Posts tagged Ear Infection

Children with Chronic Ear Infections

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Ear infections are simply inflammations of the middle ear, and they are generally triggered by bacteria which accumulate behind the eardrum. People of any age can be subject to ear infections, but children have them at a more frequent rate than do adults. By the time of a child’s third birthday, five out of six children will have had an ear infection at least once, and that makes it the single most common cause for children to be taken to a doctor.

One of the problems with this is that some children are just too young to verbalize what they are experiencing, and can’t really tell you that their ear hurts. In this situation, a parent should be on the lookout for symptoms that characterize an ear infection, such as pulling at the ears, balance problems, fevers, difficulty with sleeping, excessive crying, drainage from the ears, and non-responsiveness to quiet sounds.

Causes of Ear Infections

One of the most common causes of an ear infection in a child is an upper respiratory infection, a cold, or a sore throat. In the case of the upper respiratory infection, related bacteria can easily spread to the middle ear, and with a cold, the virus can be drawn into the middle ear as an offshoot of the main infection. In any of these cases, fluid begins to build up around the eardrum.

The reason that children are more susceptible to ear infections than adults relates to the fact that the eustachian tubes in a child’s ear are smaller than an adult’s, and that makes it more difficult for any fluids to exit the middle ear, even in the absence of any kind of infection. When those eustachian tubes become swollen by a cold or other illness, drainage may slow down to almost nothing, and blockage will be the likely result. Complicating matters, the immune system for a child is not nearly as developed or robust as an adult’s, and that makes it much harder for children to fend off the effects of any kind of infection.

Children ear infections, otoscope

Your doctor will likely use an instrument called an otoscope to determine whether your child’s eardrum is red and/or swollen with an infection.

Diagnosing a Middle Ear Infection

When you take your child to see a doctor about a possible ear infection, the doctor’s first question will be about your child’s recent medical conditions. Your doctor will try and find out if your child has had a sore throat or a head cold recently. Then the doctor will ask about any of the other common symptoms associated with an ear infection, to see if your child has been experiencing any of these. After gaining this kind of information, your doctor will probably use an instrument called an otoscope, which is a lighted instrument that can see inside the eardrum to determine whether it is red and/or swollen with an infection. If this is inconclusive, your doctor might then use a diagnostic test known as tympanometry to measure eardrum sensitivity at various points.

Treatment for Middle Ear Infections

One of the most common treatments for a middle ear infection is an antibiotic called amoxicillin, which is generally prescribed over a period of 7 to 10 days. If your child is experiencing an inordinate amount of pain or discomfort, your doctor may also recommend pain relievers such as ibuprofen or acetaminophen, and possibly even eardrops which can be delivered directly into the ear.

In cases where an ear infection cannot be definitively diagnosed, your doctor may want to adopt a wait-and-see attitude about the condition, to see if it worsens into an actual ear infection. This is more common in very young children, between the ages of six months and two years. However, even when the wait-and-see approach is adopted, your doctor will probably ask to have your child returned within three days to check on whether symptoms have worsened.

If definitive diagnosis is still lacking, it is likely that a program of antibiotic treatment will be initiated, to be sure it gets no worse. When antibiotics are prescribed, it’s very important that the child takes the prescribed dosage throughout the entire period of the prescription, so that bacteria do not have the chance to develop resistance to the medication.

Preventing Middle Ear Infections

There is no rock-solid way to prevent middle ear infections in children, and the best approach that can be adapted calls for limiting the risk factors which may trigger an ear infection. Vaccinating your child against influenza is one good track to take, and limiting your child’s exposure to children known to be sick is a good idea as well, although obviously this is not 100% enforceable.

Good hygiene for everyone in the household is important: for instance washing hands and sneezing into your elbow, to help prevent the spread of germs to your child. It’s not a good idea for anyone in the household to be smoking, and statistics bear out the fact that where at least one person at home smokes, there are more ear infections than in smokeless homes. One last method of limiting the risk factor for developing ear infections is to make sure that your infant is never put down for a long period of time, such as overnight, with a bottle in hand.

Young woman with an ear infection, such as cholesteatoma, touching her painful ear.

Cholesteatoma: What It Is and What You Need to Know

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Young woman with an ear infection, such as cholesteatoma, touching her painful ear.

Cholesteatoma is a non-cancerous growth in the middle ear.

With a name that confuses many, cholesteatoma is a delicate and troublesome problem within the ear. Describing an abnormal skin growth behind the eardrum, the middle ear, cholesteatoma is normally caused by multiple infections. However, there are other causes to note including a dysfunction in the eustachian tube.

What is the Eustachian Tube?

Running to the middle of the ear from the back of the nose, this tube is essential for our hearing. Since it allows air to reach the ear, ear pressure is equalized efficiently and our hearing works as expected. Sadly, an issue can occur with a simple cold along with allergies, sinus infections, and chronic ear infections.

With a failure in the eustachian tube, the middle ear can experience a partial vacuum and, in turn, the eardrum, or certain sections of the eardrum, is pulled out of position. As you can see, each step of the process causes another problem and it ends with a growth or cyst in the middle ear.

When left untreated, willingly or unknowingly, the size of the cholesteatoma can change while causing severe damage to the delicate bones located in the middle ear. If left for too long, hearing loss is experienced and surgery becomes one of just a few select options. Fortunately, there aren’t any serious side effects when the issue is treated which means that permanent hearing loss and muscle paralysis in the face are both unlikely. This being said, there has been cases of all three when the cholesteatoma is allowed to keep growing.

Causes of Cholesteatoma

As we’ve seen, the main causes are problems with the eustachian tube and chronic infections but there are also small numbers of people who are born with a cholesteatoma. Ultimately, this is seen as a birth defect and should be picked up on soon after birth. If children experience numerous ear infections, cholesteatoma can also become a problem at a young age.

Symptoms of Cholesteatoma

With any health issue such as this, the key information comes in knowing the symptoms so it can be recognized early. With cholesteatoma, many are actually drawn to a foul odor before anything else and this is where the ear drains fluids. After this, you might feel building pressure or a sense of fullness in the ear where the sac enlarges over time.

As with ear infections themselves, cholesteatoma will cause discomfort whether it comes through an ache in the ear, a difficulty to fall asleep at night, or a slight loss of hearing. Finally, there may be muscle weakness on the side of the cyst in addition to dizziness. If you experience any of these symptoms, we advise you to visit your doctor as soon as possible. Even if it turns out to be a simple ear infection, this will still need treatment.

Treating Cholesteatoma

As you visit your doctor, they’ll examine the inside of the ear because the signs of a cyst can often be seen early whether it’s a congregation of blood vessels or excess skin cells. If they don’t find anything but are still a little worried, they may ask for you to attend a CT scan which will show the cyst or whatever it may be causing your discomfort.

As with any other cyst, a cholesteatoma is something that needs surgery for removal. Unfortunately, cysts don’t just go away on their own; in fact, they do the opposite and grow. While you’re waiting for surgery, your doctor might suggest ear drops, antibiotics, careful cleaning, and other forms of light therapy.

During surgery, most cases are completed under a general anesthesia with the main aim of removing the cyst. If the cyst is removed, this is great news but it might not be the end of the problem depending on how serious the issue was and the state of your ear now. Typically, a second surgery will be planned at the very least to check the cyst has gone. However, you may also require a reconstruction of the damaged bones in the middle ear; this will improve your hearing and reverse other symptoms experienced. Of course, this will be judged on a case-by-case basis as not all patients would benefit from reconstruction if the damage is too severe.

In terms of the logistics, you’ll be an outpatient and a certain percentage will stay in the facility overnight as a precaution. If the cholesteatoma was extremely damaging, you might be required to stay in hospital for a few days with a course of antibiotics. On the whole, you can expect to need one or two weeks away from work. In the months ahead, check-ups and evaluations will ensure the problem has gone for good.

Summary

Although we can’t provide any prevention tips for congenital cholesteatomas, we do advise visiting the doctor as soon as you notice any of the symptoms we’ve listed. Whether it’s yourself or your child, quick action is the best way to remove the problem and ensure the middle ear bones aren’t damaged. Despite cholesteatoma being a serious ear condition, it is treatable with the right steps.

A young woman holding her head due to BPPV.

What is BPPV? (Benign Paroxysmal Positional Vertigo)

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It may look like a mouthful to say, but the medical condition known as benign paroxysmal positional vertigo (BPPV) can easily be understood by breaking it down into its constituent terms. Benign means non-life threatening and paroxysmal means that it occurs only in sudden bursts. Positional means that it is triggered by specific positions or head movements and vertigo is a sensation of dizziness. Taken altogether, someone who has BPPV would experience brief periods of dizziness, which are brought on by abrupt, unanticipated head motions.

Your Body During a BPPV Episode

Many of the issues which affect your balance originate in the inner ear, like BPPV. It starts when some of the calcium carbonate crystals which are normally carried in the gel of the utricle, somehow navigate out of that environment and into at least one of the three semi-circular canals, which are filled with fluid, and are thus also capable of hosting the crystals.

These semi-circular canals depend on fluids to determine head motions, and when the fluids become oversaturated with calcium carbonate crystals, your ability to balance is disrupted. These particulates cause excessive movement in the fluids within your inner ear, creating what we commonly know as vertigo (dizziness).

When this fluid moves, there are nerve endings inside the ear which sense that motion and transmit messages to the brain about head movements. Inaccurate signals are sent to the brain, and as a result, the BPPV patient feels dizzy and disoriented.

People Affected by BPPV

Even though you might never have heard of BPPV, it’s not an exceptionally rare condition. In fact, more than 100 out of every 100,000 people in America are affected by BPPV, most of whom are adults. The disorder rarely impacts children, and is far more prevalent in older people, particularly seniors.

The cause of the disorder is not yet understood, with most people reporting that they simply woke up one day, and as they got out of bed, realized that the bedroom was spinning all around them. Although the beginnings of BPPV are unclear, scientists and doctors have noted a correlation between the disorder and other diseases such as diabetes, osteoporosis, and inner ear infections.

A diagram of the inner ear, as related to BPPV

In diagnosing BPPV, ENT doctors look for nystagmus, which is an pattern of eye movements caused by the sensation of vertigo.

Diagnosing BPPV

It can be difficult to diagnose BPPV, because the movement of the calcium carbonate crystals does not show up on imaging scans such as magnetic resonance imaging (MRI). However, a BPPV can abruptly position their head in a way that causes the crystals to move within the fluid of the semi-circular canals, which triggers the false signals that induce dizziness.

This dizziness causes the person’s eyes to move in a very definite and predictable pattern known as nystagmus. This occurs because there is a close relationship between the eye muscles and the inner ear, which allows for a person to remain focused on immediate surroundings during head movements.

Because the false signals sent to the brain make it think the head is moving, it also mistakenly triggers eye movement, which is supposed to help maintain equilibrium. However, in this false scenario, nystagmus acts as a telltale sign.

Treatment of BPPV

Sometimes medications are prescribed as a treatment for BPPV, and in other cases, surgical solutions are recommended. But in most cases, the most effective treatment by far is relocating the wandering calcium carbonate crystals back into the utricle chamber where they belong.

The first step in this mechanical approach calls for identification of which semi-circular canal(s) the crystals have migrated to. Once that is known, a doctor will guide the patient through a series of head maneuvers which are designed to encourage the crystals to return to their original position. Self-treatment is not recommended, and it calls for a doctor who is skilled in guiding a patient through the proper maneuvers so that no damage is done to the head or neck areas.

Effectiveness of Treatment Programs

Studies have demonstrated that the success rate for properly diagnosed and guided BPPV treatment is around 90%. Once the calcium carbonate crystals have been returned to their proper position, most patients report no more than minor residual spinning sensations, and even these diminish within a couple of months.

However, it is possible for the condition to recur, and come back in full force. This usually occurs within five years of treatment, and when it does come back, it can again be treated successfully, using the gravity method of guiding the crystals back to their proper position in the ear.

An isolated ear with a swimmer's ear infection.

How to Prevent Swimmer’s Ear Infections

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Swimmer’s ear is something of a misnomer since you don’t have to be splashing around the pool or swimming to get the kind of ear infection attributed to swimmer’s ear. This ear infection is of a specific type which begins as a mild, barely noticeable itching or redness, which gradually escalates into an inflamed condition that can become very tender to the touch, and can eventually even disrupt your hearing.

You can contract swimmer’s ear infection in any number of ways, including swimming in some body of water, but also by taking a bath or shower, or even by cleaning your ears out with a cotton swab.

Causes of Swimmer’s Ear

The formal medical name for swimmer’s ear infection is otitis externa, and it occurs when water gets trapped in your ear. When that water is allowed to stay there, bacteria and sometimes fungi can grow in the ear and multiply, which then leads to an infection near the opening of the ear.

There are other causes of swimmer’s ear as well, which are not brought about by any exposure to water. If a cut or scrape occurs just inside the ear canal, that can also trigger the formation of the bacteria necessary to create an infection.

Aggressive cleaning with cotton swabs is another relatively common cause of swimmer’s ear since the swab can scratch the skin inside the ear, and bacteria can begin growing and multiplying as a result. In fact, people with excessive amounts of earwax are prone to developing swimmer’s ear, as are people bothered by eczema, which is a chronic skin condition.

Symptoms of Swimmer’s Ear

As mentioned, the first indication of swimmer’s ear is usually a mild form of itching, often accompanied by redness and swelling around the ear. When the infection begins to progress, the area becomes more inflamed and more painful. Many people who have contracted swimmers ear report that it’s extremely painful, far beyond what you might expect from such a seemingly simple medical condition.

Other symptoms can develop if swimmer’s ear is left untreated, some of which can be quite serious. Fluid build-up in the ear, swollen lymph nodes, a swollen or closed up ear, and a high fever are all symptoms that can result from an untreated ear infection. This damage is not permanent and will subside once the infection is cleared up with medication.

An ENT examines a patient's swimmer's ear infection.

The best thing to do if you have a swimmer’s ear infection is to seek the attention of your physician or ENT. They’ll be able to give you antibiotics you need to clear up the infection.

Treatment for Swimmer’s Ear

Someone who has contracted swimmer’s ear infection should take a pain reliever like Ibuprofen if the patient cannot see a doctor immediately. In some milder cases, the pain and discomfort will subside on its own, but if that doesn’t happen within just a few days, it’s always advisable to make an appointment with a physician. If you can’t get an appointment to see your doctor for treatment, you should try to get into an urgent care facility and have the infected ear examined.

To confirm a diagnosis of swimmer’s ear, a physician will take a fluid sample from the area around the ear, and the first treatment option will usually be antibiotic eardrops. If these don’t clear up the problem in a short timeframe, an oral antibiotic is likely to be the next option.

There are times however, when this line of treatment is ineffective and something else has to be tried. If ear antibiotics don’t work, it’s usually because there has been so much debris or fluid built up in the ear canal, that antibiotic eardrops cannot penetrate the obstruction. If this is the case, your doctor may attempt to clear the debris out of the ear canal by using a vacuum apparatus.

Once the buildup of debris has been dissipated, antibiotic eardrops will again probably be effective. One reason why oral antibiotics could possibly be ineffective as a means of treatment, is if the infection wasn’t really caused by bacteria in the first place, but was triggered by a fungus.

Preventing Swimmer’s Ear Infections

You don’t have to avoid swimming, bathing, or showering in order to avoid swimmer’s ear infections. One of the most effective ways of ensuring that water doesn’t become trapped in the inner ear is to wear earplugs when swimming. After showers or baths, you can lean your body toward the side which feels like it has water trapped, and shake your head somewhat vigorously. This will usually dislodge any inner ear water, and clear out the ear canals. It’s also advisable to limit your cotton swab cleaning of the ears as much as possible, so you don’t scratch the interior skin and trigger an infection.

A man receives a check-up for middle ear infections.

Treatment for Chronic Middle Ear Infections

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A middle ear infection, also known as ‘otitis media,’ is an infection or inflammation that occurs inside the eardrums.  This can cause sinus issues, among others.  Generally speaking, people with middle ear infections pick them up from colds, coughs, sore throats, and other respiratory problems. Of course, the word ‘chronic’ suggests this is an ongoing problem, which is why we want to address the treatment side of things today.

With ear infections, doctors like to wait at least two months to three months before classifying it as ‘chronic.’ ‘Acute’ ear infections usually only last for a few weeks. Typically, those with an acute infection will experience fluids accumulating behind the eardrum.

These fluids can remain behind the eardrum for a few months. If the fluid stays in place for a prolonged period or there’s some form of negative pressure, the patient will continue to see problems long into the future. Over time, the middle ear may develop a hole in the eardrum, leading to more severe issues. Doctors talk about middle ear infections in terms of months as opposed to days or weeks because chronic middle ear infections typically start without pain or any real symptoms. As time goes on, the ears may pop after sustained pressure and result in hearing loss.

Before talking about the treatments and what you can do to alleviate the issue, we should note that infants and young children are particularly prone to middle ear infections. In fact, three in every four children will experience a middle ear infection before their third birthday.  As the canal that connects the back of the nose/throat to the middle ear, the ‘Eustachian tube’ is more horizontal and much shorter when children are younger. For the microorganisms that cause infection, a shorter tube allows them to enter the middle ear faster.  In combination with a young child’s weaker immune system, and children find it hard to stave off.

A young girl gets checked for middle ear infections by a doctor.

Young children are more susceptible to middle ear infections due to a shorter Eustachian tube that allows bacteria easier access to the middle ear.

Treating Middle Ear Infections

In the majority of cases, antibiotics will be the first course of treatment. Even though there’s no real evidence to suggest their effectiveness in treating otitis media, since most middle ear infections are viral, they can remove various symptoms and make it easier for the infection to resolve itself.  Antibiotics usually fix the problem in around five days. Doctors often prescribe amoxicillin, allowing you to get back on your feet in no time.

After medication, many children and adults require grommets, which are also an option if the middle ear infection doesn’t clear up immediately. Grommets are tiny tubes placed inside the eardrum that aid with drainage. As we discovered earlier, the problem worsens when the fluid doesn’t drain away, so grommets could stop the negative spiral of events that makes otitis media worse.

Under general anesthesia, these grommets can be installed in around 15 minutes and are left inside the ear for several months. With the eardrum open, the middle ear infection can heal fully, and the grommet will eventually be pushed out. You typically won’t feel any pain, and the majority of grommets are removed between six months and a year after being installed.

If the problem is too severe for either of these solutions, surgery is recommended if there aren’t any other solutions available. With this option, the idea will be to remove the infected tissue and the areas causing the recurring pain and discomfort. Once these problem areas have been eliminated, an intact eardrum can then recreate a middle ear space as found in healthy ears.  Hearing can then be restored.

At first, you may find it strange that hearing is the last thing to be restored, but the first two steps are pivotal to stop the infection from returning. If these two steps aren’t met at the beginning, anything else done to improve hearing will be futile. If the infection comes back after the hearing is restored, hearing can be lost again so this is why the order of priority has been developed in this way.

In most cases, the problem will clear itself up with the help of antibiotics. If this doesn’t work, your doctor should discuss more great solutions so you can move forward with your life without worrying about infection and discomfort in your ears.

Young woman is covering her ears due to her tinnitus symptoms.

The Severity of Tinnitus Symptoms Among Adults

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Young woman is covering her ears due to her tinnitus symptoms.

More and more adults seem to be experiencing tinnitus symptoms.

Loud noises and environments seem to be doing more damage than expected to people’s hearing. While the lifestyle of teenagers has led to a them experiencing tinnitus symptoms, the same appears to be true for adults. According to a recent study by the University of California, approximately 1 in 10 adults in the U.S. have tinnitus.

Research into Tinnitus Symptoms

Tinnitus is a symptom of an underlying condition. People with tinnitus will often hear noises when there are none. These noises present themselves as a ringing, clicking, hissing or roaring.

The most common causes include ear infections, heart disease, brain tumor, emotional stress, and head injuries. However, tinnitus itself can lead to functional impairments in thought processing, emotions, hearing, sleep and concentration.

Researchers at the University of California examined a 2007 National Health Interview Survey. Their initial findings revealed that an estimated 3.4 million U.S. adults experienced tinnitus in the past 12 months.

Among those, 27 percent have suffered from symptoms over the past 15 years, while another 36 percent constantly deals with symptoms. Only 7.2 percent felt tinnitus was a big problem. This is a stark difference from the 42 percent who believe the condition didn’t affect their lives.

Researchers believe that work-related noise is the main cause of these symptoms. The problem is that many people do not report experiencing tinnitus to their physician. The CDC estimates that four million people work each day in damaging noise. Even worse, ten million people in the U.S. have hearing loss related to noise.

More studies need to be performed to get a better idea of how tinnitus affects people, as well as how to treat their tinnitus symptoms.  The authors of the study say that “The recent guidelines published by the American Academy of Otolaryngology–Head and Neck Surgery (AAO­HNSF) provide a logical framework for clinicians treating these patients, but the current results indicate that most patients may not be offered management recommendations consistent with the suggested protocol.”

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