What Causes Otitis Externa
Otitis externa is an infection of the skin of the ear canal and is very common. The ear canal is a narrow, warm, blind-ended tunnel, which makes it a good protected environment for germs to grow in if they are given a chance. Most infections are caused by a germ . Occasionally, they can be due to a fungal or yeast infection.
Some things can make you more prone to otitis externa – for example:
Substances entering the earIf you regularly get water in an ear then this may provide moisture for germs to grow. It may also cause itching. You may then scratch or poke the ear. This can damage the skin in the ear canal and cause inflammation. Inflamed skin can quickly become infected. A vicious circle may then develop. The inflammation and infection cause more itch, you then scratch more, which then can makes things worse.
If you get shampoo, hairspray or other products into your ear this may have the same effect and may be worse, as the chemicals may additionally irritate the sensitive skin of the canal.
SwimmingOtitis externa is much more common in regular swimmers, due to water getting into the ear canal. In fact, otitis externa is sometimes called swimmer’s ear. It is more likely if you are swimming in water which isn’t clean, such as ponds.
Warm weatherOtitis externa is more likely to develop in hot, humid and ‘sweaty’ weather. It is more common in hot countries.
Why Do Kids Get Ear Infections
Kids get ear infections more than adults do for several reasons:
- Their shorter, more horizontal eustachian tubes let bacteria and viruses find their way into the middle ear more easily. The tubes are also narrower, so more likely to get blocked.
- Their adenoids, gland-like structures at the back of the throat, are larger and can interfere with the opening of the eustachian tubes.
Other things that can put kids at risk include secondhand smoke, bottle-feeding, and being around other kids in childcare. Ear infections are more common in boys than girls.
Ear infections are not contagious, but the colds that sometimes cause them can be. Infections are common during winter weather, when many people get upper respiratory tract infections or colds .
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Antibiotics and outer ear infections
- The most recent policy statement by the American Academy of Pediatrics encourages pain management and not antibiotics as the initial approach to most outer and middle ear infections. Since outer ear infections are generally bacterial in cause, this type of ear infection can be prevented by avoiding prolonged ear canal immersion.
- Antibiotic eardrops have been shown to accelerate the healing process in swimmers ear, but avoiding prolonged water in the ear canal also is highly recommended. Rarely, severe cases of swimmers ear will cause the ear canal tissue become swollen shut. To treat this, an ear wick is placed in the ear to allow the antibiotic eardrops into the narrowed ear canal. Oral antibiotics often are used in severe cases.
Antibiotics and middle ear infections
Antibiotics and inner ear infections
- Inner ear infections are rare, and usually need to be treated by an Ear, Nose, and Throat specialist.
If you have an ear infection in which antibiotics are not prescribed, follow up for re-evaluation by the doctor is important.
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Causes Of Outer Ear Infections
This could be a very painful condition. Predisposing factors include swimming in polluted water , the use of cotton buds and narrow ear canals. The causative agents are usually bacteria, fungi or viruses.
It is best treated by getting the debris or trapped wax out of the ear and then using antibiotic ear drops and pain killers. In some situations, the infection may be bad enough to need a foamy splint to be inserted in the ear. This splint absorbs the antibiotic ear drops and ensures that the antibiotic ear drops are in constant contact with the inflamed ear canal skin. The splint is removed after 48-72hrs by which time there is enough space for the ear drops to get into the ear canal.
Eustachian Tube Bypass Procedure
The Eustachian tube bypass procedure is designed as a long-term solution for patients who have chronic Eustachian tube dysfunction and recurrent middle ear infections. It involves a special tube that ventilates the middle ear through a tiny tunnel in the ear canal.
How do I know if Im a candidate for the bypass procedure?
The procedure is offered to patients who have already needed several myringotomy tubes in the past and continue to suffer from Eustachian tube dysfunction. Typically, the patients have had ETD for many years. The surgery is especially offered to patients who no longer want to have repeated myringotomy tubes.
There are patients with poor middle ear ventilation for whom traditional tubes are not advisable. In these patients, poor ventilation may result in the eardrum being pulled inwards , making it difficult or inadvisable to place a regular tube. The bypass tube allows the eardrum to heal, giving the patient more options in the future.
What is the difference between the tube used in bypass procedure and a regular myringotomy tube?
The Eustachian tube bypass procedure uses a specialized tube that ventilates the middle ear through a small tunnel in the bony ear canal. It does not require any incision on the ear drum, so it minimizes any hearing damage to the ear. Unlike the classic myringotomy tube, which can fall out after 6 months, the Eustachian tube bypass procedure involves a tube that can permanently stay in the ear without falling out.
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Ear Anatomy 101 Turns Out Its Complicated
The human ear, after all, is quite a complex structure. It is made up of three parts: the outer ear, middle ear, and inner ear.
The outer ear is the part that sticks out from your head and includes the ear canal that leads up to your eardrum
The middle ear is an air-filled space between your eardrum and your skull. This space holds the tiny ear bones you need to hear sound. This part of the ear is connected to the eustachian tube, which opens to the back of your nose. That uncomfortable, stuffy feeling when your ears pop on an airplane? That is your eustachian tube opening to equalize the pressure in your middle ear.
Finally, the inner ear – which controls hearing and balance – is located within your skull bone.
Any Other Words Of Advice For Adults Regarding Ear Infections
Dr. Wang: Do not stick anything in your ears! Also, if you have diabetes, be very careful with ear infections. They might be much more persistent, painful and treatment resistant. If this happens to you, really prioritize getting your blood sugar under control, because that can greatly affect your bodys ability to shake the infection.
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Does My Child Need Tubes
Ear tubes are small, plastic devices surgically placed into the childs eardrum to help trapped fluid drain. Ear tubes are used to treat chronic or recurring middle ear infections. Your pediatrician may recommend your child be evaluated by a pediatric ear, nose, and throat specialist if there are concerns about frequent infections .
Ear tubes can help decrease the frequency of ear infections, reduce oral antibiotic use, improve hearing, and help with speech delay.
Hearing Aids And Other Ear Devices
A hearing aid is a compact electronic device that can improve hearing by making sounds clearer and louder. Although a hearing aid canât restore hearing loss completely, it can often help to improve it. Wearing a hearing aid can make everyday life easier and make a significant difference when conversing, talking on the phone, or watching television. Patients attending The Harley Street ENT Clinic can be referred to Harley Hearing Centre, our in-house service for obtaining independent advice about hearing aids and other ear protection and treatment devices.
The first step to getting hearing aids is an assessment by a hearing aid specialist to determine whether it will be possible to restore hearing. The specialist can then recommend a suitable device. Hearing aids come in several different forms, including devices that sit behind the ear, in the ear, and completely within the ear canal, so-called âinvisibleâ hearing aids. In some cases a custom made hearing aid may need to be created using a silicone cast of the ear. Once the device is ready, the hearing aid will be programmed using computer-based software to suit the patientâs level of hearing loss at various frequencies. The effects should be apparent immediately, but it can take several weeks to get used to using a hearing aid and follow up appointments with the hearing aid specialist will be needed.
Ear Protection Devices
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Removal Of Foreign Body
Various foreign objects can become lodged in the ear canal, including cotton bud tips, foam plugs or even hearing aid ear pieces. Small toys or beads can put into the ear by children. Foreign bodies are prone to cause infections so prompt removal can prevent or relieve symptoms such as pain, hearing loss and discharge.
Several methods can be used by ENT specialists to remove foreign bodies from the ear. Great care must be taken to avoid trauma to the ear canal skin or pushing the object further into the ear causing damage to the ear drum. Magnification with a microscope is essential. Fine micro forceps or hooks, or micro suction is usually successful. Rarely gentle irrigation may be used instead.
Key Point: Young children with foreign bodies in the ear canal should always be treated by an ENT specialist, as ham-fisted attempts by others can result in considerable pain and distress and a conditioned dislike of doctors for many years!
What Is An Ear Infection
An ear infection of the middle ear, medically known as acute otitis media, can be caused by a bacteria or virus. Most often, ear infections occur in the middle ear, which is the air-filled space between the eardrum and the oval window of the ear. The middle ear is responsible for transmitting sound from the outer ear to the inner ear.
In addition to a middle ear infection, its also possible to have an outer ear infection like swimmers ear or an inner ear infection. Labyrinthitis is a serious inner ear infection that affects hearing and balance. People with labyrinthitis often experience vertigo and some hearing loss.
If a middle ear infection is bacterial, its most likely the bacteria Streptococcus pneumoniae causing the infection. A virus can cause also cause ear infections. A a cold or allergies can cause congestion that blocks the Eustachian tube, which connects the middle ear to the back of the throat. This congestion can lead to a buildup of fluid and pressure and provides an environment for bacteria or viruses that have traveled up the Eustachian tube into the middle ear to flourish, resulting in an ear infection.
Even the CDC recommends breast-feeding children exclusively for the first six months of their lives and continuing until they are at least 1 year old. Injury to the ear, climate changes, altitude changes, pacifier use, family history of ear infections, and exposure to cigarette smoke are other risk factors.
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When Should I See A Specialist To Treat Swimmer’s Ear
If your ear infection has not gone away 10 to 14 days after treatment with antibiotic eardrops, you have lost your hearing, you see pus or other yellow/green matter oozing from your ear, or experience a worsening of any of the symptoms of swimmer’s ear, you should be seen by an ear specialist .
Last reviewed by a Cleveland Clinic medical professional on 01/29/2019.
Ear Wicks And Dressings
If the ear canal skin is very swollen due to a severe infection, it may be impossible to apply antibiotic/anti-inflammatory ears drops as access is restricted. Optimum treatment involves inserting a small cellulose wick , about 1.5cm long, using the operating microscope and micro forceps. The wick remains in place for a few days and facilitates local drug absorption.
The outer part of the wick is just visible at the entrance to the ear canal and when moistened with drops it enlarges to the size of the swollen canal. Drops are subsequently instilled at the prescribed frequency, usually three times per day. As the wick is in close contact with the skin lining most of the length of the ear canal, the drug is delivered locally to all the required area. The wick is usually removed after a few days, when the swelling has resolved, and treatment can be continued by applying the ear drops in the normal manner.
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Can Vicks Vaporub Cure An Earache
Online bloggers and several websites have recently started to tout the use of Vicks for conditions affecting the ear, such as tinnitus, earaches, and earwax buildup.
Theres no research indicating that Vicks is effective for any of these uses. In addition, the manufacturer doesnt reference or recommend Vicks VapoRub be used for these purposes.
Its possible that the soothing effect of Vicks does, in fact, reduce the perception of pain in the ear. Before you put it in yours or your childs ears, its important to assess the risks. More on that below.
Its also important to remember that Vicks cant cure an ear infection. So, it shouldnt be put in the ears of children for this purpose.
Externa Recurrent Otitis Externa And Chronic Otitis Externa
The only difference between these three ‘types’ of otitis externa is the length of time for which you have had the condition.
Acute otitis externa – this term means you have had the condition for less than three months. Usually, in fact, you will only have it for a week or so.
Recurrent otitis externa – this term means the condition keeps coming back. You have episodes that get better but then you develop the same symptoms again.
Chronic otitis externa – this term means the condition has lasted for more than three months. Sometimes it can last for years. This is often because, even though you have had treatment, the underlying reasons for it are still there.
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Diagnosis Of Outer Ear Infection
Your GP will usually be able to diagnose an outer ear infection by asking about your symptoms and examining your ear. They may also ask about your medical history to check if theres anything that could have caused your symptoms.
Your GP may look into your ear using an instrument called an otoscope to check for any signs of infection. They may ask you to move your ear or jaw to see if you feel pain.
If your symptoms are particularly severe or they dont get better after treatment or they come back, your GP may collect some discharge using a cotton swab. This will be sent to a laboratory for testing to find out whether the cause of your ear infection is bacterial or a fungus.
Signs And Symptoms Of Ear Infections In Children:
- Ear pain, especially when lying down
- Tugging or pulling at an ear
- Trouble sleeping
- Sore throat
When to see a Doctor?
It is important to get an accurate diagnosis and rule out any other severe conditions. You should call your childs doctor if:
- Symptoms last for more than a day
- Your baby is less than 6 months old with any of the above symptoms
- Ear pain is severe
- Your infant or toddler is sleepless or irritable after a cold or other upper respiratory infection
- You observe a discharge or fluid from the ear
Your doctor will advise medications or suggest going with the home remedies depending on the severity of the infection. The latest guidelines from the American Association of Pediatrics suggest that doctors should focus on pain management, not antibiotics, for ear infections. This is because ear infections often go away on their own, and the overuse of antibiotics could lead to antibiotic-resistant infections.
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Managing Your Symptoms At Home
The advice below should help to relieve your symptoms to some extent and help to prevent complications:
- avoid getting your affected ear wet wearing a shower cap while showering and bathing can help, but you should avoid swimming until the condition has fully cleared
- remove any discharge or debris by gently swabbing your outer ear with cotton wool, being careful not to damage it don’t stick cotton wool or a cotton bud inside your ear
- remove anything from your affected ear that may cause an allergic reaction, such as hearing aids, ear plugs and earrings
- use painkillers such as paracetamol or ibuprofen to relieve ear pain these aren’t suitable for everyone, so make sure you check the information leaflet that comes with the medication first if you’re still unsure, check with your GP, practice nurse or pharmacist
- if your condition is caused by a boil in your ear, placing a warm flannel or cloth over the affected ear can help it heal faster
Oral And Intravenous Antibiotics
Most persons with OE do not require oral medications. Oral antibiotics are generally reserved for patients with fever, immunosuppression, diabetes, adenopathy, or an infection extending outside the ear canal. They should be given to individuals with cellulitis of the face or neck skin or to persons in whom severe edema of the ear canal limits penetration of topical agents.
IV antibiotics are used in individuals with necrotizing OE they may also be appropriate for patients with severe cellulitis or persons whose symptoms do not respond to topical and oral antibiotics. A prolonged course of IV antibiotics, lasting for up to 6 weeks, may be required. If the patient is stable, IV antibiotics may be administered at home. Begin treatment with antibiotics to cover pseudomonads, and alter the regimen as necessary on the basis of culture results.
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