How to treat ear infections?

Bacteria or fungal infections are the most common problems encountered in the ear. These infections can occur due to many reasons like water in the ear canal (swimmer's ear), trauma to the skin of the ear canal permitting entrance of organisms into the tissues, systemic conditions like vitamin deficiency and endocrine disorders, dermatosis such as psoriasis, eczema or seborric dermatitis, temporal bone osteomyelitis, obstruction of the eustachian tube caused by URI, barotrauma, following radiation therapy and perforation of the tympanic membrane.

The ear infection treatment depends upon the cause, the part of ear (outer, middle and inner) that is affected and the severity of infection. The principles of therapy is aimed at
1. Relieving pain or discomfort.
2. Reducing the swelling of the ear canal.
3. Eradicating the infection by medical or surgical measures.

The ear infections are otitis externa, malignant otitis externa, acute otitis media, serous otitis media and chronic otitis media. Wherever the infection may be, the treatment depends on the cause and the causative organism.

Ear infection treatments:
1. Ear infection always presents with pain, so it not uncommon for the infected person to require prescription analgesics for the first 48 to 92 hours.

2. If there is swelling of the tissues in the ear canal, it may be necessary to insert a wick to keep the canal open so that liquid medications like Burow's solution or antibiotics can be instilled.

3. Many are generally started with broad spectrum antibiotics to take care of any kind of infection caused by any organism.

4. If the organism does not respond as expected to the broad spectrum antibiotics, a pus swab is collected for culture and the specific organism and its growth is identified.

5. Appropriate antibiotics to treat infection, and corticosteroid agents to reduce swelling and soothe the inflamed tissue are started simultaneously.

6. Antifungal medication may be prescribed if they are needed.

7. If the infection has caused a sore, daily dressing should be made at the doctor's office by a nurse or a doctor.

8. The local wound care may involve debridement of the infected tissue, including the bone and cartilage depending upon the extent of infection.

9. Severe infections are treated with parenteral antibiotic treatment which includes the combination of an antipseudomonal agent and an aminoglycoside.

10. The dosage and duration of antibiotic therapy may depend upon the virulence of the bacteria and the physical status of the affected person.

11. If there is oozing of pus discharge, they are drained out by placing a tube and cleaned in a sterile way.

12. If the infection is in the middle ear, the ear is cleaned by visualizing through microscope and the pus discharge is sucked out by gentle suctioning instruments.

13. In case of block in the middle ear which is causing the infection, a surgical procedure called tympanotomy or myringotomy is done. The procedure takes only 15 minutes and is done under local anesthesia. Here an incision is made through the tympanic membrane microscopically to relieve pressure and drain the discharge present in the middle ear.

14. The next surgical treatment that is considered when other medical management fails is tympanoplasty. Tympanoplasty is surgical reconstruction of the tympanic membrane and ossicles. The purpose of this procedure is to reestablish middle ear function, close the tympanic membrane perforation, prevent recurrent infection and improve hearing. This is done under general anesthesia in a outpatient environment itself and the prognosis is very good.

15. Mastoidectomy is also another surgical management that is performed to remove cholesteatoma, gain access to diseased structures and create a safe, dry and healthy ear. They are performed as a two seating procedure. The second surgery may be done after 6 months to check the recurrence of cholesteatoma. This surgery is done under general anesthesia in an outpatient setting. A pressure dressing will be applied after this surgery which is removed only after 24 to 48 hours.

General instructions to avoid ear infections:
1. Avoid self-cleaning of the external auditory canal.
2. Do not use cotton tipped applicators like buds.
3. Avoid water entering into the ear while showering, shampooing and swimming.
4. Use lamb's wool or cotton ball covered with vaseline to prevent water contamination.
5. Prevent upper respiratory tract infections.

Treat ear infections seriously and take appropriate step to stop spread of infection. Otherwise infections may lead to further complications like permanent hearing loss, meningitis and even death.