Ear infection

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What Is An Ear Infection?
Types
Symptoms
Causes
Risk Factors
Prevention
Diagnosis
Treatment
Home Remedies
Lifestyle/management
Prognosis
Complications
Alternative Treatments
References

Your ears are one of the most important sensory organs of your body and yet you manage to neglect it the most. They do their job in silence and hardly vie for your attention, but when they do, they do it with a vengeance. Ear infections can be painful and cause much trouble if you end up having one.

What Is An Ear Infection?

Your ears are one of your body's most important sensory organs, yet you neglect them the most. They do their job in silence and hardly vie for your attention, but when they do, they do it with a vengeance. As a result, ear infections can be painful and cause much trouble if you have one.

Types

The ear is divided into three parts: the external ear, middle ear and inner. Therefore, an infection can take hold in any of these ear regions.

External ear infection

The external ear infection is usually limited to the outer ear and is an outcome of a bacterial or fungal invasion. Some common reasons for superficial ear infection are:

Wax accumulation: Some amount of wax build-up in the ear is natural, but if excessive wax accumulation happens over time, it serves to be a perfect breeding ground for the bacteria or fungus to grow and thrive if water enters the ear while bathing. If neglected, the wax build-up can lead to a condition called a wax granuloma, wherein the eardrum can extrude through the ear tube, causing pain and watery discharge from the ears.

Otitis externa: This external ear infection is widespread with swimmers, so much so that it’s also known as Swimmer’s ears. Otitis externa usually happens if any liquid or fluid substance enters the ear. This fluid gives the exact environment to common fungal infections and occasionally to some bacteria, which are already present inside the ear, to grow and give rise to an infection. It can also trap bacteria due to excess use of earphones or if you use cotton swabs for cleaning the ears often. Excessive wax build-up and fluid accumulation inside the ear can also lead to the condition. Though the infection can be painful and troublesome, the good news is that it might not cause any permanent hearing loss like other ear infections. But an immediate treatment or consultation with an ENT specialist is highly recommended.

Middle ear infection

Most middle ear infections, also called otitis media, happen due to a common cold or allergies in the nasal or throat area. Usually, if the person suffers from a cough /cold and tries to blow his nose, infection from nasal and pharyngeal areas quickly enters the Eustachian tube that connects the throat and the middle ear. In addition, viruses and bacteria can sometimes reach the middle ear through the tube and cause an infection. This is because the eustachian tube equalises the pressure on both sides of the eardrum.

Also, they are more common in infants and babies than in adults. This is because bottle-fed babies can hold milk in the mouth for a longer time, reaching the middle ear space through the eustachian tube, which is shorter and straighter in infants.

A middle ear infection can range from an acute one to a chronic one.

Acute middle ear infections are usually characterized by sharp pain, irritation, and a low-grade fever. This kind of infection is generally of short duration and leaves soon after a doctor ensures proper care.

Chronic middle ear infections can be a little severe and bother a person for weeks or months. A chronic middle ear infection is characterized by pain, irritability and discharge through the ears. A chronic ear infection can either result in:

a) Eustachian tube dysfunction

b) Perforation in the eardrum

c) Erosion of the ear bones

In case of a chronic ear infection, medical attention becomes necessary as the infection can be fatal if ignored. It can also result in surgery or, worst case, hearing loss.

Internal ear infection

Though an internal ear infection or infection of the labyrinth is very rare, it could sometimes happen due to a viral attack that enters the bloodstream. If it is ignored for too long, it can lead to vertigo, a part of the inner ear that controls balance may be inflamed, triggering the same, or sudden hearing loss.

Symptoms

Whether it is an external, middle or internal ear infection, some of the common symptoms that one can suffer from following an ear infection are:

Acute pain in the infected ear

Occasional decrease in hearing

Discharge from the ears

Dizziness

Headaches along with ear pain

Fever

In the case of babies, apart from a bout of crying and refusal of a feed, constant tugging to the ears are common symptoms

Ear infections can sometimes be confused with temporomandibular joint dysfunction (TMJ). This disease mimics ear pain as the same nerve is shared between the jaw joint and the ear canal. Ear pain associated with activities like pain or difficulty during talking, chewing or yawning, the individual may most probably have TMJ. A dentist or a TMJ doctor visit will have expertise in treating this condition. Other causes of ear pain may also be a sore throat, infections of the ear canal (swimmer’s ear), allergies or cold, which may cause pressure to increase in the ears.

Causes

An ear infection is usually caused due to a bacterial or fungal attack and is more common in children than adults. In general, it can give rise to acute pain and cause a lot of disturbance at the onset.

Risk Factors

Certain risk factors increase one’s chances of getting an ear infection.

Age: It is seen that infants and children in the age group of 6 months to 2 years are at a higher risk of getting an ear infection.

Colds: If individuals have a cold, there are more chances of getting an ear infection.

Family history: Certain families can have a high predisposition to ear infections.

Allergies: In cases of allergies, inflammation and enlargement of the adenoids (a small part of tissue behind the opening of the cavity of the nose that traps bacteria and viruses) can take place, which can block the eustachian tube (a tube which connects the throat to the middle ear and helps in equalizing the pressure in the ear) and prevent drainage of ear fluid. This build-up of fluid in the ear can cause pain, pressure and risk of infection.

Chronic illnesses: Individuals with chronic illnesses, especially respiratory illnesses such as asthma, and those immunodeficient are at higher risk of getting ear infections.

Prevention

The organisms which cause ear infections, such as viruses or bacteria, are contagious, not the ear infection itself. It is, therefore, vital to keep the following things in mind to prevent ear infections. The standard preventive measures include –

Breastfeeding- Breastfeeding can build immunity in your child and should be exclusively done for the first six months. It is important to maintain an angle while breastfeeding to prevent the milk from going into the eustachian tube and becoming a cause of infection.

Vaccinations- As pneumococcal bacteria is the most commonly occurring ear infection, vaccinating your child with a pneumococcal conjugate vaccine can help protect against several strains of this bacteria.

Keep your ears dry: Avoid cleaning your ears with an earbud at home. Instead, go for a professional clean-up at least once a year to remove the wax developed in your ears. If you get fluids in your ears while using a hairspray, during the rains, or while swimming, make sure to clean the outer ear with a clean cloth to avoid bacteria or fungal growth that can lead to an infection. Avoid excessive use of earphones and keep the decibel levels low. Do not put in cotton swabs inside your ears as that can lead to trapping bacteria within.

Precautions- If your child goes to a day-care, insist on good hand hygiene practices and avoid sharing food to minimize infections. Also, avoid exposure to smoke and people who smoke.

Don’t ignore a warning sign: If you suffer from an ear infection symptoms, it is wise to get tested by an ENT specialist.

Diagnosis

To diagnose an ear infection, history taking and physical examination will be initially done. The doctor will ask about any signs of ear pain or related symptoms in history taking. In the physical examination, the doctor will pass a scope into the ear to identify any signs of infection, swelling or pus. He may also assess the stiffness of the eardrum, which indicates infection, by passing a small puff of air into the ear. Certain tests can be done to differentiate between recent infections or chronic infections. This is important as the treatment for both is different. Other tests may also be performed, which are as follows.

Hearing test- The doctor may prescribe this in repetitive ear infections to rule out impaired hearing.

Tympanometry- The eardrum movement can be assessed via this test in which varying amounts of air are inserted into the ear canal.

Acoustic reflectometry—This test is used to assess the amount of fluid in the ear to rule out infections.

Tympanocentesis— This test is used to assess the type of infection present. The fluid or pus from the ear is removed with a needle under anaesthesia. This fluid is then cultured to assess which medication will best work on it.

Treatment

If the infection is not severe usually medical management takes care of it with antibiotics and nasal decongestants. However, chronic middle ear infections with ear perforations and bony destruction require surgical management.

Some of the common treatments and procedures to treat ear infections are as follows:

Cleaning of the wax:

If wax build-up in your ears gives rise to an infection, a cleaning needs to be done to address the problem. The doctor does this professional cleaning under a head light with specialized micro instruments. Many practitioners also practice the syringing technique to clean the wax but it is highly condemned and obsolete now. Also, do not use ear buds to clean the ear as they are unsterile and may cause an injury if not used properly.

Using ear drops:

Sometimes if a professional cleaning is not needed then some ear drops might be suggested to help dissolve the wax and address the infection. Many OTC ear drops are also available to address the problem of wax buildup. It is advisable not to use any ear drops without a proper examination from your ENT specialist

Sometimes surgeries like the following might be suggested to treat an uncontrolled ear infection:

Tympanoplasty: ‘If a middle ear infection has made certain perforations on the eardrums of the ear, then a tympanoplasty is done wherein surgically a new eardrum is grafted for the patient to counter hearing loss and fight the infection.

Recent advances now allow endoscopic surgery which has no stitches and faster recovery.

Mastoidectomy: In case the ear infection erodes the bones in the ear leading to a condition called cholesteatoma, an immediate surgical intervention is necessitated. In mastoidectomy, the disease or infected part of the mastoid bone behind the ears, is drilled out to stop the infection from reaching the brain. Else it could lead to a permanent hearing loss in the individual.

A surgery to address ear infection can be an OPD procedure or might need a day’s stay in the hospital; following proper after care instruction provided by the doctor can help one get back to normalcy pretty soon.

Home Remedies

Certain home remedies can help relieve ear pain till you show it to the doctor.

Cold or hot compression: Using heat or cold on the affected ear, can help relieve pain.

Sleeping position: Taking a position that places your affected ear at a height above the rest of your body or alternating sleeping sides, depending on which ear is affected, can help relieve pain. These simple techniques will help relieve pressure on the affected ear, which will, in turn, reduce pain.

Lifestyle/management

Individuals with an ear infection can take certain steps to help themselves.

Xylitol, a natural sugar originating from fruits, can be used in chewing gum or candy. Chewing this can help regulate bacteria in the mouth.

Avoid smoking and exposure to second-hand smoke to reduce ear infection recurrences.

Reduce the use of pacifiers in babies to prevent ear infections.

Unearth the reason behind ear infections, by consulting with a good physician to identify if food allergies cause the ear infections.

Avoid stacking things into children’s ears to relieve their pain. Instead, consult a physician.

In the case of ear infections, there is no need to cover one’s ears when venturing out.

Swimming may be done, as long as there is no tear in one’s ears and no fluid or pus drainage.

High altitudes or plane journeys should be avoided to reduce ear pain when taking off or landing due to pressure differences. This can be minimized by chewing on a candy, swallowing water or utilizing pacifiers (in children), if these trips cannot be avoided.

Ear infections are not contagious; children can resume school once the fever abates.

Prognosis

ppropriate medication, most ear infections clear up within a few days, and pain relief may occur within a few hours. However, if untreated, the infection may spread, leading to mastoiditis (infection in the mastoid bone) or, in rare circumstances, even meningitis. Some individuals may also face difficulties in hearing. In younger children, it may impair the development of speech and language.

Complications

Complications of ear infection are rare but may occur if left untreated.

Hearing loss: Hearing loss, which may be mild or temporary, may occur due to repeated ear infections.

Delayed speech and language development: Due to muffled hearing, children's speech development may be impaired, as they require to listen to speech and language to hone these skills.

Tear in the eardrum: Prolonged pressure from the eardrum fluid can cause a eardrum tear. This may be seen in about 5% to 10% of children, which may require surgery if it does not heal on its own.

Spread of the infection: Ear infections, if left untreated, may spread to neighbouring bones and organs, causing mastoiditis (mastoid bone-the bone posterior to the ear) and meningitis (infection of the membranes surrounding the spinal cord and the brain).

Alternative Treatments

Some natural therapies are seen to be beneficial in ear infections.

Herbal ear drops- A mix of St. John’s wort, garlic and calendula effectively reduces ear pain in cases of ear infection.

Xylitol- This natural sugar is effective in ear infection when taken several times a day over some months as it has been found to be effective against the progress of certain bacteria.

However, it is precautionary to talk to your physician before starting any natural therapy as there may be certain interactions between this treatment and the treatment you are currently on. Herbal remedies can be effective and safe, but topically may be irritating when used. Xylitol has also been found to be safe but can cause an upset stomach and diarrhoea, if doses exceed 30 grams in a day.

References

3 Home remedies for an ear infection. Cleveland Clinic. Available at: https://health.clevelandclinic.org/3-home-remedies-for-an-ear-infection/. Accessed on: March 29, 2021.

Ear Infection. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/8613-ear-infection-otitis-media. Accessed on: March 29, 2021.

Ear Infection. Familydoctor.org. Available at: https://familydoctor.org/condition/ear-infection/. Accessed on: March 29, 2021.

Diagnosis of Middle Ear Infection. Winchester Hospital. Available at: https://www.winchesterhospital.org/health-library/article?id=19357. Accessed on: March 29, 2021.

Recurrent ear infections (holistic). Peace Health. Available at: https://www.peacehealth.org/medical-topics/id/hn-1207009. Accessed on: March 29, 2021.

Middle ear infection. Harvard Health Publishing. Available at: https://www.health.harvard.edu/a_to_z/middle-ear-infection-otitis-media-a-to-z. Accessed on: March 29, 2021.