Ear Infections

Outer ear infections

An outer ear infection is an inflammatory condition of the skin which lines the ear canal. It can also affect the ear itself and the ear drum and be present in only one ear but is frequently present in both. The medical term for this type of infection is otitis externa.

There are three types of outer ear infections:

• Dry
• Wet or discharging
• Chronic or long term

Dry outer ear infection

This type of ear infection is also known as a furuncle which results from an infected hair follicle at the entrance to the ear canal. Symptoms may include: sudden onset, extreme pain and a red swelling in the outer canal. The glands behind the ear may be tender and there may be some loss of hearing. If the furuncle bursts, the canal will be wet and blocked with discharge or pus.

Treatment

• Regular pain relief and the application of local heat (warm flannel).
• Oral antibiotics may be given if there are signs of a temperature, swelling to the affected ear and if you are feeling generally unwell. They may also be given if you have a low immunity, for example if you are diabetic, have recently had chemotherapy or have HIV/AIDS.
• If the furuncle has burst then the ear canal will need cleaning by a specially trained nurse or doctor before any treatment is started.
• A cream or ointment may be placed in the ear canal on a very thin dressing called a ribbon gauze or wick, which may ease the symptoms.

A follow up appointment with the nurse or doctor may be required within a few days of the first treatment to ensure that the infection is settling.

A Wet or discharging outer ear infection

This is also known as acute diffuse otitis externa and commonly referred to as swimmers' ear. You may have recently been abroad on holiday, frequently swim or use cotton buds and other implements to clean your ears which may have caused an infection.

Symptoms include: sudden onset, pain, the ear canal may be inflamed and red and there may be discharge.

Treatment

• Regular pain relief.
• The ear canal will firstly need cleaning by a specially trained nurse or doctor.
• An ointment or cream may be applied to the canal, a dressing/wick may be inserted with an ointment or cream on it, drops or a spray may be prescribed if appropriate.
• Research has found that oral antibiotics do not appear to work as well as those applied directly to the affected ear. However they may be considered if the ear is swollen, if there is a high temperature, and if you are feeling generally unwell.

A return visit to the nurse or doctor will be required for the ear canal to be cleaned again and further treatment to be given if needed.

Chronic or long term outer ear infection

The infection is also called chronic otitis externa and is given that name if it has persisted for more than six months without completely healing. It may be caused by an unresolved acute infection, skin problems such as eczema or psoriasis or a foreign body (something stuck in the ear). This condition is less painful than the acute infection and symptoms may include itching, narrowing of the ear canal, hearing loss or the canal may be blocked with wet or dry skin and discharge.

Treatment

• The ear canal will first need cleaning by a specially trained nurse or doctor.
• Once cleaned, treatment in the form of an ointment or cream may be applied directly to the ear canal, on a wick or ribbon gauze dressing, or drops/spray.
• Pain relief is rarely needed with this condition as the ear feels uncomfortable and generally not painful.

Middle Ear Infections

A middle ear infection is an infection that occurs behind the eardrum, in the middle part of the ear. The medical term for middle ear infection is otitis media.

There are three different types of middle ear infection:

• Acute middle ear infection.
• Glue ear.
• Discharging middle ear infection.

Acute middle ear infection

This type of infection is a sudden but temporary inflammation to the lining of the middle ear which can be very painful. The middle ear fills with infected fluid and can make the ear drum bulge outwards into the ear canal or suck it backwards into the middle ear. It may follow a cough, cold or chest infection. The medical term for this type of infection is an acute otitis media.75% of cases occur in children under 10 years with the greatest number of cases between 3 and 6 years of age. Symptoms may include pain, a high temperature and reduced hearing to the affected ear.

Treatment

• Regular pain relief is essential.
• 60% of cases are thought to resolve in 24 hours and 80% within 3 days; therefore the current guidelines from the Department of Health for children over the age of 2 years are to watch and wait and not to prescribe oral antibiotics.

Glue ear

This is a persistent middle ear infection with an accumulation of sticky, thick fluid in the middle ear. It is not generally painful but affects the hearing of a patient. It is diagnosed if an acute middle ear infection has not resolved after three months. The medical term for this type of infection is an otitis media with effusion.

Treatment

Often the infection will settle and spontaneously resolve after six months, however if this is not the case then there are several treatments that maybe attempted:

• Auto-inflation under specialist supervision from a doctor a balloon is inflated by blowing into it from one nostril, whilst sealing the other. This encourages air into the middle ear and helps reduce the pressure.
• Grommets may be considered if symptoms continue for over 6 months. These are tiny tubes which are inserted surgically into the eardrum which allow air into the middle ear.
• Adenoidectomy the adenoids sit at the back of the nose where the nasal passages meet with the throat. When a child has a cold or sore throat they can become enlarged and press on the tube that allows air into the middle ear. This can cause fluid to build up in the middle ear which in the long term can lead to glue ear. They are removed surgically, often at the same time as the tonsils.
• Hearing aids may be used, especially in the case of children, to help with the hearing loss whilst waiting for the condition to resolve.

Chronic discharging middle ear infection

This condition occurs when a hole (perforation) in the eardrum allows infection that has developed in the middle ear (behind the ear drum) to pass into the ear canal where a secondary infection can develop due to the constant discharge. It may be uncomfortable and affect the patients hearing. The medical term for this condition is chronic suppurative otitis media.

Treatment

The ear canal needs a thorough clean by a specially trained nurse or doctor before any treatment is started. Antibiotic drops may be prescribed. If the drops are unsuccessful in treating the infection, then oral antibiotics may be given. However oral antibiotics may also be considered if the ear is swollen, if there is a high temperature, and if you are feeling generally unwell. It will require regular appointments with your healthcare professional until the infection has settled.If the perforation regularly discharges then an operation to repair the hole may be considered.