An ear in need
Although ear infections strike people of all ages, children are particularly susceptible, especially between the ages of 6 months to 7 years.
Infections occur in several different parts of the ear:
- Middle ear (otitis media) infection is the most common
- External ear (otitis externa) infection is also known as swimmer's ear
- Inner ear infections (otitis interna and labyrinthitis) are less common
Symptoms of an ear infection vary, and can include dull or sharp pain that is felt intermittently or constantly. You may also feel burning or throbbing in the ear. All earaches need prompt and careful attention.
Your physician can easily identify which part of your ear is infected and prescribe the appropriate treatment for you. Treatment usually takes from a few to several days. However it is possible, especially in cases involving children, that the condition will recur. Recurrence, especially in children, is difficult and frustrating. But it is essential to follow your physician's directions to prevent complications. In some cases, middle ear infections can cause a perforated eardrum, inflammation of the bone behind the ear (mastoiditis), or other complications.
Pain in the ear should never be ignored. In most cases, when treated properly, complications, if any, will be minimal.
Infections and inflammation in the middle ear (otitis media) are most frequently caused by bacterial or viral infection and/or Eustachian tube obstruction. Less commonly, a ruptured eardrum may cause an infection. Middle ear infections are the most common and tend to recur, especially among children. The narrower tubes and sharper angles in a child's ear make them more prone to blockage and, therefore, infection.
Ear infections can also occur in your outer ear (otitis externa), the section that extends from the ear opening to the eardrum. This is often called swimmer's ear because it frequently develops when swimming in water that contains bacteria. When water is trapped in your ear canal, it creates a prime environment for a fungal or bacterial infection. Other causes of swimmer's ear include allergies, and either chemical irritants or foreign objects in the ear canal.
Inner ear infections (labyrinithitis) are rare but can be quite serious. An infection of the labyrinth (the semicircular canals of the inner ear) can cause total loss of hearing.
Characteristics of Ear Infections
Inflammation or infection of your middle ear (otitis media), which may be acute (short-term) or chronic, and accompanied by earache, irritability, fever, a feeling of fullness in the ear, and/or discharge from the ear. Trapped, infected "pus" creates pressure in the tubes.
Immersion in water can lead to infection in the outer ear canal (external otitis). You may feel ear pain and, less commonly, itching. You may also have a low fever or discharge a small amount of pus.
Pain in both types of ear infections may worsen when the ear is tugged. Symptoms may be accompanied by loss of hearing.
How Common Are Ear Infections?
Ear infections are most commonly diagnosed in children, accounting for over 50% of all visits to pediatricians. By age 6, 90% of all children have had at least one middle ear infection. Acute ear infections affect two-thirds of American children by age 2, and chronic ear infections affect two-thirds of children under age 6. Approximately billion is spent annually on medical and surgical treatment of earaches in the United States.
Ear infections occur in all ages, but because their Eustachian tubes are smaller and angled more sharply than adults, making it easier for bacteria to get in, children and infants are particularly susceptible to otitis media, or middle ear infections. Children also get more colds than adults, making them more susceptible to ear infections. Senior citizens are more susceptible than younger adults, and may be more likely to experience some degree of hearing loss resulting from an infection. Studies show that males get ear infections slightly more often than females.
What You Can Expect
Sometimes ear infections resolve without use of antibiotics; your doctor may opt to watch and wait — at least at first. In most cases, when treated with antibiotics and/or surgery, treatment will be effective and complications, if any, will be minimal. Some patients will be prone to recurrence.
Goals of Treatment
The immediate cipro goals of treatment are to relieve pain, to clear up the infection, and to prevent possible complications such as loss of hearing.
Treatments for earaches and ear infections vary according to the cause and site of the infection. Antibiotics and ear drops are the two most commonly used therapies to treat ear infections in the United States. If antibiotics are not successful, a simple surgical procedure can also help clear up reoccurring ear infections.
Treatment for acute otitis media consists mainly of antibiotics (amoxicillin, ampicillin, etc). It is important that you take this medication exactly as directed and for as long as prescribed to prevent recurrence. (Treatment is usually seven to 10 days.) If antibiotics do not clear the infection or it does not resolve spontaneously, chronic otitis media may require surgery to place a drainage tube into your eardrum.
Treatment for otitis externa, or swimmer's ear, may include antibiotic, antifungal, or corticosteroid ear drops. Your doctor may place a wicking device into your ear canal to help keep the drops in contact with the canal for longer. Your doctor may prescribe oral antibiotics. Stay out of the water until your treatment is completed. If you suffer from pain, heat may offer some relief.
Labyrinthitis is an inner ear infection. The most common form of labyrinthitis is caused by a virus. In some cases, surgery may be necessary to remove infected tissue. The vast majority of cases — though they may involve vertigo (dizziness, imbalance) — resolve without intervention.
It is important that you treat your ear infections or be sure that they have resolved; untreated or unresolved middle ear infections can result in a ruptured eardrum. If fluid is present, otitis externa can also occur. Other possible complications include mastoiditis, meningitis, cholesteatomas, and permanent hearing loss. It's important to call your physician if, despite treatment, you have a fever above 102°F, if the signs of infection persist for more than 48 hours, or if you suffer from severe headaches, convulsions, or dizziness. In monitoring a child, you should also contact your physician if there is swelling around the child's ear or twitching of the child's face muscles.
Ear infections are curable. However, they may recur.
The success of treatment for clearing up the ear infection and reducing your pain varies. If antibiotics are not effective with middle ear infections, surgery may be necessary. However, note that the surgery itself may encourage additional infections at a later time.
- Heat can be applied to the area around your ears to alleviate pain.
- Eardrops may also relieve pain.
- Nonprescription nasal sprays or drops may help open the Eustachian tube and relieve pressure in the middle ear.
- Humidifiers are popular adjucant treatments for ear infections and upper respiratory tract infections in children. Low humidity may be a contributing factor to middle ear infections by causing nasal swelling and reduced ventilation of the Eustachian tube. It may also reduce ventilation of the tube and dry the tube lining, which could lead to an increase in secretions and an inability to clear fluid. If you use a humidifier, it may help reverse these tendencies in otitis media with effusion (effusion refers to fluid in the Eustachian tube).
Most treatment for ear infections is performed on an outpatient basis, unless the condition is serious enough to require surgery.
Healthcare Professionals Who May Be Involved in Treatment
There are several health professionals who usually participate in diagnosing and/or treating ear infections:
- Family physicians
- General physicians
- Ear, nose, and throat specialists
Activity and Diet Restrictions
Ear infection symptoms usually improve in two to three days. To assure speedy recovery, follow some simple guidelines:
- Rest or reduced activity until fever and pain subside.
- Avoid participating in water sports and flying, if possible.
- Food sensitivities contribute to many middle ear infections. Many children are sensitive to milk, dairy, wheat, and eggs. An elimination diet is a way of helping to pinpoint the food(s) causing the problem. For help conducting a formal elimination diet, consult a nutritionally oriented doctor or a naturopath.
The standard medical approach to ear infections in children is antibiotics, analgesics, and/or antihistamines. However, if the ear infection is long-standing or unresponsive to the drugs, surgery is often performed.
The common, minor, same-day surgery involves placement of a tiny myringotomy tube through the eardrum to assist drainage of fluid. This is not a curative procedure and children with myringotomy tubes are more likely to have subsequent ear infections.
NOTE: Currently, myringotomies are being performed on close to one million American children each year. There is debate over the need for this procedure.
Managing Ear Infection Treatment
Managing therapy depends on which type of ear infection you or your child has.
Middle ear infection:
- Administer antibiotics and ear drops, as instructed by your physician. Take all the prescribed antibiotics.
- Avoid flying and water sports, if possible.
- For infants, breastfeed when possible, and do not allow your child to take a bottle to bed.
- Administer antibiotics and ear drops as instructed by the physician. Take all the prescribed antibiotics.
- Do not swim until infection clears up.
Monitoring the Condition
After your physician's diagnosis and treatment, self care is usually adequate. However, your physician should monitor your general condition and medications, and you should contact your doctor if the pain persists despite treatment. Severe earaches and resistant infections may require treatment by an ear, nose, and throat specialist.
Several complications may arise from untreated or poorly treated middle ear infections:
- Middle ear effusions
- Eardrum rupture
- Hearing loss (usually temporary, but sometimes permanent)
- Mastoiditis (inflammation of the mastoid bone behind the ear; rare)
- Meningitis (rare)
- Dural venous thrombophlebitis
- Brain abscess
- Facial nerve paralysis
Swimmer's ear (auditory ear canal infection) can also result in:
- Complete closure of the ear canal (causing significant hearing loss)
- Cellulitis (deep tissue infection)
- Boils in the ear canal
- Chronic inflammation that is difficult to cure
Quality of Life
If you or your child suffer repeatedly from swimmer's ear or middle ear infection, you may want to take the following precautions:
- Try to avoid getting water up the nose when swimming and bathing.
- Cut back on the amount of time spent in the water (limit children to no longer than one hour).
- Allow your ears to dry for one and two hours before returning to the water.
- After children bathe or shower, have them dry their ears with a small ball of cotton (not a cotton swab).
- Dry your ears, or your child's ears, immediately after bathing, and use ear drops as directed.
- If you or your child has persistent swimmer's ear, stay out of the water for at least one week (possibly longer if the pain and itching do not clear up).
- Breastfeed whenever possible. Do not give your child a bottle to take to bed because fluid could flow from the throat to the Eustachian tube, increasing the chances of developing an ear infection.
Considerations for Children and Adolescents
The majority of patients diagnosed with middle ear infections are children.
Considerations for Older People
The immune system is somewhat less effective in aging people, opening the way for viral and other infections as well as immune disorders and allergies.
You can use ear drops to relieve pain, but remember that adverse reactions and side effects may be more frequent and/or severe in older people.
Moreover, older people may experience hearing loss or enlarged adenoids after an ear infection. If this happens to you, ask your doctor about using a steroid nasal spray, antihistamines, or decongestants during future respiratory infections.
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