Ear infections are common and easily managed by your local family physician. Fortunately, the majority of infections settle without ill effects whether the problem is in the outer, middle or inner ear, although sometimes longer term problems can arise.
The ear is divided into three parts: outer, middle and inner (see diagram). Infection in each part will give rise to certain patterns of symptoms and the type of symptoms which may occur with ear infections include:
The only sign of an ear infection in young children may simply be a fever and some tugging of the ear by the child.
Dependent on which features are predominant, it is possible to identify the infection as arising within one of the three parts of the ear.
Outer ear infections (otitis externa)
This is an infection of the skin of the ear canal and very common. It can be extremely painful so that sleep may be impossible. Usually, outer ear infections are caused by a bacterial infection though occasionally, it may be fungal related.
The skin can become so swollen that the ear canal closes, causing temporary deafness, and there can be a scanty discharge from the ear. It occurs commonly in people who suffer from skin problems such as eczema, psoriasis or dermatitis but also in people with narrow ear canals or who swim a great deal. It can affect both ears and often keeps recurring, especially if you are otherwise rundown or stressed. Not surprisingly, such symptoms usually mean that you will need to consult your doctor in order to receive effective treatment.
Treatment for outer ear infections is generally in the form of antibiotic ear drops which are instilled into the ear canal for at least a week. Sometimes antibiotics by mouth will also be necessary. In severe cases referral to an ear nose and throat specialist is both necessary and appropriate for cleaning of the ear canal and more intensive treatment.
Middle ear infections (otitis media)
Middle ear infections are also extremely common, particularly in children. The most common is acute otitis media which is characterised by a severe earache and high temperature, generally in a child, with associated hearing loss.
Like an abscess, once the eardrum bursts and the pus comes out of the ear the pain eases. Happily, the eardrum almost always heals once the infection settles and the hearing also returns to normal.
Longer term problems can occur when such infections are frequent, because there can be damage to the eardrum, or perhaps persistent deafness due to fluid remaining behind the eardrum (glue ear). In such cases referral to a specialist is appropriate.
A second but more serious form of middle ear infection is when it becomes chronic or long-lasting. Generally, chronic middle ear disease is associated with a smelly ear discharge and deafness, but rarely with pain.
Other significant symptoms such as tinnitus, weakness of the face or dizziness can occasionally occur. In these cases referral to an ear nose and throat surgeon is very important as the treatment usually involves surgery to remove the infection from the middle ear and mastoid bone. To ignore such disease can be potentially dangerous.
Mastoiditis is an acute infection of the mastoid bone which surrounds the ear. It is much less common than in previous decades, but certainly still occurs, especially in toddlers, and it needs urgent treatment with antibiotics once the child is admitted to hospital.
Inner ear infections
Infections of the inner ear are fortunately less common and are generally caused by viruses, although occasionally by secondary bacterial infection. They tend to cause problems with sudden hearing loss or dizziness.
The common cold virus is perhaps the most common cause of inner ear infections but many other viruses have also been associated with sudden deafness such as mumps, measles and herpes.
Your family practitioner should be able to manage most infections of the ears. Problems that do not settle with treatment may warrant a referral for specialist help.
Most ear infections will initially be treated with either antibiotic ear drops or antibiotics taken by mouth. When the infection is severe, admission to hospital may be necessary for antibiotics via a drip. In some complicated cases surgery may be the best form of treatment.
(Adapted from www.entuk.org)
Causes of dizziness
There are a multitude of causes of dizziness which may have nothing to do with the balance organ in the inner ear. Fainting attacks, heart problems, thyroid problems and brain problems can all give rise to feelings of light-headedness, giddiness and general imbalance.
One form of dizziness is vertigo. Vertigo is the hallucination of movement usually described as either the environment moving in relation to the patient or the patient moving in relation to the environment as a spinning or rotatory sensation. Vertigo is specifically linked to problems with the inner ear. Of the people who suffer from vertigo due to inner ear problems, 99% will recover with time and without any treatment.
Balance and the ability to remain upright is dependent upon three systems:
All three of these systems give information to the brain about the position of the body in space. Generally people can keep their balance if two of the three systems are working, but they cannot cope with only one system working. This is why most people tend to become more unsteady as they get older, because they may have arthritis in their legs and their neck or poor eyesight
The balance organ (or labyrinth) is made up of three semicircular canals and the vestibule, which are all filled with liquid. The semicircular canals sense rotational movement and the vestibule senses acceleration and deceleration.
Inner ear disease and vertigo
Many different factors can affect the inner ear and cause vertigo. One way to distinguish them is by the duration of the dizziness.
Short-lived episodes of dizziness (few seconds to minutes)
An extremely common type of vertigo is benign paroxysmal positional vertigo (BPPV). This is typically a very sudden onset of dizziness, which settles rapidly after a few seconds or at most a couple of minutes.
It is often started off by the person suddenly looking upwards or sideways, and some people get it when they turn over in bed. In between attacks, the sufferer feels entirely normal. It is probably caused by a little piece of lining coming loose in the inner ear and floating into the balance receptor, causing a sudden increase in nerve stimulus to the brain.
Sometimes the attacks start following a whiplash injury or other head injury, but often there appears to be no reason that they should have started. The attacks usually disappear with time.
Medicines do not help, but a manoeuvre known as Epley's Manoeuvre can be extremely effective in some patients. This can be carried out a trained family practitioner, a ear nose and throat surgeon or physiotherapy department.
Medium length episodes of dizziness (half-hour to several hours)
These types of vertigo are rarer and are thought to be due to an increase in pressure of the fluid in the inner ear, although nobody really knows for sure.
Menière's disease or endolymphatic hydrops result in episodes of severe vertigo that can last up to several hours. The dizzy episodes are usually linked with vomiting, and the sufferer can often tell an episode is about to start because he or she notices a drop in their hearing, a feeling of fullness in the ear and some tinnitus. The hearing recovers once the vertigo has settled, but may gradually deteriorate with time. In between episodes, the patient feels completely normal. A hearing test is usually performed to determine the degree of hearing impairment.
Treatment of Menière's disease can involve medicines and, more rarely, surgery, but this will be organised by your local ear nose and throat department once the diagnosis of Menière's disease has been made.
Longer episodes of dizziness (days to weeks)
An infection of the inner ear (labyrinthitis) or an inflammation of the balance nerve (vestibular neuronitis) can give rise to severe rotatory dizziness for up to two to three weeks, with a slow return to normal balance which can take a further few weeks.
Again, the initial episode is often associated with vomiting and the patient can be bed-bound because the dizziness is so severe. This is best treated at first with a vestibular sedative such as Stemetil, but any treatment should be stopped quite quickly to allow the brain to compensate and recover from the dizziness. Recovery is much quicker in the long run if treatment with anti-dizziness medicines is not prolonged.
The majority of patients who experience episodes of vertigo will recover without any long-term ill effects and usually within a few weeks or month of the onset of the symptoms.
In the majority, specialist investigations do not help with the diagnosis but they can be helpful in certain circumstances. If they are thought necessary, investigations of vertigo can be carried out by a trained family physician, neurologist, general physician or ear nose and throat surgeon or a audiological physician.
Types of test that may be requested include: audiological (hearing) tests, tests of balance, blood tests (rarely), and radiological examinations such as an MRI scan or CT scan.
In general the treatment of vertigo is symptomatic, ie treatment is given to control the symptoms without regard to the specific cause of the vertigo. The body is very good at overcoming the imbalance experienced during inner ear disease, and so symptomatic treatment should be short because it can delay this natural compensation.
Rehabilitation (including Cawthorne Cooksey Exercises)
There are specifically targeted exercises to speed up the brain's natural compensation after inner ear disease. Recovery can be hastened by these exercises which can be organised by your local ear nose and throat or physiotherapy department.
The inner ear may be ‘suppressed' (or made sleepy) by the use of drugs such as Stemetil or Stugeron. These drugs reduce the overactivity of the balance organ and so reduce the dizziness and vomiting that can occur in inner ear problems.
However, they are not a long-term solution and should be used for as short a time as possible because they prolong the time taken for the body to readjust after the vertigo.
This is a longer term disease and there are two aims of treatment. One is to treat the acute episodes of dizziness with vestibular sedatives (see above), and the other is to try to reduce the frequency of the dizzy episodes.
Frequently advice will be given to restrict intake of salt, caffeine and alcohol, which can help some patients with Menière's disease. Increasing the bloodflow of the inner ear may help and so drugs like Betahistine (Serc) are often prescribed.
Some people with Menière's disease may benefit from surgery if the episodes of vertigo are frequent and disabling and not responding to medical treatment.
Surgery may be advised if medical treatment proves ineffective and the episodes of vertigo are disabling. The options range from those such as the simple insertion of a grommet through to operations which completely destroy the inner ear, or divide the nerves leading from the inner ear to the brain.
Unfortunately, many (although not all) effective surgical operations also destroy the hearing of that ear and so the vertigo is usually severe before a patient opts to undergo such treatment.
Because there are so many different causes of vertigo, there are several different operations and so it would take too much space to detail them all here, but your ear nose and throat consultant will go through them with you.
There are always new treatments being developed and there is very encouraging progress being made using drugs delivered directly into the ear which selectively destroy the inner ear balance mechanisms without affecting hearing.
Further work is still to be undertaken in this area and will no doubt result in improved techniques for the control of vertigo in patients who are long-term sufferers. Anyone suffering from persistent recurrence of vertigo should consult their doctor in order to find the cause and to arrange effective treatment.
(adapted from www.entuk.org)
The ear canal is lined with hair follicles and glands that produce a waxy oil called cerumen. The wax usually makes its way to the opening of the ear, where it may fall out by itself or during bathing. Ear wax can build up and obstruct the ear canal, and blockage from ear wax is one of the most common causes of hearing loss.
Ear wax protects the ear by trapping and preventing dust, bacteria and small objects from entering and damaging the ear. It also protects the delicate skin of the ear canal from getting irritated when water enters the canal.
In some people, the glands produce more wax than can be easily removed from the ear. This extra wax may harden in the ear canal and cause blockage. When you try to clean the ear with cotton buds, instead of helping , you may instead push wax deeper and cause more problems. Common symptoms of excessive or impacted ear wax include earaches, fullness in the ear, ringing noises in the ear, or hearing loss.
Most cases of ear wax blockage can be treated at home. The following can be used to soften wax in the ear:
Another method is to wash out the wax.
To avoid damaging your ear or causing an infection:
**Never try to clean the ear by putting any object such as a cotton bud/rod into the ear canal.**
If you cannot remove the wax plug or you have discomfort, consult your doctor, who may remove the wax by:
Text adapted from: MedlinePlus
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