Ear Infections

Ear infections commonly occur in either the middle ear or in the ear canal. When the infection is in the middle ear it is called otitis media. In the ear canal it is otitis externa.

Otitis Media

The middle ear is located behind the eardrum and contains a chain of tiny bones which connects the eardrum to the inner ear. This space normally contains air. The presence of fluid can interfere with hearing.

Middle ear infections are very common in small children. They are most common at ages 2 and 5 years. The air containing middle ear space is ventilated by the eustachian tube. The eustachian tube connects the middle ear with the throat. Its function is to ventilate the middles ear space and equalize the pressure with the outside. When this tube is obstructed, a vacuum develops in the middle ear. The vacuum is then replaced by fluid. This fluid frequently interferes with hearing. The fluid also may become infected. If the infection is not treated, the eardrum will usually rupture, thus allowing the ear to drain. Once the pus drains, the immune system will usually resolve the infection. Occasionally, complications such as facial paralysis, neck abscess or even brain abscess may result from untreated infections.

Most middle ear infections are treated with antibiotics. If the infections are frequent or if fluid does not clear from the middle ear after an infection and interferes with hearing, placement of tubes may be considered. In children this operation is done under a light general anesthesia. In adults, it is frequently done as an office procedure under local anesthesia. An incision is made in the eardrum and a small tube is inserted into the incision. Without the tube, the eardrum would heal within a day or two. Depending on the design of the tube, it may stay in several months to several years before the eardrum heals underneath it and extrudes the tube. The tube functions to bypass the eustachian tube and ventilate the middle ear space preventing the accumulation of fluid and the ensuing infection. The tube mimics the body’s natural process of perforation of the eardrum to ventilate the middle ear and drain the infection.

Otitis Externa

The ear canal which extends from the opening down to the eardrum is occasionally infected. This is usually associated with the prolonged presence of moisture in the ear canal. We frequently see otitis externa in people who spend a lot of time in the water.
It is more common in diabetics or in immunocompromised patients. Careful cleaning of the ear canal and antibiotic ear drops usually suffice to clear the infection.

 


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