What is an ear infection?
An ear infection – also known as acute otitis media – is an infection located in the middle ear, which is the part behind the eardrum. It is more prevalent in children than in adults.
While ear infections often go away without ear treatment being needed, in some cases treatment is used to manage the pain and clear the infection.
Outer Ear Infections
This is inflammation of the skin and cartilage of the outer ear. It is often due to a bacterial infection following a fairly minor injury to the ear. The ear has a very red appearance and can often exude pus like material. The patient often has severe pain. The causative organism is pseudomonas and treatment should include drugs such as Ciprofloxacin. Occasionally cartilage can be lost as a result of the infection giving rise to deformity of the ear once the infection has settled.
This is often due to infection in a hair follicle on the outer ear canal. It results in a small collection of pus under the skin and as there is close apposition of the skin overlying the ear cartilage it gives rise to intense pain. There can be associated hearing loss and discharge from the ear. Treatment involves lancing the mini abscess and treating with oral antibiotics. Sometimes the build up of debris in the outer ear needs to be cleared.
View of ear canal with swelling coming from the top due to the furuncle
The skin of the outer ear canal is quite unique in that the surface skin cells migrate from the deep ear canal towards the outside. This process is facilitated by the production of ear wax which helps to soften the dead skin cells. Any disturbance to this process such as excessive use of cotton buds, swimming or outer ear skin conditions such as eczema can give rise to a condition known as otitis externa. Here the first symptom is usually a sense of itchiness and thereafter there can be pain, discharge and hearing loss. Sometimes the pain can be so severe and the ear canal so swollen that treatment cannot be offered in the outpatient setting and the patient may need a general anaesthetic in order that the debris can be removed. The main stay treatment at this stage is to remove any debris in the ear canal, to instil antibiotic drops/ointment and to treat the patient with oral and topical antibiotics. Very occasionally a patient needs to be admitted for intravenous therapy. In early cases treatment with topical ear drops alone can be sufficient. In an ideal world a swab is taken from the ear to see what bacteria are growing and the medical treatment can then be targeted accurately.
Although the vast majority of infections are due to bacteria it is possible to get infections due to viruses (myringitis) and occasionally due to fungus infection such as Candida or aspergillus. In addition to removing debris anti fungal preparations are instilled into the ear canal.
View of ear canal showing infected debris which looks like wet blotting paper
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After control of infection, the middle ear components can be reconstructed surgically.
Chronic infection of middle ear with perforated ear drum
Chronic Otitis Media
If the acute episode fails to resolve completely then the symptoms can be prolonged and when these exist for more than three months the term chronic otitis media is used. In rare occasions then there can be the patient’s own skin growing internally forming a ball of infected material (cholesteatoma). This can be associated with active infection and can slowly erode the little bones in the middle ear giving rise to hearing loss and is usually associated with smelly ear discharge. There can also be intermittent episodes of pain. Another type of chronic otitis media is when there is a long standing perforation in the ear drum and here there are episodes of ear pain associated with discharge but this condition rarely progresses to any serious condition unlike that associated with cholesteatoma.
Why see Dr Kalpesh Patel for your ear infection treatment?
At London ENT Clinic you are in the very best hands when it comes to ear infections. We use state of the art techniques for the diagnosis and treatment of ear conditions, led by Dr Kalpesh S Patel and his team of experts.
If you would like to ask us any questions on ear infections directly, feel free to call us on 020 7262 0297
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First time I needed to see a specialist in the UK and I have to say that Mr. Kalpesh Patel is super professional and efficient. Clear communication and helpful.
Very tidy and clean environment with an amazing team to support the clinic. Mr. Patel which I met for the first time was kind and a good listener. Received a good diagnose and treatment. I highly recommend Mr Patel.
I highly recommend Mr Patel to anyone having nose related problems. He is very experienced and extremely supportive throughout the whole process.
I highly recommend Mr Patel. He and his staff were helpful and kind, and I left his office more knowledgeable and feeling better. Mr Patel explained the issue in simple terms using diagrams, but the best part about seeing him was the treatment and prescription he provided, which has given me immense relief. Thank you ever so much.
I highly recommend Kalpesh Patel and his team. My son (4 years old) had sleep apnea due to his tonsils and from our consultation to surgery and post check up's he has been amazing. He was reassuring and provided all the information we needed as nervous parents. Highly recommend him.
Superb, excellent, my mum was suffering from a bad ear ache and I called in the morning and he was fully booked but when I said it was an emergency and I need my Mum to be seen today as she wasn’t able to sleep for 2 days, he took that into consideration and said he would see her by noon, thankfully Mum was relived and happy with him, such a kind person and immediately diagnosed my mums problems on the spot, thank you so much Dr!
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What sort of treatments are available?
our doctor can carry out a number of tests in making a diagnosis of an ear infection. A pneumatic otoscope is a specialised tool which can be used to make a diagnosis, allowing the doctor to examine the ear and see if there is fluid located behind the eardrum.
Additional tests can include: acoustic reflectometry, which is a test that measures the volume of sound which is reflected from the eardrum, testing the absorption and thus the pressure created by fluid; tympanometry, which measures the movement of the eardrum; and tympanocentesis, which involves the piercing of the ear drum with a very small tube that can drain fluid to test it for bacteria and viruses.
Once a diagnosis of an ear infection has been made, the following treatment options are available:
- For children under six months old, antibiotics can be administered without an observational waiting time. It is always important to finish an antibiotics course to prevent the infection from recurring.
- Ear tubes can be recommended in order to drain fluid from the middle ear. This treatment option is often advised if a child has chronic ear infections, and the continuous build-up of fluid in the ear, even after an infection has cleared up. This technique involves a surgical procedure known as a myringotomy, to suck fluids out before a tympanostomy tube is installed in the hole created to help prevent fluid build-up. Some tubes stay in for a long time and need to be removed surgically, while others fall out naturally in around six months to a year.
- Pain medication such as over the counter drugs like ibuprofen and acetaminophen can be prescribed to relieve symptoms. Anaesthetic drops can also be recommended, provided there is not a tear or hole in the eardrum.
- Antibiotic therapy can be recommended for certain cases, such as; children over the age of 6 months with moderate or severe pain, or a temperature of 39 C or over; and children from six to 23 months with mild ear pain for less than two days, and a temperature of less than 39 C.
Ear infection treatment FAQ
In general, ear infections clear up within two weeks. There are home remedies and over the counter medication which can offer relief, but in some cases – such as bacterial infections which are severe or have not gone away after a few days – antibiotics can be needed.
Antibiotics generally heal an ear infection within a few days. It is vital that you finish the entire course of antibiotics which have been prescribed so that the infection doesn’t come back and become more resistant.
Some common symptoms of an ear infection are: pain inside the ear; young children acting in a ‘fussy’ manner; a persistent sensation of ‘pressure’ inside the ear; a pus-like substance coming from the ear; and hearing loss.
As the infection itself is treated, swelling will typically reduce and pus will drain. After the infection is cleared, your ear will usually start to function normally, and your hearing will improve.
Ear infections are most common when children are between the ages of three months and three years old and are common up until eight years old. It is true that the majority of children will have had an ear infection by the time they are six. It has been found that almost 40 per cent will have three or more infections by their third birthday.
Ear infections are not contagious, and cannot spread among people. However, it is important to note that the colds which can cause ear infections are contagious. These types of common colds can be spread by germs that come from the mouth or nose when coughing or sneezing.
There are several practices that are recognised as being able to prevent hearing loss. These include: washing hands often; breastfeeding infants; keeping immunisations updated; avoiding second-hand cigarette smoke; and avoiding very crowded areas.