Ear Infections

There are three different types of ear infections: Outer, Middle, and Inner. Treatments vary depending on the type and location of each infection.

Outer Ear Infections

Outer ear infections are often lumped together with the condition known as swimmers ear. Although some outer ear infections, called Otitis Externa, may be caused by swimming, most are caused by a combination of heat, moisture (e.g., sweat) and local trauma (e.g., scratching).  

Many outer ear infections actually start as a type of heat rash, often accompanied by itching. The skin inside the ear canal swells and the ear becomes tender, feeling blocked. Unfortunately, the common tendency to attempt cleaning the ear with cotton swabs (Q-tips) or irrigating it with solutions such as hydrogen peroxide, usually aggravates the condition. As the swelling in the ear canal increases, the pain may become severe. The ear becomes more tender to the touch and may become red and swollen.

Treatment requires a careful examination by a physician, a thorough and gentle cleaning of the ears, and the topical application of antimicrobial and anti-inflammatory medication. Antibiotics by mouth are occasionally required and severe cases may require hospitalization and intravenous medication. 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 will direct you to more specialized treatments.

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 without proper visualization and equipment it may lead to infection, damage, or chronic dermatitis of the ear canals.

Middle Ear Infections

Middle ear infections, called Otitis Media, represents an infection of the space between the eardrum and the inner ear. After the common cold, these infections are the most common illness of childhood, and the most frequent reason that children seek medical care.  However, middle ear infections can and do occur at any age, but they are uncommon before the age of about six weeks.

Middle ear infections most often occur between the ages of six months and three years. A second peak period occurs between four and six years old. Some middle ear infections may follow a cold or sinus infection, while others may follow abrupt pressure changes that may occur, such as when flying in an airplane. Severe infections usually manifest as a rapid onset of ear pain and hearing is muffled. The pain can accelerate over just a few hours, and in some cases, the pressure may cause the eardrum to rupture with a sudden discharge of mucous, pus, or blood. As opposed to outer ear infections, movement of the ear itself is not usually painful.

A related condition, Otitis Media with Effusion (OME) or Chronic Serous Otitis Media (CSOM), results from the presence of fluid or mucous trapped behind the eardrum (much like mucous trapped in a sinus). This may have no associated pain, but is associated with a significant hearing loss; this is because the fluid prevents efficient motion of the eardrum and hearing bones.

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, adenoidectomy, and tonsillectomy, are sometimes necessary. Untreated middle ear infections can result in temporary or permanent hearing loss and other complications. Medical evaluation, intervention, and surveillance 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 usually not 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 are inflammations or irritations of the balance centers in the ear. These episodes of inflammation usually result in the very abrupt onset of severe dizziness, often accompanied by nausea and vomiting.

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. A good number of incidents are thought to be the result of prior or active viral infections. If you suffer an acute attack of dizziness, 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.