Ear Infections

What You Should Know

Otitis Media
Swimmer's Ear
Chronic Suppurative Otitis Media

Otitis Media

Causes

Otitis media refers to inflammation of the middle ear and is the most common cause of earaches. When infection occurs, the condition is called "acute otitis media." Acute otitis media can occur when a cold, allergy, or upper respiratory infection--or the presence of bacteria or viruses--leads to a build-up of pus and mucus that blocks the Eustachian tube. The build-up provides a fertile breeding ground for bacteria that can cause inflammation or infection.

If media otitis lasts for weeks without clearing up despite treatment, it is called chronic otitis media. A fluid buildup in the ear without infection is termed serous otitis media.

Symptoms

The primary symptoms are earache and swelling, although it may also be accompanied by a stuffy or runny nose, sore throat and fever. Otitis media may result in serious complications if it is not treated. An untreated infection can travel from the middle ear to the nearby parts of the head, including the brain. Although the hearing loss caused by otitis media is usually temporary, untreated otitis media may lead to permanent hearing impairment. Persistent fluid in the middle ear and chronic otitis media can reduce a child's hearing at a time that is critical for speech and language development. Children who have early hearing impairment from frequent ear infections are at greater risk for speech and language disabilities.

Diagnosis

An examination of the ear using an otoscope will determine if otitis media is present. Inflammation of the eardrum indicates an infection. Tympanometry, which checks for fluid in the middle ear may also be conducted. If needed, an audiologist will perform a hearing test to determine if there is hearing loss.

Treatment

In cases where an infection is present, treatment includes the use of antibiotics. If the patient is experiencing pain, the physician may also prescribe a pain reliever. Persistent or recurrent infections may require surgical intervention.

Swimmer’s Ear (otitis externa)

Symptoms

Swimmer’s ear is usually accompanied by ear pain, especially when pulling the outer ear. Other symptoms include itching of the ear or ear canal, discharge from the ear, and swelling or redness around the ear.

Causes

Swimmer's ear (otitis externa) is an inflammation and infection of the ear canal. It is a fairly common condition, especially among teenagers and young adults. It occurs when water, dirt or debris gets into the ear canal. Swimming in polluted water and scratching the ear canal, especially with cotton swabs or small objects, can also inflame the ear canal. Other bacteria, and occasionally, fungus, can also cause infection. Skin conditions such as eczema or psoriasis can also cause a chronic, long-term external ear inflammation.

Diagnosis

An examination of the ear using an examining microscope will be conducted to evaluate the cause of the condition. In some cases, seeing the eardrum may be difficult because of the swollen outer canal. Performing a culture on the ear's drainage may identify bacteria or fungus and direct therapy.

Treatment

Treatment may include ear drops containing antibiotics to address the infection, and corticosteroids to reduce itching and inflammation. If the ear canal is very swollen, a wick may be applied in the ear to allow the drops to travel to the end of the canal. In some cases, medications may be used in addition to ear drops. A pain reliever may also be prescribed.

Chronic Suppurative Otitis Media

Symptoms

Chronic Suppurative Otitis Media (CSOM) refers to a perforated tympanic membrane and either constant or intermittent drainage from the ear. Symptoms include discharge from the ear and, oftentimes, hearing loss.

Causes

CSOM is usually the result of a chronic tympanic membrane perforation and infection in the middle ear. The infection usually extends to the mastoid bone behind the ear. It is aggravated by water entering the ear canal and getting through the tympanic membrane perforation into the middle ear. Upper respiratory tract infections (e.g. colds or the flu) can also aggravate the infection. If left untreated, CSOM can result in potentially devastating consequences such as permanent hearing loss, facial nerve paralysis, and infections of the spinal fluid (meningitis) or brain abscess.

Diagnosis

An examination of the ear using an otoscope and diagnostic microscope is used
to evaluate the condition. Audiograms are used to gauge the extent of hearing loss. A CAT scan may also be prescribed to determine the extent of disease.

Treatment

A combination of therapies may be used to treat CSOM. Antibiotics alone are usually ineffective as they do not address the tympanic membrane perforation and cannot often eradicate disease within the bone-enclosed mastoid. If the patient’s medical condition permits, surgery is often recommended in conjunction with antibiotic therapy. Specifically, a tympanomastoidectomy procedure in which the mastoid is opened and cleaned and the eardrum perforation is repaired is usually indicated. Depending on the extent of disease, the surgery may be staged, meaning a second surgery may be necessary to reconstruct the hearing mechanism after the infection has been addressed through the first surgery. The two procedures are usually spaced by approximately six months.