Ear infections can be divided into those that involve the skin of the ear canal (so-called “swimmer’s ear”) and those that involve the middle ear, which is the part of the ear on the other side of the eardrum (these are the kind that children get). Although usually it is relatively easy to tell the two types apart, sometimes it’s a little tricky or rarely, a patient may have both kinds at once. What follows is a short guide to the symptoms and treatment of each.


External Otitis (Swimmer’s Ear)

Although chronic water exposure makes this type of infection more likely, most people that get it haven’t been near the water in days. External otitis occurs when bacteria get underneath the skin of the ear canal and cause a local cellulitis (pain and swelling). Everyone has these bacteria living on their skin surfaces, but they generally cause no problems unless there’s a break in the skin which allows the bacteria to enter. Presumably the reason that water exposure makes this more likely is that the softening of the skin that occurs when it gets wet makes it easier for the bacteria to enter. By the same token, itching or scatching your ears with your fingernail, bobby pin etc. can cause a small break in the skin which can cause an external otitis.

External otitis can be so severe that the ear canal completely closes off and/or external ear is affected. There may or may not be any drainage. Treatment is ear drops and occasionally an oral antibiotic is prescribed as well. Occasionally an external otitis can be caused by a fungus rather than a bacteria. In this case, special antifungal ear drops are needed.


Otitis Media and Serous Otitis (Fluid in the Ear)

These two conditions are often lumped together but in fact may be quite different. In an average healthy individual, the Eustachian tube (a narrow opening between the middle ear and the back of the nose) keeps the air pressure on the inside of the eardrum the same as that outside the eardrum. This maximizes the movement of the eardrum to sound waves. If the tube becomes blocked (by a viral infection, allergies, etc.), the air inside the middle ear is gradually absorbed into the bloodstream and you are left with a partial vacuum in the middle ear. This may give you the sensation that your ear is “blocked”. If this condition persists for a day or so, fluid is drawn into the middle ear as a result of the negative pressure and now you have a serous otitis, or “fluid in the ear”. By itself, this does not necessarily mean you have an ear infection, and an antibiotic may not be of benefit.

An ear infection (otitis media) implies that there are bacteria actively growing in the middle ear as opposed to fluid sitting passively. This almost always is accompanied by the usual signs of a bacterial infection such as pain and fever. This obviously needs to be treated with an oral antibiotic. Occasionally a decongestant or antihistamine is prescribed as well. Recurrent ear infections or chronic serous otitis are sometimes treated by pressure equalization (PE) tubes, which act like artificial Eustachian tubes.