The Ear can be broadly classified into the outer ear, the middle ear and the inner ear. The outer ear comprises the external ear that can be seen, the external ear canal where wax may build up and finally the eardrum, called the tympanic membrane. The middle ear comprises of the usually air-filled space behind the ear drum and it houses the 3 small bones of hearing that connect the ear drum to the inner ear. The inner ear comprises the organ of hearing (called the cochlea) and the balance organ (called the vestibular organ).
Ear Infections can occur in any of these 3 regions. An outer infection otherwise known as otitis externa, middle ear infection (otitis media) and inner ear infections. By far the most common is an infection of the external ear canal. This type of ear infection is called Otitis Externa. It can happen in an otherwise fully healthy individual and is related often to retained moisture in the ear canal. As such, going swimming especially in water that is not clean, is a risk factor associated with such infections. Allowing water to enter the ear canal during a shower may also predispose to this infection. Other risk factors include digging of the ears as this may traumatize the skin and allow bacteria or fungi to infect the broken skin. Impacted ear wax is another risk factor. The ear is self cleaning for most individuals, but may accumulate in other individuals. In such a situation, using ear wax softeners and going for ear syringing or cleaning by an ENT surgeon is advised.
Otitis Externa (External Ear Canal Infections) usually present with pain and discharge from the ear canal. The ear may feel blocked constantly and hearing is often decreased as well. There may be an associated fever in young children but oftentimes adults do not have a fever. The external ear may also appear red and scaly at the opening of the ear canal. These infections are mostly caused by bacteria. However, in quite a few individuals, the infection is caused by special fungi. The treatment of Otitis Externa involves primarily the use of topical antibiotic and antifungal ear drops. This helps to coat the entire ear canal with the medicines to kill the bacteria and fungi. A family general practicioner may also sometimes prescribe a course of oral antibiotics. A visit to the ENT surgeon allows the debris and infected material in the ear canal to be thoroughly cleaned. This aids the delivery of the topical ear drops and speeds up the treatment of the infection. This toilet or cleaning of the ear canal may have to be performed regularly in the first few weeks. The ear should be kept dry during this time, with attention paid to preventing water from entering the ear during showers and avoiding swimming.
These infections if treated early, are often self limiting over a few weeks. In selected individuals, particularly those who have poorly controlled Diabetes Mellitus or who have impaired immunity, these infections may be very hard to treat and may involve the bones of the ear canal and skull base, in a condition called Malignant Otitis Externa. This is a potentially life threatening condition and requires aggressive treatment with intravenous antibiotics. If your external ear canal infection does not resolve within a few weeks, seek an early consultation with an ENT specialist who will be able to diagnose and treat you.
Otitis Media is an infection of the middle ear space. This is often the result of an ascending infection from the upper respiratory tract, where bacteria travels up the Eustachian tube opening, located at the back of the nose, up the tube into the middle ear space. This often leads to a sensation of a blocked ear, pain in the ears and occasional discharge from the ears. It often happens after an upper respiratory tract infection (“cold” or “flu”).
Otitis media is usually painless. It often presents with blocked sensation and may affect hearing.
Treatment of Otitis Media involves a course of oral antibiotics. Nasal decongestants may also be used to relieve nasal obstruction. These infections usually resolve within a few weeks.
However, the fluid behind the ear drum may remain. If it is persistent the fluid is often drained by means of a simple procedure called a myringotomy and grommet tube insertion, where a small cut is made on the ear drum under an operating microscope and a small tube inserted to allow the fluid to drain out through the ear canal.
In another group of patients, there may be a hole in the ear drum caused by previous Otitis Media infections. If this hole does not heal spontaneously, then there will also be a route of entry of bacteria into the middle ear space through the external ear canal. This is particularly common during a swim or when water enters the ear canal after a shower. This predisposes to an infection of the middle ear space and these patients will have discharge of infected fluid from the ear canal. Treatment involves the use of topical antibiotic ear drops and oral antibiotics. This infection situation is called Chronic Suppurative Otitis Media. If repeated many times, it may further damage the small bones of hearing. A surgical procedure called myringoplasty or tympanoplasty can be performed to repair the hole in the ear drum.
Lastly, the inner ear may also become infected. The infection may involve only the hearing organ, or just the vestibular organ or both organs. The patient may therefore feel one or more of several effects: Dizziness that is spinning (vertigo), hearing loss and tinnitus (often described as “ringing in the ear”). These inner ear infections are often caused by viruses. The treatment of these infections involves the use of steroids to reduce the inflammation and well as some anti-viral medications. Oftentimes, the body clears the infection spontaneously with good and full recovery of function. However, if symptoms persist, it is important to see an ENT specialist as there may be other more sinister causes of the symptoms of hearing loss or dizziness.