Ear infections are common and represent a significant proportion of a family doctor's work. Fortunately, the majority of infections settle without ill effects whether the problem is in the outer, middle or inner ear, although sometimes longer term problems can arise.
The ear is divided into three parts: outer, middle and inner (see diagram). Infection in each part will give rise to certain patterns of symptoms and the type of symptoms which may occur with ear infections include:
- pain or earache
- discharge which may be blood-stained or smelly
- noises (tinnitus)
The only sign of an ear infection in young children may simply be a fever and some tugging of the ear by the child.
Dependent on which features are predominant, it is possible to identify the infection as arising within one of the three parts of the ear.
Drawings by S Blatrix, adapted with permission from 'Promenade around the cochlea'. This is an excellent site for explaining in detail how the ear works.
Outer ear infections (otitis externa)
This is an infection of the skin of the ear canal and very common. It can be extremely painful so that sleep may be impossible. Generally, outer ear infections are caused by a bacterial infection of the skin of the canal, although occasionally it may be due to a fungus or yeast.
The skin can become so swollen that the ear canal closes, causing temporary deafness, and there can be a scanty discharge from the ear. It occurs commonly in people who suffer from skin problems such as eczema, psoriasis or dermatitis but also in people with narrow ear canals or who swim a great deal.
It can affect both ears and often keeps recurring, especially if you are otherwise rundown or stressed. Not surprisingly, such symptoms usually mean that you will need to consult your doctor in order to receive effective treatment.
Treatment for outer ear infections is generally in the form of antibiotic ear drops which are instilled into the ear canal for at least a week. Sometimes antibiotics by mouth will also be necessary. In severe cases referral to an ear nose and throat specialist is both necessary and appropriate for cleaning of the ear canal and more intensive treatment.
Eczema of the ear canal and pinna
Ear discharge in otitis externa
By D Bowdler and R Lloyd Faulconbridge, University Hospital Lewisham
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