Posted by Rosie Dooley, BSc (Hons) Audiology, RHAD on October 6, 2019
An ear infection is common in children but much less so in adults. It is responsible for millions of GP visits every year and remains the most common reason for antibiotic prescription in children aged 6-24 months[i]. Its aetiology can be bacterial, viral or fungal, each causing varying symptoms but usually including pain, tinnitus and aural fullness.
Outer ear infections are medically known as otitis externa, are infections of the ear canal and the pinna (the visible outer ear). They can consist of a rash or soreness of the skin, potentially with accompanying discharge and can be caused by the injury resulting from the cotton bud or similar use in the canal. As the ear canal is a warm and sheltered space, it is the perfect environment for germs to inhabit and fungal infections can manifest here too.
Otitis media are infections of the middle ear space behind the tympanic membrane and are generally caused by a virus or bacteria entering the middle ear space from the eustachian tube and sinuses. Streptococcus pneumonia (pneumococcus), Hemophilus Influenza, Pseudomonas, and Moraxella account for about 85% of cases of acute otitis media[ii]. They result in a build-up of fluid behind the eardrum causing an unequal pressure across the eardrum. The potential symptoms of this pressure build-up are aural fullness – the feeling of being blocked, pain and hearing loss.
These are infections of the complex balance and hearing structures beyond the middle ear space – the vestibular system and the cochlear. Inflammation of the vestibular system, known as labyrinthitis or vestibular neuritis, causes vertigo and nausea but true bacterial or viral infections can also affect this system and the cochlear.
Diagnosis of outer and middle ear infections involve a medical professional listening to your symptoms and then conducting a detailed examination of the canal and tympanic membrane using an otoscope. Swabs can be taken of any discharge or fungal matter in the canal to be examined in a laboratory. Fluid build-up behind the tympanic membrane is further identified by Tympanometry, which measures how well the membrane is functioning.
If there is fluid build behind it – it will not move as well as normal and the Tympanometry will be able to record this. Diagnosis of inner ear infections is more complex, as the symptoms tend to be more varied and can be symptoms of another condition. Always see your GP if have dizziness, hearing loss or ringing in your ears.
Ask for an emergency GP appointment or call 111 if you have a very sudden onset (within 72 hours) of hearing loss, as you may be suffering from sudden sensorineural hearing loss (SSHL).[iii] SSHL can be treated with high dose steroids, the more quickly given after the onset of the hearing loss, the greater the likelihood of success.
Hear4U Audiologists cannot clinically diagnose infection but can offer supporting evidence to your GP. All Hear4U Audiologists are trained to take swabs for lab investigation, with the results being sent on to your GP surgery aiding faster diagnosis and treatment. Hearing tests and tympanometry are also offered at all Hear4U centres.
Treatment of ear infection, of course, depends on its aetiology. Bacterial and fungal infections can be treated with antibiotics and antifungal drops. Viral inner ear infections are more difficult to treat though usually resolve on their own. The symptoms of inner ear infection can be treated with over the counter medication – speak to your GP or pharmacist for advice.
[i] Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: A prospective, cohort study. J Infect Dis. 1989;160:83
[iii] R J Stachler, S S Chandrasekhar, S M Archer, R M Rosenfeld, S R Schwartz, D M Barrs. 2012.
“Clinical Practice Guideline: Sudden Hearing Loss,” Otolaryngology-Head and Neck Surgery. Volume
146, Issue 1S, pp. S1–S35.