Ease pain from ear infection: The request could not be satisfied
3 Home Remedies for an Ear Infection – Cleveland Clinic
Your kiddo is tugging on her ear again. Uh-oh. Or maybe ear pain is keeping you up at night. No matter the age, ear infections are no fun. ENT-otolaryngologist Anh Nguyen-Huynh, MD, explains all about ear infections, and the earache remedies you can try at home.
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What type of ear infection is it?
There are two common types of ear infections:
- Otitis media: This ear infection affects the middle ear (right behind the eardrum). Middle ear infections are common in kids and tend to cause trouble hearing, fevers, and pain without much outward signs such as ear drainage or swelling.
- Otitis externa: This infection affects the ear canal, and is commonly known as swimmer’s ear because water exposure is a risk factor for it. Swimmer’s ear is painful, too, and tends to have more visible signs such as a swollen ear canal or pus drainage.
“There are several home remedies for earaches,” says Dr. Nguyen-Huynh. “Try these for the first two or three days if symptoms are mild.”
Earache remedies you can try
1. Hot or cold compress
The skinny: Grab an ice or heat pack and put it on
the affected ear to help with the pain.
Doctor’s advice: The temperature you use is up to you. Wrap it in a towel to
make sure it’s not too cold or too hot. You don’t want to cause any burns.
2. Over-the-counter (OTC) pain relievers
The skinny: Pain relievers work as advertised, helping take the edge off the pain.
Doctor’s advice: Both adults and kids can rest easier when they take acetaminophen or ibuprofen at the right dosage. These medications reduce pain and fever, making you feel more comfortable.
3. Sleep position
The skinny: How you sleep can affect ear pain. Rest with your head on two or more pillows, so the affected ear is higher than the rest of your body. Or if the left ear has an infection, sleep on your right side. Less pressure = less ear pain.
Doctor’s advice: It could be effective, though a few inches may not make a big difference in pressure measurement. But if it makes you feel better, go for it.
Two home remedies for earaches that are best left on the shelf
1. OTC numbing drops
Dr. Nguyen-Huynh recommends
avoiding numbing drops. “The effect is very brief, and sometimes it does the
opposite and stings the ear.”
Be it garlic, tea tree or olive —
people swear by putting oil in the ear to help with ear infections. While
garlic does have antibacterial properties, Dr. Nguyen-Huynh urges caution. If you’re
using it for a middle ear infection, it won’t get to the source of the problem.
And even if you do have a hole in your eardrum, there aren’t studies showing
it’s safe to put garlic in there.
When to see a doctor about an earache
Dr. Nguyen-Huynh recommends seeing a doctor if:
symptoms remain after two
or three days, even if you’ve tried over-the-counter or home remedies.
ear is very painful, or
you have other symptoms that bother you.
Other common conditions, such as temporomandibular joint dysfunction (TMJ), can masquerade as earache infections. TMJ causes ear pain because the ear canal and the jaw joint share a nerve. “If you have ear pain along with trouble chewing, talking or yawning, then you should see a dentist or TMJ expert to be sure you’re treating the right condition,” notes Dr. Nguyen-Huynh.
The good news? Hot and cold compresses and OTC pain relievers can also help relieve TMJ pain until you sort things out.
Earaches in Children – American Family Physician
Please note: This information was current at the time of publication. But medical information is always changing, and some information given here may be out of date. For regularly updated information on a variety of health topics, please visit familydoctor.org, the AAFP patient education website.
Patient Information Collections
Information from Your Family Doctor
Am Fam Physician. 2001 Feb 15;63(4):771-772.
How does the ear work?
The ear works by receiving sound waves and sending messages to the brain. The outer ear includes the part of the ear you can see and the ear canal. The sound waves go through the ear canal and hit the eardrum and cause it to vibrate (see the picture below).
The vibration of the eardrum causes the tiny bones in the ear to move. This movement sends the sound waves to the inner ear.
What causes earaches?
Earaches commonly happen when the ear canal becomes blocked, which keeps fluid from draining out of the canal. Fluid in the middle ear provides a good place for an infection to start. Infection with blockage increases pressure behind the eardrum, causing much of the pain.
The ear canals can become blocked because of allergies, a cold or other infection. In other cases, the adenoid gland near the ear becomes enlarged and blocks the ear canal.
Acute ear infections usually clear up in one or two weeks. Sometimes, ear infections last longer and become chronic. After an infection, fluid may stay in the middle ear. This may lead to more infections and hearing loss.
What are the symptoms of ear infections?
The most common symptoms of an acute ear infection are ear pain (which may be sudden and severe) and fever. If your child is too young to tell you what hurts, he or she may cry and fuss. Your child may also be irritable or listless, have trouble hearing, or not feel like eating.
Will earaches hurt my child’s hearing?
Middle ear infections and fluid in the ear are the most common causes of temporary hearing loss in children. Children who have ongoing problems with hearing may have trouble developing their speech and language skills. For this reason, it is important to talk with your doctor if your child has repeated ear infections.
What is the treatment for ear infections?
If your doctor thinks the infection is caused by bacteria, he or she may prescribe an antibiotic. (Antibiotics don’t work for infections caused by viruses.) It’s important to follow the directions for giving your child the medicine.
Pain relievers like acetaminophen (Children’s or Infants’ Tylenol) and ibuprofen (Children’s Advil or Children’s Motrin) can help make your child feel better and reduce fever. Don’t give your child aspirin unless your doctor says it’s okay.
A warm, not hot, heating pad held over the ear can also help relieve the earache.
Ear drops to relieve pain are sometimes prescribed.
An immunization (“shot”) that helps prevent some ear infections is available. Talk to your doctor for more information.
What can be done to prevent ear infections from returning?
Some children seem to get many ear infections. If your child has had three ear infections in six months or four in one year, your doctor may suggest that your child take a low dose of antibiotic every day, usually during the winter when these infections are most common.
Your doctor may want to see your child a few times when he or she is taking the antibiotic to make sure another ear infection does not happen.
What about fluid that stays in the middle ear?
Your child’s hearing may be affected if fluid stays in the middle ear after an infection. This may also lead to repeat infections. Usually the fluid goes away in two to three months, and hearing returns to normal. Your doctor may want to check your child again at this time to see if fluid is still present.
If the fluid stays for more than a few months, your doctor may want to check your child’s hearing. Your doctor may recommend ear tubes (tympanostomy tubes) to drain the fluid if your child’s hearing has decreased a lot. Ear tubes may also decrease the number of ear infections. These tiny plastic tubes help balance the pressure in your child’s ears and allow air into the middle ear so that fluid can drain out down the ear canal.
What can parents do about middle ear infections? – InformedHealth.org
Children who have an acute middle ear infection (acute otitis media) usually have an earache and a fever. They sleep badly, are restless and cry a lot. What are the treatment options and when is it important to seek medical advice?
Middle ear infections usually clear up after a few days. Complications are very rare. The earache often already goes away again after one day. Until that happens, medication to relieve pain and reduce fever, such as ibuprofen and acetaminophen (paracetamol), can be used to relieve the symptoms. A lot of care and attention is also helpful, and some children feel that certain home remedies have a soothing effect too.
Antibiotics often do not work and can have side effects. So there’s usually a good reason to wait two or three days at first, to see whether a middle ear infection clears up on its own. If the symptoms don’t get better, the child can still take antibiotics then. Antibiotics also help in children who are leaking pus from their ear, and in children who are under two years old and have an infection in both ears.
If a child is unwell, it can be important to seek medical advice early on. The doctor can tell whether it’s a middle ear infection and how severe it is. You can then discuss the most appropriate treatment approach together. If the symptoms don’t get better despite treatment, or if the child has problems such as hearing loss, it’s advisable to see the doctor again.
Pain relief and fever-reducing treatment
Fast pain relief is the focus of treatment. Children can be given acetaminophen (paracetamol) and ibuprofen. In Germany and other countries, these medications are available without a prescription. Both relieve pain and lower fever. They can be given as suppositories or syrup. Ibuprofen has an anti-inflammatory effect too.
The dosage of these medications depends on the child’s age and body weight. When using them, the minimum time interval between doses must be observed as well. You will find more information about how to use them and about their possible side effects in the package insert that comes with them. If you still have any questions, you can also ask your doctor or pharmacist.
Acetylsalicylic acid (ASA, the drug in “Aspirin”) should not be used in children and teenagers unless a doctor has prescribed it because it could lead to a rare, but dangerous, side effect called Reye’s syndrome.
Antibiotics only slightly influence the course of middle ear infections, and they can have side effects. They do not help to relieve pain within the first 24 hours. The difference isn’t noticeable until a little later: Research shows that about 15 out of 100 children are still in pain two to three days after taking antibiotics – in contrast to 22 out of 100 children who did not take antibiotics.
Antibiotics can also reduce the risk of the eardrum bursting. In studies, only 1 out of 100 children who took antibiotics had an eardrum burst – whereas this happened to 3 out of 100 children who did not take antibiotics. The hole in the eardrum is usually only small and heals on its own within a few days or weeks. It’s more serious if the eardrum bursts several times or if the hole is large.
Antibiotics were considerably more effective in two groups of children:
Both are signs of a bacterial infection, which can be treated effectively with antibiotics. Antibiotics can relieve pain and reduce fever after three to seven days in about 25 to 35 out of 100 children in these groups.
Side effects of antibiotics
Antibiotics can cause side effects such as nausea, diarrhea and rashes. Around 5 out of 100 children who use antibiotics have one of these side effects. Using antibiotics too often also leads to the development and spread of bacteria that no longer react to antibiotics (“resistant” bacteria).
Watchful waiting treatment approach
Antibiotics work best in children who have symptoms that suggest their middle ear infection is caused by bacteria (see above). If a child doesn’t have these symptoms, there are good reasons to not give them antibiotics right away, and instead only use them if the earache doesn’t improve or even gets worse after two or three days. Sometimes doctors write a prescription for antibiotics after making the diagnosis, and ask the parents of the sick child to wait before picking the antibiotics up from a pharmacy. In the meantime, the child is given painkillers and, if necessary, something to reduce fever.
This “watchful waiting” approach avoids the possible side effects of antibiotics and doesn’t have any long-term disadvantages. Studies have looked into whether this kind of approach leads to more complications or recurrences of middle ear infections. But this was not found to be the case.
If this approach is taken, it is important to carefully monitor the child’s symptoms and stay in contact with the doctor. That way you can react appropriately if the infection doesn’t get better or if it gets worse.
Decongestant nose drops or nasal sprays
Nose drops and nasal sprays can reduce swelling in the mucous membranes. They are used to help open up the passages leading to the middle ear. But research has not shown that decongestants help make middle ear infections go away faster or relieve the symptoms.
Many children who have a middle ear infection also have a stuffy nose at the same time. Nasal sprays and nose drops can help unblock their nose for a few hours, making it easier for them to breathe. But decongestants should only be used for a few days, and only in the dose recommended for the child’s age. If they are used too long, too often or at too high a dose, they can permanently damage the lining of the nose. In Germany and other countries, decongestant nose drops and nasal sprays are available as over-the-counter drugs in pharmacies.
Earache can also be relieved with ear drops, which have a local effect. In Germany, these ear drops are usually made up of a combination of the drugs phenazone and procaine. There is no research on whether ear drops help in babies and children under the age of three. But they might relieve earache in children aged three and above.
Using ear drops can cause problems if the eardrum has burst. When in doubt, don’t hesitate to ask a doctor.
Incision in the eardrum (paracentesis)
Sometimes a small cut (incision) is made in the eardrum to allow fluid to drain out of the tympanic cavity. But this minor procedure, called paracentesis, is used only if there are complications – for example, if the built-up fluid becomes very painful.
Home remedies and complementary medicine
Many parents also use home remedies or complementary medicine methods to treat middle ear infections. But the effectiveness of most of these treatments has either not been tested in scientific studies at all, or has not been confirmed by research.
Cooling wet towels are sometimes wrapped around the child’s lower legs to reduce a fever. Some parents also place onion wraps on their child’s ear, or they warm the affected ear with infrared light. Although these home remedies have not been scientifically proven to work, some children find them soothing.
Other parents use homeopathic or herbal remedies. But here again, there is no proof that these kinds of remedies can help in children with acute middle ear infections.
If a middle ear infection causes the mucous membranes to swell up and release fluid, the tympanic cavity fills up with the fluid. This is called otitis media with effusion or “glue ear.” It usually goes away after a few days or weeks, but in some children it remains and causes hearing problems. This can slow the development of speech in small children.
When a child has persistent glue ear it’s best to wait a few months to see if it clears up on its own. A doctor should check the child’s ears regularly in the meantime. If the glue ear doesn’t clear up, paracentesis may be considered. This small cut in the eardrum allows the fluid to drain, or it can be vacuumed up.
If fluid still keeps on building up in the child’s ear and he or she can’t hear properly, ear tubes are often recommended. These are narrow tubes made out of plastic or metal, and they allow air to flow to and from the middle ear. Ear tubes can relieve glue ear quickly and improve hearing in the first few months, but there is no proof that they can provide long-term improvement and help to prevent problems with speech and language development.
Ear tubes can also be used in children who have middle ear infections very frequently. In these children, they can probably lower the risk of new infections.
Ear tubes are normally inserted while the child is under general anesthetic, and they usually fall out of the ear on their own after about six to twelve months. There usually aren’t any complications during the procedure. Possible risks include infection or a tube slipping into the tympanic cavity. In rare cases hearing problems may develop after the procedure if the incision doesn’t heal after the treatment or if there is scarring on the ear drum.
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Learn signs of a middle ear infection
What is a middle ear infection?
A middle ear infection, otherwise known as otitis media, is a viral or bacterial infection of the air-filled cavity behind the eardrum. In most cases, a middle ear infection affects just one ear, but can also occur in both ears simultaneously. The infection can cause painful inflammation, as well as a build-up of fluid in the middle ear. Although people of any age can develop the infection, it is most common in younger children, with a high percentage of children experiencing the condition before the age of 10.
In some cases, a middle ear infection may disappear without treatment. While antibiotics are only sometimes necessary to fight the infection, pain-relievers are commonly prescribed to lessen the pain caused by the condition. Further treatment options are available for recurrent middle ear infections. Complications are rare, meaning it is generally considered a non-serious condition.
There are three common types of middle ear infection:
- Acute otitis media: This is the most common form. It is characterised by its rapid onset and often results in ear pain, fever and hearing impairment. It usually lasts for between a few days and a few weeks.
- Otitis media with effusion: Once the initial infection has faded, non-infectious fluid or mucus may continue to build, resulting in pronounced hearing loss and a feeling of fullness in the ear. Otitis media with effusion can also result from a fluid build-up that was never infected. In such cases, antibiotics will often not work as a treatment method. This form often lasts longer than acute otitis media; running its course after around four to six weeks.
- Chronic otitis media: An acute middle ear infection with or without effusion that does not fully disappear or repeats frequently. This can lead to a prolonged inflammatory reaction with subsequent fluid build-up and often to a tear or perforation in the ear drum. When this happens, there will also be discharge from the middle ear. Chronic otitis media can lead to long-term hearing impairment.
Symptoms of a middle ear infection
A middle ear infection generally develops very rapidly.
Signs and symptoms in children may include:
- Ear pain
- Generally feeling unwell (malaise)
- Muffled hearing/partial hearing loss
- Fluid in the ear or yellow, clear or bloody discharge from the ears
- Increased irritability, restlessness, crying and trouble feeding
- Nausea, vomiting and/or dizziness
- A child may excessively pull, tug or touch their ears
Symptoms of a middle ear infection in adults may include:
- Ear pain
- Partial hearing loss/muffled hearing
- Fluid in the ear (that may leak out) or yellow, clear or bloody discharge from the ears
It is important to consult a doctor when:
- Symptoms develop in a child of six months or younger
- A child displays symptoms for 48 hours or more and has a temperature of 39 C (102. 2 F) or more
- Symptoms show no sign of improvement after two or three days
- Symptoms become worse rather than better over the first few days
- Discharge presents itself
- Symptoms are experienced by a person with an underlying health condition, such as cystic fibrosis or congenital heart disease, which could make complications more likely
Causes of a middle ear infection
Middle ear infections are caused by viruses and bacteria, often resulting from other conditions (flu, cold, allergy) that can cause blockage and swelling of the eustachian tubes that connect the throat and the middle ear. When this happens, a vacuum is created, allowing germs and fluid from the throat to enter the middle ear. A middle ear infection develops when bacteria or viruses grow in this fluid.
Children are more susceptible to middle ear infections than adults, partly because their eustachian tubes are narrower, so they are more easily blocked. Children also have relatively larger adenoids than adults. These are masses of tissue situated at the point where the nose bends into the throat that are vulnerable to infection, swelling and inflammation – when this happens, they can block the eustachian tubes and cause a middle ear infection.
Diagnosing a middle ear infection
A doctor will generally be able to diagnose a middle ear infection by considering a person’s symptoms and looking for specific signs. Using an otoscope (a lighted wand-like instrument), a doctor will be able to look into the ears, throat and nose for any signs of infection. While the area around the eardrum will most likely be red and swollen, this will normally only be noticeable upon examination with an otoscope. The ear itself will generally not be red or swollen.
In some cases, especially when the condition is predicted to have taken the form of otitis media with effusion, a pneumatic otoscope may be used to confirm a diagnosis. This instrument pumps air into the middle ear and measures the resulting pressure changes. If little response is felt, this indicates the presence of fluid in the ear.
To further confirm a middle ear infection diagnosis, a doctor may order a number of further tests, including:
- Tympanometry: By testing the movement of the eardrum, this test can provide an indirect measure of pressure and fluid build-up behind the eardrum
- Acoustic reflectometry: By emitting sound into the eardrum and measuring the response from the eardrum, the amount of fluid in the eardrum can be measured. The more sound is reflected by the eardrum, the more fluid is present in the middle ear
- Tympanocentesis: If a middle ear infection is persistent, this test can be used to determine what kind of bacteria is present. This is done by piercing the eardrum, draining the fluid and then testing the make-up of this fluid
Middle ear infection treatment
In many cases, no treatment is required for a middle ear infection, with the symptoms fading quickly and the infection clearing up completely in anywhere between a number of days and two weeks. However, if the symptoms are severe or the infection is persistent, treatment methods are available.
Over-the-counter pain relief medication such as ibuprofen and acetaminophen (paracetamol) can be used by those experiencing a middle ear infection. When giving these drugs to children, a medical professional should be consulted first. Adults should read the instructions on the packaging closely before taking medicinal pain relief. For less severe pain, or if pharmaceuticals are not an option, a warm compress over the ear can also help relieve pain.
In children, antibiotics will normally be prescribed when:
- The infection is severe
- The child is younger than two years old, has an infection in both ears and has mild to severe pain and fever
- The child is at risk of complications from the infection
In cases outside of these parameters, doctors will generally wait a few days before prescribing antibiotics. Adults will typically be prescribed antibiotics when the symptoms are severe or when the infection does not disappear naturally.
When taking antibiotics, it is extremely important to follow the exact instructions of the doctor or pharmacist and ensure the full course is taken. Failure to do so can result in a recurrence of the problem and in the development of antibiotic resistance in the bacteria causing the infection.
Ear tubes (grommets)
If an individual experiences persistent middle ear infections (generally defined as three episodes in six months or four in a year) then ear tubes – sometimes known as grommets – may be necessary.
To place these, a small hole is created in the eardrum. Through this, fluid is drained and a tube is fitted to ventilate the middle ear and prevent the further buildup of fluids. Some ear tubes will naturally fall out after a number of months, whereas others are designed to be worn for longer and may require a procedure in order to remove them. Both the initial insertion and the removal are relatively straightforward outpatient procedures.
Preventing a middle ear infection
There are several ways to help children avoid a middle ear infection. They include:
- Breastfeeding rather than bottle feeding
- Avoiding a child’s exposure to tobacco smoke
- Ensuring a child is up-to-date with their routine vaccinations – particularly the pneumococcal vaccine and the DTaP/IPV/Hib (5-in-1) vaccine
- Avoiding situations where exposure to bacterial infection is a risk (group child care, for example)
- Avoiding use of a pacifier
Complications associated with a middle ear infection
Complications from middle ear infections are extremely uncommon, but can occur, especially in very young children with a not yet fully developed immune system. These complications include:
- Mastoiditis: When the infection spreads into the bones of the ear. Symptoms include fever, pain, tenderness, headache and a creamy discharge from the ear. This condition is treatable, but seeking medical attention early is important.
- Cholesteatoma: A result of tissue build-up from recurrent instances of infection. If left untreated, the condition can cause serious damage. Treatment typically involves surgery.
- Labyrinthitis: A condition that occurs when an infection in the middle ear spreads to the inner ear. Symptoms include dizziness, hearing loss, vertigo and loss of balance. It is treatable.
- Other complications: Other possible complications include facial paralysis, meningitis and brain abscess, but these conditions are extremely rare.
Middle ear infection FAQs
Q: Are there any home remedies for treating a middle ear infection?
A: There are a variety of natural remedies for treating a middle ear infection. These treatment methods may provide some immediate relief, however, a doctor should also be consulted in cases where symptoms persist for more that a couple of days. Remedies include:
- Salt: Heat salt in a pan, wrap it in a cloth and place the cloth against the affected ear for up to ten minutes. This should help draw out fluid from the ear and provide some relief
- Garlic or onions: The antimicrobial properties of garlic and onions give them natural pain relieving qualities. Garlic can be eaten raw. Alternatively, it can be boiled and crushed, then wrapped in a cloth and placed against the ear. It can also be cooked in sesame or mustard oil until black, strained and applied to the ears in drops
- Olive oil: Slightly heat the olive oil and apply a few drop to the ears
- Warm compress: Heat a cloth to a bearable level and place against the outer ear
Q: Are middle ear infections contagious?
A: Middle ear infections are not contagious or spreading. However, part of their causes, like viral infections (such as the common cold) are contagious and spread from person to person.
Middle ear infections – Better Health Channel
Middle ear infection (called otitis media) is an infection behind the eardrum. Ear infections are very common and are usually painful. By the age of six, most children have grown out of middle ear infections and are not likely to suffer long-term problems.
Symptoms of middle ear infections
Infection can cause:
- Earache – mild to severe pain in the ear or face or pulling at the ear and irritability in an infant
- Fever – a high temperature might be the only symptom in babies or young children
- Mild deafness – caused by fluid which builds up from the infection
- Ear discharge – this happens when the eardrum bursts because of pressure behind it.
Children usually recover from mild infections in three to five hours, although your child may feel tired afterwards.
Diagnosis of middle ear infections
Diagnosis is made by the doctor examining the ear drum with an auriscope.
Infections are caused by a virus or bacteria
Middle ear infections are usually caused by a viral or bacterial infection and often happen during or after a child has a cold.
Treating middle ear infections
Mild cases of infection can be treated quickly with paracetamol (for example, Panadol, Dymadon, Tempra). Do not give regular paracetamol medicine for more than 24 hours without seeking advice from your doctor. It will help if you raise the head of your child’s bed.
Some middle ear infections lead to the condition known as glue ear, when thick fluid in the middle ear causes slight deafness. This is not permanent, but it may need treatment. This can include antibiotics and surgery to insert pressure-equalising tubes in the ear drums. Children with glue ear usually recover in a few weeks after the fluid has drained away.
When to see your doctor
See your doctor if your child:
- Is six months of age or younger
- Has a high fever or bad earache
- Has an ear discharge that lasts more than 24 hours
- Continues to have fever or bad earache two days (48 hours) after they start treatment
- Still seems to have trouble hearing after six to eight weeks
- Seems to be getting worse or you are worried at any time.
Treatment with antibiotics
Children six months of age or younger will generally require an antibiotic. In older children, antibiotics may not be needed in all cases.
If antibiotics are prescribed, it is important that your child finishes the medicine according to the instructions (usually for five to seven days). Your child must keep taking the medicine, even if they seem better after a day or two.
Your doctor may occasionally prescribe ear drops. Other medications, such as decongestants do not help middle ear infections.
Where to get help
- Your doctor
- NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
- Royal Children’s Hospital Tel. (03) 9345 5522
- Your maternal and child health nurse
- Your local hospital emergency or casualty department.
- 24 hour Maternal and Child Health Telephone Service: Tel. 13 22 29 for the cost of a local call throughout Victoria.
Things to remember
- Ear infections are very common and usually painful.
- Ear infections do not usually cause long-term problems.
- If the doctor prescribes medicine, it is important your child finishes the whole course.
Treating ear infections in children
If your child is rubbing his ear, should you run to the doctor’s office to demand antibiotics? Probably not. Your child may simply have fluid in the ear and not the classic ear infection that parents and children dread.
Middle Ear Fluid (Otitis Media with Effusion)
Over 2 million American children experience fluid in the middle ear each year, often following a cold or an acute ear infection. The condition is also called a silent ear infection because many children have no symptoms. Some children, though, may rub their ear or experience mild pain, sleep disturbances, unexplained clumsiness, muffled hearing, or delays in language and speech development. The condition may be diagnosed during a routine well-child visit with the use of a pneumatic otoscope, which allows the doctor to see how easily the eardrum moves.
Billions of dollars are spent in the U.S. for diagnosing and treating fluid in the ear each year. However, the fluid most often disappears of its own accord and does not lead to acute ear infections. Also, antihistamines and antibiotics have little effect on the condition and do not help prevent delays in learning or language and speech development.
According to recommendations made by the American Academy of Pediatrics, the only treatment middle ear fluid warrants is watchful waiting. If your child is diagnosed with this condition, the pediatrician will want to reexamine your child in three to six months to be sure the fluid has disappeared. If the fluid persists longer than three months, the physician will recommend your child be tested for hearing and speech development. If the fluid lasts for more than four months and signs of persistent hearing loss are evident, the physician may recommend your child have tubes implanted into the ear to promote drainage.
Some children may need evaluation of hearing, speech, and language development sooner than others. These include children already at risk for developmental delays or difficulties because of an unrelated condition. With these children earlier intervention may be appropriate.
Classic Ear Infection (Acute Otitis Media)
The classic ear infection differs from the silent ear infection because of the sudden onset of significant pain and signs of infection including redness and inflammation. This type of infection is commonly, although not specifically, associated with fever, persistent crying, a runny nose, and perhaps even eye or ear drainage. Often, a pediatrician is unable to diagnose such an infection with certainty because of the difficulty in observing the child’s ear. What is really a case of middle ear fluid may be diagnosed as an acute ear infection.
Acute ear infections are the most common infection for which antibiotics are prescribed to children. However, roughly 80 percent of children with acute ear infections get better without antibiotic treatment. In addition, studies show delaying antibiotic treatment with watchful waiting does not increase the likelihood of developing a serious illness.
If your otherwise healthy child is suffering from an acute ear infection the pediatrician will likely prescribe acetaminophen or ibuprofen for pain relief. The doctor may also offer a prescription for an antibiotic, but only to start it if the symptoms are not improving after two to three days.
Starting an antibiotic immediately is reasonable if your child is
- six months or younger and has a diagnosis of certain or suspected acute infection
- between the ages of six months and two years and has severe symptoms with a diagnosis of certain or suspected acute infection
- between the ages of two and twelve years and has severe symptoms with a diagnosis of certain acute infection.
To help prevent acute ear infections, breastfeed your infant for at least six months, avoid “bottle propping,” and eliminate your child’s exposure to secondhand smoke.
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Please note the date of last review or update on all articles. No content on this site, regardless of date,
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Earache | healthdirect
beginning of content
Earache is a common complaint, especially in children. It is generally caused by an ear infection, but can also be caused by:
- allergies or irritation
- changes in air pressure, such as when you take off or land in a plane
- an object in the ear
- a burst eardrum (for example, if something has been pushed too far into the ear or from a middle ear infection)
- an injury
- a build up of ear wax
- loud noises
- referred pain from a throat infection or an infection near the ear like sinusitis or tonsillitis
- problems with the jaw
- dental problems, such as teeth grinding or an abscess
If the pain persists or gets worse, or if you feel sick or have a temperature, see your doctor.
Some earaches go away on their own within 7 days and do not need treatment. Children rarely need antibiotics for an earache. Simple painkillers like paracetamol can help.
But you should see your doctor if:
- the pain doesn’t go away or is getting worse
- you are feeling unwell with fevers
- you have a discharge from your ears
- it is a child under 2 who has the earache
- you are worried and unsure what to do
Never try to remove something stuck in the ear yourself. Over the counter ear drops or olive oil drops should not be used if the ear drum has burst, and they will not help an ear infection.
Ways to ease the pain include:
- holding a warm cloth or heat pack to your ear
- covering your ears if cold weather or wind makes symptoms worse
If you have a discharge, you can gently clean the outer ear with cotton wool. If there is discharge from both ears, use a new piece of cotton wool for each ear.
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Last reviewed: November 2019
90,000 Otitis media is an inflammatory process that develops in the middle ear
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90,000 Otitis media ᐈ Treatment and symptoms
Otitis media is the medical term for ear inflammation.
- otitis media – an inflammation of the inner ear, often called labyrinthitis
- otitis media: inflammation of the middle ear, (occurs in both acute and chronic forms)
- otitis externa: inflammation of the external auditory canal or auricle
If the inflammation of the middle ear is persistent or recurrent, then we are talking about a chronic form of otitis media. In this case, in most cases, patients develop a defect in the tympanic membrane (a hole in the membrane).There are three forms of chronic otitis media: chronic purulent inflammation of the mucous membrane, chronic purulent inflammation of the mucous membrane and bone structures of the middle ear, and cholesteatoma. None of the above three forms of chronic otitis media (otitis media) can be treated without professional medical attention and surgical therapy.
Typical signs of acute otitis media are sudden, sharp pains, as well as a sensation of noise and pulsation in the ears, all of which can be accompanied by dizziness and hearing impairment.
With purulent inflammation of the middle ear, the tympanic membrane is often damaged and bloody-purulent fluid is released from the ear. After the perforation of the membrane, the pain in the ear may disappear.
Nonspecific symptoms of otitis media include fever (most often in young children), weakness, severe malaise, nausea and vomiting.
Symptoms for chronic otitis media
1) during the active (secretory) phase of the inflammatory process, purulent discharge of a yellowish color, often with a pungent odor, flows out through the ear canal, which can lead to infectious inflammation of the mucous membrane of the ear canal.In this case, inflammation can spread to the bones of the middle ear and provoke adhesions in connective tissues and bone structures. These phenomena, called thymanofibrosis and thymanosclerosis, cause progressive hearing loss, which is also caused by bacterial toxins from chronically inflamed middle ear mucosa. If the middle and inner ear are affected, sensorineural hearing loss may occur, i. e. combined deafness. Chronic otitis media, as a rule, after the secretory phase does not cause fever and pain.Patients mainly consult a doctor when they experience discomfort with discharge with a putrid odor from the auricle, with progressive hearing loss, dizziness, tinnitus, problems with balance, coordination of movements, or even more severe complications.
2) Symptoms of chronic suppuration of the mucous membrane and bone tissue:
Discharge from the auricle is purulent, viscous, mucous, yellow with a putrid odor. In an acute middle ear infection, pressure occurs behind the eardrum, often causing severe mastoid pain.In a number of situations, the inflammatory process with purulent otitis media passes to the bone tissue of the temporal region and the mastoid process of the temporal bone.
With an exacerbation of chronic inflammation of the middle ear, the so-called super-infection, the pain intensifies and the temperature rises. The patient has a gradual weakening of hearing until it is completely lost, tinnitus, in rare cases, dizziness, imbalance, paralysis of the facial nerve (neuritis). In a number of situations, the inflammatory process with purulent otitis media passes to the bone tissue of the temporal region and the mastoid process, and the pus accumulated above the tympanic membrane does not break through it and does not come out through the auditory tube, then the infection can penetrate through the venous vessels into the cranial cavity, which leads to severe intracranial complications such as blood poisoning (sepsis), inflammation of the venous vessels of the brain with the formation of blood clots, meningitis (infectious inflammation of the cerebral membrane), encephalitis or brain abscess
3) Symptoms of cholesteatoma:
Cholesteatoma (a tumor-like formation that develops in the middle ear cavity) has various signs depending on the stage of development of the disease: from a feeling of fullness in the ear and dull aching pain in the mastoid process, to neuralgia (shooting sharp pain) in the ear, and at the stage of exacerbation cholesteatoma is characterized by prolonged pain, fever, discharge from the auricle, progressive hearing loss with or without tinnitus, dizziness, imbalance, neurosis (paresis) of the facial nerve. The disease usually develops at a slow pace. Increasing in size, the cholesteatoma can destroy the nearby bone structures of the skull, its contents will penetrate into the brain, which can cause infectious inflammation of the lining of the brain (meningitis), inflammation of the brain (encephalitis), brain abscess and other serious consequences.
Causes and risks
One of the causes of otitis media is acute respiratory disease of the nasopharynx.Acute otitis media in 80% of cases develops on the basis of a viral infection of the mucous membrane of the upper respiratory tract. The most common pathogens of infection are rhino virus, RS (respiratory syncytial) – virus, influenza virus, which rapidly multiply in the nasopharynx and Eustachian tube. In addition, in about 20% of patients, the infection is also caused by a certain type of bacteria that penetrates through the Eustachian tube into the middle ear, such as, for example, streptococci (Streptococcus pneumoniae) or the bacillus influenza (Haemophilus influenza).
This process is observed mainly in patients with frequent cases of chronic inflammation of the nasal mucosa or paranasal sinuses.
Possible causes of chronic otitis media include allergic diseases of the upper respiratory tract or (less commonly) swelling in the nasopharynx. A special form of chronic otitis media, cholesteatoma, can be congenital (genuines Cholesteatom) or result from a fracture of the longitudinal temporal bone (post-traumatic cholesteatoma).
Primary acquired cholesteatoma occurs as a result of a retracted saccular cavity (pocket) of the tympanic membrane and negative pressure within the middle ear. As soon as the retraction becomes too deep, and the keratin is no longer able to be removed from the fold, its remnants begin to accumulate in it. Secondary acquired cholesteatoma occurs due to ingrowth of squamous epithelial cells from the edges of a rupture in the tympanic membrane. Such a rupture most often occurs as a result of an infectious inflammatory process in the middle ear.
Examination and diagnosis
In order to identify acute inflammation of the middle ear, to establish a diagnosis of acute otitis media, the otolaryngologist examines the eardrum, nasopharynx, nasal cavity and paranasal sinuses. In some cases, it is necessary to check the patient’s balance and coordination of movements in order to timely identify possible consequences of the disease, for example, labyrinthitis with toxic damage to the inner ear. In this case, such research methods are used as tympanometry, threshold audiometry, sound audiometry.
Diagnostics also includes hearing tests. Auricular discharge is often analyzed. In case of suspicion of complications, for example, mastoiditis (inflammation of the mastoid process of the temporal bone) or other side effects, an X-ray examination is performed. With the help of an X-ray, the results of a computed tomography of the temporal bone or cranium, it is possible to determine in a timely manner the expediency of surgical intervention.
Treatment of otitis media is mainly symptomatic.This means that it is aimed at eliminating the symptoms of the disease, and not the cause that caused the disease. This is due to the fact that otitis media is caused by various viruses and bacteria that are resistant to many antibiotics, so not every antibiotic provides an effective treatment result.
At the initial stage of the disease, it is recommended to use decongestant nasal sprays. Additionally, it is prescribed to take anti-inflammatory, antipyretic and pain relievers of natural origin, for example, tablets, which include Bromelain.Tablets with the active ingredient Diclofenac also have anti-inflammatory, decongestant and analgesic effects. In case of intolerance to Diclofenac, it can be replaced with Ibuprofen, if there are no contraindications to taking it. Children are advised, after consulting a doctor, to take paracetamol as an analgesic and antipyretic agent. Treatment of otitis media also includes instilling anesthetic drops into the ear canal, but only as directed by a doctor. Self-medication is unacceptable, since the symptoms will be mild and make it difficult to diagnose the disease.
Antibiotic treatment is prescribed by a doctor in order to prevent serious complications after otitis media and to reduce the risk of the consequences of otitis media. At the same time, it is important to strictly follow all instructions regarding the frequency and duration of antibiotic use.
If the tympanic membrane does not burst during inflammation and the purulent contents accumulated above it does not get out, the doctor may make a small incision in the anterior lower part of the membrane so that pus can flow out through this opening.This procedure is performed for adults under local anesthesia and for children under general anesthesia. Due to the fact that the incision in the eardrum within a few days can heal on its own, the doctor often inserts a small plastic, titanium or gold tube into it to facilitate the outflow of purulent contents, ventilate the middle ear and ensure normal air pressure in it. If such a drainage tube does not come off by itself within 6-12 months due to the fact that the hole is clogged with sulfur or squeezed by a thickened scar on the eardrum, then it is removed promptly.In this case, the tympanic membrane is restored in most cases by itself.
If otitis media often occurs in children at an early age, then they are recommended to remove enlarged from birth or chronically inflamed tonsils, adenoids, children’s “polyps”. In adolescent children with frequent or chronic inflammation of the nasal mucosa and paranasal sinuses, accompanied by otitis media, surgery is a necessary treatment. Here we are talking about the so-called sanitation of the nasopharynx, nose and paranasal sinuses.None of the above forms of chronic otitis media can be treated only surgically – it is necessary only when conservative treatment does not give the desired result.
Treatment course and prognosis
As a rule, with timely diagnosis and proper treatment, otitis media proceeds without consequences and is completely curable. About 80% of patients get rid of symptoms within 2-7 days from the onset of the disease.
However, chronic otitis media sometimes causes complications, the most common of which is mastoiditis (inflammation of the mastoid bone of the temporal bone).The mastoid is part of the skull bone, is located near the middle ear and is also filled with air. With mastoiditis, bone tissue is often affected and inflammation can spread to the lining of the brain or the brain.
Frequent otitis media in childhood leads to hearing loss and a delay in the development of speech in the child. One of the complications of the disease can be inflammation of the inner ear (labyrinthitis).
Acute otitis media sometimes occurs on the basis of certain infectious diseases, for example, scarlet fever or measles, and manifests itself with symptoms typical for it.
Sialoadenitis – symptoms and treatment of inflammation of the salivary glands
Sialoadenitis is an inflammation of the salivary glands. In the oral cavity there are three pairs of large salivary glands: parotid, submandibular and sublingual. They secrete saliva and drain it through special ducts into the mouth to help digestion. Saliva softens food and also helps to swallow it. The inflammatory process not only complicates the production of saliva and the feeding process, but also causes a lot of inconvenience due to the appearance of painful symptoms.The disease is treated by a doctor in the Department of Maxillofacial Surgery, and in some cases by an infectious disease specialist.
Causes of siladenitis
By the nature of the causes of inflammation, sialoadenitis is epidemic and non-epidemic. In the first case, we are talking about infections, and the most common cause of damage to the salivary glands is mumps, or mumps. In this case, the virus is transmitted by airborne droplets from an infected person to a healthy person.
Sialoadenitis of a non-epidemic nature is most often associated with blockage of the ducts of the glands. Such a violation can be triggered by trauma, the ingress of a foreign body, the formation of stones – sialolithiasis.
There are factors that increase the likelihood of developing sialoadenitis. Among them:
- Irregular or improper oral hygiene;
- systemic, somatic diseases leading to changes in the composition and viscosity of saliva;
- transferred infectious diseases – viral encephalitis, influenza, ARVI, etc.;
- transferred surgical interventions.
By localization, unilateral and bilateral sialoadenitis is distinguished, and by the nature of the inflammation, the pathology can be serous, purulent and gangrenous.
Symptoms of the disease
The main symptoms of sialoadenitis include the following:
- Pain while chewing;
- redness, swelling of the cheeks, neck;
- violation of taste perception;
- unpleasant taste in the mouth;
- dryness of the mucous membranes;
- general deterioration in well-being;
- Difficulty opening the mouth.
In acute sialoadenitis, symptoms increase rapidly and may also quickly subside. However, in the absence of proper treatment, the disease can become chronic, therefore, even if you feel better, it is important to consult a dentist.
Lack of therapy can cause complications, the most common of which include the formation of abscesses (abscesses), secondary infection – the attachment of a bacterial infection to a fungal infection, etc. This will require more serious intervention and long-term treatment, so you should not postpone a visit to the doctor.
Diagnosis of acute and chronic sialoadenitis begins with an examination of the oral cavity. The doctor will note an increase in the salivary glands, determine the nature of the discharge. If an abscess is suspected, an ultrasound scan may be required. Laboratory studies will help assess the general condition, the severity of the inflammatory process and choose the right treatment. In the presence of purulent discharge, the doctor will prescribe a bacteriological culture to determine the flora and causative agent of the disease and choose the right antibiotic therapy.
Sometimes diagnostic methods such as:
- CT of the skull;
- mucosal biopsy;
- PCR studies;
- Radiography, MRI of salivary glands, etc.
This will clarify the nature of the disease, exclude possible severe pathologies and complications.
Acute forms of sialoadenitis must be treated. The doctor will prescribe medications that increase saliva production, as well as antibacterial drugs and antiseptics for rinsing.Physiotherapy, for example, UHF and laser exposure, can also serve as an addition. Relief with an integrated approach can already occur on the third day, and on the 7-8th day, complete recovery occurs.
Treatment of sialoadenitis requires oral hygiene. It is important to brush your teeth not only twice a day, but also after every meal. For easier chewing, food is best divided into small pieces. You should not eat hot food and drinks, the food should be at a comfortable temperature.
As symptomatic therapy, antipyretic and pain relievers can be used. With their ineffectiveness and severe pain, novocaine blockade can be performed.
Chronic forms of the disease are more persistent, and therefore take longer to heal. Surgical treatment is required if there are indications such as structural changes in the salivary glands. Galvanization can be used – exposure to electric current, removal of stones, drainage of the gland to remove contents and cleanse tissues.Removal is a last resort; in most cases, doctors try to preserve the salivary glands. Treatment is carried out under conditions of maxillofacial surgery.
With calculous siloadenitis, only surgical treatment is possible: it is important to remove the stone, treat the salivary gland with antiseptic agents.
Sialoadenitis in children
Sialoadenitis is often found in children, while the cause of the disease can be not only mumps, but also cytomegalovirus infection. In this case, the doctor will select a specific treatment for the underlying ailment.
With the bacterial nature of the disease, treatment with antibiotics active against gram-positive bacteria from the genus staphylococci is indicated. The doctor will also select suitable antiseptics for mouthwash. General guidelines include lifestyle adjustments to provide hydration and stimulate increased salivation. The following measures will help:
- warm compresses;
- soft massage of the inflamed gland;
- thorough oral hygiene;
- Consuming lemon juice, sour gummies and other saliva-stimulating foods.
When treating sialoadenitis, a specialist may recommend dissolving a slice of lemon or other acidic food.
If the measures are ineffective and there are indications, surgical intervention can be performed. Sometimes superficial parotidectomy is indicated – excision of the submandibular gland. However, this is an extreme measure, the doctor will try to preserve his own tissues and cope with inflammation without surgery.
The disease does not pose a serious danger to health and life, but it significantly worsens the general condition and can cause complications in the absence of timely appropriate treatment.The main consequences are:
- the spread of the purulent process and the formation of inflammatory diseases of the oral cavity;
- accession of a secondary infection;
- mediastinitis – inflammation of the mediastinum;
- adhesion of the walls of the salivary gland, which leads to complete inoperability and the need for removal;
- sepsis with damage to the mucous membranes of vital organs, etc.
That is why it is important for both adults and children to consult a dentist in a timely manner and undergo a course of treatment.
Features of prevention
To prevent sialoadenitis, it is important to quit smoking, adhere to a healthy lifestyle, and sanitize the oral cavity in a timely manner. Only qualified professionals should treat common infections and inflammatory diseases of the oral cavity.
Modern approaches to the treatment of otitis externa of various etiologies | Turovsky A.B., Popova I.A., Shadrin G.B.
Modern approaches to the treatment of otitis externa of various etiology are presented
Inflammatory diseases of the external ear in patients of different age groups, according to numerous domestic and foreign studies, account for up to 17% of all ENT pathology.In the outpatient clinic, the proportion of patients with various forms of otitis media reaches 38%, of which patients with external otitis media – on average 50%. The trend towards an increase in the incidence of otitis externa among all age groups continues. This is due not only to the adverse effects of the environment, the wide and uncontrolled use of medications that cause immunological changes in the body, but also to an increase in the number of patients with an allergic background. The greatest prevalence of pathology is noted in older childhood and young age.Throughout life, on average, every 10th person suffers otitis externa at least once, and 3-5% of the population suffer from chronic otitis externa . The disease is most common among people who are in high humidity conditions for a long time.
Etiology and pathogenesis
Inflammatory diseases of the external ear, according to the literature, in 60–98% of cases are bacterial in nature. The microbial landscape in otitis externa has changed over time. Recently, the role of Pseudomonas aeruginosa has increased on average to 78%, while Staphylococcus aureus occurs only in 9–27% of cases .Beginning as otitis externa caused by Pseudomonas aeruginosa, malignant otitis externa can progress to pseudomonas osteomyelitis of the temporal bone. Less commonly, in inflammatory diseases of the outer ear, Staphylococcus epidermidis, Streptococcus pyogenes, Streptococcus pneumonia, Enterococcae, Escherichia coli, Proteus, Klebsiella pneumonia, Mycoplasma pneumonia, anaerobes and other microorganisms are determined. In addition to the bacterial flora, pathogenic fungi play an essential role in the development of otitis externa.In some cases, bacterial or bacterial-fungal associations act as an etiotropic factor.
The general condition of the body plays a significant role in the etiopathogenesis of otitis media. In this regard, otitis externa is very often found in patients with diabetes mellitus, impaired immune status.
Such protective mechanisms as a weak acidic environment (pH 5.0–5.7) on the surface of the skin of the external auditory canal and the protective properties of earwax prevent excessive growth of microflora.The development of the inflammatory process in the outer ear is preceded by a violation of the integrity of the skin, which can be caused by many reasons: trauma, prolonged exposure to a humid environment, skin changes against the background of metabolic disorders, diabetes mellitus, various dermatitis, eczematous processes. Factors predisposing to the onset of otitis externa are the anatomical features of the structure: narrow external auditory canals, the presence of exostosis, as well as wearing a hearing aid, water ingress into the ears, lack of education and changes in the composition of earwax, impaired local and general immune status, radiation exposure  . ..
According to the etiological factor, otitis externa can be bacterial, viral, fungal, allergic, idiopathic.
The main symptoms of otitis externa are ear pain (70%), itching (60%), hearing loss (32%), and a feeling of pressure or distention in the ear (22%) . Otoscopically, hyperemia and infiltration of the skin of the membranous-cartilaginous part of the ear canal is determined, its lumen sometimes narrows to such an extent that the eardrum becomes inaccessible for viewing.Desquamated epithelium mixes with pus, resulting in the formation of mushy masses with a pungent putrid odor. When pressing on the tragus or pulling the auricle backward and upward, as a rule, pain occurs in such patients, which makes it possible to carry out a differential diagnosis between inflammation of the outer and middle ear. Diffuse otitis externa should be differentiated from malignant otitis externa, furunculosis, bullous otitis externa and seborrheic dermatitis . Oncological diseases of the external ear, fortunately, are not so common, but long-term ongoing infectious inflammation that does not respond to conservative treatment, with pronounced growth of granulation tissue, may require biopsy followed by histological examination to exclude malignant neoplasm of the external ear .
Diffuse otitis externa is characterized by damage to the skin of the external auditory canal, subcutaneous tissue (in the membranous-cartilaginous part) and the periosteum, which lies directly under the skin in the bony part of the external auditory canal. The disease is usually accompanied by pain in the ear, hearing loss, itching and purulent discharge. The diagnosis is based on the presence of typical signs of diffuse inflammation of the skin of the external auditory canal, which sometimes extends to the eardrum.The process has an acute or chronic course with exacerbations.
In some cases, otitis externa caused by Pseudomonas aeruginosa can take on a malignant course and turn into pseudomonal osteomyelitis of the temporal bone, if untreated, the infection progresses, spreading to the auricle, scalp and parotid salivary gland. Subsequently, the lesion affects the middle and inner ear, which can lead to the development of meningitis and otogenic brain abscesses.
With limited otitis externa, inflammation is always localized in the fibro-cartilaginous part of the external auditory canal.This must be taken into account in the differential diagnosis of purulent otitis media, accompanied by mastoiditis, when the overhanging of the skin in the anterior-upper part of the external auditory canal is otoscopically determined. The stage of infiltration is characterized by local hyperemia and thickening of the skin. At the stage of abscess formation, redness of the skin can spread to the entire surface of the external auditory canal, however, a sharply painful infiltrate with a translucent purulent rod at its apex, dense on palpation, is always determined.For limited otitis externa, damage to the hair follicle and the surrounding subcutaneous tissue is characteristic. The disease is accompanied by pain in the ear, gradually progressive, persistent in nature, aggravated by opening the mouth and chewing. Hearing loss is not a typical complaint, however, with a large boil that blocks the lumen of the external auditory canal, a pattern of conductive hearing loss can be observed on the side of the affected ear.
Diagnostics and differential diagnostics
The diagnosis of otitis externa is based on the patient’s complaints, medical history, data on the general clinical picture, and the results of otoscopy.The optimal diagnostic method is considered to be the conduct of complex laboratory microbiological studies aimed at identifying the causative agent of the disease and determining its sensitivity to specific therapy.
Differential diagnosis of diffuse otitis externa should be carried out with acute otitis media, mastoiditis, as well as with purulent parotitis.
Typical signs of erysipelas of the external ear are symptoms of general intoxication: an increase in body temperature to 39-40 ° C, chills and headache.Allocate erythematous form, bullous and bullous-hemorrhagic. In the erythematous form, there is marked hyperemia and edema of the skin of the entire auricle with clear edges, including the earlobe. On palpation, a sharp soreness is determined. The bullous form of the disease is characterized by the formation of blisters with serous contents against the background of hyperemia of the auricle. With a bullous-hemorrhagic form, bubbles with serous-hemorrhagic contents are determined. It is also possible that erysipelas may spread to the tympanic membrane, and erysipelas otitis media occurs.Differential diagnosis is carried out with chondroperichondritis of the auricle (the earlobe is not included in the inflammatory process), as well as with mastoiditis (when hyperemia spreads to the mastoid process).
Chondroperichondritis of the auricle is a diffuse inflammation of the perichondrium with the involvement of the outer ear skin in the process. According to the form of the disease, serous and purulent perichondritis are distinguished. The causes of the disease can be injuries, burns, insect bites. The occurrence of perichondritis is also possible as a complication of the furuncle of the ear canal, as well as diffuse otitis externa.The clinical picture of chondroperichondritis is characterized by pain in the area of the auricle or external auditory canal with irradiation into the adjacent tissues. Edema and hyperemia spread throughout the auricle, excluding the earlobe. In the future, fluctuations may appear due to the formation of purulent exudate. With the progression of the disease, cartilage melts with rejection of necrotic tissues and subsequent deformation of the auricle. The differential diagnosis is carried out with erysipelas and otogematoma.
With herpetic otitis media, severe intoxication and fever are observed. Sharp pain in the ear, itching, tingling sensation are also characteristic. The features of herpetic lesions of the ear include rashes in the form of pink spots, followed by the formation of vesicles with transparent contents. The rash is localized along the sensory nerves (posterior surface of the auricle, earlobe, skin of the ear canal). After self-opening of the bubbles after 7-10 days, crusts form, after which, after falling off, no traces remain on the skin.With this disease, complications are possible in the form of arachnoiditis, meningitis, brain abscess, peripheral paresis of the facial nerve, as well as vestibular disorders, sensorineural hearing loss.
Differential diagnosis is carried out with eczema of the external ear, a bullous form of erysipelas.
Due to the lack of early microbiological diagnostics, treatment tactics for otitis externa in adults and children are mainly based on the initial empirical prescription of systemic and local anti-inflammatory drugs.For the effectiveness of antimicrobial therapy in otitis externa, a prerequisite is the appointment of broad-spectrum antibacterial drugs with a high level of bioavailability and safety, as well as symptomatic and hyposensitizing therapy .
Otitis externa therapy is prescribed taking into account the clinical picture and the nature of the pathogenic microflora. With an uncomplicated course, it is enough to prescribe a short course of local composite preparations containing antibiotics.Patients with moderate and severe course of diffuse external otitis media with an increase in body temperature, spread of the inflammatory process outside the ear canal, the presence of regional lymphadenopathy, suspicion of infection spread to the middle ear or signs of necrotization of the process, as well as in the case of a prolonged course, the use of systemic antibiotic therapy is recommended [6 ].
When treating a furuncle of the external auditory canal, as a rule, systemic antibiotics are prescribed.The drugs of choice are protected penicillins or cephalosporin drugs. At the stage of infiltration, as a local therapy, it is advisable to use antibacterial ointments 3-4 r. / Day. Combination with physiotherapy (UHF therapy) is possible. If therapy is ineffective at the stage of abscess formation, surgical treatment is performed (opening the boil).
Treatment of erysipelas is carried out in a hospital setting. For treatment, antibiotics of the penicillin series are used in combination with hyposensitizing therapy.As a local therapy, extinguishing of the affected areas with a 3-5% solution of potassium permanganate is used.
In the treatment of perichondritis of the auricle, antibiotics of a wide spectrum of action are the drugs of choice: cephalosporins of the III-IV generation, fluoroquinolones – in adults and children over 15 years old. As a local therapy, they use quenching with a 3-5% solution of potassium permanganate, ointment applications with polymyxin, as well as physiotherapeutic procedures (UFO, UHF therapy, laser therapy).When fluctuations appear, the subperichondral abscesses are opened and drained with the removal of necrotic tissue sites.
In case of herpetic lesions of the external ear, treatment should be comprehensive, including detoxification, anti-inflammatory and hyposensitizing therapy. In addition, specific antiviral therapy with acyclovir is required. To prevent secondary bacterial inflammation, antibiotics of the penicillin and cephalosporin series are prescribed.
For mycotic otitis externa, nitrofungin is used. It is used for various types of fungal skin lesions: trichophytosis, fungal eczema, epidermophytosis, candidiasis. With candidiasis, you can combine nitrofungin treatment with clotrimazole. Amphotericin B, amphoglucamine, and mycoheptin are effective against molds.
For malignant otitis externa, antibiotics that are active against Pseudomonas aeruginosa are urgently prescribed: penicillins (azlocillin, piperacillin), cephalosporins (ceftazidime, cefoperazone, cefepime), aztreonam, ciprofloxacin.It is advisable to prescribe all these antibiotics in combination with aminoglycosides (gentamicin, tobramycin, netilmicin, amikacin) and use in high doses intravenously for 4–8 weeks. (excluding aminoglycosides). With stabilization of the state, it is possible to switch to oral therapy with ciprofloxacin.
In the treatment of bacterial diffuse otitis externa, etiotropic therapy depends on the type of pathogen. In case of diffuse bacterial otitis media, the drugs of choice for systemic antibacterial therapy are broad-spectrum antibiotics, preference is given to drugs with antipseudomonal activity (cephalosporins of the third generation, fluoroquinolones – in adults and children over 15 years old).
Topical drugs are central to the treatment of otitis externa. Given the range of the main causative agents of acute diffuse otitis externa, drugs that are effective against Staphylococcus aureus and Pseudomonas aeruginosa should be used, and given the presence of a characteristic pain syndrome in this pathology, it is advisable to use local drugs, which include a local anesthetic component. Of the antibacterial agents for the local treatment of diffuse otitis externa, aminoglycosides are most often used, i.e.because these drugs completely cover the spectrum (primarily gram-negative microorganisms that cause otitis externa) and provide a good application effect.
Drugs used for topical treatment of otitis externa are available in the form of ointments, creams, ear drops. Ear drops are a versatile and most common form of release.
In our opinion, for the treatment of diffuse otitis externa, one of the most effective are ear drops Anauran – a combined preparation, which, along with neomycin and polymyxin B, which have a powerful antimicrobial effect, includes lidocaine, a strong local anesthetic.
Neomycin sulfate is an antibiotic of the aminoglycoside group with a broad spectrum of action. The drug is a complex of antibiotics (neomycin A, neomycin B, neomycin C), formed during the life of the radiant fungus (actinomycete) Streptomyces fradiae or related microorganisms. Neomycin sulfate has a wide range of bactericidal activity: against strains of gram-positive and gram-negative bacteria (including S. pneumoniae, Staphylococcus spp., E. coll, Proteus spp., Shigella dysenteria spp., Shigella boydii spp., Shigella flexneri spp. and Shigella sonnei spp .). Resistance of microorganisms to neomycin develops extremely slowly.
The uniqueness and effectiveness of Anauran’s action is explained by the presence of polymyxin in the drops, which distinguishes Anauran from similar drugs. Polymyxins are a group of antibiotics synthesized by a specific strain of the spore-forming bacillus; in terms of chemical composition, they belong to cyclic peptides.Systemic use of polymyxins is limited due to their high toxicity. At the same time, side effects with topical application of polymyxin are extremely rare. The main indications for its use are severe infections caused by pseudomonads and Klebsiella (pneumonia, lung abscess, sepsis, endocarditis, meningitis). The unique spectrum of antibacterial action against gram-negative bacteria, and especially the majority of P. aeruginosa and E. Coli strains , makes polymyxin the drug of choice for the treatment of otitis externa .
The presence of lidocaine, a local anesthetic, in the composition of the drug, allows you to quickly and safely cope with the pain that accompanies most diseases of the outer ear, as well as relieve such a manifestation of inflammation as puffiness. Adequate anesthesia is one of the first places in the complex therapy of otitis externa, it can significantly alleviate the condition of patients as soon as possible.
Thus, Anauran can be recommended as the drug of choice in the treatment of otitis externa of bacterial etiology.
In conclusion, it should be noted that the best method of treating otitis media is its prevention, that is, timely treatment of acute respiratory viral infections, diseases of the nose, paranasal sinuses and nasopharynx, as well as observance of the rules of hygiene of the outer ear.
Otitis media ›Diseases› DoctorPiter.ru
Anyone who has suffered from otitis media at least once in his life will not confuse this disease with any other. And just in case, in cold weather, even if he does not wear a hat, he hides his ears under a special strip to protect them from hypothermia.But it is not at all cold ears that most often cause the disease.
Pain inside the ear, radiating to the temple, sometimes such that it is simply unbearable to endure it. As a rule, it begins against the background of a cold, accompanied by a high fever. Sometimes inflammation is manifested by purulent discharge.
Otitis media is a very common pathology, it develops most often due to inflammatory processes in the nose and nasopharynx.But in order to understand how this happens, one must have an idea of what the ear is. What we see and understand by this word is just an auricle. It acts as a shock absorber between the external and internal environment of the ear and the function of a kind of horn that collects sound waves. A deep auditory meatus 2 – 2.5 cm in diameter is located behind the shell. Behind it is the eardrum, and then the middle ear. It is called so because it is located between the outer and inner ear and is a practically closed cavity, with a volume of about 1 cubic meter.see With the external environment it is connected by the auditory tube, which passes from the middle ear to the nasopharynx. It is needed to maintain normal pressure in the ear, mucus gets into it, if there is a lot of it in the middle ear, there may be pus in case of pathology. And it is she who is the main input source of infection that penetrates the ear from the nasopharynx. Infection ascending through the auditory tube enters the middle ear and inflammation develops.
The fact is that normal atmospheric pressure and pressure in the middle ear are exactly the same.If it changes quickly, for example, when going up a high-speed elevator, then there is a feeling of ear congestion. But we make two or three swallowing movements, and the auditory tube opens, a new portion of air enters and the pressure is equalized. For the same reason, candy is given on planes – it allows us to swallow, which helps open the auditory tube. With inflammation in the nasopharynx, the auditory tube becomes inflamed and closes, and the tympanic cavity becomes closed. The oxygen that remains there is absorbed into the bloodstream, the pressure decreases, and the person begins to feel pressure on the ears and even pain.
If the inflammation is strong, then due to a decrease in pressure, the so-called transudate or exudate begins to sweat from the bloodstream. This liquid becomes a great nutrient broth for bacteria that get there from the nasopharynx. A blooming purulent inflammation of the middle ear flares up. And since the volume in it is small, the pressure rises quickly and causes such severe pain that pain relief is required. If it is possible to open the auditory tube, then the pus will go through it and the ear will recover.
In children under three years of age (by this age, almost every baby suffers otitis media), the auditory tube is short and wide – through it, the infection enters the ear very quickly, but it can also quickly spontaneously come out of it. Also, oddly enough, a child’s eardrum is thicker than an adult’s. Therefore, in adults, suppuration from the ear during illness occurs more often – the contents of the middle ear breaks through the eardrum and flows out. And once the pressure in the ear has dropped, it becomes easier for a person.When the pressure returns to normal, a scar forms in the hole formed on the membrane and the person does not experience the consequences of otitis media.
The scar on the eardrum does not affect the quality of hearing. But due to frequent otitis media, scars can also form in the middle ear, on which the quality of hearing depends to a large extent. The middle ear is deep in the bone. And inside it there are three bones that form a chain. One of its “links” is a hammer, its head rests against the anvil, and it rests against the stirrup.The hammer handle is included in the eardrum. The eardrum moves – the hammer moves, it pushes the anvil, it is the stirrup. The streamer, in turn, begins to move fluids in the inner ear – a formation similar to a cochlea and located in the very thickness of the temporal bone, thanks to which we hear. Scars interfere with the normal interaction of the bones, it is difficult for them to move, therefore hearing loss develops.
The ear can hurt not only with otitis media, but also for other reasons, for example, with trigeminal neuralgia or pulpitis and periodontitis, pain often “gives” to the ear, it accompanies diseases such as lymphadenitis and childhood infectious disease – mumps.If an adult can, by concentrating, understand that it is the ear that hurts, then the child is unlikely to be able to distinguish one pain from another. Therefore, before giving him first aid, you should lightly press on the tragus (the protrusion of the auricle that covers the ear canal). If he feels pain, then it really is otitis media.
It’s a paradox, but the very first remedy for such pain is drops from a runny nose in the nose. And leaning towards the sore ear. If both ears hurt, then when digging in the right ear, you should turn your head to the right, the left – to the left.Any vasoconstrictor (vasoconstrictor) is suitable.
To relieve pain before the doctor arrives, you can drip warm (body temperature) boric alcohol into your ear. Or moisten a cotton swab with it and insert it deep into the ear canal, as close to the eardrum as possible. A warming compress helps to relieve the condition. It’s easy to make. You need to take gauze folded in several layers, or flannel cloth, cut to the middle on one side, wet with warm diluted alcohol or vodka and put on your ear.On top you need to put compress paper, tracing paper or polyethylene (from a regular bag), close this structure with a layer of cotton wool and fasten it tightly – this can be done with a bandage or a simple scarf, the main thing is that air does not penetrate there. The compress keeps warm for 4-6 hours, then it is removed, and a warm scarf is put on the head.
To correctly diagnose the disease, you should consult an otolaryngologist (ENT doctor) immediately after the onset of symptoms.In addition to collecting anamnesis, based on the patient’s condition, he can prescribe an otoscopy, an X-ray of the skull, a complete blood count, as well as a hearing test using tuning forks and audiometry.
The key to treating otitis media is the auditory tube. This means that first of all it is necessary to treat the nose, therefore, as a rule, any vasoconstrictor drops are prescribed (“Naphtizin”, “Sanorin”, “Tizin”, “Nazivin” …). External drops (in the ear) are also used, mainly Otipax is prescribed.They contain anti-inflammatory, pain relieving ingredients and alcohol. In addition, anti-inflammatory and alcohol drops are prescribed. Dry heat or compress (described above) is also recommended. The heat has an anti-inflammatory effect, increases blood flow to the ear area and helps the eustachian tube open up.
That is, the treatment regimen is simple – to open the auditory tube, provide warmth and instill the medicine in the ear. However, it is only good before the perforation occurs – the eardrum has burst.In this case, any alcohol drops will cause a burning sensation; drops containing antibiotics will be required. The need to use antibiotics in the treatment of otitis media is being debated today. Nevertheless, they are almost always prescribed for adults, children are also often prescribed, although they can be cured without using them, it all depends on the severity of the disease. But there is danger here. There are only three types of antibiotic drops that you can drip into your ears. The remaining couple dozen contain so-called aminoglycoside antibiotics, which can cause deafness.In the annotations to them, it is written in small print – you can not bury when the eardrum is perforated, for example, the popular “Sofradex”, which flows like a river into the ears, can cause deafness. Children can only be instilled with Otofa. Everything else is for otitis externa.
Aminoglycoside antibiotics (gentamicin, streptomycin), which are prescribed to us for a variety of diseases, including otitis media, ENT doctors call their enemies. In addition to the fact that they are used for a long time and no longer have a therapeutic effect, these antibiotics are very aggressive in relation to the organ of hearing.With otitis media, they cannot be used at all. Against the background of inflammation, the barrier between the inner and middle ear decreases, and gentamicin, entering the inner ear, kills hair cells there and causes antibiotic deafness.
In acute otitis media, physiotherapeutic procedures can be prescribed: UHF, laser therapy on the area of the auditory tube orifice, pneumomassage.
Surgical treatment of acute otitis media is rarely used, mainly for children. Since the child has a thick membrane, it is difficult to break through it, therefore, only in childhood such an operation as paracentesis is performed – the doctor cuts the membrane with a special scalpel and the child recovers faster.
Of great danger are otitis media associated with childhood infectious diseases (measles, rubella), they can cause too much destruction of the tympanic membrane – a hole is formed. This is already chronic otitis media. Sufferers cover their ears with an oiled cotton swab in the shower or in the pool, otherwise the bacterial flora, which is always present in the ear canal, is carried into the middle ear with water. New technologies in ENT surgery make it possible to patch a hole in the eardrum and chronic otitis media is a thing of the past.
If a hole in the eardrum is formed not in the center, but along the edge, then a dangerous disease can develop – osteomyelitis of the bone. It is accompanied by an unpleasant odor, similar to that of a sore tooth. This complication develops over the years and requires a mandatory operation, otherwise the risk of developing meningitis is too great. In St. Petersburg, this complication of otitis media is rare, but in other regions it is quite common.
Since acute otitis media develops most often against the background of acute respiratory viral infections, immunity should be strengthened, and during seasonal morbidity, immunomodulatory drugs and vitamins should be taken.
It is necessary to properly cleanse the nose (blow out the right and left sides of the nose alternately).
Although it is not ear hypothermia that causes middle ear inflammation, don’t go without a hat in cold weather. The head will freeze – the nose will “flow” and the ears may hurt.
The inflammatory process in otitis media lasts up to two weeks, and during this period, treatment should not be stopped, even if the ears no longer hurt. Otherwise, serious complications are possible, and certainly untreated otitis media will turn into a chronic form.
Do not go to the pool after suffering otitis media for one, or preferably two months.
© Dr. Peter
90,000 Ear pain and allergies. How are they related?
Certain types of allergies can cause a person to develop ear pain. Many allergic reactions cause stuffiness or irritation in the nose and sinuses, which in turn connect to the ears. This can cause the pressure in the ears to build up or fluid build up in the ears.
In such cases, ear pain can be cured by removing its cause, that is, manifestations of allergies.
Why allergies cause ear pain
Allergic rhinitis can sometimes cause ear pain. In such conditions, stagnation of mucus occurs in the sinuses and ear canals. As a consequence, it can lead to ear pain and / or discomfort.
During an allergic reaction, the body releases various biologically active substances, such as histamine , , which play an important role in the development of allergy symptoms.In particular, runny nose, watery eyes, sore throat.
In response to this irritation, the sinuses swell and accumulate fluid. This, in turn, can affect the ears and cause pain.
In particular, ear pain can occur with allergies if:
- fluid accumulates behind the eardrum, leading to the development of an ear infection;
- clogs the Eustachian tube, and this causes an increase in pressure in it.
Can allergies cause ear infections
Allergies can lead to ear infections.Moreover, they often develop in people with seasonal or year-round allergies.
Environmental allergies can affect the Eustachian tube. It connects the middle ear cavity with the pharynx and allows air from the pharynx to enter the tympanic cavity.
The Eustachian tube maintains an equilibrium between the pressure in this cavity and the external atmospheric pressure. This is necessary for the correct transmission of the vibrations of the eardrum to the inner ear.
Allergies can cause swelling around the Eustachian tube, making it difficult for fluid from the middle ear to drain into the throat. If this fluid collects behind the eardrum, the risk of bacterial and viral growth increases. As a consequence, they can cause middle ear infections.
Symptoms of a middle ear infection usually appear suddenly and may include:
- Pain in one or both ears,
- redness of the auricle,
- ear discharge,
- Fullness in the ear,
- hearing loss,
- sore throat,
- popping or popping sounds in the ears,
- loss of orientation by a person in space (in rare cases).
Treatment of ear pain
If a person experiences ear pain due to allergies, treatment of its manifestations will help alleviate these sensations.
The first step in such treatment is to identify the factors causing the allergy. An allergist will help you find the cause of your allergic reactions.
When the patient learns which allergens affect him, he will be able to avoid contact with them. For example, if you are allergic to dust mites, exposure to the allergen will reduce the ventilation of your living quarters and keep them clean.
If a person is allergic to pollen, they may need to limit the amount of time they spend outdoors. And above all when the amount of pollen is especially high.
There are some other treatment options.
ASIT, or allergen-specific immunotherapy, can help achieve long-term relief from allergy symptoms. This method is especially effective in the treatment of sensitivity caused by environmental allergens: pollen, house dust mites, animal epidermis.
Another name for it is allergenic immunotherapy (AIT).
Now ASIT is the only method of treating allergies, and not relieving its symptoms.
Injections, sprays or tablets that a person receives during the course of ASIT contain a very small amount of the allergen. The one that is causing the symptoms in that particular patient.
He receives a dose that is sufficient to elicit an immune response, but not sufficient to provoke a serious allergic reaction.Thus, a decrease in sensitivity to an allergen, elimination or reduction of the severity of clinical symptoms is ensured.
High-quality allergens of the Spanish company Inmunotek (Inmunotek) are available in Ukraine for ASIT: the injectable drug “Alxoid” and the sublingual spray “Oraltek” (Oraltek).
For the treatment of allergies, the doctor may prescribe different medications:
- nasal corticosteroid sprays;
- nasal antihistamine sprays;
- antihistamine tablets;
Taking any allergy medication exactly as prescribed by your doctor will help relieve unpleasant symptoms, including ear pain.
But these drugs should not be prescribed to oneself and taken too long, as they can cause side effects.
A doctor may prescribe allergy medications to people with seasonal allergies even before the dusting season of a particular plant begins. In this way, the onset of symptoms and the release of inflammatory mediators, in particular histamine, can be prevented.
Ear infection treatment
If a patient develops an ear infection due to an allergy, the doctor may prescribe antibiotics to treat it. Antihistamines, decongestants, and pain relievers can also relieve symptoms.
The “Sinusalt” nasal rinsing system can also make them easier. It helps to clear the nose, and also reduces swelling and congestion of mucus, preventing the development of otitis media.
Diagnosis of allergy causing pain
Allergists and Immunologists are doctors who specialize in the diagnosis and treatment of allergies.To find out what a person is sensitive to, they take a complete history and conduct allergy tests.
A skin prick test is often used for this. It involves puncturing the skin and applying a small amount of the allergen to the puncture site.
Within 15 minutes, the skin will either remain as it was, or a reaction will appear on it. If the patient is sensitive to the applied allergen, the skin will swell slightly or itch.
In cases where a person is sensitive to many factors at once, has skin diseases or is taking medications, it is better to carry out molecular allergy diagnostics.
When to see a doctor
It is better for a person experiencing ear pain not to self-medicate, but to see a doctor. He will determine if the cause of the pain is an allergy or an infection. In addition, the doctor will be able to rule out other potential causes of the disease.
If a person has symptoms of an ear infection, which are accompanied by severe pain and do not go away within 48-72 hours, they should see a doctor immediately.
Allergens trigger the release of histamine and other substances into the body that irritate the mucous membranes of the nose and sinuses. Thus, allergic rhinitis can interfere with the development of otitis media and cause ear pain.
In some cases, ear infections can cause swelling and fluid buildup behind the eardrum.
It is necessary to see a doctor to establish a diagnosis and find out if the cause of the pain in the ear is allergy.Once the patient knows which allergens are causing his body to react, he can act to avoid or reduce their influence.
Prescribed medications, including antihistamines and decongestants, can help relieve symptoms. In turn, allergy treatment should help relieve any associated ear pain.
If a person has an ear infection, antibiotics may be needed.
In case of sharp and severe pain, you can not hesitate to see a doctor.