Ear infection, or “otitis,” can affect the inner ear or outer ear. Otitis media is an infection of the middle ear, the area right behind the ear drum. It usually occurs when a cold or an upper respiratory infection introduces bacteria into the ear through the eustachian tube. Otitis externa, also known as “swimmer’s ear,” is an infection of the outer ear and ear canal due to spending long periods of time in the water.
Ear infections are common, especially among children. According to the College of Family Physicians of Canada, more than three quarters of all children will have at least one ear infection by their third birthday, and nearly half of those will have three or more infections by then.
Signs & Symptoms
Acute otitis media (AOM), where parts of the middle ear are infected and swollen, is the most common ear infection, according to the National Institutes of Health. Common symptoms of AOM are earache and fever, though some people may also experience hearing loss, headaches and problems with balance, according to the Mayo Clinic. Children may be too young to describe what’s wrong, and as a result may get fussy, cry excessively, have trouble sleeping and have a reduced appetite. Pus or blood might drain from the ear if the ear drum has burst.
Otitis media with effusion (OME) happens when fluid stays trapped behind the ear drum. OME may not present any symptoms and it can happen after an ear infection has run its course, according to the NIH. Otitis externa have symptoms that are very similar to middle ear infections, though people may also experience itchy and painful ear canals. It can lead to a slight amount of clear discharge that can turn yellowish without treatment.
Diagnosis & Tests
Ear infection can be detected through a simple examination of the ears at the physician’s office with a small lighted instrument called the otoscope. An infected ear may have areas of dullness or redness or there may be air bubbles or fluid behind the eardrum. The doctor will also examine the throat and sinuses and see if the patient has any recent cold or allergy symptoms.
Additional tests may be performed to further confirm the diagnosis and differentiate between AOM and OME. Tympanometry uses sound tones and air pressure to measure how flexible the eardrum is at different pressures. Reflectometry places a small instrument near the ear and measures how sound emitted from the device is reflected back from the ear drum. This allows the doctor to see if there’s fluid trapped behind the eardrum.
Treatments & Medications
Although ear infection is usually caused by bacteria and antibiotics are often prescribed, neither OME or AOM should be treated with antibiotics at initial onset, according to the Centers for Disease Control and Prevention. In fact, OME usually will not benefit from antibiotic treatment since it can occur after the infection. Children from 2 months to 2-years-old with non-severe illness should be placed on observation for the initial 48 to 72 hours, according to a guideline drafted by the American Academy of Family Physicians and the American Academy of Pediatrics. Antibiotics, specifically amoxicillin, could be prescribed if illness does not improve after the observation period. A standard 10-day course is recommended for younger children and for children with severe illness; whereas a five- to seven-day course is appropriate for children 6 and older with mild to moderate illness.
Unlike OME and AOM, otitis externa will usually require antibiotic treatment, according to CDC guidelines. Corticosteroids can also be used for reducing itching and inflammation. In all types of ear infection, pain relievers like acetaminophen (such as Tylenol) or ibuprofen (such as Advil) can help reduce pain and fever.
Risks of ear infection can be reduced by simple hygienic practices such as keeping hands and toys clean. Vaccinations with influenza vaccines and the 7-valent pneumococcal conjugate vaccine (PCV7) can also reduce the risk of illness and subsequent ear infections, according to the CDC. In addition, homes should be kept smoke-free since studies collected by the NIH have shown that babies have more ear infections when they are exposed to secondhand smoke.
Breastfeeding or the use of fully ventilated bottles have also been found to reduce incidences of AOM. According to a 2009 study in the journal Pediatric Research, breastfed children have more serum antibodies, which can help them fight off AOM. In addition, when a baby is bottlefed, negative pressure inside the bottle may cause the infant to suck excessively and generate negative pressure within the eustachian tube, which can encourage AOM.
Otitis externa can be avoided by limiting time spent in water, according to the NIH. After swimming, water should be drained from the ear canal by turning the head to the side and pulling the earlobe in different directions. According to the CDC, do not insert cotton swabs into the ear since this can scratch up the ear canal or the wax layer, which can increase the risk of infection. Keeping pools and hot tubs clean with disinfectants and regular pH testing will also reduce the risk of infection.
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Dr. Troost is a ENT specialist in medical and surgical management of ear, nose and throat problems. He also focuses on problems with snoring and sleep apnea