Ear Conditions

Our ears are complex organs, and as a result, susceptible to a variety of conditions that can occur. Children are especially prone to certain ear conditions. Read below for some information on how to identify a few of the common ones, and if you think you or your chlid may be experiencing symptoms of anything outlined below then please schedule an appointment.

Otitis Externa (Swimmer's Ear)

Also called swimmer's ear, otitis externa is an inflammation of the external ear canal. The condition is caused by fungi or bacteria. Water that gets trapped in the ear canal (such as what happens during swimming) encourages the growth of fungi and bacteria.

What causes swimmer's ear?

The most common cause of swimmer's ear is excessive wetness that occurs from swimming. Swimmer's ear can also be caused by the following:

  • being in warm, humid places
  • harsh cleaning of the ear canal
  • trauma to the ear canal
  • dry ear canal skin
  • a foreign body in the ear canal
  • lack of cerumen (earwax)
  • eczema and other forms of dermatitis
What are the symptoms of swimmer's ear?

Although each individual may experience symptoms differently, here are the most common symptoms of swimmer's ear:

  • redness of the outer ear
  • itching in the ear
  • pain, especially when touching or wiggling the auricle
  • drainage from the ear
  • swollen glands in the neck
  • swollen ear canal
  • hearing loss
How is swimmer's ear diagnosed?

We start with a complete medical history and physical examination. We use an otoscope, which is an instrument with lenses and a light that helps us to examine the ear. The otoscope also allows us to see if there is an infection in the middle ear (otitis media). Otitis media usually does not occur with swimmer's ear, but it is possible. We may take a culture of the ear drainage if necessary.

How is swimmer's ear treated?

When treated by a physician, swimmer's ear usually clears up within 7 to 10 days. Treatment is based upon the following:

  • your age, overall health, and medical history
  • extent of the condition
  • tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment may include:

  • antibiotic ear drops and/or oral antibiotics
  • corticosteroid ear drops (to help decrease the swelling)
  • pain medication
  • keeping the ear dry, as directed by your physician
  • a cotton wick placed in the ear (this wick helps the antibiotic drops enter and work more effectively in the ear canal)
How is swimmer's ear prevented?

Try these simple techniques:

  • Place two to three drops of a mixture of vinegar/isopropyl alcohol into your ears after the ears come in contact with water.
  • Use ear plugs for swimming or bathing.
  • Do not aggressively clean your ear canal.

Foreign Bodies in the Ear

Foreign bodies in the ear, while more common among children, can happen to anyone. For example, food, dust, and dirt particles can become lodged in the ear. Insects can fly into the ear canal, causing potential harm. Earrings can cause problems for the ear lobe because they can be placed too deep during insertion or can cause an infection.

So how do you know if you have a foreign body in your ear?

Some objects do not cause symptoms but others (such as food or insects) cause pain, redness, or drainage. It is important to note that hearing may be affected if the object is blocking the ear canal.

How are foreign bodies in the ear treated?

If you have a foreign body in your ear we recommend prompt removal of the object by a physician. One or more of these techniques may be used:

  • instruments inserted into the ear
  • magnets if the object is metal
  • cleaning the ear canal with water
  • using a machine with suction to help pull the object out

Once the object is out, your physician will re-examine the ear to check if there has been any harm to the ear canal or eardrum. Antibiotic drops may be prescribed to treat any possible infection.

Otitis Media (Middle Ear Infection)

Otitis media is inflammation located in the middle ear, which may cause the space behind the eardrum (the middle ear) to become filled with infected fluid. The eardrum usually appears red and swollen. A cold, sore throat, or respiratory infection can cause otitis media.

Middle ear fluid (also known as effusion) and otitis media can occur in the same individual at different times. When ear infections are effectively treated with antibiotics, the pus changes into a different form of fluid. Although this fluid may not cause pain, it may cause a mild sensation of ear fullness or discomfort. This fluid is harmful because it can cause an ear infection.

The fluid temporarily reduces and distorts hearing. If one is not diagnosed or treated, ear infections or fluid in the ear may result in a hearing disability and also affect speech.

Here are some interesting facts about otitis media:

  • although it mainly affects children, otitis media can also occur in adults.
  • otitis media is the most commonly diagnosed disorder in children in the United States.
  • about 30 million doctor visits each year are a result of otitis media.
  • otitis media occurs more often in the winter and early spring.
Who is at risk for getting ear infections?

Risk of developing ear infections may increase from the following:

  • being around someone who smokes
  • a family history of ear infections
  • having a cold
What causes otitis media?

Middle ear infections usually occur because of poor function of the eustachian tube, the canal that links the middle ear with the throat area. The eustachian tube helps to equalize the pressure between the air around you and the middle ear.

When this tube is not working properly, it prevents normal drainage of fluid from the middle ear, causing fluid to build up behind the eardrum. When this fluid cannot drain, bacteria and viruses in the ear can grow and lead to acute otitis media.

Why doesn't the eustachian tube work properly in some individuals?

Here are some common reasons:

  • a cold or allergy, which can lead to swelling and congestion of the lining of the nose, throat, and eustachian tube
  • immature anatomy of the eustachian tube
  • enlarged adenoids
  • small lumen of eustachian tube
What are the different types of otitis media?

There are several types of otitis media, including:

  • acute otitis media (AOM): The middle ear infection occurs abruptly, causing swelling, ear pain, and temporary hearing loss.
  • otitis media with effusion (OME): Fluid (effusion) remains in the middle ear after an initial infection subsides. A feeling of fullness in the ear and temporary hearing loss may be noted.
What are the symptoms of otitis media?

Although each individual may experience symptoms differently, here are the most common ones:

  • unusual irritability
  • difficulty sleeping or staying asleep
  • tugging or pulling at one or both ears
  • fever
  • fluid draining from ear(s)
  • loss of balance
  • hearing difficulties
  • ear pain
  • nausea and vomiting
  • diarrhea
  • decreased appetite
  • congestion

You should always consult your physician if you suspect your may have otitis media because these symptoms may resemble other medical conditions or problems.

How do you diagnose otitis media?

We start with a complete medical history and physical examination. Using an otoscope, we inspect the outer ear(s) and eardrum(s). A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.

Another test we might use is tympanometry, which can determine how the middle ear is functioning. Tympanometry does not indicate whether the person is hearing or not, but helps to detect changes in pressure in the middle ear.

How do you treat otitis media?

Specific treatment will be determined based on the following:

  • age, overall health, and medical history
  • extent of the condition
  • tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment may include antibiotic medications by mouth, ear drops, or medication for pain. If fluid remains in the ear(s) for longer than three months, your physician may suggest that small tubes be placed in the ear(s). This surgical procedure, called myringotomy (see via the left), is usually used as a last resort after medical treatment has not helped or that the risks of medical treatment (such as reactions to antibiotics) are too high.

What happens if otitis media is not treated?

Any/all of the following can occur:

  • infection in other parts of the head
  • permanent hearing loss (rarely)
  • problems with speech and language development

Myringotomy Tubes (Ear Tubes)

Some individuals require myringotomy tubes (also called ear tubes, tympanostomy tubes, or ventilation tubes) to treat otitis media.

What are myringotomy tubes?

Myringotomy tubes are small tubes that are surgically placed into your eardrum by an otolaryngologist (an ear, nose, and throat surgeon). The tubes are made of plastic, metal, or Teflon. They are placed to help air enter the middle ear in order to reduce the risk of ear infections. During an ear infection, fluid accumulates in the middle ear, which can affect hearing. Even after an infection is gone, fluid may remain in the ear. Myringotomy tubes help prevent fluid from building up.

Over one million people each year have tubes placed in their ears. The most common ages for placement are in children, from one to three years old. By the age of five years, most children have wider and longer eustachian tubes (a canal that links the middle ear with the throat area), thus allowing better drainage of fluids from the ear. However, adults may sometimes experience the same thing.

When will I need myringotomy tubes?

You may need myringotomy tubes if:

  • otitis media with effusion (fluid) has been present for 8 to 12 weeks in spite of adequate medical therapy
  • recurrent episodes of acute otitis media (at least four a year)
  • persistent high negative middle ear pressure associated with one of the following: conductive hearing loss, persistent or recurrent otalgia, persistent or recurrent vertigo, or a retraction pocked of the tympanic membrane
  • complications of otitis media
  • fluid in the ears and more than three months of hearing loss
  • changes in the actual structure of the eardrum from ear infections
  • difficulty speaking
What are the benefits of myringotomy tubes?

The benefits of myringotomy tubes are different for everyone. Please discuss these with your physician and surgeon. The following are potential benefits:

  • Ear tubes help to reduce the risk in number and frequency of future ear infections.
  • Ear tubes reduce the severity of the symptoms associated with ear infections.
  • Infections are easier to treat.
  • Hearing is restored in some children who experience hearing problems.
  • Speech is not harmed.
  • Ear tubes allow time for the eustachian tube to work more efficiently.
  • Behavior, sleep, and communication may improve if ear infections were causing problems.

For those who have persistent ear fluid, the benefits will be immediate. Once the fluid is suctioned from the ear, hearing is improved. If the fluid is thick, drainage from all the small spaces throughout the middle ear may continue for a day or two. Drainage that the tube provides keeps fluid from coming back as long as the tube is functioning (not clogged with wax or other debris). The tube also allows for ventilation (exchange of oxygen) into the ear.

For those with recurrent ear infections, the tube makes it less likely that the ear will become infected in the future, thus reducing the need for antibiotics. However, it is still possible to get an ear infection, especially when one has a cold. Should this happen, the ventilation tube serves to drain the infected fluid out of the ear. You will experience less pain and fever than if the infection were undrained (as before surgery).

What are the risks of myringotomy tubes?

As with all surgical procedures, some risks may be involved with myringotomy tubes. Please discuss the following with us:

  • Some individuals with ear tubes continue to develop ear infections.
  • There may be problems with the tubes coming out. They usually fall out after about one year. If ear infections recur, the tubes may need to be replaced.
  • If the tubes remain in the ear too long, the surgeon may need to remove them.
  • About 30 percent of individuals with tubes have to have tubes reinserted within five years.
  • Some patients may develop an infection after the tubes are inserted.
  • Sometimes, after the tube comes out, a small hole may remain in the eardrum. This hole may need to be repaired with surgery.

The most common complication of ear tube placement is drainage from the ear. Although the tube is placed to allow for drainage as well as ventilation, sometimes the drainage continues for several days and requires specific treatment. This happens at some point during the life of the tube in about 10 to 15 percent of patients. If drainage continues, the ear may be suctioned to keep the tube from getting clogged and to help in clearing infections. Medicated ear drops are usually prescribed to help fight the infection. Sometimes oral antibiotics may also be needed.

How are the myringotomy tubes inserted?

The myringotomy procedure is considered same-day surgery. You will have surgery under general anesthesia and will go home later that same day. Before the surgery, you will meet with some members of the healthcare team. The team includes:

  • an otolaryngologist: a physician who specializes in the medical and surgical treatment of problems of the ear, nose, and throat
  • an anesthesiologist, who will administer your anesthesia and will monitor you during surgery
  • same-day surgery nurses, who will prepare you for surgery
  • operating room nurses, who will assist your physicians during surgery
  • nurses in the post-anesthesia care unit (formerly called the recovery room), who will care for you as you emerge from general anesthesia

Prior to surgery, your anesthesiologist will perform a history and examination and develop a plan of general anesthesia. The anesthesiologist will discuss this plan with you and you may ask him/her any questions you may have.

During the surgery, the otolaryngologist makes a small opening in your eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to ventilate the middle ear and prevent fluid from accumulating. Your hearing is restored after the fluid is drained. The tubes usually fall out on their own after 6 to 12 months.

Your otolaryngologist may also recommend the removal of the adenoids (lymph tissue located in the space above the soft roof of the mouth, also called the nasopharynx) if they are infected. Removal of the adenoids has shown to help some with otitis media.

What will happen after myringotomy?

You will be monitored closely. All discharge criteria must be met in order to go home.

What follow-up care is necessary?

Your otolaryngologist will determine what follow-up care will be needed. Usually you will return to see the doctor in about six weeks, then four to six months after the tubes have been inserted, and then approximately one year later. In between these visits, we will help manage your care in consultation with the otolaryngologist.

Generally, the following instructions will be given to you following surgery:

Antibiotic ear drops are to be used after the insertion of the tubes to prevent infection.

Call your physician if any of the following symptoms occur:

  • drainage from the ear
  • ear pain
  • fever
  • myringotomy tube displaced (out of ear)

You will be instructed on the use of earplugs while in the water. Different physicians may have different recommendations regarding the use of earplugs.

Mastoiditis

Mastoiditis is an inflammation or infection of the mastoid bone, which is a portion of the temporal bone. The mastoid consists of air cells that drain into the middle ear. Mastoiditis can be a mild infection or can develop into life-threatening complications. Mastoiditis is usually a complication of acute otitis media (middle ear infection).

What causes mastoiditis?

Mastoiditis usually results when inflammation of a middle ear infection extends into the mastoid air cells. An individual with mastoiditis usually has had a recent or recurring middle ear infection(s). Antibiotics for ear infections reduce the risk of mastoiditis.

What are the symptoms of mastoiditis?

Each individual may experience symptoms differently. Here are the most common:

  • pain behind the ear
  • recent ear infection
  • fever
  • irritability
  • redness or swelling of the tissue behind the ear
  • drainage from an ear infection

Because symptoms of mastoiditis may resemble other medical conditions or problems, consult your physician for a diagnosis.

How do you diagnose mastoiditis?

We start with a complete medical history and physical examination. We then inspect the outer ear(s) and eardrum(s) using an otoscope, a lighted instrument that allows us to see inside the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.

Another test we might use is tympanometry, which can determine how the middle ear is functioning. Tympanometry does not tell whether one is hearing or not but helps to detect changes in pressure in the middle ear. If tympanometry is performed, the patient must remain still and not cry, talk, or move. (This can be difficult!) If one has frequent ear infections, we may suggest that a hearing test be performed.

We may also order the following tests to help confirm the diagnosis:

  • bloodwork
  • X-rays of the head
  • culture from the infected ear

If you have symptoms of a brain abscess or other intracranial complication, your physician may order the following:

  • computed tomography scan (also called a CT or CAT scan), a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images, or horizontal and vertical "slices," of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs.
  • magnetic resonance imaging (MRI), a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

If you have symptoms of meningitis, your physician may order a lumbar puncture. During this procedure a special needle is placed into the lower back and into the spinal canal, the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. During a lumbar puncture, a small amount of cerebral spinal fluid (the fluid that bathes the brain and spinal cord) is removed and sent for testing to determine if there is an infection or other problems.

How is mastoiditis treated?

Specific treatment for mastoiditis will be determined by your physician based on:

  • age, overall health, and medical history
  • extent of the disease
  • tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment usually requires hospitalization and a complete evaluation by an otolaryngologist (a physician who specializes in ear, nose, and throat disorders). In most cases, treatment will consist of antibiotics given through an intravenous (IV) catheter (a thin tube). Surgery may be needed to drain the fluid from the middle ear and/or mastoid bone.

Your physician may suggest a myringotomy, a surgical procedure that involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube may be placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating. Hearing is restored after the fluid is drained. The tubes usually fall out on their own after six to 12 months.

What are the effects of mastoiditis?

If the infection continues to spread, even though antibiotics have been given, the following complications may occur:

  • meningitis, an infection of the outside of the brain
  • brain abscess, a pocket of pus and infection that may develop in the brain

Early and proper treatment of mastoiditis is necessary to prevent the development of these life-threatening complications.

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