Earache

Anatomy of the Ear

The ear is the organ of hearing. It is divided into three parts: the inner ear, middle ear, and outer or external ear.

• The outer ear is made up of the pinna, which is the visible portion of the ear, and the auditory canal, which spans from the external ear opening to the tympanic membrane or the eardrums. Cerumen, or earwax, is the secretion of the glands in the ear canal that serve to protect the middle and the inner ear.
• The middle ear is a cavity between the eardrums and the inner ear. It houses the three smallest bones of the body, which are called the ossicles. It also has an opening for the Eustachian tube, which connects the middle ear to the nasal cavity.
• The inner ear consists of two fluid-filled structures: the cochlea and the semicircular canals. These two structures are responsible for hearing and balance, respectively. The sound perceived by our external ear travels through the ear canal to the middle ear. It causes vibration of the ossicles, which are transmitted to the fluid in the cochlea. The cochlea converts the vibrations to electrochemical signals, which are interpreted by our brain as sound.

Ear infections

Ear infections are the most common causes of ear pain. Ear infections can be divided in two: otitis externa and otitis media. Otitis externa is infection of the outer ear whereas otitis media is the infection of the middle ear.

Otitis externa happens when microorganisms infect the external ear canal. This is common among swimmers because their ears are frequently exposed to water that can harbor infectious microorganisms. Hence, otitis externa is also called the “swimmer’s ear.” However, this condition is not limited to swimmers. Other people may also get this infection especially in those who manipulate or scrape their ears to remove the earwax and in those who insert cotton buds deep into the ear canal.

Otitis media, on the other hand, happens when the middle ear is infected by microorganisms. This is common among children because of the anatomy of the Eustachian tube. In children, the Eustachian tube is shorter and follows a straighter path to the nasopharynx (back of throat); hence, infections can easily spread from the nose to the ears. Otitis media can also happen when the eardrum is ruptured like in cases of increased pressure (as in scuba diving or explosions). A ruptured eardrum makes the middle ear more exposed to the external environment, thus increasing the risk of infection.

Signs and symptoms

Signs and symptoms of ear infections include the following:

• Ear pain
• Redness and swelling of the ears
• Ear discharge, which can be foul-smelling or pus-like
• Fever
• Hearing loss
• Fussiness in younger children
• Frequent scratching or pulling of ears in younger children

Diagnosis

Special tests are rarely needed in the diagnosis of ear infections. When a person is suspected to have an ear infection, the ear doctor will simply look at his ears using an otoscope. If signs of ear infection are present, like redness of the ear canal, ruptured eardrums, or pus in the ears, then the doctor can immediately give a diagnosis of ear infection.

Treatment

External ear infections are usually treated with antibiotics that are in the form of eardrops. These antibiotics are given for at least 7 days to kill the microorganisms inside the ears. Administering these eardrops can be tricky or even scary for first-timers. Here are some tips that can make the administration easier:

• Before putting the drops, make sure that the ear is dry. This can be done by simply putting a clean absorbent cloth in front of the ear canal for a few seconds to let it absorb the fluid from the canal.
• Tilt your head or, better yet, lie on your side to facilitate administration of the drops. If a companion is available, ask him or her to deliver the drops to make sure that it goes right into the ear canal.
• Maintain your head tilted or keep lying on your side for 15-20 minutes to allow the medication to be absorbed by the ear.

To prevent further contamination of the ears, do not engage in swimming activities while undergoing treatment for ear infections. While showering, cover the ears with a head cap or plug them with vaselinized cotton balls to prevent water from getting in.

Middle ear infections can be treated with drops as above but are frequently treated with oral antibiotics by mouth for 7-10 days.

Aside from eardrops, other medications can be given for ear infections. These include medications for the symptomatic relief pain and/or fever.  Over-the-counter pain medications like acetaminophen and ibuprofen are also available. However, for children, the dosage of these medications is dependent on weight, so a doctor’s advice might be beneficial. Aspirin, a common pain medication, should NOT be given to children because it can cause Reye’s syndrome. Reye’s syndrome is a rare but potentially fatal condition that is characterized by rashes, seizures and confusion due to the swelling of the brain and the liver.

Although most individual feel improvement after 3 to 5 days of treatment, it is important that medications are completed as prescribed by the doctor. Early termination of medication can lead to incomplete treatment and may result in recurrence of the infection.

Complications

Treatment of ear infections is very important, especially in children, because it can lead to serious complications if left on its own. These complications include:

• Partial hearing loss or complete deafness
• Learning difficulties: A deaf child will have a lot of trouble learning new things.
• Brain abscess (extremely rare): The ear infection can creep into the brain.

Prevention

The following are methods that can be helpful in preventing ear infections:

• Do not manipulate your ears. Earwax is a normal secretion of the ear and does not require removal.
• Wash your hands frequently with soap and water to avoid getting or spreading the infection.
• When swimming, wear a clean pair of earplugs to protect your ears.
• Since infection can easily spread from the nose to the ears, get vaccines against common respiratory viral illnesses.