NMC Healthcare
NMC ENT care

What is an ear infection?

Ear infections are usually divided into those which occur in the ear canal (otitis externa) and those which occur in the small space behind the eardrum (the middle ear). You may hear an infection of the middle ear referred to as 'acute otitis media'.

How does an ear infection occur?


ear infection

The small space behind the eardrum in the middle ear is normally filled with air. It is connected to the back of the throat by a tiny channel called the Eustachian tube.

The middle ear space sometimes becomes filled with mucus (fluid), often during a cold. The mucus may then become infected by germs (bacteria or viruses). Children with glue ear who have mucus behind their eardrum are more prone to ear infections.

What are the symptoms of an ear infection?

  • Earache is common but does not always occur.
  • Dulled hearing may develop for a few days.
  • High temperature (fever) is common.
  • Children may feel sick or vomit and can be generally unwell.
  • Young babies cannot point to their pain. One of the causes of a hot, irritable, crying baby is an ear infection.
  • Sometimes the eardrum bursts (perforates). This lets out infected mucus and the ear becomes runny for a few days. As the pain of earache is due to a tense eardrum, a burst eardrum often relieves the pain. A perforated eardrum usually heals within a few weeks after the infection clears.

What is the treatment for an ear infection?

Most bouts of ear infection will clear on their own without treatment within 2-3 days. The immune system can usually clear germs (bacteria or viruses) that cause ear infections. However, treatments that may be advised include the following:

Painkillers
If the ear infection is causing pain, then give painkillers to children regularly until the pain eases. eg: paracetamol or ibuprofen. These medicines will also lower a raised temperature which can make a child feel better. If antibiotics are prescribed, you should still give the painkiller as well until the pain eases.

Recent research studies have found that a few drops of a local anesthetic medication (lidocaine) placed into the ear may help to ease pain. Further studies are needed to clarify the use of this treatment. However, it seems logical and may become more widely used over time, especially in children with severe ear pain.

Antibiotics - are prescribed in some cases only
Antibiotics are not advised in most cases. This is because the infection usually clears within 2-3 days on its own. Also, it is best not to take antibiotics unless needed, as side-effects such as diarrhea or rash can sometimes be a problem. Antibiotics are more likely to be prescribed if:

  • The child is under 2 years old (as the risk of complications is greater in babies).
  • The infection is severe.
  • The infection is not settling within 2-3 days.
  • Complications develop.

When an ear infection first develops it is common for a doctor to advise a 'wait and see' approach for 2-3 days. This means just using painkillers to ease the pain and to see if the infection clears. In most cases, the infection clears. However, if it does not, then following a review by a doctor an antibiotic may be advised. Sometimes, it may be difficult to see a doctor again in 2-3 days if things do not improve - for example, over a weekend. In this situation a doctor may give you a prescription for an antibiotic with the advice to use it to get the antibiotic only if the condition does not improve within 2-3 days.

What are the possible complications from an ear infection?

It is common for some mucus to remain behind the eardrum after the infection clears. This may cause dulled hearing for a while. This usually clears within a week or so and hearing then returns to normal. Sometimes the mucus does not clear properly and 'glue ear' may develop. Hearing may then remain dulled. See a doctor if dulled hearing persists after an ear infection has gone.

If the eardrum bursts (perforates), then it usually heals over within a few weeks once the infection clears. In some cases the perforation remains long-term and may need treatment to fix it.

If a child is normally well, then the risk of other serious complications developing from an ear infection is small. Rarely, a serious infection of the bone behind the ear develops from an ear infection. This is called mastoiditis. Very rarely, the infection spreads deeper into the inner ear, brain or other nearby tissues. This can cause various symptoms that can affect the brain and nearby nerves. See a doctor if a child becomes more ill, does not improve over 2-3 days, or develops any symptoms that you are not sure about.

Hearing Disorders

Hearing loss is very common. It can be very distressing, particularly if progressive and particularly if it affects both ears. Everyone’s hearing gets worse as they get older, but there are many types of hearing loss and not all are restricted to older people.

There are the two main types of hearing loss. they may occur separately or together.

Conductive hearing loss

Conductive hearing loss occurs when sounds are unable to pass from the outer ear to the inner ear. This is often as the result of earwax or fluid in the middle ear, although it may also be caused by a burst (ruptured) eardrum or by Otosclerosis.

Causes of conductive hearing loss: the eardrum and ear canal

  • Blockage of the ear canal
  • Foreign bodies in the ear canal
  • Perforated eardrum

Causes of conductive hearing loss: the middle ear

  • Eustachian tube dysfunction
  • Glue ear, ear infection and middle ear effusion
  • Otosclerosis
  • Cholesteatoma

Sensorineural hearing loss

Sensorineural hearing loss is any hearing loss that involves the nerves - the cochlea and the hearing (auditory) nerve and the brain itself. Sensorineural deafness is usually (but not always) gradual in onset. It is usually due to poor hair cell function. It does not usually affect the entire range of sound frequencies, at least not at first. Unfortunately, though, it is more often irreversible, as once the hearing nerves are destroyed they do not regenerate.

Causes of sensorineural hearing loss: the cochlea

  • Age-related hearing loss 
  • Menieres disease

Causes of sensorineural hearing loss: the auditory nerve and the brain

  • Acoustic neuroma
  • Multiple sclerosis, brain injury through trauma, stroke and brain infection

Signs of hearing loss

  • Require frequent repetitions
  • Think that others are mumbling
  • Have your TV or radio turned up to a high volume
  • Read lips or more intently watch people’s faces when they speak to you.
  • Difficulty in understanding what people are saying especially in a noisy background?

Diagnostic Services (Audiology)

  • Pure Tone Audiometry
  • Speech Audiometry
  • Behavioral and Conditioned Play Audiometry
  • Tympanometry (Middle ear analysis)
  • Acoustic Reflex
  • Auditory Brainstem Response (ABR)
  • Newborn Hearing screening using OAE & BERA (ABR)
  • In addition to providing hearing evaluations, we also provide digital hearing aid prescription, fitting and programming.
  • Custom Earmoulds and ear plugs

Surgery

  • Stapedectomy/Stapedotomy: A Stapedectomy is performed to improve the movement of sound to the inner ear. It is a surgical procedure in which the innermost bone (stapes) of the three bones (the stapes, the incus, and the malleus) of the middle ear is removed, and replaced with a small plastic tube surrounding a short length of stainless steel wire (a prosthesis).
  • Tympanoplasty/Ossiculoplasty: Tympanoplasty is a surgery used to repair perforated eardrums or tympanic membrane whereas an ossiculoplasty involves reconstructing the ossicles within the middle ear
  • Endoscopic Tympanoplasty
  • Tympanic neurectomy
  • Mastoidectomy (All types): A mastoidectomy is performed to remove infected mastoid air cells resulting from ear infections, such as mastoiditis or chronic otitis, or by inflammatory disease of the middle ear (Cholesteatoma). Depending on the severity the type of mastoidectomy varies. The different types are Radical mastoidectomy, Canal wall down Mastoidectomy, Canal wall up Mastoidectomy, Cortical mastoidectomy and Modified radical mastoidectomy
  • Myringotomy: It is a surgical procedure in which a tiny incision is created in the eardrum to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear.
  • Grommet insertion: Grommets are tiny tubes that can be inserted into the eardrums to treat conditions that affect the middle ear, such as recurrent middle ear infections and glue ear.
  • Repair perilymph leak: A perilymph fistula, or PLF, is an abnormal opening in fluid filled inner ear
  • Excision tympanic glomus tumor

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