Ear infections are a common problem among people of all ages and are seen very frequently in an ENT practice. There are three main categories of ear infections: the outer ear, middle ear, and inner ear infections. Outer and middle ear infections are far more common and result in countless trips to the doctor’s office every year.
An outer ear infection, or Otitis Externa, is defined as an infection of the ear canal as opposed to an infection of the middle ear on the other side of the eardrum. A common slang term for this type of infection is “swimmer’s ear” given the increased risk of an outer ear infection with exposure to water. It is a very common infection occurring in about 4 of every 1,000 people annually. The main risk factors for acquiring an external ear infection are water exposure in the ear canal and scratching of the canal with q-tips or other objects placed in the ear canal. Given its association with water exposure and swimming, it is more common in the summer months but can occur at any time. The most striking symptom is generally ear pain that can be quite severe. Other symptoms include itching, drainage from the ear, and hearing loss. It is usually not possible to tell the difference between an outer and middle ear infection based on symptoms because the symptoms are very similar for both types of ear infection. The only reliable way to make the diagnosis is by examining the ear canal. The majority of external ear infections are caused by bacteria including Pseudomonas, Staph, and Strep. A smaller number of cases are caused by fungus.
Once Otitis Externa is diagnosed by a Primary Care Physician, it is treated with antibiotic eardrops rather than oral antibiotics. Placing the antibiotic drops directly into the ear canal much more effectively eliminates the infection. Adding a topical steroid to the antibiotic drop will often result in a speedier recovery. The ear pain is usually treated with Tylenol and/or Ibuprofen. However, occasionally the pain can be so severe as to require narcotic pain medication. It is also important to avoid further water exposure to the affected ear since that will likely prolong the infection. Generally, outer ear infections improve within 2 or 3 days after starting the eardrops.
Occasionally, these infections will persist despite the drops. In this situation, a referral to an ENT physician is necessary to address these more severe cases. One thing that can be offered by an ENT physician is a thorough cleaning of the ear canal. Sometimes the simple act of removing all the debris is all that is needed to allow the prescribed eardrops to be successful. The most severe infections can result in swelling of the ear canal so that the eardrops will not reach the entire canal. In this case, an ENT doctor may place a cotton “wick” in the ear canal for a few days to allow the antibiotic drop to get to where it needs to cure the infection. A culture of the drainage may also be helpful if a resistant bacteria is suspected. Another valuable tool is using a microscope to examine the ear. The microscope can reveal evidence of a fungal infection or more serious problems. Since many resistant outer ear infections are caused by fungal organisms that do not respond to the “normal” antibiotics, it is critical to identify fungal disease so that appropriate antifungal drops can be prescribed.
Most outer ear infections respond well to treatment, but rare complications can occur. The infection can potentially spread to the soft tissues of the face and neck, which requires oral or even IV antibiotics. In patients with diabetes or a compromised immune system, the infections can become aggressive and invade the bone of the skull and ear. This is a very infrequent occurrence but needs to be managed with an emergent surgical procedure.
“How can I avoid getting swimmer’s ear?” is a common question in any ENT practice. The answer is to keep your ears as dry as possible and to avoid manipulation with anything smaller than your elbow (Just like your Mom used to tell you!). Drying your ears with a hairdryer after swimming can be helpful. For those people that continue to have problems, placing a mixture of rubbing alcohol and white vinegar in the ear canal after swimming can minimize the chance of ear canal infection.