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Job Osazuwa
The ear is a vital organ of the body playing the strategic role of hearing. But this function is often impeded by different infections or conditions.
There could be partial or permanent ear damage or hearing loss. Therefore, understanding its anatomy, protecting and keeping one’s ear healthy, is important to avoid destroying it unconsciously.
An ear infection, or otitis media, is the most common cause of earaches. Although this condition is a frequent cause of infant distress and is often associated with children, it can also affect adults.
The infection in the middle ear (the space behind the eardrum where tiny bones pick up vibrations and pass them along to the inner ear) very often accompanies a common cold, the flu, or other types of respiratory infections. This is because the middle ear is connected to the upper respiratory tract by a tiny channel known as the Eustachian tube. Germs that are growing in the nose or sinus cavities can climb up the Eustachian tube and enter the middle ear to start growing.
Most parents are frustratingly familiar with ear infections. Except for wellness baby visits, ear infections are the most common reason for trips to the paediatrician, accounting for approximately 30 million doctor visits a year in the United States. It is also common in Nigeria.
Today, almost half of all antibiotic prescriptions written for children are for ear infections, and the cost of treating middle ear infections on annual basis, has kept increasing and running into billions.
Untreated, ear infections can lead to more serious complications, including mastoiditis (a rare inflammation of a bone adjacent to the ear), hearing loss, perforation of the eardrum, meningitis, facial nerve paralysis, and possibly – in adults – Meniere’s disease.
Meniere’s disease is a disorder of the inner ear that can lead to dizzy spells (vertigo) and hearing loss. In most cases, Meniere’s disease affects only one ear.
Meniere’s disease can occur at any age, but it usually starts between young and middle-aged adulthood. It’s considered a chronic condition, but various treatments can help relieve symptoms and minimize the long-term impact on your life.
Causes
The middle ear is a small space behind the ear drum that is supposed to be well ventilated by air that normally passes up from behind the nose, through the Eustachian tube, keeping the middle ear clean and dry. When there is not enough fresh air ventilating the middle ear, such as when the Eustachian tube is clogged or blocked, the area becomes damp, stagnant, and warm, a perfect breeding ground for germs.
In children and infants, the Eustachian tube is often too soft or immature and has a harder time staying open. Allergies, post nasal drainage, sinus infections, common cold viruses and adenoid problems can all interfere with the Eustachian tube’s ability to let air pass into the middle ear.
When the doctor looks at the eardrum, he or she will see that it is red, often bulging, and be able to make the diagnosis of an ear infection.
For children, the most common trigger of an ear infection is an upper respiratory viral infection, such as a cold or the flu. These disorders can make the Eustachian tube so swollen that air can no longer flow into the middle ear. Allergies – to pollen, dust, animal dander, or food – can produce the same effect as a cold or flu, as can smoke, fumes, and other environmental toxins.
Bacteria can cause an ear infection directly, but usually these organisms come on the heels of a viral infection or an allergic reaction, quickly finding their way into the warm, moist environment of the middle ear. Invading bacteria can wreak major havoc, turning inflammation into infection and provoking fevers.
Among the bacteria most often found in infected middle ears are the same varieties responsible for many cases of sinusitis, pneumonia, and other respiratory infections.
According to the American Academy of Otolaryngology-Head and Neck Surgery (ear, nose, and throat physicians), the conjugate pneumococcal vaccine is very effective against several strains of the most common bacteria that cause ear infections. Over there, the vaccine is routinely given to infants and toddlers to prevent meningitis, pneumonia, and blood infections. Your child’s doctor should advise you on the use of this vaccine, which may help to prevent at least some ear infections.
Ear infections occur in various patterns. A single, isolated case is called an acute ear infection (acute otitis media). If the condition clears up but comes back as many as three times in a 6-month period (or four times in a single year), the person is said to have recurrent ear infections (recurrent acute otitis media). This usually indicates the Eustachian tube isn’t working well. A fluid build-up in the middle ear without infection is termed otitis media with effusion, a condition where fluid stays in the ear because it is not well ventilated, but germs have not started to grow.
In recent years, scientists have identified the characteristics of people most likely to suffer recurrent middle ear infections, which are: Males, individuals with a family history of ear infections, babies who are bottle-fed formula (babies who are fed breast milk have fewer ear infections), children who attend day care centres and people living in households with tobacco smokers. Others are people with abnormalities of the palate, such as a cleft palate and people with poor immune systems or chronic respiratory diseases, such as cystic fibrosis and asthma.
Symptoms
The symptoms of an ear infection in adults are: Earache (either a sharp, sudden pain or a dull, continuous pain); a sharp stabbing pain with immediate warm drainage from the ear canal; a feeling of fullness in the ear; nausea; muffled hearing and ear drainage.
Signs of infection include a red eardrum or a bulging eardrum with fluid behind it. The fluid may be thin like during a cold, or thick like pus. It is located in the middle ear, just behind the ear drum. Otitis media means inflammation of the middle ear.
In children, the symptoms are: Tugging at the ear; poor sleep; fever; irritability and restlessness. Others are ear drainage, diminished appetite and crying at night when lying down. However, some of these identified symptoms could be as a result of other illnesses.
Visit your doctor about an ear infection if your body temperature rises above 100.4 degrees; a fever signals the possibility of a more serious infection (especially in infants and young children); and if you or your child frequently develops ear infections; repeated bouts with the disorder can lead to hearing loss or more serious infections.
When it is noticed that you or your child has hearing problems; the infection may be the cause. If you suspect that your young child has an ear infection, visit a specialist.
Prevention
If you watch over a young child, you probably know how common earaches can be. Adults get them, too, but kids usually get them more often because they haven’t built up their immune systems to fight off common viruses and bacteria yet.
You can’t always stop all ear infections. But you can learn what causes them and then take steps to lower the chances that you or a child in your care will get them.
These things can help reduce the number of infections your child may get: Breastfeeding: Babies who nurse for 12 months or more tend to have fewer infections. If breastfeeding isn’t an option, bottle feed your child in an upright, sitting position.
Fresh air: Don’t expose your baby to cigarette smoke. Try to avoid other forms of air pollution, too, when you can.
Immunizations: Keep up to date on your child’s shots.
Toss the pacifiers: If your baby is using a pacifier after 12 months old, the chance for ear infections increases. Do your best to wean your little one off them.
Wash: Clean your child’s hands and your own often with soap and water. This can reduce the spread of germs and prevent your child from catching the flu or a cold. Another tip, even though it can be very hard: Try to keep dirty objects away from your child’s mouth.
You get these infections in your middle ear. It’s an air-filled space behind your eardrum. It holds tiny, vibrating bones that pick up sound waves so you can hear.
A cold, the flu, or even allergies can all bring one on, too. That’s because they tend to cause congestion and swelling in your nasal passages and throat. When fluid builds up and doesn’t drain effectively, it can increase your chance of an ear infection.
Risks
Ear infections tend to occur more in fall and winter because upper-respiratory infections such as cold and flu are on the rise then, too. Children who are two and younger get more ear infections because of the small size and shape of their Eustachian tubes.
Other things that can come into play: Bottles and pacifiers: If children drink from a bottle while lying down or use a pacifier, then they’re more likely to get ear infections.
You are not as likely to get an ear infection as a child. That’s because a grown-up’s Eustachian tubes are larger. And the shape of an adult’s tube means it’s less likely to get clogged. If you have pain or fluids coming out of your ear, you need to see a doctor as soon as possible.
Diagnosis
If you care for children, you likely know already how often they come down with earaches. Adults get them, too, but youngsters have them much more often. That’s because they don’t fight off viruses and bacteria as well, and their little ears aren’t good at draining fluids yet.
You or your child may have a sore throat, stuffy nose, or fever along with an earache. These are signs of a possible infection. Call your doctor so she can find out for sure what’s going on. If it is an infection, she can recommend the best treatment for your case.
Your doctor will ask you about any symptoms you’ve had. Be sure to come to the office with any notes you might need and questions on your mind. The doctor will look at the eardrum with an instrument called an otoscope for signs of infection. This is a tough task with a fussy infant, so be ready to help calm the little one if it’s your child with the earache.
A puffer attached to the otoscope blows air to see if your thin eardrum moves. With fluid in the middle ear, the eardrum is more rigid and doesn’t move back and forth. The specialist might also look for signs of infection with another instrument. It’s called a tympanometer, and it uses sound and air pressure to check for fluid in the middle ear.
Treatments
Often, a virus causes an ear infection, in which case antibiotics won’t help. If, based on the history, your doctor suspects that bacteria may have caused the infection, she will prescribe an antibiotic.
Pain Relief: If a virus or bacteria are causing the infection and you have to wait for it to get better, you don’t need to live with the pain. Your doctor may recommend a pain reliever, typically acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), which also helps reduce a fever. Aspirin should be avoided in children because of the threat of Reye’s syndrome, a rare condition that can cause swelling in the brain or liver. Pain can also be reduced by using low heat from a heating pad. Be very careful using a heating pad with children.
Antibiotics: If your doctor decides to go with antibiotics, follow all the instructions. Take all of the doses even if you or your child is feeling better. Call your doctor or pharmacist if you skip a dose or feel sick from the medicine. If you don’t take the whole course, your infection could come back and become resistant to more treatments.
Drainage: If an infection causes serious complications, fluid remains in the ear for a long time, or your child has ear infections that keep coming back, your doctor might want to do a procedure called a myringotomy. The doctor creates a small hole in the eardrum so fluids such as water, blood, or pus can drain out. In many cases, she will put in a tube so it won’t get backed up again. The tube, which will usually fall out on its own in about 6 to 18 months, lets the fluid out and air flow through to keep the middle ear dry. Tubes also reduce pain, improve hearing and cut down on the number of infections your child may have.
When younger children get these ear tubes, it’s surgery. They will need to go to the hospital and take something to sleep during the procedure, which usually lasts about 15 minutes. Meanwhile, older children and adults can have it done while they’re awake. For them, it can be done in their doctor’s office.
This surgery rarely leads to infection or scarring and usually provides long-term results. If the tubes come out and the infections return, talk to your doctor about more treatments. Doctors generally don’t consider the removal of tonsils helpful for ear infections.
