Ear infections are a common problem among people of all ages and are seen very frequently in an ENT practice. There are three main categories of ear infection: outer ear, middle ear, and inner ear infections. Outer and middle ear infections are far more common than inner ear infections.
An outer ear infection, or Otitis Externa, is defined as an infection of the ear canal as opposed to an infection of the middle ear, which lies behind the eardrum. A common slang term for this type of infection is “swimmer’s ear” given the increased risk of an outer ear infection with exposure to water. It is a very common infection occurring in about 4 of every 1,000 people annually. The main risk factors for developing an external ear infection are water exposure, minor trauma from scratching the ear canal with Qtips and wearing devices in the ear canal such as hearing aids, ear buds or ear plugs. Items worn in the ear canal can trap moisture, particularly during the warm, humid months of the spring, summer and fall. Otitis Externa is more common during these seasons, but can occur at any time.
The most striking symptom is generally ear pain that can be quite severe. Other symptoms include: itching, drainage from the ear, and hearing loss. It may be difficult to tell the difference between an outer and middle ear infection based on symptoms as they are very similar for both types of ear infection. The only reliable way to make the diagnosis is by examining the ear. The majority of external ear infections are caused by bacteria, but some can be caused by fungus.
Once Otitis Externa has been diagnosed it is generally treated with antibiotic eardrops rather than oral antibiotics. Adding a topical steroid to the antibiotic drop will often result in a quicker recovery. The ear pain is usually treated over-the-counter pain medications. It is important to avoid further water exposure during treatment, as this can prolong the infection. Generally, outer ear infections improve within 2 or 3 days after starting the eardrops.
Occasionally these infections will persist despite the drops. This often indicates that a more thorough evaluation and cleaning of the ear canal is necessary. Sometimes the simple action of removing all the debris in the ear canal will help the prescribed eardrops be successful. Severe infections can result in swelling of the ear canal, which prevents the eardrops from reaching the deeper portions of the canal. In this case an ENT doctor may need to place a cotton “wick” in the ear canal for a few days. This allows the antibiotic drop to reach all parts of the ear canal and helps treat the infection more effectively. A culture of the drainage may also be helpful if a resistant bacteria is suspected or recurrent infections occur.
Another valuable tool is using a microscope to examine the ear. The microscope can reveal evidence of a fungal infection or a more serious problem. Since many resistant outer ear infections are caused by fungal organisms that do not respond to the “normal” antibiotics, it is critical to identify fungal disease so that appropriate antifungal treatment can begin.
Most outer ear infections respond well to treatment, but rare complications can occur. The infection can potentially spread to the soft tissues of the face and neck, which may require oral or even intravenous antibiotics. In patients with diabetes or a compromised immune system, the infections can become aggressive and invade the bone of the skull and ear. This is a very infrequent occurrence.
“How can I avoid getting swimmer’s ear?” is a common question in any ENT practice. The answer is to keep your ears as dry as possible and to avoid manipulation with anything smaller than your elbow (just as your Mom used to tell you!). Drying your ears with a hairdryer on the cool setting after swimming can be helpful. For those people that continue to have problems, your ENT physician can sometimes recommend drops to be used regularly after water exposure.