Ear infections are a common ailment and a frequent reason for medical visits, especially in children.
Ear infections can occur in the middle ear (acute otitis media), inner ear (otitis interna) or outer ear, also known as swimmer’s ear (otitis externa). Infections can be acute, happening over a brief timeframe. In other instances, they can come and go, known as chronic ear infections.
The middle ear consists of three small bones: the malleus, incus and stapes, commonly referred to as the hammer, anvil and stirrup. Along with the tensor tympani muscle, these tiny bones in the tympanic cavity play an important role in transmitting sound vibrations from the outer ear to the inner ear. They carry sound waves through the middle ear, enabling us to hear.
Middle ear infections result from a bacterial or viral infection in the middle ear as well as a blockage in the eustachian tubes – the tubes that run from the middle ear to the back of the nose. The eustachian tubes play an important role in regulating air pressure, air flow and draining normal ear secretions from the middle ear. In a middle ear infection, the bacteria or virus causes fluid to build up in the middle ear behind the ear drum, leading to swelling, pain and other symptoms.
Several factors can cause this build up or blockage, including:
Symptoms of middle ear infection include:
For children, symptoms may also include:
Children and infants are more likely to suffer from a middle ear infection because their eustachian tubes, which are positioned horizontally and are more narrow and shorter than adults, can be easily blocked, but a middle ear infection may also occur in adults.
In some cases, fluid in the middle ear persists even after the bacterial or viral infection has subsided. This is known at otitis media with effusion. This can become a chronic condition, especially in children, making them prone to future ear infections. There are treatments, including surgery to place ear tubes, that can help restore normal middle ear and supplement eustachian tube function.
Treatment for a middle ear infection will depend on several factors, including age and severity of symptoms, but antibiotics are usually not needed. Symptoms should improve within a few days, and most infections clear up without treatment in a couple of weeks.
For children ages 2 or older and adults who are otherwise healthy with only mild symptoms, a wait-and-see approach for the first 48 to 72 hours is often recommended when deciding to seek treatment.
It is time to see the doctor if symptoms worsen over 24 to 48 hours with any of the following symptoms:
Inner ear infections are much less common than other types of ear infections and have the potential to cause hearing loss. Those with inner ear infections are likely to experience ringing in the ear (tinnitus), hearing loss, dizziness or nausea. If you are experiencing these symptoms and they are not tied to another illness, you should schedule an appointment with your doctor.
Common in the summer, swimmer’s ear is an infection of the external ear canal – the area from the opening of the ear to the eardrum. It is usually caused by water or moisture that stays in the ear canal after swimming. Short-term, or acute swimmer’s ear occurs when bacteria grow in this moist, dark environment.
Cuts or scratches in the canal can cause breaks in the skin that also allow bacteria to grow. These cuts/scratches are most commonly caused by the use of cotton swabs or hairpins, scratching the inside of your ear canal with a fingernail, or inserting things into your ears such as hearing aids or earphones. Chronic or persistent otitis externa is often caused by fungal infection.
Signs of swimmer’s ear:
See your doctor if you think you or your child may have swimmer’s ear. He or she will examine the ear and can begin treating the infection with prescription ear drops or cream.
Most ear infections will resolve on their own without medication. There are steps you can take to treat symptoms and relieve pain or pressure caused by an ear infection at home, including:
If your doctor determines that your ear infection is caused by bacteria, they will prescribe antibiotics to treat the bacterial infection and prevent it from spreading.
You can help prevent ear infections in general by avoiding water in the ear, not picking at your ear, and not inserting anything into the ear, such as a cotton swab. Ears are self-cleaning. Wiping the opening of the ear with a towel is all that is required to dry ears and avoid infection. If you swim often, make sure to dry your ears out with either a blow dryer set to cool or a few drops of a mixture of 50% rubbing alcohol and 50% white vinegar placed into the ear canals.
The risk of developing a middle ear infection can be reduced by avoiding contact with someone who is sick, being up to date on vaccinations and avoiding exposure to cigarette smoke.
In children and babies, breast feeding provides antibodies that help boost the immune system and protect against all infections, including ear infections. If you bottle feed, be sure to hold the baby in an upright position while feeding. Avoid offering bottles when the baby is lying down or in a crib or propping the bottle with a pillow or blanket.
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