Otitis externa symptoms & treatments – Illnesses & conditions

Otitis externa is a condition that causes inflammation (redness and swelling) of the external ear canal, which is the tube between the outer ear and eardrum.

Otitis externa is often referred to as “swimmer’s ear” because repeated exposure to water can make the ear canal more vulnerable to inflammation.

Symptoms of otitis externa include:

• ear pain, which can be severe
• itchiness in the ear canal
• a discharge of liquid or pus from the ear
• some degree of temporary hearing loss

Usually only one ear is affected.

With treatment, these symptoms should clear up within a few days. However, some cases can persist for several months or longer.

Read more about the symptoms of otitis externa

When to see your GP

You should see your GP if you may have otitis externa.

Your GP will ask about your symptoms and whether you regularly use any items that are inserted into your ears, such as hearing aids or ear plugs. They may also examine inside your ear using an instrument called an otoscope.

If you have recurring episodes of otitis externa that haven’t responded to treatment, your GP may take a swab of the inside of your ear. This will be tested to help determine what type of infection you have, if any, so appropriate medication can be prescribed.

What causes otitis externa?

Most cases of otitis externa are caused by a bacterial infection, although the condition can also be caused by:

• irritation
• fungal infections
• allergies

There are a number of things that can make you more likely to develop otitis externa, including:

• damaging the skin inside your ear
• regularly getting water in your ear

Getting water in your ear is particularly significant, because this can cause you to scratch inside your ear, and the moisture also provides an ideal environment for bacteria to grow.

Read more about the causes of otitis externa.

Who is affected?

Otitis externa is relatively common. It’s estimated that around 1 in 10 people will be affected by it at some point in their lives.

The condition is slightly more common in women than men and is most often diagnosed in adults 45 to 75 years of age.

People with certain long-term (chronic) conditions are at greater risk of developing the condition. These include:

How otitis externa is treated

Otitis externa sometimes gets better without treatment, but it can take several weeks. Your GP can prescribe ear drop medication that usually improves the symptoms within a few days.

There are a number of different types of ear drops that may be used to treat otitis externa, but they all tend to be used several times a day for about a week. 

Your GP may refer you to a specialist for further treatment and advice if symptoms are severe or they fail to respond to treatment.

Read more about treating otitis externa

Preventing otitis externa

To help reduce your chances of developing otitis externa, you should avoid inserting cotton wool buds and other things into your ears (including your fingers), as this can damage the sensitive skin in your ear canal.

If you’re a regular swimmer, consider using ear plugs when swimming or wearing a swimming cap to cover your ears and protect them from water.

You should also try to avoid getting water, soap or shampoo into your ears when you have a shower or bath.

Read more about preventing otitis externa

Complications

Complications of otitis externa are uncommon, but some can be very serious.

One rare complication of otitis externa is necrotising otitis externa, which is where an infection spreads from the ear canal into the surrounding bone.

This requires prompt treatment with antibiotics and sometimes surgery, as it can be fatal if left untreated.

Read more about the complications of otitis externa

Common Causes, Symptoms, and Treatment Options

An ear infection is often a viral or bacterial infection affecting your middle ear. This is the air-filled area behind your eardrum containing the very small vibrating bones of your ear. Kids tend to get ear infections more than adults. Ear infections are also usually painful due to the buildup of fluids and inflammation in the middle ear.

The accumulation of fluid inside your ear canal can damage your ear canal’s protective layer. This is known as swollen ear canal and is a condition of the ear associated with redness and inflammation inside the canal. Lipid makes up the protective layer.

The inflammation causes your ear to feel warmer on the inside, narrowing the canal. Another term for swollen ear canal is “swimmer’s ear” since it’s a common condition many swimmers deal with because they’re in the water a lot of the time.

Since ear infections sometimes go away on their own, treatment might start with monitoring the condition and managing your pain. Severe cases of a swollen ear canal and ear infection in babies generally require antibiotics. Certain long-term issues of swollen ear canal like persistent infections, persistent middle ear fluids or frequent infections can lead to hearing issues and other complications.

Swollen Ear Canal Causes

Some common causes of swollen ear canal include:

Lifestyle Factors

• Cleaning your ears too frequently.

• Using headphones that plug your ears for long periods.

• Using cotton balls to clean your ear.

• Getting scratches in your ear’s inner walls.

Putting things in your ear can cause this condition too. Don’t put things like pen caps, hairpins or your fingers in your ears. Even hearing aids can cause swollen ear canal if moisture gets trapped in the ear canal.

Chemicals

Using chemicals can increase your risk of a swollen ear canal.  Certain chemicals actually cause ear canal infection. They get into your ear through common substances you use often like:

• Hair dyes

• Hair sprays

• Earwax softeners

Skin Conditions

Another risk factor for this condition is underlying skin conditions. Certain skin conditions can cause you to be more susceptible to ear infections. Some of these skin conditions are:

Seborrheic dermatitis may also lead to the condition. It’s a skin condition where your skin becomes irritated because of a mucous coating over it. A greasy substance secretes inside your ear in a swollen ear canal case. The mucous covering leads to seborrheic dermatitis that leads to infection.

Underlying Allergic Conditions

Individuals who have underlying allergic conditions, such as:

have a greater risk of ear infections. An allergic reaction can also cause swollen ear canal. Certain substances like excessive sweat, shampoo, certain medications and soapy water can cause an allergic reaction that leads to the condition.

Weakened Immune System

Weaker immunity caused by certain conditions like AIDS may also cause you to be more susceptible to ear infections. If you’re being treated for cancer with chemotherapy, you’re at a great risk of ear infections.

Fungal Infections

Fungal infections can lead to swollen ear canal. In fact, it’s a common cause of the condition. Candida albicans and different types of Aspergillus are the common fungus that can cause fungal infection.

Narrow Ear Canals

Some individuals have narrow ear canals, which make moisture draining more difficult. When water gets trapped it can promote bacterial growth and infection resulting in ear canal swelling.

Symptoms of a Swollen Ear Canal

Whether an infection caused your swimmer’s ear or a dunk in the pool did, the symptoms of swollen ear canal are the same and include:

• Pain in your ear; sometimes severe

• Itching sensation in your ear

• Fluid drainage from your ear

• Ear hurts when pulling your earlobe gently or moving your head

• A yellowish, bad-smelling discharge from your ear

• Tender inside your ear

• Things sound muffled

If you notice any symptoms or signs of an ear infection, see one of our Houston ENT doctors. You’ll also want to give us a call if you have ringing in your ears or you feel dizzy. This could mean you have a more severe problem that our doctor will need to evaluate. You’ll also want to see our doctor if you are experiencing severe pain. We can prescribe you medication for relief.

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Complications of a Swollen Ear Canal as a Result of Frequent Infections and Fluid Buildup

Long-term complications don’t usually arise from ear infections, but persistent or frequent infections and fluid buildup can cause serious complications such as:

• Developmental or speech delays. If hearing becomes impaired temporarily or permanently in toddlers and infants, they could experience developmental, social and speech delays.

• Impaired hearing.  Ear infections can often cause mild hearing loss that will come and go, but once the infection clears, the hearing should go back to normal. Persistent infection or fluid buildup in your middle ear can cause more substantial hearing loss. If your eardrum has permanent damage or there’s damage to other middle ear structures it could lead to permanent hearing loss.

• Tearing of your eardrum.  Eardrum tears tend to heal within 72 hours, but some do require surgical repair.

• A spread of an infection.  Infections left untreated or those not responding to treatment very well can spread to neighboring tissues. Infection of your mastoid (bony protrusion behind your ear) is known as mastoiditis and can cause bone damage and pus-filled cysts. Serious middle ear infections rarely spread to other skull tissues like brain membranes (meningitis) or your brain.

Swollen Ear Canal Treatment Options

You have a few treatment options for a swollen ear canal, which depend primarily on the cause.

Cleaning/Drainage

Your doctor will use a small device or suction to clear away earwax, debris or extra skin and drain water. They need to do this to allow the prescription antibiotic eardrops to move through the infected ear areas freely. Depending on the swelling or blockage, your doctor might insert gauze or cotton in your air to promote drainage.

Eardrops

If an infection is causing your swollen ear symptoms, our doctor will treat the infection with medication and allow the ear to heal.

To treat fungi and bacteria, your doctor will give you a prescription for eardrops. These drops also help restore the normal pH balance of your ears and reduce inflammation.

If an infection isn’t causing your swollen ear symptoms, but instead environmental causes, like having a  sensitivity reaction or an insect bite, our doctor will prescribe you medicine that soothes the inflammatory reaction that’s causing your swelling.

Preventing a Swollen Ear Canal

The most essential steps to prevent swollen ear canal is to not use cotton swaps and keep your ears dry. For people who are frequently in the water, like swimmers, place alcohol drops in your ear canals to evaporate moisture after swimming. You can also dry your ear canal with a hairdryer.

Schedule an Appointment for an Evaluation and Treatment of a Swollen Ear Canal with Houston ent and allergy

Proper treatment of your swollen ear canal should get rid of any complications. Don’t hesitate to receive treatment or you losing your hearing or the infection spreading to other areas of your head. If you suspect swollen ear canal, request an appointment with one of our doctors and Houston ENT & Allergy Services right away. Call us at 281-623-1312.

By: Tara Morrison, MD

Ear Infections | HealthLink BC

Topic Overview

Is this topic for you?

This topic covers infections of the middle ear, commonly called ear infections. For information on outer ear infections, see the topic Ear Canal Problems (Swimmer’s Ear). For information on inner ear infections, see the topic Labyrinthitis.

What is a middle ear infection?

The middle ear is the small part of your ear behind your eardrum. It can get infected when germs from the nose and throat are trapped there.

What causes a middle ear infection?

A small tube connects your ear to your throat. These two tubes are called eustachian tubes (say “yoo-STAY-shee-un”). A cold can cause this tube to swell. When the tube swells enough to become blocked, it can trap fluid inside your ear. This makes it a perfect place for germs to grow and cause an infection.

Ear infections happen mostly to young children, because their tubes are smaller and get blocked more easily.

What are the symptoms?

The main symptom is an earache. It can be mild, or it can hurt a lot. Babies and young children may be fussy. They may pull at their ears and cry. They may have trouble sleeping. They may also have a fever.

You may see thick, yellow fluid coming from their ears. This happens when the infection has caused the eardrum to burst and the fluid flows out. This isn’t serious and usually makes the pain go away. The eardrum usually heals on its own.

When fluid builds up but doesn’t get infected, children often say that their ears just feel plugged. They may have trouble hearing, but their hearing usually returns to normal after the fluid is gone. It may take weeks for the fluid to drain away.

How is a middle ear infection diagnosed?

Your doctor will talk to you about your child’s symptoms. Then he or she will look into your child’s ears. A special tool with a light lets the doctor see if the eardrum is red and if there is fluid behind it. This examination is rarely uncomfortable. It bothers some children more than others.

How is it treated?

Most ear infections go away on their own, although antibiotics are recommended for children younger than 6 months of age and for children at high risk for complications. You can treat your child at home with an over-the-counter pain reliever like acetaminophen (such as Tylenol), a warm cloth on the ear, and rest. Do not give aspirin to anyone younger than 18. Your doctor may give you eardrops that can help your child’s pain. Be safe with medicines. Read and follow all instructions on the label.

Your doctor can give your child antibiotics, but ear infections often get better without them. Talk about this with your doctor. Whether you use them will depend on how old your child is and how bad the infection is.

Minor surgery to put tubes in the ears may help if your child has hearing problems or repeat infections.

Sometimes after an infection, a child cannot hear well for a while. Call your doctor if this lasts for 3 to 4 months. Children need to be able to hear in order to learn how to talk.

Can ear infections be prevented?

There are many ways to help prevent ear infections.

• Do not smoke. Ear infections happen more often to children who are around cigarette smoke. Even the fumes from tobacco smoke on your hair and clothes can affect them.
• Encourage handwashing.
• Breastfeed your baby.
• Have your child immunized.
• Make sure your child doesn’t go to sleep while sucking on a bottle.
• Try to limit the use of group child care.

Cause

Middle ear infections are caused by bacteria and viruses.

Swelling from an upper respiratory infection or allergy can block the eustachian tubes, which connect the middle ears to the throat. So air can’t reach the middle ear. This creates a vacuum and suction, which pulls fluid and germs from the nose and throat into the middle ear. The swollen tube prevents this fluid from draining. The fluid is a perfect breeding ground for bacteria or viruses to grow into an ear infection.

• Bacterial infections. Bacteria cause many ear infections. The most common types are Streptococcus pneumoniae (also called pneumococcus), Haemophilus influenzae, and Moraxella catarrhalis.
• Viral infections. Viruses can also lead to ear infections. The respiratory syncytial virus (RSV) and flu (influenza) virus are the types most frequently found.

Inflammation and fluid buildup can occur without infection and cause a feeling of stuffiness in the ears. This is known as otitis media with effusion.

Symptoms

Symptoms of a middle ear infection (acute otitis media) often start 2 to 7 days after the start of a cold or other upper respiratory infection. Symptoms of an ear infection may include:

• Ear pain (mild to severe). Babies often pull or tug at their ears when they have an earache.
• Fever.
• Drainage from the ear that is thick and yellow or bloody. This means the eardrum has probably burst (ruptured). The hole in the eardrum often heals by itself in a few weeks.
• Loss of appetite, vomiting, and grumpy behaviour.
• Trouble sleeping.

Symptoms of fluid buildup may include:

• Popping, ringing, or a feeling of fullness or pressure in the ear. Children often have trouble describing this feeling. They may rub their ears trying to relieve pressure.
• Trouble hearing. Children who have problems hearing may seem dreamy or inattentive, or they may appear grumpy or cranky.
• Balance problems and dizziness.

Some children don’t have any symptoms.

What Happens

Middle ear infection

Middle ear infections usually occur along with an upper respiratory infection (URI), such as a cold. Fluid builds up in the middle ear, creating a perfect breeding ground for bacteria or viruses to grow into an ear infection.

Pus forms as the body tries to fight the ear infection. More fluid collects and pushes against the eardrum, causing pain and sometimes problems hearing. Fever typically lasts a few days. And pain and crying usually last for several hours. After that, most children have some pain on and off for several days, although young children may have pain that comes and goes for more than a week.

Antibiotic treatment may shorten some symptoms. But most of the time the immune system can fight infection and heal the ear infection without the use of these medicines.

In severe cases, too much fluid can increase pressure on the eardrum until it ruptures, allowing the fluid to drain. When this happens, fever and pain usually go away and the infection clears. The eardrum usually heals on its own, often in just a couple of weeks.

Sometimes complications, such as an ear infection with chronic drainage, can occur with repeat ear infections.

Middle ear fluid buildup

Most children who have ear infections still have some fluid behind the eardrum a few weeks after the infection is gone. For some children, the fluid clears in about a month. And a few children still have fluid buildup (effusion) several months after an ear infection clears. This fluid buildup in the ear is called otitis media with effusion. Hearing problems can result, because the fluid affects how the middle ear works. Usually, infection does not occur.

Otitis media with fluid buildup (effusion) may occur even if a child has not had an obvious ear infection or upper respiratory infection. In these cases, something else has caused eustachian tube blockage.

In rare cases, complications can arise from middle ear infection or fluid buildup. Examples include hearing loss and ruptured eardrum.

What Increases Your Risk

Some things that increase the risk for middle ear infection are out of your control. These include:

• Age. Children ages 3 years and younger are most likely to get ear infections. Also, young children get more colds and other upper respiratory infections. Most children have at least one ear infection before they are 7 years old.
• Birth defects or other medical conditions. Babies with cleft palate or Down syndrome are more likely to get ear infections.
• Weakened immune system. Children with severely impaired immune systems have more ear infections than healthy children.
• Family history. Children are more likely to have repeat middle ear infections if a parent or sibling had repeat ear infections.
• Allergies. Allergies cause long-term stuffiness in the nose that can block one or both eustachian tubes, which connect the back of the nose and throat with the middle ears. This blockage can cause fluid to build up in the middle ear.

Other things that increase the risk for ear infection include:

• Repeat colds and upper respiratory infections. Most ear infections develop from these illnesses.
• Exposure to cigarette smoke. Babies who are around cigarette smoke are more likely to have ear infections than babies who are not. Also, ear infections seem to last longer in babies who are near cigarette smoke.
• Bottle-feeding. Bottle-fed babies are more likely to develop ear infections within the first year of life than babies who are breastfed. Also, bottle-fed babies may be more likely to get ear infections if they drink their bottles lying down rather than being held in an upright position.
• Child care centres. Children who are around many other children, such as in child care centres, are more likely to have repeat ear infections.
• Pacifier use. A young child who uses a pacifier is more likely to get ear infections.

Things that increase the risk for repeated ear infections also include:

• Ear infections at an early age. Babies who have their first ear infection before 6 months of age are more likely to have other ear infections.
• Persistent fluid in the ear. Fluid behind the eardrum that lasts longer than a few weeks after an ear infection increases the risk for repeated infection.
• Prior infections. Children who had an ear infection within the previous 3 months are more likely to have another ear infection, especially if the infection was treated with antibiotics.

When should you call your doctor?

Call your doctor immediately if:

• Your child has sudden hearing loss, severe pain, or dizziness.
• Your child seems to be very sick with symptoms such as a high fever and stiff neck.
• You notice redness, swelling, or pain behind or around your child’s ear, especially if your child doesn’t move the muscles on that side of his or her face.

Call your doctor if:

• You can’t quiet your child who has a severe earache by using home treatment over several hours.
• Your baby pulls or rubs his or her ear and appears to be in pain (crying, screaming).
• Your child’s ear pain increases even with treatment.
• Your child has a fever of 38.3°C (101°F) or higher with other signs of ear infection.
• You suspect that your child’s eardrum has burst, or fluid that looks like pus or blood is draining from the ear.
• Your child has an object stuck in his or her ear.
• Your child with an ear infection continues to have symptoms (fever and pain) after 48 hours of treatment with an antibiotic.
• Your child with an ear tube develops an earache or has drainage from his or her ear.

Watchful waiting

Watchful waiting is when you and your doctor watch symptoms to see if the health problem improves on its own. If it does, no treatment is needed. If the symptoms don’t get better or if they get worse, then it’s time to take the next treatment step.

Your doctor may recommend watchful waiting if your child is age 6 months or older, has mild ear pain, and is otherwise healthy. Most ear infections get better without antibiotics. But if your child’s pain doesn’t get better with non-prescription children’s pain reliever (such as acetaminophen) or the symptoms continue after 48 hours, call a doctor.

Who to see

Your family doctor or general practitioner can diagnose and treat ear infections. If your child has repeated ear infections, he or she may be referred to one of the following specialists:

Examinations and Tests

Middle ear infections are usually diagnosed using a health history, a physical examination, and an ear examination.

The doctor uses a pneumatic otoscope to look at the eardrum for signs of an ear infection or fluid buildup. For example, the doctor can see if the eardrum moves freely when the pneumatic otoscope pushes air into the ear.

Other tests may include:

• Tympanometry, which measures how the eardrum responds to a change of air pressure inside the ear.
• Hearing tests. These tests are recommended for children who have had fluid in one or both ears (otitis media with effusion) for a total of 3 months. The tests may be done sooner if hearing loss is suspected.
• Tympanocentesis. This test can remove fluid if it has stayed behind the eardrum (chronic otitis media with effusion) or if infection continues even with antibiotics.
• Blood tests, which are done if there are signs of immune problems.

Treatment Overview

The first treatment of a middle ear infection focuses on relieving pain. The doctor will also assess your child for any risk of complications.

If your child’s condition improves in the first couple of days, treating the symptoms at home may be all that is needed. For more information, see Home Treatment.

If your child isn’t better after a couple of days of home treatment, call your doctor. He or she may prescribe antibiotics.

Follow-up examinations with a doctor are important to check for persistent infection, fluid behind the eardrum (otitis media with effusion), or repeat infections. Even if your child seems well, he or she may need a follow-up visit in about 4 weeks, especially if your child is young.

Antibiotics

Your doctor can give your child antibiotics, but ear infections often get better without them. Talk about this with your doctor. Whether you use antibiotics will depend on how old your child is and how bad the infection is. For more information, see Medications.

If your child has cochlear implants, your doctor will probably prescribe antibiotics, because serious complications of ear infections, including bacterial meningitis, are more common in children who have cochlear implants than in children who do not have cochlear implants.

Repeat ear infections

If a child has repeat ear infections (three or more ear infections in a 6-month period or four in 1 year), you may want to consider treatment to prevent future infections.

One option that has been used a lot in the past is long-term oral antibiotic treatment. There is debate within the medical community about using antibiotics on a long-term basis to prevent ear infections. Many doctors don’t want to prescribe long-term antibiotics, because they are not sure that they really work. Also, when antibiotics are used too often, bacteria can become resistant to antibiotics.

Having tubes put in the ears is another option for treating repeat ear infections.

Fluid buildup and hearing problems

Fluid behind the eardrum after an ear infection is normal. And in most children, the fluid clears up within 3 months without treatment. If your child has fluid buildup without infection, you may try watchful waiting.

Have your child’s hearing tested if the fluid lasts longer than 3 months. If hearing is normal, you may choose to keep watching your child without treatment.

If a child has fluid behind the eardrum for more than 3 months and has significant hearing problems, then treatment is needed. Sometimes short-term hearing loss occurs, which is especially a concern in children ages 2 and younger. Normal hearing is very important when young children are learning to talk.

If your child is younger than 2, your doctor may not wait 3 months to start treatment. Hearing problems at this age could affect your child’s speaking ability. This is also why children in this age group are closely watched when they have ear infections.

If there is a hearing problem, your doctor may also prescribe antibiotics to keep the fluid in the ear from getting infected. The doctor might also suggest placing tubes in the ears to drain the fluid and improve hearing.

Surgery

Doctors may consider surgery for children who have repeat ear infections or for those who have persistent fluid behind the eardrum. Procedures include inserting ear tubes or removing adenoids and, in rare cases, the tonsils. For more information, see Surgery.

Treating other problems

Children who get rare but serious problems from ear infections, such as infection in the tissues around the brain and spinal cord (meningitis) or infection in the bone behind the ear (mastoiditis), need treatment right away.

Prevention

You may be able to prevent your child from getting middle ear infections.

• Don’t smoke. Ear infections are more common in children who are around cigarette smoke in the home. Even fumes from tobacco smoke on your hair and clothes can affect the child.
• Breastfeed your baby. There is some evidence that breastfeeding helps reduce the risk of ear infections, especially if they run in your family. If you bottle-feed, don’t let your baby drink a bottle while he or she is lying down.
• Wash your hands often. Handwashing stops infection from spreading by killing germs.
• Make sure your child receives all the recommended immunizations. For more information, see the topic Immunizations.
• Take your child to a smaller child care centre. Fewer children means less contact with bacteria and viruses. Try to limit the use of any group child care, where germs can easily spread.
• Do not give your baby a pacifier. Try to wean your child from his or her pacifier before about 6 months of age. Babies who use pacifiers after 12 months of age are more likely to get ear infections.

Home Treatment

Rest and care at home is often all that children age 6 months and older need when they have an ear infection. Most ear infections get better without treatment. If your child is mildly ill and home treatment takes care of the earache, you may choose not to see a doctor.

At home, try these tips:

• Use pain relievers. Pain relievers such as non-steroidal anti-inflammatory medicines (Advil, Aleve, and Motrin, for example) and acetaminophen (such as Tylenol) will help your child feel better. Giving your child something for pain before bedtime is especially important.
  • Follow all instructions on the label. If you give medicine to your baby, follow your doctor’s advice about what amount to give.
  • Do not give aspirin to anyone younger than 18, because it is linked to Reye syndrome, a serious illness.
• Apply heat to the ear, which may help with pain. Use a warm cloth.
• Encourage rest. Resting will help the body fight the infection. Arrange for quiet play activities.
• Use eardrops. Doctors often suggest eardrops for earache pain. Don’t use eardrops without a doctor’s advice, especially if your child has tubes in his or her ears. For more information, see the safest way to insert eardrops.

If your child isn’t better after a few days of home treatment, call your doctor.

Care for ear tubes or ruptured eardrums

Ask your doctor if your child needs to take extra care to keep water from getting in the ears when there’s a hole or tube in the eardrum. Your child may need to wear earplugs. Check with your doctor to find out what he or she recommends.

Care during air travel

If your child with an ear infection must take an airplane trip, talk with your doctor about how to help your child cope with ear pain during the trip.

Medications

Antibiotics can treat ear infections caused by bacteria. But most children with ear infections get better without them. If the care you give at home relieves pain and the symptoms are getting better after a few days, you may not need antibiotics.

Your doctor will likely give antibiotics right away if:

For children age 6 months and older, many doctors wait for a few days to see if the ear infection will get better on its own. When doctors do prescribe antibiotics, they most often use amoxicillin, because it works well and costs less than other brands.

When your child takes antibiotics for an ear infection, it is very important to take all of the medicine as directed, even if your child feels better. Do not use leftover antibiotics to treat another illness. Misuse of antibiotics can lead to drug-resistant bacteria.

Deciding about antibiotics

Some doctors prefer to treat all ear infections with antibiotics, because it’s hard to tell which ear infections will clear up on their own. Some things to consider before your child takes antibiotics include:

• Risk for antibiotic-resistant bacteria. The greatest problem with using antibiotics to treat ear infections is the possibility of creating bacteria that can’t be killed by the usual antibiotics (antibiotic-resistant bacteria). Use antibiotics only when they’re needed.
• Side effects of antibiotics. Mild side effects, such as diarrhea and rash, from taking antibiotics are common. Severe side effects are rare.
• Cost. Most antibiotics are expensive. You may want to weigh the cost against the fact that most ear infections clear up without treatment.

Antibiotics have only minimal benefits in reducing pain and fever.

If your child still has symptoms (fever and earache) longer than 48 hours after starting an antibiotic, a different antibiotic may work better. Call your doctor if your child isn’t feeling better after 2 days of antibiotic treatment.

Other medicines

Other medicines that can treat symptoms of ear infection include:

• Acetaminophen (for example, Tylenol) and non-steroidal anti-inflammatory medicines (for example, Advil, Aleve, and Motrin), for pain and fever. Follow all instructions on the label. If you give medicine to your baby, follow your doctor’s advice about what amount to give. Do not give aspirin to anyone younger than 18 because of its link to Reye syndrome, a serious illness.
• Some eardrops, which help with severe earache. But do not use eardrops if the eardrum is ruptured. For more information, see the safest way to insert eardrops.
• Sometimes corticosteroids are given with antibiotics to get rid of fluid behind the eardrum. Steroid medicines are not a good choice for treating ear infections. Do not use them if a child has been around someone with chickenpox within the last 3 weeks.

Most studies find that decongestants, antihistamines, and other non-prescription cold remedies usually don’t help prevent or treat ear infections or fluid behind the eardrum. Antihistamines that may make your child sleepy can thicken fluids and may actually make your child feel worse. Check with the doctor before giving these medicines to your child. Experts say not to give decongestants to children younger than 6 years.

Surgery

Ear tube placement

Surgery for middle ear infections often means placing a drainage tube into the eardrum of one or both ears. It’s one of the most common childhood operations.

Inserting ear tubes (myringotomy or tympanostomy with tube placement):

• May help to relieve hearing problems.
• Helps prevent buildup of pressure and fluid in the middle ear.
• Allows fluid to drain from the middle ear.
• Ventilates the middle ear after the fluid is gone.
• May prevent repeat ear infections.

While the child is under general anesthesia, the surgeon cuts a small hole in the eardrum and inserts a small plastic tube in the opening.

Most tubes stay in place for about 6 to 12 months and then usually fall out on their own. After the tubes are out, the hole in the eardrum usually closes in 3 to 4 weeks. Some children need tubes put back in their ears because fluid behind the eardrum returns.

In rare cases, tubes may scar the eardrum and lead to permanent hearing loss.

Deciding about ear tubes

Doctors consider tube placement for children who have had repeat infections or fluid behind the eardrum in both ears for 3 to 4 months and have trouble hearing. Sometimes they consider tubes for a child who has fluid in only one ear but also has trouble hearing. Learn the pros and cons of this surgery. Before deciding, ask how the surgery can help or hurt your child.

Care after ear tubes are placed

Ask your doctor if your child needs to take extra care to keep water from getting in the ears when bathing or swimming. Your child may need to wear earplugs. Check with your doctor to find out what he or she recommends.

You can use antibiotic eardrops for ear infections while tubes are in place. In some cases, antibiotic eardrops seem to work better than antibiotics by mouth when tubes are present.^{footnote 3}

Adenoids and/or tonsil removal

Adenoid removal (adenoidectomy) or adenoid and tonsil removal (adenotonsillectomy) may help some children who have repeat ear infections or fluid behind the eardrum. Children younger than 4 don’t usually have their adenoids taken out unless they have severe nasal blockage.

As a treatment for chronic ear infections, experts recommend removing adenoids and tonsils only after tubes and antibiotics have failed. Removing adenoids may improve air and fluid flow in nasal passages. This may reduce the chance of fluid collecting in the middle ear, which can lead to infection. When used along with other treatments, removing adenoids (adenoidectomy) can help some children who have repeat ear infections. But taking out the tonsils with the adenoids (adenotonsillectomy) isn’t very helpful.^{footnote 4} Tonsils are removed if they are frequently infected. Experts don’t recommend tonsil removal alone as a treatment for ear infections.^{footnote 5}

Ruptured eardrum

Surgeons sometimes operate to close a ruptured eardrum that hasn’t healed in 3 to 6 months, though this is rare. The eardrum usually heals on its own within a few weeks. If a child has had many ear infections, you may delay surgery until the child is 6 to 8 years old to allow time for eustachian tube function to improve. At this point, there is a better chance that surgery will work.

Other Treatment

Allergy treatment can help children who have allergies and who also have frequent ear infections. Allergy testing isn’t suggested unless children have signs of allergies.

Some people use herbal remedies, such as echinacea and garlic oil capsules, to treat ear infections. There is no scientific evidence that these therapies work. If you are thinking about using these therapies for your child’s ear infection, talk with your doctor.

References

Citations

1. Le Saux N, et al. (2016). Management of acute otitis media in children six months of age or older. Paediatrics and Child Health, 21(1): 39–44. http://www.cps.ca/en/documents/position/acute-otitis-media. Accessed January 4, 2017.
2. Vayalumkal JV (2016). Acute otitis media in childhood. Compendium of Therapeutic Choices. http://www.e-therapeutics.ca. Accessed January 4, 2017.
3. Klein JO (2011). Infections of the ear. In CD Rudolph et al., eds., Rudolph’s Pediatrics, 22nd ed., pp. 973–979. New York: McGraw-Hill.
4. Williamson I (2015). Otitis media with effusion in children. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/0502/overview.html. Accessed April 14, 2016.
5. Pai S, Parikh SR (2012). Otitis media. In AK Lalwani, ed., Current Diagnosis and Treatment Otolaryngology Head and Neck Surgery, 3rd ed., pp. 674–681. New York: McGraw-Hill.

Other Works Consulted

• An expanded pneumococcal vaccine (Prevnar 13) for infants and children (2010). Medical Letter on Drugs and Therapeutics, 52(1345): 67–68.
• Berkman ND, et al. (2013) Otitis Media With Effusion: Comparative Effectiveness of Treatments. Comparative Effectiveness Review No. 101. (AHRQ Publication No. 13-EHC091-EF). Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.effectivehealthcare.ahrq.gov/reports/final.cfm.
• Kerschner JE (2011). Otitis media. In RM Kleigman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 2199–2213. Philadelphia: Saunders.
• Klein JO, Bluestone CD (2009). Otitis media. In RD Feigin et al., eds., Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 6th ed., vol. 1, pp. 216–236. Philadelphia: Saunders Elsevier.
• Morris P (2012). Chronic suppurative otitis media. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/pdf/clinical-evidence/en-gb/systematic-review/0507.pdf. Accessed March 12, 2014.
• Pai S, Parikh SR (2012). Otitis media. In AK Lalwani, ed., Current Diagnosis and Treatment Otolaryngology Head and Neck Surgery, 3rd ed. , pp. 674–681. New York: McGraw-Hill.
• Shekelle PG, et al. (2010). Management of Acute Otitis Media: Update. Evidence Report/Technology Assessment No. 198. Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.ahrq.gov/clinic/tp/otitisuptp.htm.
• Venekamp RP, et al. (2014). Acute otitis media in children. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/0301/overview.html. Accessed April 14, 2016.

Credits

Current as of:
July 29, 2019

Author: Healthwise Staff
Medical Review:
Susan C. Kim MD – Pediatrics
Thomas M. Bailey MD – Family Medicine
Kathleen Romito MD – Family Medicine
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Charles M. Myer III MD – Otolaryngology
John Pope MD – Pediatrics

How to Reduce Ear Infection Pain: Family Urgent Care: Internal Medicine

Ear infections are common in children but they also occur in adults. Many ear infections resolve on their own without antibiotics. But whether your ear infection requires antibiotics, you’re still likely to experience discomfort while waiting for the infection to heal.

Ear infections, also known as acute otitis media, can cause pressure and pain in your middle ear, which you may even feel in your cheek. But you can manage a lot of this pain on your own at home. 

Our providers at Family Urgent Care put together this information to explain more about how to treat the pain of an ear infection. 

What causes an ear infection

Ear infections are common and are often caused by bacteria or a virus. The infection of the eustachian tubes in the middle ear causes pain and swelling in the ear, nasal passages, and throat. Ear infections can even cause temporary hearing loss.

How to treat an ear infection

Many ear infections go away on their own within a week or two, but you may experience pain and discomfort while you wait for the infection to resolve. There are some things that you can do to ease the discomfort of an ear infection, including:

Apply heat

Apply heat to your ear and the side of your face using a heating pad or a sock filled with rice that you warm up in the microwave. Hold it to your ear for 15-20 minutes three or four times a day. You may also find it helpful to alternate the use of hot and cold compresses.

Use eardrops

You may find relief from a middle ear infection by putting medicated eardrops in your ear. Allow the drops to remain in your ear canal, rather than using a cotton swab to try to get them out.

Use over-the-counter pain relievers

Over-the-counter pain relievers, such as acetaminophen and ibuprofen, can help to provide relief from the pain of an ear infection. Follow the dosing directions on the package and do not exceed the recommended amount. 

Do not use aspirin for pain relief for children and teenagers, because aspirin has been associated with a rare but serious illness called Reye’s syndrome.

How to prevent ear infections

If you are prone to getting recurring ear infections, you may be able to prevent them. If you have allergies, use effective allergy treatments to prevent ear infections from developing. Wash your hands regularly, especially during cold and flu season. 

Don’t smoke and avoid secondhand smoke as much as possible. Smoking and secondhand smoke both contribute to the incidence of ear infections. In addition, keep up with your vaccinations, including the flu vaccine.

When to call the doctor

There’s nothing wrong with waiting out an ear infection for a few days with supportive home treatment. But sometimes an ear infection clearly needs antibiotics or further treatment. You may need further medical treatment if you have a fever above 102.2 or if your symptoms seem to be getting worse.

If you have an ear infection and need answers, we’re always available to help. Contact us at either our Schererville or Chicago, Illinois, office.

Ear Problems – familydoctor.org

Ear infections | Caring for kids

Middle ear infections are also called otitis media. They are very common, especially in children between 6 months and 3 years of age. They are usually not serious and aren’t contagious. Most ear infections happen when a child has already had a cold for a few days.

What causes an ear infection?

Viruses or bacteria (germs) cause middle ear infections. The eustachian tube connects the middle ear with the back of the throat. Germs travel from the back of the throat when the eustachian tube is swollen from a cold, causing infection in the middle ear.

Who is at higher risk for ear infections?

• Children less than 5 years old, because they have shorter eustachian tubes.
• Children who attend daycare, because they tend to have more colds.
• Children with allergies.
• Children who are exposed to cigarette smoke. Smoke causes inflammation of the eustachian tube, making ear infections more likely.
• Children who were not breastfed. Breast milk has antibodies that help fight infections.
• Babies who are being bottle fed, especially if they swallow milk while lying too flat. Milk can enter the eustachian tube and cause inflammation, which increases the risk of an ear infection. Children should be held upright while drinking a bottle. When they are old enough to hold their own bottle well, they should be taught to drink from a regular cup (not a “sippy cup”) and no longer given a bottle.
• Children with cleft palates, as their eustachian tubes are often inflamed.
• Children of First Nations and Inuit descent, though it’s not clear why.

How do I know if my child has an ear infection?

Older children will usually complain of an earache. While younger children might not be able to say they have an earache, they may:

• have an unexplained fever,
• be fussy,
• have trouble sleeping,
• tug or pull at their ears, or
• have trouble hearing quiet sounds.

Some children with an ear infection may also have fluid draining from the ear.

How is an ear infection diagnosed?

​Doctors diagnose ear infections by looking at the ear drum (tympanic membrane) with a special light called an otoscope. They look for fluid in the middle ear, at the colour and position of the ear drum, and monitor the pressure in the middle ear. Common viral infections can make the ear drum look red, but antibiotics are not needed.

How is an ear infection treated?

• If a child doesn’t have too much discomfort or a high fever, the doctor will likely wait 24 to 48 hours (1 to 2 days) to see if the ear infection gets better on its own. If the child does not improve or gets worse, you should take them back to the doctor.|
   
• You child’s doctor will prescribe antibiotics if:
  • your child is moderately to severely ill with a high fever (more than 39◦C),
  • your child has severe pain,
  • the condition has not improved for 48 hours, or
  • the ear canal has new fluid.  

• For an uncomplicated ear infection, children between 6 months and 2 years usually take an antibiotic for 10 days. Children over 2 years of age will take an antibiotic for 5 days.

• The doctor might suggest acetaminophen or ibuprofen to reduce the child’s pain. Only give ibuprofen if your child is drinking reasonably well. Do not give ibuprofen to babies under 6 months old without first talking to your doctor.

• Do not give over-the-counter medications (ones you can buy without a prescription) to babies and children under 6 years without first talking to your doctor. The only exceptions are medications used to treat fever, such as ibuprofen and acetaminophen.

Children usually feel better within 1 day of starting an antibiotic. Your doctor might want to see your child again to be sure the infection has cleared up completely. Fluid can remain in the middle ear without inflammation for a few weeks.

When do children need tubes in their ears?

If your child has frequent ear infections, or if he has trouble hearing because of ongoing fluid in the middle ear, he may need a tube inserted through the ear drum and into the middle ear. The tube helps to keep air pressure normal on both sides of the ear drum and helps fluid drain from the middle ear.

Putting tubes in requires a brief operation by an ear, nose and throat surgeon. Children usually go home the same day.

When should I call the doctor?

Call your doctor if you think your child has an ear infection AND:

• has other serious medical problems,
• seems ill,
• vomits over and over,
• is younger than 6 months old,
• is older than 6 months old and has had a fever for more than 48 hours,
• has swelling behind the ear,
• is very sleepy,
• is very irritable,
• has a skin rash,
• isn’t hearing well or at all,
• remains in a lot of pain despite at least one dose of acetaminophen or ibuprofen, or
• still has an earache after 2 days of treatment with acetaminophen or ibuprofen.

How can I prevent my child from getting an ear infection?

• Wash your child’s hands and your own often to reduce the chance of catching a cold.
• Breastfeed your baby.
• Avoid bottle-feeding your baby when they are lying down. Never put your baby to bed with a bottle.
• Transition your baby from a bottle to a cup by 1 year of age.
• Don’t use a pacifier (soother) too often.
• Don’t smoke, and keep your child away from any secondhand smoke. Exposure to smoke can increase the risk of ear infections.
• Ensure your child gets the pneumococcal vaccine (if they are at least 2 months of age, and have not already had this shot).
• Ensure your child gets a flu shot every year. 

More information from the CPS

Reviewed by the following CPS committees

• Infectious Diseases and Immunization Committee

Last updated: January 2016

Ear Pain Mimics: It’s Not All About Otitis Media

Urgent message: Though ear pain is often due to otitis media or externa, it is important to include other diagnoses, some of which could be life-threatening, “can’t miss” causes.

Introduction

Patient complaints of ear pain (otalgia) are seen frequently in the urgent care setting. It can be frustrating for patients and providers when a patient’s ear pain has no obvious cause. Differential diagnoses include several primary and secondary causes of otalgia. (See Table 1.)

Lab values or radiological films are rarely helpful; the best diagnostic tool for ear-pain complaints is a focused physical examination of the patient’s head and neck

COMMON DIFFERENTIAL DIAGNOSES

Otitis media

General

Acute otitis media (AOM) is an inflammatory and sometimes infectious process of the middle and inner ear which may be suppurative or from a sterile effusion. Chronic serous otitis media (CSOM) is not painful. Noninfectious fluid found in CSOM can persist in the middle ear for up to 12 weeks.

The peak incidence of AOM occurs in children under the age of 2 and is more common in boys than in girls. By age 6, 90% of children will have had at least one ear infection. Viral infections are the cause of 70% of these ear infections.^1,2

The most common viral causes are:

• Respiratory syncytial virus
• Rhinovirus
• Coronavirus
• Influenza
• Parainfluenza

The most common bacterial infections are:

• Streptococcus pneumonia
• Haemophilus influenza
• Moraxella catarrhalis
• Gram-negative enteric bacteria
• Staphylococcus aureus

Mixed viral and bacterial infections occur frequently.³ The incidence of mixed infections reported in the literature varies from 20% to 60%.⁴

Ear infections occur most frequently in the winter months. Risk factors include bottle-feeding, exposure to second-hand smoke, attending daycare, allergies, family history, and craniofacial abnormalities. The patients may describe widely different patterns of onset, pain, aggravating and relieving factors.

History

Include previous ear infections, ear surgeries, and environmental allergies and treatment in your patient’s history. Ask your patient about any recent travel, flying, or trauma. A pediatric history should include birth, delivery, immunizations, current development, secondhand smoke exposure, allergies, and daycare attendance.

If your patient has fluid in their middle or inner ear they will have decreased, muffled, or absent hearing; this can be assessed with finger rub and whisper tests. Positive Weber and Rinne tests will specifically indicate a conductive hearing loss if there is fluid present in your patient’s middle or inner ear.

Exam

Upon otoscopic examination, air-fluid levels may be present with or without purulence and erythema. observation of drainage in the ear canal is indicative of acute suppurative otitis media. Submandibular and deep cervical chain nodes are usually the first to become swollen in patients with AOM; however, palpation of the head and neck may or may not demonstrate any swollen lymph nodes. Pneumatic otoscopy is 70%–90% sensitive and specific for determining the presence of middle ear effusion.⁵ In most cases, visualizing a bulging, erythematous tympanic membrane is sufficient for diagnosis.⁵ Cloudy tympanic membrane is 90.8% sensitive, 91.7% specific.⁶  Bulging TM is 61.2% specific, 96.9% sensitive. Ear rubbing is 42% specific, 87% sensitive.

AOM is not particularly common in adults. According to the most recent American Association of Pediatrics (AAP), oral antibiotics are recommended for AOM (bilateral or unilateral) in children 6 months and older with severe signs or symptoms. Severe AOM is defined as moderate pain for 48 hours and fever greater than 102.2⁰F. Antibiotic therapy should be used for bilateral AOM in children 6 months through 23 months of age without severe signs or symptoms. If AOM is unilateral, close follow-up is appropriate. Monitoring with close follow-up is recommended for patients with less than severe symptoms who are greater than 12 months old. Close follow-up can be accomplished via phone call or office visit. Resolution of acute pain and purulence is typically seen within 48 hours of onset without antibiotic therapy.^2,7

Antibiotic therapy is summarized in Table 2.^2,3,7,8

If an individual has myringotomy tubes or a perforated eardrum, use drops. Do not irrigate. You will know if patients with tubes have an ear infection because their tubes will drain. Insert 2-3 drops in the affected ear three times daily; ear canals are small and cannot hold more liquid than 2-3 drops. Table 3 gives an overview of antibiotic ear drops.^2,3,7,8

ATB, antibiotic

Otitis Externa

General

Otitis externa (swimmer’s ear) is an infection of the outer ear canal. It is a very painful condition and can be associated with radiation of pain, pruritus, hearing loss, or drainage. Patients often complain of a feeling of fullness in the affected ear. Onset of otitis externa may be rapid or slow and may, or may not, be associated with a fever.⁹ Pain may be worse with motion or manipulation of the ear.

Otitis externa is caused by an infectious pathogen entering the skin of ear canal, often due to microabrasions from Q-tips, ear buds, or hearing aids.

History

Inquire about swimming and other potential sources of moisture, such as earplugs, eczema, psoriasis, dermatitis, or acne. The most common bacterial pathogens are Pseudomonas aeruginosa and Staphylococcus aureus. Ten percent of these infections are fungal, typically aspergillus or candida.³ Otitis externa is often caused by more than one pathogen.³

Exam

Visual inspection may reveal redness, swelling, or scaling of the external ear. There may be visible drainage (otorrhea). Lymphadenopathy may be palpable at the base of the ear. Hearing will be decreased in the affected ear. Otoscopic exam may be difficult if there is drainage. If there is no drainage, mucopurulent debris is seen in the ear canal. Fungal debris may be fluffy white (Candida) or dark in color (Aspergillus).

Eczema and other skin conditions can be particularly troublesome for patients. Dry skin around the ear can cause itching. Controlling the eczema is necessary to prevent otitis externa from developing. Steroid creams such as triamcinolone can be used up to 3 times daily. A referral to dermatology or otolaryngology for these patients should be considered.

Management

Otitis externa treatment starts with cleaning of the ear canal. The underlying skin is usually very macerated and inflamed; irrigation with water can be performed after a perforated eardrum is excluded.

An ear wick may be inserted if the canal is swollen. Ear wicks should fall out within 24-48 hours. Patients should be seen 2-3 days after insertion of an ear wick to ensure the ear wick fell out and the patient’s infection is resolving. Severe pain out of proportion to physical exam findings may be from malignant otitis externa; emergent referral is recommended. For patients in whom a wick is poorly tolerated, or cases where the canal is blocked, oral antibiotics may be needed.

Patients should be strongly encouraged to refrain from inserting anything into the ear for the purpose of cleaning the ear. Swimmers should consider getting custom earplugs made by an audiologist.

Ramsay Hunt Syndrome

General

Ramsay Hunt syndrome is caused by the varicella zoster virus in patients who have previously had chickenpox; the virus lays dormant until a shingles outbreak occurs. Ramsay Hunt syndrome is characterized by a unilateral vesicular facial rash, which involves portions of the patient’s ear, mouth, neck, and scalp. Cardinal signs also include paralysis of facial nerves on the affected side and a loss of taste on the anterior two-thirds of their tongue (Figure 1). Either the rash or the facial paralysis may come first. Symptoms can last for several weeks. Symptoms may be permanent. Pain characteristics, aggravating factors, and relieving factors can vary widely. Symptoms are persistent and may include tinnitus and/or dizziness.

Figure 1. Ramsay Hunt Syndrome

History

Obtain a history of childhood illnesses and vaccinations. The patient may have a recent history of shingles or similar rashes. Ask if there is any previous history of vertigo, hearing loss, or facial paralysis. Also, inquire about new medications (specifically immunosuppressive therapies and steroids), history of stroke, blood clots, or vascular disease.

Exam  

Visual inspection will demonstrate a vesicular rash on the external ear, face, and scalp. Look for signs of infection to the eye. Complete a neurological exam. Have your patient raise their eyebrows, smile showing their teeth, and stick out their tongue. Facial weakness on one side will be noticeable. Whisper and finger rub testing will reveal diminished hearing on the affected side. Weber and Rinne will indicate sensorineural hearing loss. You may observe vesicles inside the ear canal upon otoscopic examination.

Management

Treatment is most effective if started within the first 72 hours after the rash develops. Antiviral medications have demonstrated a decrease in the duration of illness and reduced incidence of post herpetic neuralgia. Patients over the age of 50 years have the largest benefit from treatment. Valacyclovir 1,000 mg by mouth three times daily for 5 to 7 days is the first-line therapy, but acyclovir and famciclovir may also be used). A prednisone taper has been shown to decrease pain in patients over 50 years of age.¹⁰ Cool, wet compresses can help with itching and painful rash. Moisturizing eye drops should be used during the day. Eye lubricants may be needed at night. The affected eye should be taped shut to prevent injury.

Mastoiditis

General

Mastoiditis is a potentially life-threatening infection of the mastoid air cells behind the ear. This infection is caused by Streptococcus pneumonia, Streptococcus pyogenes, Staphylococcus aureus, Haemophilus influenza, or Moraxella catarrhalis.¹¹ Symptoms are present 2-6 days after the onset of acute otitis media. Mastoiditis is more prevalent in children but can also occur in adults.

            Onset of mastoiditis is gradual and usually follows an episode of otitis media or upper respiratory infection. Pain is severe, constant, and isolated to the affected ear. It may be described as sharp, dull, or aching. Pain may persist for days or even weeks. Aggravating factors typically include palpation, chewing, swallowing, and walking.

History

The medical history should include an inquiry about antibiotic use within the past 30 days. Obtain a history of hearing loss. Inquire whether the patient has a history of diabetes, stroke, blood clots, or myringotomy tubes. Consider ruling out blood clots in the brain if there have been any changes in vision or headache.

Exam

On examination, the patient will have retro auricular pain and tenderness over the mastoid. Erythema, warmth, and swelling behind the auricle of the affected ear should raise a strong suspicion for mastoiditis.

Testing

A CT scan with and without contrast of the temporal bones should be ordered if mastoiditis is suspected based on exam findings. Emergent referral to ENT or transfer to the ED is recommended.

Immediate referral to ENT is needed if mastoiditis is present. These patients frequently require hospitalization and close monitoring.

Temporal Mandibular Joint Dysfunction

Temporal mandibular joint (TMJ) dysfunction includes pain in the muscles of mastication or the TMJ joint. It is most common in women between the ages 20 and 40 years of age. It is the second most common cause of orofacial pain.^12,13 Trismus, spasms, myositis inflammation, trauma (dislocation/fracture), degenerative arthritis, or infection can all cause TMJ pain.

Past medical history may include recent dental work, grinding teeth (bruxism), braces, baby teeth falling out, or eruption of adult teeth. Aggravating factors can include chewing, yawning, jaw clenching, and walking. The pain is often characterized as dull, achy, poorly localized, intermittent, and unilateral.

Physical examination includes special attention to the temporalis, buccinators, and zygomaticus muscles. Make sure to palpate the masseter muscle at the back of the jaw. It is located behind the teeth, and it is necessary to palpate in the mouth with a gloved hand. This muscle opens and closes the jaw. Sometimes it is the only location patients will feel pain on palpation. The masseter muscle forms the front wall to the ear and is often the reason pain is felt in the ear. Have the patient open and close their mouth while palpating the TMJ joint. Feel for popping, clicking, or dislocation of the joint with opening and closing of the mandible.

Treatments include: no gum chewing, soft diet, NSAIDs, and alternating ice and heat to the affected area for 20 minutes, three times daily. Muscle relaxers may be of benefit for some patients with severe pain.¹³  Cyclobenzaprine 10 mg up to three times a day can be prescribed. In older patients or those with contraindications to cyclobenzaprine; baclofen 10 mg up to three times daily may be a better alternative.^14,15 Referral to a dentist that treats bruxism may be necessary for some patients.

Barotrauma

Barotrauma is caused by significant atmospheric pressure changes and results in damage to the tympanic membrane and other ear tissues. Barotrauma usually occurs during diving or flying. It can occur when a patient is slapped with an open hand. Patients with congestion prior to flying can be susceptible to barotrauma. It is common for patients to report allergies or nasal congestion prior to the incident giving rise to their barotrauma diagnosis. A history of chronic ear infections or myringotomy tubes may predispose a patient to barotrauma injury. Physical examination will reveal a visible perforation or fluid or blood in the canal.

Management

Symptomatic management includes healing with time; antibiotics, steroids and decongestants have not been shown to improve healing. Nonemergent surgery may be necessary for severe injuries.

Prevention

Patients with nasal congestion may use a nasal decongestant—2 squirts in each nostril prophylactically when traveling on a plane. This will open the Eustachian tubes and help equalize middle ear pressures. A steroid nasal inhaler, two squirts in each nostril, twice daily for two weeks prior to flying will also help to shrink the turbinates and the lining of the sinus cavities.¹⁶ This aids in maintaining normal inner ear pressures. Likewise, frequent swallowing also helps equalize inner ear pressure. It can be helpful for patients susceptible to barotrauma to have water, chewing gum, and hard candy available when flying.

Gastroesophageal Reflux Disorder

HPI

Gastroesophageal reflux can cause a multitude of symptoms, including otalgia, globus sensation (feeling of a lump in the throat), heartburn, chest pain, radiating pain, hoarseness, throat clearing, nausea, and regurgitation of food. The first symptoms for them may be globus sensation or ear complaints.¹⁷ Past medical history may include heartburn or treatment for reflux. Physical examination will be unremarkable. This diagnosis is made based on history.

Discuss dietary modifications such as limiting caffeine, nicotine, and alcohol. Other things to avoid are whole milk products, chocolate, peppermint, cinnamon, tomatoes, and anything that aggravates symptoms. The initial treatment is H₂ blockers or proton pump inhibitors (PPIs). Patient should be encouraged to take these medications 30 minutes prior to eating on an empty stomach.⁸ Patients need referral to the emergency room if they are having trouble swallowing or breathing. Referral can also be made to otolaryngology to confirm the diagnosis.

Other Potential Diagnoses

Other diagnoses to consider were listed in Table 1. Most are caused by an insult or aggravation to a cranial nerve. Some causes of otalgia are simple, such as embedded foreign bodies, cerumen impaction, or cellulitis. Some causes of otalgia can be life-threatening, such as acute myocardial infarction and thoracic aneurysm.¹⁸ Otalgia is frequently caused by otitis media; nevertheless, the provider should consider the causes enumerated in Table 1 when formulating a differential diagnosis during an atypical examination.

Conclusion

Complaints of otalgia are frequent in the urgent care setting, with patients often believing they have an ear infection that warrants a prescription for an antibiotic prescription. Consideration of an expanded differential may lead the provider to discover an alternative diagnosis. Approach each patient with an open mind and look for the clues that will help formulate an accurate diagnosis.

Citation: Phelps B, Phelps K. Ear pain mimics: it’s not all about otitis media. J Urgent Care Med. December 2019. Available at: https://www.jucm.com/ear-pain-mimics-its-not-all-about-otitis-media/.

References

1. Earwood JS, Rogers TS, Rathjan NA. Ear pain: diagnosing common and uncommon causes. Am Fam Physician. 2018;97(1):20-27.
2. Rosenfeld R, Shin J, Schwartz S, et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngol Head Neck Surg. 2016;154(2):201-214.
3. Uphold CR, Graham MV, eds. Clinical Guidelines in Family Practice. Gainesville, FL: Barmarrae Books, Inc.; 2013.
4. Bakletz L. Immunopathogenesis of polymicrobial otitis media. J Leukocyte Biol. 2010;87:213-222.
5. Burrows HL, Blackwood RA, Cooke JM, et al. Otitis Media. University of Michigan. Available at: http://www.med.umich.edu/1info/FHP/practiceguides/om/OM.pdf. Accessed November 11, 2019.
6. Rothman R, Owens T, Simel D. Does this child have acute otitis media? JAMA. 2003;290(12): 1633-1640.
7. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics, 2013;131(3):e964-e999.
8. Gilbert DN, Eliopoulos GM, Chambers HF, eds. The Sanford Guide To Antimicrobial Therapy. 47^th ed. Sperryville, VA: Antimicrobial Therapy, Inc.; 2017.
9. Schafer P, Baugh R. Acute otitis externa: an update. Am Fam Physician, 2012;6(11):1055-1061.
10. Ryu EW, Lee HY, Lee SY, et al. Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome. Am J Otolaryngol. 2012;33(3):313-318.
11. Wald ER. Acute mastoiditis in children: clinical features and diagnosis. In: UpToDate, Edwards MS, Messner AH, eds. Waltham, MA, 2018.
12. Bueno C, Pereira D, Pattussi M, et al. Gender rdifferences in temporomandibular disorders in adult populational studies: a systematic review and meta‐analysis. J Oral Rehabil. 2018;45(9):720-729.
13. Mehta RN. Temporomandibular disorders in adults. In: UpToDate, Kunins L, ed. Waltham, MA, 2019.
14. Food and Drug Administration. Cyclobenzapine: Prescribing Information. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/021777s017lbl.pdf. Accessed November 7, 2019.
15. Food and Drug Administration. Baclofen: Prescribing Information. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/208193s000lbl.pdf. Accessed November 7, 2019.
16. Chang C. Correct use of nasal sprays for eustacian tube dysfunction. Faquier ENT Constultants; September 13, 2018. Available at: https://www.fauquierent.net/etd2.htm. Accessed November 7, 2019.
17. Flint P. Throat disorders. In: Goldman L, Schafer A, eds. Goldman-Cecil Medicine. Philadelphia, PA; Elsevier; 2020: 2565-2571.
18. Amirhaeri S, Spencer D. Myocardial infarction with unusual presentation of otalgia: a case report. Int J Emerg Med. 2010;3(4):459-460.

Beth Phelps, DNP, ACNP, CNP

90,000 What are the most common causes of inner ear pain?

Pain in the inner ear can be difficult to ignore and can be devastating to a person’s hearing or balance. Inner ear pain describes pain felt deep inside the ear – in the labyrinth or bone, cochlea, or vestibular system. This excruciating pain is caused by a bacterial or viral infection, or may be a symptom of a more serious medical condition. People with inner ear problems should seek the help of a qualified healthcare professional.

Infection of the inner ear area is usually viral. A viral infection can result from a virus that infects other parts of the body, such as mononucleosis. In some cases, a viral infection of the inner ear is isolated. Viral infections of the inner ear usually affect the ear labyrinth or the vestibulocochlear nerve, which connects the ear to the brain.

Ear pain caused by a viral infection is usually accompanied by other symptoms. Dizziness, loss of balance, dizziness, and hearing or vision problems can also result from an inner ear infection.Some people with inner ear infections experience nausea and ringing in their ears. These symptoms range from mild to severe, and not every person experiences every symptom.

Bacterial infections of the inner ear are less common. Symptoms are identical to those of a viral ear infection. Only a physician can distinguish between the two with testing and physical examination. Ear pain felt deep in the ear can also migrate from the middle ear, where infections are more common.

In addition to viral and bacterial infections, pain can also spread to the inner ear area from your teeth, jaw, or sinuses.A condition called mastoiditis, which is an infection of the bone directly behind the ear, can cause severe pain in the inner ear. People with blocked Eustachian tubes – the tubes that drain the ear – experience pressure and may hear fluid in the ear along with pain in the inner ear.

Chronic inner ear pain is sometimes a symptom of a long-term illness. People can suffer from lupus, chronic fatigue syndrome, and multiple sclerosis.Malignant neoplasms and lesions can also cause pain in the inner ear.

Treatment for inner ear pain depends on the cause. Treatment options include, but are not limited to, medications, hot and cold compresses, and surgery. The doctor will prescribe the best course of action to treat the cause and the course of pain relief appropriate to the level of pain and the severity of the situation.

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Tympanostomy

By Yuri Talalaiko,

otorhinolaryngologist, Ph.M.Sc.

Each person has a set of feelings that he needs to interact with the world around him. Most of the information (about 80%) we get thanks to vision, in second place is hearing (10%), all other senses are provided; the remaining 10%. The human ear is a very delicate apparatus capable of distinguishing thousands of different sounds, determining their source and distance to it. The formation of speech is impossible without hearing. A child who has not heard since infancy will not be able to speak in the future.Even a small hearing loss in one ear causes a lot of inconvenience – it becomes impossible to determine the direction of the sound source.

Hearing loss (hearing loss) can occur due to various reasons. For patients of different ages, these reasons are different. Babies are characterized by various developmental anomalies and congenital ear diseases. For older children, adolescents and adults – inflammatory diseases of the middle ear. In older patients, hearing is most often impaired due to changes in blood circulation in the inner ear.Regardless of the patient’s age and the causes of hearing loss, hearing loss is an alarming symptom and requires a visit to a doctor. The equipment of the ENT clinic of the European Medical Center allows for accurate diagnosis of any diseases leading to hearing loss.

Inflammatory diseases of the middle ear

The most common cause of hearing loss is inflammatory disease of the middle ear.

The middle ear is a cavity located inside the temporal bone.From the side of the ear canal, it is separated from the environment by the eardrum. There is air behind the eardrum, the pressure of which should normally be equal to the ambient pressure. Only under this condition does the middle ear function normally, providing sound conduction from the eardrum to the inner ear. Air is supplied to the middle ear by the auditory tube, the organ that connects the ear to the nasopharynx.

Violation of the ventilation function of the auditory tube leads to negative pressure inside the middle ear.This, in turn, can lead to the formation of fluid in the middle ear cavity – medium exudative (serous) otitis media. When the fluid becomes infected, purulent otitis media occurs.

Tympanostomy

Most often, the treatment of otitis media is medication, however, in some cases, successful treatment requires surgical restoration of aeration of the middle ear cavity (tympanostomy, or tympanic membrane bypass). The operation consists in installing an aeration tube into the tympanic membrane.Indications for tympanostomy are severe or prolonged course of acute purulent otitis media, prolonged (a month or more) exudative otitis media, recurrent otitis media, prolonged dysfunction of the auditory tube.

The intervention is performed in the operating room under general anesthesia. Most often it is gas mask anesthesia. For the operation, special microinstruments and a microscope are used. The first step is an incision of the tympanic membrane (about 2 mm). It is produced in that part of the tympanic membrane where damage to the structures of the middle ear is excluded.If there is fluid in the ear cavity, it is removed through the incision with a vacuum aspirator. A silicone aeration tube is then inserted into the incision. This concludes the operation. Tympanostomy usually takes 5-10 minutes. If necessary, the operation can be combined with other interventions, such as adenotomy (removal of the adenoids).

There are many different models of tympanostomy tubes, differing from each other in shape and material (titanium, polypropylene, silicone).Tubes for long-term and short-term use are fundamentally different. Most of the tubes have an inner diameter of 1 – 1.5 mm, which is sufficient for normal operation. The choice of a specific model is made immediately before the operation.

Postoperative period

Patients are discharged from the hospital a few hours after the operation. In the postoperative period, no special ear care is required. In some cases, antibacterial ear drops may be recommended.The tympanostomy tube in the vast majority of cases does not cause any subjective sensations in the ear. Also, in most cases, patients notice an improvement in hearing immediately after surgery.

During the entire period of the tympanostmic tube, it is necessary to protect the ear from the ingress of water during bathing and shampooing. The best fit for this purpose are earplugs, which are individually made by the audiologist.

A few days after the tympanostomy tube is inserted, the patient should be seen by an otorhinolaryngologist.During the examination, he will determine the position of the tube, its patency and functionality, as well as appoint an audiologist’s consultation to assess the hearing. Further examinations are carried out as needed. When tympanostomy tubes are worn for a long time, it is necessary to carry out examinations once every few months.

Removal of the tympanostomy tube is performed if the function of the inner ear is restored. In adults, tubing can be removed at the otolaryngologist’s office at your regular appointment.In children, it is preferable to remove them in the operating room under conditions of short-term general anesthesia. In most cases, tympanostomy tubes for short-term wear will fall out on their own within 6-12 months after insertion. The tympanic membrane heals completely after 2-3 weeks after removal or prolapse of the tympanotic tube.

Contraindications

There are no contraindications to eardrum shunting. Potential individual risks should be consulted with a physician.

In conclusion, it should be noted that tympanostomy is a safe, effective, and in some cases, irreplaceable procedure that allows you to quickly and effectively solve many problems of the middle ear.

Author: Yuri Talalaiko, otorhinolaryngologist, Ph.D.

What to do if a child has a fever and an ear hurts?

P It is customary to distinguish three types of otitis media. The external one is characterized by inflammation of the auricle and the external auditory canal.Inflammation can be triggered by fungi, boils, skin diseases, a foreign object in the ear, or a sulfur plug. The disease proceeds mainly without temperature, but is often characterized by pain, lumbago, ringing, noise, buzz in the ears.

Otitis media is an inflammation of the tympanic cavity of the middle ear, as well as the Eustachian tube. It connects the nasopharynx to the middle ear, which allows air to flow to the tympanic cavity so that the pressure on both sides of the eardrum, which separates the outer and outer ear, is normal.

In young children, it is short and wide, which makes it easier for germs from the nasopharynx to enter the middle ear and cause inflammation. Therefore, before the age of three, about ninety percent of babies have had otitis media at least once.

Inflammation of the middle part of the ear can be of both viral and bacterial origin: it all depends on the ailment that caused it. Usually otitis media is a complication of flu, sore throat, sinusitis, and other respiratory conditions. If the flu is of a viral origin, then the cause of other ailments may be different.

It is very important to correctly determine this point, since the diseases caused by the virus do not respond to antibiotics. Otitis media develops due to the fact that the infection penetrates from the nasopharynx into the Eustachian tube, which results in its inflammation, and then the middle ear.

Otitis media is characterized by severe ear pain and high fever. In a severe form, the disease turns into a purulent stage, and if measures are not taken in time, pus breaks through the eardrum and goes out. In the worst case, it breaks the membranes that separate the middle from the inner ear, and ends up in the cochlea, provoking inflammation of the labyrinth.

Otitis media, known as labyrinthitis, is extremely dangerous. The cells of the inner ear are so sensitive that under the influence of inflammatory processes they are destroyed and no longer restored, which leads to hearing loss and even deafness. Not only hearing acuity deteriorates, but also the work of the vestibular apparatus, which is located in the inner ear.

90,000 Incision and paracentesis of the tympanic membrane. Indications, consequences

Incision and paracentesis of the tympanic membrane.Indications, consequences

The ear is an extremely delicate organ. The level of hearing depends on the state of its elements. Clinical situations may arise when a puncture or incision needs to be made in the ear. Myringotomy is a small incision in the center of the tympanic membrane that is performed in a health care facility by a qualified otolaryngologist. A more gentle option is a puncture of the tympanic membrane, which is also called paracentesis.

The eardrum is a structure in the form of a thin connective tissue film (membrane) that separates the middle and inner ear.She:

• transmits sound vibrations to the inner ear;
• serves as a barrier that keeps foreign bodies out of the inner ear.

The tympanic membrane is normally impenetrable. Therefore, it not only does not let foreign objects into the inner ear, but also does not release its pathological secretions, which accumulate in various diseases.

In order to free the inner ear from pathological contents, a puncture or incision of the tympanic membrane is performed.Thanks to this small and technically uncomplicated manipulation, the patient’s condition is significantly improved. It can be performed both in the dressing or manipulation hospital, and in the office of the polyclinic.

Indications for puncture and incision of the tympanic membrane

Paracentesis and myringotomy of the tympanic membrane are most often performed in the following pathological conditions of the inner ear:

• accumulation of serous effusion resulting from inflammation;
• outpouring of blood;
• progression of the inflammatory process and the formation of pus.

Such conditions are observed in different types of otitis media. One-time execution of one of these two manipulations leads to significant relief of the patient’s condition, and then his recovery.

Paracentesis of the tympanic membrane is indicated in the presence of clinical symptoms from the ear and other structures – for example, when signs of irritation of the meninges appear.

An incision of the tympanic membrane is performed if the puncture is little or ineffective, which happens in the following cases:

• there are too many pathological secretions in the inner ear cavity and a small opening is not enough for their evacuation;
• the opening of the tympanic membrane, due to the specificity of its tissues, quickly tightens, the inner ear does not have time to get rid of the pathological contents.

If the procedure was performed correctly, the hole in the eardrum after a puncture or incision is tightened after a few days without consequences for hearing. Therefore, the patient should not worry about the violation of the integrity of the tympanic membrane, performed for therapeutic purposes.

Consequences of a puncture of the tympanic membrane and its incision

The above manipulations are harmless procedures. After their implementation, the patient can almost immediately return to the usual rhythm of life.But in some cases, after paracentesis of the tympanic membrane or its incision, the following consequences may develop:

• hearing impairment – if the structures of the inner ear were affected during the manipulation;
• ear bleeding – if local blood vessels were affected;
• relapse of the disease – in particular, suppuration, if, during puncture or incision, the sanation was not carried out in full;
• cicatricial changes in the tympanic membrane – if the procedure was ineffective and it was repeated.

Patients are advised to seek help from well-known clinics, whose specialists have extensive experience in carrying out such manipulations.

Puncture of the tympanic membrane in children

In childhood, pathological discharge in the inner ear accumulates faster than in adults. Therefore, a puncture of the tympanic membrane with otitis media in a child should be done immediately, without waiting for the increase in symptoms, since even 1-2 days of delay can be fraught with health.

This is due to the structural features of the tympanic membrane in children. In small patients, it is more:

• thick;
• dense;
• resistant to spontaneous perforation (spontaneous hole formation).

Because of these characteristics, spontaneous drainage of the inner ear (release of the contents) is very rare in childhood. Therefore, only the paracentesis of the tympanic membrane in children can relieve them of the accumulation of secretions in the inner ear.

Despite the fact that the eardrum in children is thicker, its puncture or incision is not technically difficult to manipulate. More difficulty arises from the emotional response of the child. Therefore, an otolaryngologist performing an incision or puncture of the tympanic membrane in a small patient must also be a psychologist.

On our website https://www.dobrobut.com you can find out more details about the possible consequences of a puncture of the eardrum and other nuances.

Related services:
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Experts warn: headphones are harmful to the ears | Study and work in Germany | DW

The invention of the smartphone not only made communication more mobile, but also gave us the opportunity to go through life with music, without losing, so to speak, connection with the outside world – at least with where we are expecting a call.Accompanied by musical accompaniment in headphones, the road to work seems shorter, morning jogging is more efficient, and the world around us is less monotonous. The louder the sound, the easier it is to immerse yourself in the world of your own fantasies … And the easier it is at the same time to cause a serious health problem.

Noise instead of music in the ears

According to the largest German health insurance company Barmer, young people today are increasingly hearing impaired. “The trend is clear,” says Mani Rafii, Barmer board member.“Added to the noise around us in the city is the noise coming from the digital world.” This noise is harmful.

In five years, the number of insured clients aged 15 to 35 at Barmer who require hearing aids has increased by a third. “The fact that hearing deteriorates after 50-60 years is completely normal. But it is very worrying that these problems are affecting young people, “says Ursula Marschall, head of Medicine and Healthcare Research at Barmer, in an interview with DW.

When thinking about health, don’t forget about your ears!

The reason lies, of course, not in the music itself, but in how loud and how long it sounds. According to the observations of experts, many teenagers listen to loud music through headphones almost continuously. “There are musical compositions that you just can’t help but play loudly. But even they are dangerous only if you listen to them for several hours, or even days in a row,” explains Ursula Marshall.

It has been proven that constant listening to music with an intensity of 65 dB (this is approximately the level of a loud conversation) already causes hearing impairment, although many do not perceive this as unbearable noise.Noise of 85 dB (a motorcycle with a muffler) or higher leads to serious hearing impairment, and 120 dB (jackhammer) leads to hearing loss and even deafness.

Pause for ears

Sensitive hairs in the inner ear are responsible for the sound signal. “The cells of the inner ear have the ability to temporarily adapt to noise, but the defense mechanism is triggered only if the noise lasts for a short time,” explains the expert. For example, after an evening at a disco with loud music, you may notice that your hearing is a little dull.

The closer the sound source is to the ear, the more intensely it is perceived. Therefore, loud music from headphones is much more harmful than music from speakers. “At the disco, you can move away from the speaker, and in the headphones, the loud sound acts directly on the eardrum,” the doctor explains.

Therefore, vacuum earplugs are much more harmful than overhead headphones. But whatever the headset is, the ears should be given rest in any case. “If you leave a nightclub, do not immediately insert headphones into your ears, wait until morning,” the doctor urges.

How to prevent

Impaired hearing cannot be restored. But just at a young age, this problem is overlooked and recognized too late, so that serious consequences often cannot be avoided. After all, the earlier the hearing impairment is determined, the easier it is to prevent its deterioration to partial or complete deafness.

“Hearing impairment, as a rule, you notice not yourself, but with the help of others: for example, when you do not understand the question asked to you.The problem also lies in the subjectivity of noise perception “, – notes Ursula Marshall. Someone even gets in the way of quiet music, while someone always seems to be loud enough. Therefore, it is better to ask others if they think the sound level in your headphones is normal.

For The expert also gives other tips for keeping your hearing acuity. When buying headphones, it is better to choose a model with active noise cancellation. They do not have to make the music louder, trying to drown out external sounds. power.Maybe a quiet background is enough?

Noisy cities

Hearing impairment is a common problem in urban dwellers. In March, the German startup Mimi Hearing Technologies published a rating of the noisiest cities, analyzing the situation in 50 megacities. According to the results, the researchers called Zurich the quietest city, and Guangzhou the most noisy. Among German cities, the situation was best assessed in Dusseldorf and Munich. St. Petersburg – on the 21st place in terms of noise pollution, Moscow – on the 35th.In general, in large cities, the hearing ability of residents matches the quality of hearing of people who are ten years older than them.

See also:

• Can pregnant women drink coffee, or 10 factors affecting health

  Can pregnant women drink coffee?

  Specialists from the Norwegian Institute of Public Health in Oslo conducted a survey of almost 60 thousand women at 17, 22 and 30 weeks of pregnancy. At the same time, the weight of the fetus was approximately determined.It turned out that one to two cups of coffee a day means 20-30 grams of underweight for the baby. However, coffee consumption does not affect the duration of pregnancy, that is, it does not lead to premature birth.

• Can pregnant women drink coffee or 10 health factors

  Zero drinks are dangerous to health

  How do drinks with zero sugar and calories affect the body? Scientists differ on this score. According to a study by Columbia University in the United States, daily consumption of “zero” soda increases the risk of heart attack or stroke by 48 percent.

• Can pregnant women drink coffee, or 10 factors affecting health

  The average German drinks a bath of alcohol per year

  People in Germany drink an average of 9.6 liters of pure alcohol per year. This is 325 bottles of beer, 27 bottles of wine, 5 bottles of champagne and 7 bottles of vodka – a whole bathtub filled with alcohol. These are the data of the German Center for the Prevention and Control of Alcohol and Drug Addiction. Now in Germany there are 1,300 organizations working to help get rid of alcoholism.

• Can pregnant women drink coffee, or 10 factors affecting health

  Germans are ready to give up meat

  For the sake of their health, more than half of Germans are ready to change their diet and reduce their consumption of meat products. These are the results of a representative survey conducted by the Society for the Study of Consumption in Nuremberg. Interestingly, there are far more women (63.9 percent) than men (44.1 percent) among the supporters of the transition to a vegetarian or partially vegetarian lifestyle.

• Can pregnant women drink coffee, or 10 factors affecting health

  Drugs for the treatment of influenza are of little benefit

  This is the conclusion of the authors of a study conducted by the international non-profit organization Cochrane Collaboration. We analyzed the results of 20 studies of Tamiflu and 26 studies on the effectiveness of Relenza with a total number of patients exceeding 24 thousand people.

• Can pregnant women drink coffee, or 10 factors affecting health

  What food will protect an infant from allergies

  The answer to this question is given, in particular, by the international GINI study. One of the results: during pregnancy and lactation, mothers themselves, contrary to previous recommendations, can safely eat any food that does not cause any allergic reactions in them, including cow’s milk, products from wheat, soybeans, as well as nuts and fish.

• Can pregnant women drink coffee, or 10 factors affecting health

  Germans are tired of summer time

  Almost three quarters of German residents (73 percent) believe that there is no need to switch to summer time. These are the results of a survey conducted by the German sociological institute Forsa. According to the insurance company DAK, last year in the first three working days after the transition to daylight saving time, the number of clients of this company who took sick leave was 15 percent higher than on other days.

• Can pregnant women drink coffee, or 10 factors affecting health

  Every fourth German is afraid of dentists

  25.8 percent of people in Germany have a very high fear of going to the dentist. This is the main result of a representative survey commissioned by Apotheken Umschau magazine. The survey involved 2,229 men and women over 14 years old. Also, almost every fourth of them (23.1 percent) admitted that they go to the dentist only when he starts to suffer from toothache.

• Can pregnant women drink coffee, or 10 factors that affect health

  Coffee prevents cardiovascular disease

  According to a study by the South Korean hospital Kangbuk Samsung Hospital, regular coffee drinking – three to five cups a day – can prevent vascular thrombosis. More than 25,000 employees were under the supervision of doctors for a long time. “Moderate coffee lovers” (as opposed to those who drank much more or less coffee) had practically no signs of cardiovascular disease.

• Can pregnant women drink coffee, or 10 factors affecting health

  A ban on smoking: consequences for residents of Germany

  2 years after the complete ban on smoking in restaurants, cafes and pubs of the federal state of North Rhine-Westphalia at 63 percent of them income decreased by more than ten percent. But now in Germany, according to statistics, about 26 percent of the population smoke – as little as ever.

  Author: Natalia Koroleva, Maxim Nelyubin, Vladimir Fradkin

90,000 Otosclerosis: diagnostics, surgery and clinics

What is otosclerosis?

With otosclerosis, the bone remodeling process is disrupted, which leads to ossification (sclerosis) in the ear.As a result, the bones responsible for the transmission of sound lose mobility, and deafness occurs in the later stages of the disease. Ossification usually begins in the middle ear and can spread to the inner ear. The disease first develops on one side, and then spreads to the other ear.

The cause of the pathology is usually a violation of bone metabolism in the labyrinth capsule – a small bony part in the inner ear. Starting from the tympanic membrane, the disease spreads from there to the stirrup.As ossification develops, the stirrup loses its vibration range, constantly reducing its ability to transmit sound.

Otosclerosis usually appears between the ages of 20 and 40. Women are affected more often than men. Of almost 10% of the population with changes in the middle and inner ear, only 1% is due to otosclerosis.

What are the symptoms of otosclerosis?

The most important symptom of progressive otosclerosis is hearing impairment. In 60–70% of cases, the disease spreads to the second ear.In women, otosclerosis often begins during pregnancy. Associated symptoms of otosclerosis usually include

tinnitus (ringing in the ears)

in which a person hears a buzzing and / or whistling sound.

Causes of otosclerosis

The exact causes of otosclerosis are still unclear. Risk factors that can lead to the onset of the disease are viral infections (for example, mumps, rubella, measles).

Autoimmune diseases are also considered as a possible cause.In autoimmune disease, the body’s defense cells are hypersensitive to their own tissues, which are perceived as foreign bodies and attack them.

Genetic predisposition is also taken into account. This establishes the frequency of cases in the family and it becomes possible to identify five genes (the so-called OTSC-genes 1-5), which are changed in patients with otosclerosis. Due to a genetic abnormality, it is possible to inherit the defect, so that the disease often occurs in the children of the sick parent.

Otosclerosis is very common in women during pregnancy and less commonly in postmenopausal women. It is not uncommon for women with otosclerosis to report an increase in symptoms as soon as they take birth control. Therefore, it is believed that hormones also play a role in the development of otosclerosis: an increased level of hormones, apparently, accelerates the remodeling processes of ossification.

Diagnosis of otosclerosis

The ENT doctor is the first choice for patients with ear, nose and throat problems.At the first interview, the doctor records the nature and development of the disease by asking various questions, such as:

• How often do these complaints occur in your family?
• Have you had any complaints in the past?
• Have you recently had a bacterial or viral infection?
• Do you often hear buzzing and buzzing in your ears?

After a detailed conversation, the doctor begins a physical examination. He uses a kind of magnifying glass with light and inserts it into both ears (otoscopy).Already at this stage, he can observe changes: reddish edema indicates, for example, inflammation. Patients with otosclerosis usually show no signs of swelling or redness, and the ear canal and eardrum appear normal at first glance. However, in some rare cases, a reddish spot appears that shines through the eardrum (the so-called Schwartz symptom).

If the otoscopy does not provide any precise information, a hearing test is usually done.Especially important is the test with a tuning fork by Rinne and Weber. The ENT doctor vibrates the tuning fork and holds it in front of the patient’s ear or places it in various places in the head area and asks the patient to say when he no longer hears vibration and if he hears it at all. With this test, the doctor can already determine whether it is a disorder of sound perception or conduction. If there is a disturbance in sound conduction, then the sound waves are not transmitted properly to the inner ear.If sound perception is impaired, it can be assumed that the problem is in the inner ear, the auditory nerve.

In otosclerosis, the process of hardening occurs mainly in the middle ear (sound conduction is disturbed), but there is also otosclerosis of the labyrinth capsule, which leads to changes in the inner ear (sensorineural hearing impairment). In addition, mixed forms are common, affecting both the inner and middle ear, making it more difficult to make an accurate diagnosis. By examining both ears, you can find out if the symptoms are in both ears or in only one.In case of damage to both organs, additional tests are necessary, since it is not always easy to identify the complete picture.

With tympanometry, the doctor checks the mobility of the tympanic membrane and, using the stapes reflex, assesses the mobility of the stapes: if it is immobile, the stapes reflex does not work.

Further research includes speech understanding: the audiogram allows the doctor to directly determine whether speech is heard well or poorly.

More recently, ENT specialists have also begun to work with imaging techniques: MRIs, CT scans and X-rays can show how otorosclerosis has progressed and how anatomical structures have changed in the ear region.Fractures and dislocations can also be ruled out. As an additional examination, it is possible to use the TCS test (tympanic zygomatic scintigraphy) and a balance check.

The only treatment option: otosclerosis surgery

Without treatment, otosclerosis will continue to progress. However, drugs are not able to stop the process. Cortisone therapy may be considered, which may slow hearing loss but will not improve hearing. Only surgery can help here. Doctors distinguish between stapedotomy and stapedectomy.

Stapedectomy

In a stapepectomy, surgeons remove the sclerotic stirrup either manually with surgical instruments or with a laser and replace it with an artificial one. Like the natural stirrup, its plastic counterpart is connected to the incus and eardrum so that sound transmission can continue normally.

Stapedotomy

In the past, the stirrup was completely removed and replaced with a new artificial prosthesis (stapedectomy).Currently, they resort more to stapedotomy, in which not the entire stirrup is removed, but only the long shoulder. The part connected to the oval window remains. The doctor drills a small hole, removes the tympanic membrane on one side, and attaches the replacement to the incus on one side and to the stirrup on the other. The operation itself is quite short and takes half an hour and is performed under local anesthesia. After the operation, the eardrum is folded back and returned to its original position.It is important to wear a bandage, also called an ear tamponade, for two weeks after the operation.

Capsular sclerosis treatment

With capsular sclerosis, ossification has already spread to the inner ear. Thus, not only sound conductivity is disturbed, but also the sensation of sound, because nerve pathways that are important for hearing pass here. On the one hand, stapedectomy or stapedotomy alone will not help; ossification worsens in the absence of surgery.Patients usually receive a hearing aid, but surgery is required afterwards to reduce the sclerosis. If the disease cannot be compensated for with a simple hearing aid, they resort to the so-called

cochlear implant

consisting of two small electronic components, one of which is installed outside the ear and the other directly into the inner ear, which can restore hearing.

Dizziness and nausea may occur after surgery, but these will subside within a few days.Only occasionally does the dizziness last longer than usual, and in very rare cases, hearing is impaired after surgery.

What is the prognosis for otosclerosis?

Depending on when otosclerosis occurs and when it was diagnosed, the prognosis can be different. It is clear that without therapy, any otosclerosis will lead to hearing loss and, in extreme cases, to complete deafness. The sooner patients start therapy, the better the chances of a complete cure.

Overall, more than 90% of patients undergo surgery to remove otosclerosis and experience a significant improvement in hearing.Otosclerosis cannot be stopped with medication. Therefore, it is all the more important that people with frequent hearing problems in the family regularly receive

inspections

from specialized doctors.

Only a specialized doctor can detect the disease at an early stage and thus carry out possible surgery to reduce or, at best, prevent the severe course of otosclerosis.

Otitis

Otitis media is characterized by ear inflammation.It is caused by fungal, bacterial and viral infections. Otitis media can be external, middle and internal.

External is diffuse or localized inflammation of the external ear canal. Frequent illness with otitis externa can lead to the development of otomycosis or other fungal infection.

Otitis media is a disease of the middle ear that is characterized by inflammation of the auditory tube, membranes, and ear drum. The infection enters the ear from the nasopharynx, with diseases such as ARVI, tonsillitis, sinusitis, etc.

With internal otitis media, the vestibular and auditory analyzers, which are located in the center of the inner ear, are affected. The causes of occurrence are most often various injuries, inflammation of the middle ear and as a result of complications of a general infection.

The symptoms of otitis media are as follows:

With any type of otitis media, the patient develops pain in the ear and discharge from it. The ear becomes blocked, resulting in decreased hearing.

With otitis externa, the ear canal swells and turns red.Then a mucous or purulent fluid begins to stand out from it. In addition, otitis externa is characterized by acute throbbing pain inside the ear and severe itching.

In acute otitis media, the patient complains of growing pain in the ear and high body temperature. Hearing is significantly impaired and the ear is completely healed. When suppuration appears from it, the patient’s pain disappears, and his hearing is normalized.

With internal otitis media, the patient is tormented by dizziness, noises in the ear.Vomiting and nausea appear.

The most dangerous complications of otitis media are the spread of infections in the cranial cavity, as a result of which sepsis, brain abscess or acute meningitis develops. Hearing loss can also occur.

If the otitis media is severe, then immediate hospitalization is necessary. In other cases, the disease is treated on an outpatient basis.

First of all, with otitis media, the patient must adhere to bed rest.He is prescribed physiotherapy, hot water bottles and compresses.

From medicines for otitis media, antibiotics and special anti-inflammatory drops are prescribed. These include drugs such as Garazon, Anauran, Dexon, Betagenot, Polideka, Tsipromed, Normax, etc.