Earache is a very common medical problem in both children and adults. The pain of earache results from inflammation and swelling of the structures that make up the ear.
The ear is made up of three parts: external ear (pinna and external ear canal), middle ear (ear drum, middle ear bones) and the inner ear.
Otitis externa is a skin infection of outer ear canal. This often occurs after ingress of water, or by minor injury to ear canal due to use of cotton buds or other objects.
Risk factors for otitis externa include:
- Moisture trapped in the ear canal – The condition commonly called ‘swimmer’s ear’ can occur after swimming, bathing, or in hot humid weather. Bacteria that cause infection are able to grow and multiply easily in warm, moist environment. Often a fungus may also cause this infection.
- Minor injury or scrape to the ear canal skin – This usually happens during attempts to clean the ear with objects, such as a cotton bud or paper clip.
Otitis externa may show symptoms such as gradual development of an earache, hearing loss due to blockage of the ear canal, ringing or buzzing sounds in the ear, blocked or full sensation in the ear, swelling of the ear, thick drainage from the ear canal, and touching or pulling the ear helix (upper rim) worsens the pain. In mild cases, one may describe it as an itch instead of pain.
It is an infection of middle ear and eardrum, commonly seen in infants and younger children. The infection may be viral or bacterial. It often follows a cold or upper respiratory tract infection. This infection causes inflammation of Eustachian tube and prevents normal fluid drainage from middle ear.
Factors that may predispose otitis media include allergies resulting in repeated upper respiratory infections, second hand smoke exposure, bottle-feeding when laying supine or flat, and family history of ear infections.
Symptoms: Pain is the most common symptom. Often infants and young children may not be able to localise the pain and may be fussy, irritable and sleep poorly. Other symptoms of otitis media include hearing loss, ringing or buzzing sounds in the ear, full or plugged sensation in the ear, fever, occasionally, discharge from the ear (the eardrum ruptures and the infected fluid drains out.
It is an inflammation of eardrum and may be due to localised infection or trauma. This might be due to local trauma to the eardrum, which may be caused by puncture by a foreign object like a cotton bud or paper clip used to remove wax.
There may also be barotrauma, in which the eardrum is ruptured with changes in pressure due to diving, flying in an airplane, or due to an explosion or very loud noise. Bacterial and viral infections of the eardrum may cause inflammation and blistering, also known as bullous myringitis.
Symptoms: The common symptom is pain in the ear. The pain may be extreme but also may suddenly resolve if the bulla spontaneously ruptures, decreasing the pressure in the blister. Other symptoms include fever, hearing loss and blood stained drainage from the ear canal.
A doctor usually can diagnose the cause of an earache by taking the patient’s history and performing a medical examination.
- In otitis externa, the ear canal will look swollen and inflamed, and there may be thick drainage visible. The ear and canal may be painful and tender.
- In bullous myringitis, the eardrum will look inflamed and fluid blisters can be seen when examined with an otoscope.
- In otitis media, fluid fills the middle-ear (serous otitis media), and there may be air and fluid bubbles seen behind the drum. As pressure builds, the eardrum may not move if a small puff of air is pushed through the otoscope. If the eardrum looks red and inflamed, the diagnosis of acute otitis media is made.
Hearing tests may be recommended if there have been recurrent infections or if there has been a delay in speech development. Sometimes, a sample of drainage from the ear is sent to the laboratory in an attempt to identify the specific bacteria causing the infection.This is usually reserved for infections that do not respond to normal treatment.
Otitis externa: Many cases of otitis externa may be prevented by decreasing the opportunity for water or moisture to enter the ear canal by taking the following measures:
- Carefully dry the ears after swimming or bathing, shake out excess water from the ear, wear earplugs while swimming.
- Putting objects into the ear canal can also cause otitis externa.
- Do not use objects to clean the ear (for example, paper clips,pens of finger nails) that may tear the skin. Most people have ears that are selfcleansing, and cleaning with a cotton bud is unnecessary and potentially harmful. People who have excess wax build up should have it removed by a doctor who can remove the debris under direct vision.
Otitis media: Minimise exposure of infants and children to others with colds or upper respiratory infections, and avoid bottle-feeding in the supine (lying) position. Babies who are breastfed for the first 6 months have a decreased risk of developing ear infections. Avoid exposure to secondhand smoke and keep immunisations up to date.