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.
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.
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