What is an Ear Infection?
Ear infections are divided into two categories, the outer ear (classic swimmers ear) and middle ear infections (classic otitis media, which is the common infection for children and adults.) Ear infections can be caused by bacterial, viral or fungal infections. Both types cause pain, some cause fever, and if the eardrum ruptures there can be drainage. When the eardrum does rupture there is usually instant relief from pain. This is one reason why European physicians are more apt to incise the eardrum to relieve the pressure than prescribe antibiotics. The United States prescribes more antibiotics than any other nation for ear infections, and sore throats.
Ear infections are very common in the young which is due to anatomical differences of the Eustachian tube, which is the tube that drains to the back of the throat from the ear. As an infant these tubes are more horizontal not allowing fluid build up to drain, as we age the tube angles more and less ear infections occur as we get older. This is one of the foundations for the necessity of tubes that are placed in children’s ears with recurrent ear infections. The tube allows better drainage, less fluid build up and thus less of a warm moist environment for bacteria to grow.
What is Swimmers Ear?
Swimmers ear is an infection of the outer canal of the ear. This canal, called the external canal becomes swollen, there can be drainage, pain upon chewing and touching the external ear. The classic scenario is “tragus” tenderness which is flap of skin just above the lobe. It is a myth to think that swimming in dirty lakes or streams cause this infection. The cause is any water that is not dried out inside the ear. The warm, moist environment is a perfect breeding scenario for bacteria. The most common bacteria is Pseudomonas. Other conditions can predispose one to this external ear infection such as; eczema, psoriasis, water from bathing and swimming, and even hair sprays.
How is Swimmers Ear Treated?
Swimmers ear is treated with drops. Sweet oil has thought to help, however it may relieve pain but DOES NOT relieve the infectious process. Antibiotic drops for five to seven days are very effective. Drops can be given two times a day for certain antibiotics to aid with compliance although they are more expensive. Drops two times a day are excellent for school children as they do not have to instill the drops at school. ask your clinician if these drops would be appropriate for you or your family member. There are times a compressed piece of cotton called an (ear wick) is placed in the canal witch keeps the medication right where it needs to be. This wick eventually falls out or is removed a few days later. Prevention is effective. After swimming or showering a 1:1 solution of alcohol and vinegar aids in drying out the ear as well as changing the Ph of the ear, making it not conducive for bacteria to grow.
What is a Middle ear Infection (Otitis Media)?
A middle ear infection is the most common ear infection that we all have come to know. This is the culprit that keeps our children up at night, and causes the child to scream in pain on airplanes. They can be very painful and uncomfortable. This is a collection of bacteria that forms behind the eardrum. it is visualized with an otoscope, and there are times a puff of air from the clinician helps to watch and see if the eardrum moves. Movement is a good thing, no movement implies that fluid has built up effecting the ear drum (tympanic membrane.) There are a variety of antibiotics that are useful; however the times are changing, and due to over-prescribing there are numerous bacteria that have become wise. Resistance is at an all time high, and antibiotics that used to work do not anymore. Clinicians succumbing to societal pressure is part of the problem.
How do you know your child actually has an ear infection? Why would a clinician diagnose an ear infection when there may not be one? This flies directly to Peace and Healing’s article on ethics and medicine. there are clinicians, (the minority) that want to rush the patient out the door, and knowing the patient wants an antibiotic will over diagnose and prescribe. I know this to be true since I have seen the patent the following day for a different disorder. So as a consumer , a parent how can you be sure or at least feel reassured. Ask the clinician to see. Frequently, I ask the patient’s family if they would like to look to see what an ear infection looks like. I have never been turned down. I show them the normal ear first and the red eardrum next. they are thankful, and very interested. This is their child, they are supposed to be, right? I should also note here in clinicians defense that an ear drum may be normal on day one and in twelve to twenty-four hours later be flaming red. Parents often verbalize anger as the day before the pediatrician missed the ear infection. this is not likely, and an explanation to how quick an ear can become infected should be offered. The opposite is not true. An ear does not dissipate from red to normal in less than twenty-four hours. Standards change, but for the most part, a child with six or more ear infections in one year can be a candidate for surgical tubes. Please check with your pediatrician.
How Do You Treat a Middle ear Infection?
Middle ear infections are treated with antibiotics by mouth, pills or liquid. The course is usually ten days, and it is not uncommon to possibly switch antibiotics if there is no resolution in four to five days. Anti-inflammatory medications are helpful as well as pain re-leavers. Topical numbing drops are helpful to relieve severe pain, but are NOT advised to be dispensed by the family as they mask the severity over time. Steroid nasal sprays have limited benefit but do appear to help adults decrease swelling of the Eustachian tubes to allow for more drainage. There is not good supporting evidence for this treatment modality.