Earache and ear Infections

Earache and ear Infections
Love is a many splendored thing. An earache however is not. On the human misery scale, ear pain probably ranks right up there with a severe toothache, a beesting, or a severeg migraine. Earaches can have many causes and are usually defined by whether they are on, or in the ear when they occur. Another probable cause of ear pain is what doctor’s term “referred pain”-- or pain originating from a source or condition apart from the ear. Sometimes things you would never consider as a source can in fact be the cause. Rarely, heart attack pain can be “referred” to the jaw and ear. Chronic strain or inflammation of the T.M.J., or jaw joint, can be felt in the ear. A severe toothache can be referred into the ear, as can inflammation of the parotid salivary gland. Your doctor knows how to separate true pain of the ear from referred pain.
When defining primary ear pain, doctors usually separate the condition into two separate areas:
 1) Otitis externa Conditions present on the external ear or in the ear canal up to the eardrum (
2)  Otitis media Conditions present on the inner side of the eardrum, that is, in the middle ear
Otitis externa can have a rash on the outer ear, which are caused either inflammation, infection, or both. For instance, wrestlers who wear tight leather helmets which lead to contusions and moist, warm conditions might end up with a bacterial or fungal infection on the outside of the ear. And in our Ipod generation, the same might be true for the chronic use of headphones. An anti-inflammatory or antifungal cream along with a course of antibiotic might be curative. 
Otitis externa occurs in the ear canal up to the eardrum. It might be caused by water in the ear from swimming, which is trapped deeper down in the ear canal (“swimmer’s ear”). It could be a large collection of earwax, which holds moisture deep within the external ear, allowing infection.
The usual treatment is instilling antibiotic and possibly anti-inflammatory drops, into the ear canal at regular intervals. Sometimes the ear canal is very swollen, and an ear wick has to be put in for a few days, and the collection of earwax may have to be carefully removed. Your doctor can advise you whether to use drops after bathing or swimming to prevent future infections of this type, or they may advise you to use earplugs under these circumstances.
Otitis media occurs on the inside of the eardrum. It is the space of the middle ear, where the delicate hearing bones are located as well as the hearing organ itself, the cochlea. Most of the infections of the middle ear are of viral origin and spread from the back of the nose by way of the Eustachian tube.  In the majority of cases, the body resolves these viral infections in a few days, but often a bacterial germ then moves in, causing a much more severe and potentially damaging infection. These types of infections can spread into tissue structures about the middle ear and can, in severe cases even cause a form of meningitis. When the infection has spread that far, these usually require hospitalization, skillful use of antibiotics, and frequent progress check-ups to be sure they are promptly resolving. We don’t want them to spread, and we don’t want them to burst through the eardrum. 
The middle ear is ingeniously connected to the outside air pressures by the Eustachian tubes to the back of the throat. This prevents the eardrum from bursting when one dives down in the water or ascends to high altitudes. Unfortunately, infection reaches the middle ear by this passage. In young children, the tube is short and straight, further enhancing the infectious process. When there is inflammation and mucus, sometimes the tubes do not work too well and a “vacuum” is created in the middle ear. This sucks fluid into the middle ear from surrounding tissue, creating a fluid filling the middle ear, which interferes with hearing. The fluid can get secondarily infected. When this happens too often, ear specialists might recommend ventilation tubes to be placed through the eardrums. These stay in place a few months and keep fluid and infection from building in the middle ear, allowing the serous fluid and pus to drain out of the inner ear.
Symptoms of middle ear infection include fullness and pain in the ear, fever, difficulty hearing, restlessness and crying in young children, nausea, and generally not feeling well. Occasionally, the eardrum can rupture releasing pus or bloody fluid from the ear. You don’t want to put any drops in the ear if this is the case. The best plan is to get to your doctor. You may wish to take an over the counter medication like Tylenol or Advil for fever or pain. What your child mostly needs is a thorough ear exam and definitive treatment by a physician. Antibiotics are probably in order, sometimes by injection if the child is too sick or cannot take oral medicine. Sometimes, the doctor will order a decongestant to hopefully make the Eustachian tubes work better. Have the regular follow-ups as your doctor recommends until the condition is resolved.
Remember the goals of treatment:  We want to alleviate the pain and suffering of earache, we don’t want the infection to spread to adjacent areas, and we don’t want your child to lose any hearing abilities. In the past, children unfortunately used to suffer quite a bit of deafness and prolonged illness before we had the excellent treatments we now have available to patients. 
John Drew Laurusonis, MD
Doctors Medical Center