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Doc: How do I treat Ear Infections?

Dear friends,


Welcome back to Dr Euan's TGIF blog!


Ear infections are common, and can cause a myriad of problems for patients.

For example: ear pain, pus in ear, swollen ears, otorrhea & hearing loss to name a few.


There are many causes of ear infections; so you may well ask:

what is the best way to treat an ear infection?



For today's blogpost, let us look at various common ear infections:

  1. Otitis Externa

  2. Acute Otitis Media

  3. Chronic Otitis Media

and highlight a few more sinister / dangerous ear infections

  1. Malignant / Necrotising Otitis Externa

  2. Herpes Zoster Oticus (Ramsay Hunt Syndrome)

Q: What are the symptoms of an Ear Infection?


The symptoms of an ear infection usually start quickly and include:

  • pain inside the ear

  • a high temperature

  • being sick

  • a lack of energy

  • difficulty hearing

  • discharge running out of the ear

  • a feeling of pressure or fullness inside the ear

  • itching and irritation in and around the ear

  • scaly skin in and around the ear

These symptoms are related to inflammation and infection in the ear.


Do note that for young children and babies with an ear infection, they may also:

  • rub or pull their ear

  • not react to some sounds

  • be irritable or restless

  • be off their food

  • keep losing their balance

Most ear infections clear up within 3 days, although sometimes symptoms can last up to a week.


Q: How can I treat my Ear Infection?


To help relieve any pain and discomfort from an ear infection:


Do

  • use painkillers such as paracetamol or ibuprofen (children under 16 should not take aspirin)

  • place a warm or cold flannel on the ear

  • remove any discharge by wiping the ear with cotton wool externally

Don’t

  • do not put anything inside your ear to remove earwax, such as cotton buds or your finger

  • do not let water or shampoo get in your ear

  • do not use decongestants or antihistamines – there's no evidence they help with ear infections


If you would like to read about Dr Euan's advice on the topics mentioned above, you can read his blog posts about earwax , getting water in your ear , and decongestant nasal sprays.


Q: WHAT IS OTITIS EXTERNA?


Otitis Externa (OE) is a common skin infection which affects the outer ear (pinna) and the external ear canal (EAC).


It is common in hot, humid climates (like ours) and tends to be bacterial or fungal. Most OE cases respond well to topical ear drops which you can get from your GP or local pharmacy.


However, if the OE does not settle within 5 days, perhaps you should consult an ENT Specialist to have a closer look and perform an Aural Micro-suction, to clean out the debris in the EAC.

If your doctor suspects you may have an ear infection, they may perform an aural toilet (ear cleaning)


Sometimes, the ENT Doctor may take a swab sample for culture to see what microbes are causing the infection, so as to adjust the medication/ear drops eg: antibiotic ear drops will not help much if you actually have a FUNGAL ear infection, and you may need to switch to anti-fungal drops instead.


Your doctor may prescribe you medicated ear drops for fungal or bacterial infections


Q: WHAT IS ACUTE OTITIS MEDIA (AOM)?


Acute Otitis Media (AOM) is a common ear infection, seen in infants and children; who present with fever and ear pain. This infection starts in the middle ear space, behind the ear drum and quickly becomes purulent, meaning to contain pus. Once the eardrum bursts, there is copious ear discharge, with relief of ear pain and fever.

Acute Otitis Media is commonly seen in young children and may cause fever and excessive pulling or rubbing of the ear


AOM is usually seen and treated by your GP / Family doctor with a course of oral antibiotics such as Syrup or Augmentin. As ENT surgeons, we usually do not get to see acute OM very often, as patients are well treated by their GP or Paediatrician (for young children/ infants).


It may recur a few times a year, especially if the child has frequent Acute Respiratory infections (ARI) at pre-school or kindergarten.


Q: WHAT IS CHRONIC SUPPURATIVE OTITIS MEDIA(CSOM)?


Chronic Suppurative Otitis Media (CSOM) is less common, but may lead to prolonged ear discharge and hearing loss, due to perforation of the Tympanic Membrane (TM) and even erosion of the Ossicular Chain (middle ear bones). Many patients report prolonged symptoms, going back months or years.


This condition should be seen and managed by an ENT Specialist, who may be able to offer you a Tympanoplasty (to repair the TM perforation) or even Ossiculoplasty (to repair the middle ear bones)


Usually, we will also order an audiogram to check on your hearing status, and check if you do have any associated hearing loss.


Q: WHAT IS MALIGNANT/ NECROTISING OTITIS EXTERNA?


Malignant OE is a rare but dangerous form of Otitis Externa. It tends to affect the elderly and diabetic patients more frequently.


It is almost always associated with a specific bacteria: Pseudomonas aeurginosa.


A high index of suspicion is needed to make the diagnosis, so an EARLY referral is important.


Treatment with an aggressive 6 week course of Intravenous Antibiotics is usually needed to control this type of infection. Even so, Malignant OE carries a high morbidity and even mortality rate in the elderly.


Q: WHAT IS RAMSAY HUNT SYNDROME?


Ramsay-Hunt Syndrome, or Herpes Zoster Oticus, is another rare but dangerous ear infection as it may damage your hearing and balance nerve and also the facial nerve, resulting in facial paralysis.


Justin Bieber recently contracted Ramsay-Hunt Syndrome and released a video on Instagram explaining his condition. you can watch the video through the link here.

Images from Justin Bieber's Instagram post where he explains his partial facial paralysis due to viral infection


It is caused by a reactivation of a latent infection by the chicken pox virus (Herpes Zoster virus) and sometimes you can see the classical "vesicles" or water bubbles on the ear lobe/pinna or even the ear drum.


Again, this needs a high index of suspicion and EARLY treatment with antivirals and steroids to prevent damage to the 7th (facial) Nerve and the 8th (hearing and balance) nerves.


So, dear friends, I hope that this blog post gives you a better idea of how ear infections may present and what you can/ should do, and also should NOT do!


If you are in doubt or would like to get a proper diagnosis and treatment, do make an appointment to see your GP or your ENT Specialist.


If you would like to book an appointment with us, you can contact us at Euan's ENT Surgery & Clinic


For more in-depth information, here are some useful references for you to look up:


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