Ear Infections

An ear infection occurs when fluid becomes trapped in the middle ear following a viral or bacterial infection. This painful affliction is most common in children, but can affect people of all ages. Ear infections can be either acute (of short duration) or chronic (persisting or reoccurring frequently).

Causes

The majority of ear infections are viral or bacterial in nature, usually occurring after a cold or upper respiratory infection. These conditions cause swelling of the Eustachian tube, a small canal that connects the middle ear to the nostrils and provides an outlet for fluid drainage, trapping germs and fluid in the middle ear and leading to infection.

Because children are still growing physically, some of their internal organs may also be temporarily underdeveloped. This is true of the Eustachian tube, the canal that connects the middle ear to the nostrils, providing an outlet for fluid drainage. Because the Eustachian tube is smaller in children, it is more prone to swelling; when this occurs, fluid is trapped in the middle ear. This fluid presses against the eardrum, causing pain, and can harbor germs that lead to infection. The result is an earache and, in some cases, loss of hearing. When the infection does not completely go away or returns often, it is referred to as chronic.

Symptoms

The hallmark signs of ear infection are pain and pressure in the ear and fluid drainage. These may be accompanied by a low-grade fever and hearing loss. Infants are often fussier than usual, and may cry inconsolably, refuse to eat and have trouble sleeping. They may also pull or tug on the ear. Symptoms may be milder in chronic ear infections. Should your child display any of these symptoms, bring them to the doctor; the sooner an acute ear infection is treated, the lower the chances of it developing into a chronic condition.

Treatment

Treating an ear infection begins at home. To help soothe symptoms, gently press a warm washcloth against the affected ear. You may give your child eardrops and over-the-counter medications such as acetaminophen or ibuprofen to help relieve pain. Avoid aspirin, which can be dangerous to young children.

Your child’s doctor will likely prescribe antibiotics to treat a chronic ear infection. These should be taken until used up, even if your child’s symptoms appear to be improving; otherwise, the infection could worsen.

When medication is not effective, a surgical solution involving ear tubes may be considered. These are inserted in the middle ear and provide ventilation and fluids, keeping the ear clear and preventing infection. Most ear tubes remain in place anywhere from six to 18 months and eventually fall out on their own. If not, surgery to remove them is performed.

Complications

If left untreated, chronic ear infections can lead to a variety of complications including hearing loss, damage to the bones in the middle ear, balance problems, a middle ear cyst called a cholesteatoma, facial paralysis and inflammation of the brain. For these reasons, early detection and treatment are crucial. Better still is prevention.

You can’t always stave off an ear infection, but there are steps you can take to reduce the chances of your child developing one. These include breast-feeding your baby, making sure he or she is up-to-date on vaccinations, practicing good hygiene (e.g., regular hand-washing), keeping your child away from tobacco smoke, and enrolling them in as small a day care or preschool facility as possible. Simply put, fewer children mean fewer germs.

Swimmer’s Ear

When water becomes trapped in the ear, bacteria can cause inflammation and infection of the ear canal. This painful affliction is known as swimmer’s ear and can occur following exposure to any moist environment. It is most common in children and teenagers, individuals with eczema and anybody with excess earwax.

What Causes Swimmer’s Ear?

Anybody who comes into frequent contact with water could develop swimmer’s ear (also known as external otitis). Activities such as swimming, surfing, diving and bathing are the most common causes. Water entering the ear canal can become trapped, especially when earwax is present. Any cut in the skin of the ear canal can increase the risk, as will coming into contact with water that is polluted or contains excess bacteria. Despite the name, water exposure isn’t the only way of contracting swimmer’s ear; it can be caused by anything that damages the protective film of the ear canal, such as cotton swabs, chemicals found in hairspray or hair dyes, etc. Skin conditions like eczema, psoriasis and seborrhea may also contribute.

Itchiness and pain are usually the first symptoms to appear. There may be a feeling of fullness in the ear, followed by swelling, redness and drainage of fluids. Fever, temporary hearing loss, and swollen lymph nodes may occur. If left untreated, swimmer’s ear can lead to permanent hearing loss, chronic ear infections and damage to the cartilage and bone.

Prevention and Treatment of Swimmer’s Ear

The best way to prevent swimmer’s ear is to keep moisture from entering the ear canals.

There are earplugs specially designed for swimmers that will keep water out. Or try a solution of vinegar and rubbing alcohol applied in droplet form to your ears before any water exposure. Wear a shower cap when bathing, and always dry your ears thoroughly after swimming and bathing.

If you do develop swimmer’s ear, home remedies are often a simple and effective method of treatment. Rinse and flush your ears with a saline solution or mixture of vinegar and warm water, and use a warm compress and over-the-counter pain medication to treat discomfort. If your condition is the result of a bacterial infection, you will be prescribed antibiotics.

Surfer’s Ear (Exostosis)

Those with frequent exposure to cold water – most commonly surfers and swimmers – often suffer from reactive exostosis, an inflammation of the bone in the ear canal that leads to the formation of new bone growth. Known medically as exostosis but referred to informally as surfer’s ear, this condition causes bone to thicken, leading to a narrowing (and occasionally, a complete blockage or “occlusion”) of the ear canal. It can result in significant conductive hearing loss over time.

Symptoms

As the ear canal narrows, water can become trapped inside, resulting in frequent ear infections. The infections as well as a loss of hearing and the sensation of “plugged up” ears that do not drain are the primary symptoms of surfer’s ear. The condition itself is not dangerous, but left untreated the danger of occlusion and an accompanying hearing loss increases.

Treatment

Treatment usually involves an outpatient surgical procedure known as canalplasty. This procedure is performed under general anesthesia. A surgeon uses a binocular microscope and drilling or chiseling out the bone growth. The surgeon usually performs this surgery through the ear canal, but may also make an incision behind the ear. While recovering from this procedure, it is very important to not expose the ear canal to water, as this could lead to further infections. Recovery takes between a few weeks and a few months.

Prevention

Avoiding surfing and swimming in extremely cold water or during especially windy conditions is the key to preventing surfer’s ear. In addition, keeping the ear canals warm and dry by wearing earplugs, a swim cap or a hood can all help. Custom earmolds are your best bet to ensuring a tight seal and all-day comfort.

Cholesteatoma

Cholesteatoma is an abnormal skin growth in the middle ear behind the eardrum that may also affect the mastoid (skull bone). It begins as a cyst that gradually increases in size, destroying the bones of the middle ear and causing hearing loss.

Causes

When the Eustachian tube is functioning normally, it equalizes ear pressure by moving air from the back of the nose into the middle ear. Allergies and viruses can affect performance, leading to a partial vacuum in the ear. This negative pressure stretches the eardrum, creating a pocket or cyst that fills with old skin cells and waste material, which can become easily infected. In rare cases, cholesteatoma can be congenital (present at birth).

Symptoms

Symptoms of cholesteatoma include drainage from the ear, a feeling of fullness, hearing loss, earache and dizziness. Since these are also present in other conditions, tests such as CT scans and electronystagmography can be used to rule out other conditions and confirm the diagnosis. Cholesteatomas continue to grow if not treated and can lead to complications such as:

  • Deafness.
  • Facial paralysis.
  • Brain abscess.
  • Meningitis.

Treatment

An otolaryngologist will determine the size and growth rate of the cholesteatoma and recommend treatment based on these findings. Controlling the infection with antibiotics or eardrops is a crucial first step.

If you have a large cholesteatoma it may be treated surgically. Performed under general anesthesia on an outpatient basis, the cholesteatoma is removed in order to eliminate the infection. Follow-up surgery to ensure the cholesteatoma is gone and to reconstruct damaged middle ear bones may be necessary.

Call Eastern Shore ENT & Allergy at (410) 742-1567 for more information or to schedule an appointment.