Bacterial or viral infection of the ear canal, eardrum or the middle ear is termed as ear infection. Infection of the ear canal affecting the visible external portion of the ear and ear canal is termed as otitis externa. This is mainly observed in swimmers due to contact of water to the ear. Infection of the middle ear is termed as otitis media.
Majority of the middle ear infections follow after common cold or other respiratory infections due to swelling of Eustachian tubes. Swollen tubes often block ear discharge from draining outside making it a fine place for growth of microorganisms. Ear infections can be bacterial infections caused by bacteria such as streptococcus pneumonia and haemophilus influenza or viral infections caused by flu virus. Young children with small tubes often contract ear infections. Allergies, weak immune system, birth defects, medical conditions such as down’s syndrome, exposure to cigarette smoke, use of pacifier and family history of ear infections often increases the risk for ear infections in children.
Types of ear infections (Otitis media)
- Acute otitis media: Persists for short duration. Characterized by fluid accumulation in the middle ear, swollen or ruptured eardrum, drainage of fluids and fever.
- Chronic otitis media: This persists for minimum of month. In addition to symptoms observed in case of acute otitis media, damage to eardrum and middle ear may also be observed. Chronic ear infection often starts gradually without pain and fever. Ear pressure continues to persist for months. Impaired hearing is one other chronic ear infection symptom.
Symptoms of Ear Infection
- Pain in the ears: Pain with impaired hearing is observed in case of infection of middle ear (Otitis Media). Babies who cannot express pain often remain fussy and pull the ears out of earache.
- Feeling of fullness of ears: This is due to fluid buildup in the ears. In an attempt to relieve ear pressure children often rub the ears. Ringing sound may also be heard in the ears. In few cases, fluid buildup may be observed without any infection termed as otitis media with effusion. In such cases, child feels ears are plugged and finds difficulty to hear. Discomfort in hearing without infection often disappears in few weeks after the fluid disappears.
- Few children with ear infection do not show ear infection symptoms. If symptoms develop they develop rapidly. Commonly observed symptoms of ear infection include:
- Impaired hearing: Children with poor hearing ability due to ear infection often remain inattentive and cranky.
- Discharge from ears: Infection of the ear termed as otitis externa often results in discharge from ear canal. Discharge from ears is yellow, thick and bloody in cases of middle ear infection. This occurs due to rupture of eardrum that often gets self healed within few weeks.
- Nausea, vomiting and loss of appetite.
- Lack of sound sleep.
- Vertigo: the patient finds difficulty to balance upon standing and suffers with dizziness.
Complications in Ear Infections
- Suppurative otits media: This is a chronic ear infection that develops due to recurring middle ear infections.
- Hearing loss: Permanent damage to eardrum or other structures of middle ear often results in permanent loss of hearing.
- Delay in speech: Due to temporary or permanent loss of hearing the child may show delay in development of social skills, speech and developmental skills.
- Meningitis: Infection of the tissues around spinal cord and brain.
- Mastoiditis: Infection of the bone present behind the ear.
- Meningitis and Mastoiditis that develop due to spread of ear infection are often rare. Immediate medical attention should be given to signs of ear infection.
Treatment of Ear Infections
Ear infections often get cured without any medical intervention within a week or two. Ear infection symptoms that do not seem to get better within 48 to 72 should be treated before the onset of complications. When the child complains of ear pain, the doctor looks in to the ear using pneumatic otoscope for fluid buildup and infection. Lack of free movement of eardrum upon pushing air in to the ear with the pneumatic otoscope is often an indication for infection or fluid buildup. This is often painful in few children. Other tests used to diagnose ear infections include tympanometry, hearing tests, tympanocentesis and blood tests to know problems of immune system.
Majority of ear infections symptoms can be relieved with over the counter pain medications. But, children with high risk of complications, those under two years of age and children with cochlear implants should be treated with antibiotics.
Plenty of rest: Ear infection symptoms can be relieved by taking rest. Activities such as scuba diving, extensive bending, coughing and sneezing should be avoided.
Heat compresses: Use of heating pad or warm cloth helps to relieve earache.
Pain relievers: Non steroidal drugs such as ibuprofen or acetaminophen can be used to relieve pain. Depending on the condition, pain relievers such as acetaminophen can be taken once in every 4 hours.
Cleaning: Ear discharge should be cleaned thoroughly to prevent other infections.
Drugs to ease ear pressure: Over the counter drugs such as Sudafed containing pseudoephedrine can be used to reduce ear pressure. They can be taken for two to three days once in every six hours. However, patients with high blood pressure and had an attack of chicken pox within the last three weeks of contracting ear infection should not take these drugs.
Ear drops: Ear drops containing neomycin, polymixin B or hydrocortisone can be used for four to five days once in every four hours. These work best to treat otitis externa. Ear drops should not be used if eardrum has ruptured. Ear drops work by creating an acidic environment that prevents bacterial growth.
Oral antibiotics: Ear infection symptoms such as discharge from the ears, mouth or nose can be relieved by using oral antibiotics for about five days or until the symptoms subside completely. Amoxicillin, trimethoprin or erythromycin are often used in combination with sulfa drugs such as sulfisoxazole to treat ear infections.
Surgery: In case of recurring ear infections and fluid buildup, a minor surgery is performed to insert Eustachian tubes to help the child to hear properly and avoid recurring infections. In few cases, tonsils and adenoids may also be removed to prevent recurring ear infections and fluid buildup to prevent permanent loss of hearing. After placing the ear tubes antibiotic ear drops may be used to treat any existing infections. However, otitis media with effusion often gets cured gradually without using any medications after placing the tubes.
Ruptured ear drum that does not heal on its own is closed by a surgical procedure termed as myringoplasty or tymplanoplasty.
Herbal remedies: Few people use herbs such as garlic and Echinacea capsules to treat ear infections. But this remedy is not proven scientifically. Herbal eardrops containing calendula, mullein, garlic and St.John’s wort reduce ear pain effectively like over the counter ear drops.
Chronic suppurative otitis media that is hard to treat is often treated with use of antibiotics as ear drops. Accumulated fluids should be suctioned out before administering the drops.
Decongestants and antihistamines use to relieve symptoms of cold often do not relieve ear infection symptoms. Use of antihistamines causes thickening of ear fluids and makes the condition worse.
Rare cases of ear infection symptoms caused by fungi are treated using antiseptics and antifungal agents such as clotrimazole and micanozole. Fungal ear infections are characterized by white mold like appearance of the ear canal.
Preventive and precautionary steps to be taken
- Avoid smoking and also prevent the child from coming in contact with second hand smoke.
- Hand washing and following the immunization schedules help to reduce the risk of respiratory infections and ear infection symptoms. Children should be given Pneumococcal conjugate vaccine and vaccines against influenza virus and Haemophilus influenza type B virus.
- Avoid the child from getting in to sleep while sucking bottle or a pacifier.
- Breast feeding especially babies with family history of ear infections reduces the risk for ear infections.
- Prefer child care centers with few children.
- Intake of probiotics containing lactobacillus reduces the risk for not only intestinal infections but also cold and ear infections.