Wednesday January 19, 1994
EAR INFECTIONS cause severe pain, especially in children and often in the middle of the night. An earache can be unremitting, a pain you just cannot get away from. Some years ago, I asked a young girl which of her ears was hurting. She looked up sadly and replied, ``All of them".
Some basic anatomy makes ear infections a little easier to understand.
Inside the outer opening of the ear is a small canal that comes to an end at the eardrum. In this external canal are a few hairs and a varying amount of wax. Beyond this is the middle ear space where there are tiny bones or ossicles that pick up the vibrations of the eardrum caused by sound waves, and then conduct them to the auditory nerve in the inner part of the ear. The middle ear is also connected by the rather narrow eustachian tube to the back of the throat. This is why the hearing feels muffled and woolly whenever the eustachian tube becomes blocked with a cold, or when flying in a plane. Although we do see viral infections of the inner ear that can cause severe dizziness and vomiting, infections of the outer and middle ear are far more common.
Outer ear infection (otitis externa or swimmer's ear). This occurs in the external canal and causes considerable itchiness and irritation. The ear may be sore and quite tender to touch. Although these infections typically occur after swimming in an unclean pool, anything that allows moisture to get into the ears can cause them, for instance, bathing or showering. Some people pick and scratch their ears with cotton buds and matchsticks; this should be avoided. As well as the risk of injuring the canal or the eardrum, this can also introduce further infection. Some wax is meant to be in the ears to waterproof and help clean the ears.
Sometimes a slight discharge may also occur where there is an outer ear infection. When the ear is examined with an auriscope, the outer canal will appear reddened and swollen. Frequently a lot of fluffy white debris can be seen, especially when a fungal infection is causing the problem. This can make the ear feel quite blocked.
Treatment involves the doctor mopping out as much of the debris as possible, followed by several days of antibiotic eardrops. Keeping the ears dry is important, both initially and later on, to prevent recurrences. A subsequent checkup to see that the infection has been cleared is also advisable.
Middle ear infection (otitis media). This occurs in the middle ear space and causes a persistent severe earache. It is often preceded by a cold. There may also be a fever and vomiting. Sometimes the earache builds to a peak as the eardrum bulges. If the drum perforates, fluid seeps from the ear and the pain subsides. Although a rather disturbing sight for the parent, it is usually of no great concern; most perforations heal very promptly.
Treatment involves analgesics and a full course of antibiotics.
Decongestant preparations like Sudafed or Dimetapp may also help by keeping the eustachian tube more open and taking some pressure off the eardrum. If a perforation has occurred, a follow-up check is advised to see that it has healed. It is advisable not to fly with a middle- ear infection because pressure changes can damage the eardrum.
Although this is more likely to occur in smaller aircraft, it is better to check with your doctor before any form of flying.
Recurrent ear infections in young children can be associated with fluid accumulation in the middle ear space, a condition referred to as ``glue ears". Because hearing can be affected, referral to an ENT (ear, nose and throat) specialist is usually arranged. The insertion of tiny grommet tubes in the eardrums may be required to ensure that hearing is not affected.
Sometimes milder intermittent earache can occur. This may be due to eustachian tube blockage without actual infection. This will often respond to decongestants and exercises to inflate the middle ear...
such as pinching the nose and ``popping the ears" or, in younger children, blowing up balloons.
Complications from ear infections are very unusual these days. Until a few decades ago, it was common for people to develop abscesses, chronic discharge and hearing loss from what we regard today as fairly minor infections.
If a baby is very upset and distressed, think of the possibility of an ear infection.
The old advice ``put nothing in your ear smaller than your elbow," is just as relevant as it ever was.