EAR INFECTIONS

Otitis is a general term for inflammation or infection of the ear. It is subdivided into the following:

• Otitis externa, external otitis, or "swimmer's ear" involves the outer ear and ear canal. In external otitis, the ear hurts when touched or pulled.
• Otitis media or middle ear infection involves the middle ear. In otitis media, the ear is infected or clogged with fluid behind the ear drum, in the normally air-filled middle-ear space. This very common childhood infection sometimes requires a surgical procedure called "myringotomy and tube insertion".
• Otitis interna or labyrinthitis involves the inner ear. The inner ear includes sensory organs for balance and hearing. When the inner ear is inflamed, vertigo is a common symptom.

OTITIS EXTERNA

Otitis externa ("swimmer's ear") is an inflammation of the outer ear and ear canal. Along with otitis media, external otitis is one of the two human conditions commonly called "earache". It also occurs in many other species. Inflammation of the skin of the ear canal is the essence of this disorder. The inflammation can be secondary to dermatitis (eczema) only, with no microbial infection, or it can be caused by active bacterial or fungal infection. In either case, but more often with infection, the ear canal skin swells and may become painful and/or tender to touch.

The goal of treatment is to cure the infection and to return the ear canal skin to a healthy condition. When external otitis is very mild, in its initial stages, simply refraining from swimming or washing hair for a few days, and keeping all implements out of the ear, usually results in a cure. For this reason, external otitis is called a self-limiting condition. However, if the infection is moderate to severe, or if the climate is humid enough that the skin of the ear remains moist, spontaneous improvement may not occur.

Topical solutions or suspensions in the form of ear drops are the mainstays of treatment for external otitis. Some contain antibiotics, either antibacterial or antifungal, and others are simply designed to mildly acidify the ear canal environment to discourage bacterial growth. Some prescription drops also contain anti-inflammatory steroids, which help to resolve swelling and itching. Although there is evidence that steroids are effective at reducing the length of treatment time required, fungal otitis externa (also called otomycosis) may be caused or aggravated by overly prolonged use of steroid-containing drops. In addition to topical antibiotics, oral anti-pseudomonal antibiotics can be used in case of severe soft tissue swelling extending into the face and neck and may hasten recovery.

OTITIS MEDIA

Otitis media is inflammation of the middle ear. Otitis media occurs in the area between the ear drum (the end of the outer ear) and the inner ear, including a duct known as the Eustachian tube. It is one of the two categories of ear inflammation that can underly what is commonly called an earache, the other being otitis externa. Diseases other than ear infections can also cause ear pain, including cancers of any structure that shares nerve supply with the ear.

Otitis media is very common in childhood, with the average toddler having two to three episodes a year, almost always accompanied by a viral upper respiratory infection (URI), mostly the common cold. The rhinoviruses (nose viruses) that cause the common cold infect the Eustachian tube that goes from the back of the nose to the middle ear, causing swelling and compromise of pressure equalization, which is one of the normal function of the tube.

When the middle ear becomes acutely infected by bacteria, pressure builds up behind the ear drum, usually but not always causing pain. In severe or untreated cases, the tympanic membrane may rupture, allowing the pus in the middle ear space to drain into the ear canal. If there is enough of it, this drainage may be obvious. Even though the rupture of the tympanic membrane suggests a traumatic process, it is almost always associated with the dramatic relief of pressure and pain. In a simple case of acute otitis media in an otherwise healthy person, the body's defenses are likely to resolve the infection and the ear drum nearly always heals. Antibiotic administration can prevent perforation of the eardrum and hasten recovery of the ear.

To treat the pain caused by otitis media oral as well as topical analgesics are often used. Oral agents may include ibuprofen, acetaminophen, and / or narcotics. Topical agents have also been shown to be effective, such as antipyrine and benzocaine ear drops.

OTITIS INTERNA

Otitis interna (Internal otitis) is an inflammation of the inner ear and is usually considered synonymous with labyrinthitis.

Labyrinthitis is an inflammation of the inner ear that typically results in severe vertigo lasting for one or more days. Its cause is rarely identified, but it is thought most commonly to derive from a viral inflammation of the vestibular labyrinth (the part of the inner ear responsible for balance). Patients usually present with the sudden onset of severe whirling vertigo, nausea, and vomiting. The symptoms can be so severe and disabling that patients frequently go to the emergency room for care and require vestibular suppressants such as Valium or Meclizine in order to tolerate the vertigo. Symptoms typically subside over a few days, but may leave the patient with vague imbalance which slowly improves over weeks to months. Hearing loss rarely accompanies the vertigo in labyrinthitis. Occasionally a bacterial infection of the middle ear can spread to the inner ear and cause this disease. In this situation antibiotic treatment may be helpful.