infections are actually not usually infections at all. While true infections of the inner ear can occur, they are quite rare and are usually associated with severe illness such as meningitis. Most conditions diagnosed as inner ear infections involves inflammation or irritation of the balance centers in the ear. These episodes of inflammation usually result in the very sudden, severe dizziness, often with nausea and vomiting. Any sudden change to your hearing should quickly be evaluated as well, whether or not it is also accompanied by severe acute dizziness. 

Treatment for Inner Ear Infections

There are several possible causes for these types of spells and medical attention and evaluation are definitely warranted. Antibiotics are usually not necessary for these episodes, since very few are actually caused by bacteria. Many cases are thought to be the result of prior or active viral infections. If you suffer an acute attack of dizziness or change to your hearing, timely medical evaluation is important.

If you think you might have an ear infection, and would like to make an appointment to see one of the ENT physicians, please call MetroHealth Medical Center at 216-778-8890.

young boy having his ears examined
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