ENT Doctors Houston: Allergies, Sinus, Hearing Aids, Ear Tubes

Ear Infections

Otitis Externa (Swimmer's Ear)
Otitis Media (Middle Ear Infections)

Otitis Externa (Swimmer's Ear)

What is otitis externa?

Otitis externa, commonly referred to as swimmer’s ear, is an infection involving the skin of the external ear canal. This is different from otitis media, or middle ear infection, in which the infection is behind the eardrum. Otitis externa leads to swelling of the ear canal skin and is frequently associated with severe pain as well as ear blockage.

How is otitis externa diagnosed?

Otitis externa typically leads to severe tenderness of the ear canal, which can be detected by pulling on the earlobe. Physical examination by the physician reveals a tender, swollen ear canal, frequently filled with infected debris. Commonly, the ear canal may be entirely swollen shut.

What causes otitis externa?

With otitis externa, bacteria, or sometimes fungus, penetrate the skin of the ear canal and cause inflammation. Pseudomonas Aeruginosa is the most common bacterial agent to cause this infection. Risks factors for the development of otitis externa include exposure to water, use of Q-tips, and pre-existing skin conditions of the ear canal. Water softens the skin barrier, allowing organisms to penetrate and cause infection. Q-tips remove the protective layer of wax in the ear canal and can create tiny abrasions that allow infections to start. Skin conditions, such as eczema, also lead to a breakdown in the skin barrier, promoting the start of infection.

How is otitis externa prevented?

The most important steps to prevent otitis externa include keeping the ears dry and avoiding the use of Q-tips. For individuals, such as swimmers, who are frequently exposed to water, evaporating moisture from the ear canal after swimming by placing alcohol drops, or using a hair dryer to dry the ear canal, can decrease the frequency of infections.

How is otitis externa treated?

The mainstay of treatment for otitis externa is topical antibiotic drops placed in the ear canal. (After an infection has started, alcohol drops are not effective, and will only cause burning and pain!) The ear doctor may need to clean infected debris from the ear canal to speed healing. Also, if the ear canal is too swollen to allow drops to be placed, your doctor may need to place a small sponge, or wick, in the ear canal to draw the drops past the obstruction. Oral antibiotics may be necessary for particularly severe infections.

By Cary Moorhead, MD

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Otitis Media (Middle Ear Infections)

What is otitis media?

Otitis media is essentially an infection of the middle ear space. This condition occurs very frequently in children and less commonly in adults. The otitis media typically results from eustachian tube dysfunction, which leads to blockage of the natural drainage pathway from the ear to the back of the nasal airway. Eustachian tube dysfunction is very common in children, and is likely worsened by viral infections such as the common cold and possibly by nasal allergies. The otitis media typically occurs in phases. The initial inflammatory infection is called acute otitis media, and can cause pain and hearing loss. Once the acute inflammation has subsided, the middle ear fluid may drain in a short time, or the fluid may be retained, leading to otitis media with effusion (serous otitis media). This fluid collection can remain for several months in some cases, but does not typically cause pain. This condition can cause significant conductive hearing loss.

Figure 1 Left acute otitis media.

Figure 2 Right otitis media with effusion.

How is otitis media treated?

Most cases of acute otitis media resolve without antibiotic treatment, but some require antibiotic treatment and analgesics. Rare cases can progress to more serious infections of the mastoid or brain. Serous otitis media can be observed for some time, but surgical drainage may be considered if there is a prolonged duration of hearing loss. Ventilation tubes (pressure equalization tubes) can be placed for cases of multiply recurrent acute otitis media or long duration of serous otitis media with hearing loss.

Figure 3 Left tympanic membrane with pressure equalization tube.

Myringotomy and Tube Placement

In adults, the ventilation tube can typically be placed in the office under local anesthesia. In children, the procedure is performed as an outpatient surgery that takes a few minutes. The surgery is performed through the ear canal. Some children benefit from adenoidectomy if multiple sets of ventilation tubes have been needed in the past.

How the Surgery Works

The ventilation tube provides a secondary path of middle ear ventilation that helps the middle ear stay clear of retained fluids. It is the most effective method of keeping fluid from accumulating in the middle ear.

After Surgery Care

Antibiotic ear drops are used in the ear after surgery for a few days in many cases. Regular activities are started at any time. Patients remain at risk for ear infection related to water exposure, but these infections can typically be treated with antibiotic ear drops without the need for oral antibiotics. The tube usually comes out spontaneously within a year, but some tubes fail to come out in a timely fashion, in which case there may be an increased risk of a chronic tympanic membrane perforation.

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