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.

What causes ear pain?

Otalgia is the medical terminology used for pain in the ear. Ear pain is always severe because ear is innervated by a rich nerve supply. Cranial nerves 5, 7, 9 and 10 supply to the ear, the second and third cervical nerve roots are also present there. The skin of the ear is also very sensitive causing extreme pain.

Ear pain may be because of many reasons, not necessarily indicating an ear problem alone. It is estimated that over 50% of the people who approach a physician with complaints of ear pain have no identifiable ear disease. Many complaints of ear pain are actually due to pain in the near by temporomandibular joint. Others may have the disorders of larynx and pharynx causing ear pain.

Causes of ear pain:
1. Children are more affected by ear infections which is the main cause of ear pain in them. Infections like a. Otitis externa (infection of the external ear) b. Malignant otitis externa (external ear infection turns out to be cancerous) c. Acute otitis media (infection of the middle ear) d. Chronic otitis media (persistent infection of the middle ear) are the common infections of the ear causing pain in both children and adults.

2. Serous otitis media is another ear condition where fluid gets collected in the middle ear causing severe pain without any sign of infection. This is common in scuba divers where the Eustachian tube gets blocked because of the sudden change of pressures and the fluid gets trapped in the middle ear causing pain.

3. Cerumen is the normal waxy substance that is found in the ear which protects dust and small insects from entering our ears. When these cerumen gets impacted, they cause otalgia and temporary hearing loss.

4. Attempts to clear the external auditory canal with matches, hair pins, safety pins and other implements are not only dangerous but also cause trauma to the skin leading to ear pain and ear infections.

5. Foreign bodies which accidentally enter the ear while cleaning may get stuck and cause profound ear pain.

6. Swimmer's ear, an ear condition is another cause of ear pain where water enters the swimmer's ear causing severe discomfort.

7. Eustachian tube block caused by upper respiratory infection due to pressure alteration while coughing or the mucus itself blocking the tube can cause ear pain and irritation.

8. Other inflammation of the surrounding structure like sinusitis, adenoid hypertrophy, tonsillitis and allergic rhinitis can also present with ear pain.

9. Dental caries (infected) and eruption of molar/premolar tooth may also bring about ear pain.

10. Any abuse to ear drum like loud noises beyond hearing frequency caused by sitting near speakers in a concert or a child accidentally crying/shouting loudly near the ear may cause damage of the ear drum and otalgia.

11. Tinnitus also causes some kind of discomfort which is expressed as pain by many who experience it.

12. Cyst in the ear causes severe pain which may be due to infection or block caused by the cyst itself.

13. Any discharging sinus formed by an infected acne in the face, especially near the ears will also cause severe pain in the ear.

14. Temporomandibular joint syndrome is a disorder of the joint where the temporal and the mandibular bone meet. This TMJ syndrome usually presents with ear pain as the major symptom.

15. The infection of facial nerve called as Ramsay Hunt syndrome caused by herpes zoster virus presents with ear pain as a important symptom where the ear drum and external ear is infected with fluid filled blisters.

16. Cancers of the ear structures causes severe pain. Cancers of the pharynx and larynx also presents with pain in the ear.

Ear infections can be due to any of the causes mentioned above. If you get ear pain, it is always better to see your doctor than waiting for the pain to subside or try out any self medications.