Ear Infection

An ear infection is a common bacterial or viral infection of the middle ear (the space behind the eardrum that contains the small vibrating bones of the ear).

You do not always need to seek medical attention for an ear infection, as they generally get better on their own within three days.  Some people are predisposed to experiencing recurrent ear infections.  This can cause hearing problems and other serious complications and will require treatment.

Cause

An ear infection is typically caused by a bacterial or viral infection in the middle ear.  This infection is often triggered by another illness such as a cold or flu, resulting in swelling or a blockage in one of your Eustachian tubes (tubes that run from each ear directly to the back of the throat).

The Eustachian tubes are two narrow tubes that run from each middle ear to the back of the throat, behind the nasal passages. The Eustachian tubes work to:

• Control air pressure in the middle ear
• Rejuvenate air in the ear
• Drain typical secretions from the middle ear

Eustachian tubes are narrower and more horizontal in children, which makes them more problematic to drain and more likely to become clogged.

An outer ear infection often occurs due to water remaining in the ear following swimming or bathing; hence why it is often referred to as ‘swimmers ear’.  A bacterial infection can occur if your outer ear is scratched, or if you aggravate the outer lining of your ear by putting your fingers or other objects into it.

Symptoms

Symptoms related to an ear infection can develop in one or both ears and may persist or come and go.  Pain is generally more severe with double ear infection (infection in both ears).  Common symptoms of an ear infection include:

• Mild pain or discomfort inside the ear
• Persistent pressure inside the ear
• Fussiness or pickiness in young infants
• Trouble hearing or hearing loss
• Drainage of pus-like fluid from the ear

It is important to understand when your symptoms may be a sign of something more serious.  Contact your doctor if you notice any of the following symptoms:

• Fluid (such as pus or blood) oozing out of the ear
• A high fever, headache, or dizziness
• You think an object may be stuck in your ear
• Swelling behind the ear, particularly if that side of your face feels weak
• Severe ear pain that suddenly stops (which could indicate a ruptured eardrum)
• Your symptoms do not get better, or worsen within 24 to 48 hours

Diagnosis

Your doctor will begin by taking a full medical history and discuss your symptoms.  They may use an otoscope (a lighted instrument with a magnifying lens) to get a detailed look at your ears, throat and nasal passage.

A pneumatic otoscope can release a puff of air into the ear.  When air is pushed into the ear, the reaction of your eardrum can help diagnose the problem.  If the eardrum moves easily, you may not have a middle ear infection. If the eardrum hardly moves, it indicates there is fluid pushing against it from the inside.

Additional Tests

Your doctor may perform other tests if there is any doubt about a diagnosis, if the condition has not responded to previous treatments, or if there are other long-term or serious problems.

Tympanometry
A tympanometry measures the condition and movement of the eardrum and provides an indirect measure of pressure within the middle ear.

Acoustic Reflectometry
An acoustic reflectometry measure the level of sound reflected back from the eardrum.  The eardrum usually absorbs most of the sound; however, the more pressure there is due to fluid in the middle ear, the more sound the eardrum will reflect.

Tympanocentesis
In rare cases, a doctor may use a tiny needle to pierce the eardrum and drain fluid from the middle ear.  The fluid is tested for viruses and bacteria.  This can be useful if an infection has not reacted well to previous treatments.

Treatment

The type of ear infection you have will determine the method of treatment.  

Antibiotics are not typically offered for an inner ear infection as they frequently clear up on their own.  Antibiotics may be prescribed if the infection does not clear up within three days, if you have an illness that increases the risk of complications, such as cystic fibrosis, or if there is excess fluid oozing out of the ear.

For a middle ear infection, antibiotics are often prescribed.  Some antibiotics are taken orally whereas others are applied directly to the infection site with eardrops.  Medicines for pain, such as over-the-counter pain relievers and anti-inflammatory drugs can also be taken to control your symptoms.

If you are still experiencing cold or allergy symptoms, you may be directed to take a decongestant, nasal steroids, or an antihistamine.

A bacterial infection of the outer ear can be treated with antibiotic eardrops.  If the bacterial infection is severe, antibiotic tablets are the recommended course of treatment.  Steroid eardrops can help reduce swelling.  To treat a fungal infection, your doctor may suggest antifungal eardrops.

If you have not used eardrops before, ask your doctor for some guidance, as they may not work if used incorrectly. Ensure you complete the full cycle of antibiotics as prescribed to manage symptoms and help prevent recurrence.

If the usual medical treatments fail to help or you have recurrent ear infections in a short space of time, surgery may be an option.  In most cases, tubes are placed in the ears to allow fluid to drain out.

There are precautions and steps you can take to help avoid an ear infection of any kind, including:

• Maintain clean ears by washing them regularly and carefully using a cotton swab. Make sure you dry your ears thoroughly after swimming or having a shower.
• Do not smoke and try to avoid second-hand smoke as possible.
• Control your allergies by avoiding triggers and taking any allergy medication as prescribed.
• Wash your hands thoroughly, and try to avoid people who have colds or other upper respiratory conditions.

Outlook

Ear infections are more common in children than adults; however, adults are still prone to developing them.

Appropriate treatment for your ear infection should eradicate any complications.  If you allow an ear infection to persist for too long without treatment, you increase the risk of permanent hearing loss or having the infection spread to other areas of your head.

If you are an adult with an ear infection, pay close attention to your symptoms and make an appointment with your doctor.

Need Help?

If you are concerned you may have an ear infection, you can be seen by a Consultant ENT specialist at One Ashford Hospital, usually within 48 hours. 

One Ashford Hospital is well placed to see patients requiring ear infection treatment from Ashford, Maidstone, Canterbury, Folkestone, Dover and all surrounding villages.  To book an appointment, call the hospital direct on 01233 364 022 or email here.