Otitis externa presents as ear pain and sometimes plugging. This is usually the result of retained ear wax or skin debris combined with moisture from swimming or the shower. Bacteria grow in this environment and cause the infection. Treatment involves clearing out the debris clogging the ear combined with the use of antibiotic ear drops and possibly oral antibiotics. Sometimes the trigger is a chronic ear skin condition, eczema, which allows bacteria to get under the surface of the skin and cause infection. This can be controlled with topical cortisone ointment.
Otitis media or middle ear infection is quite common. This can also present as ear pain or ear plugging. Sometimes in young children the only symptom is poor hearing or delay in speech. This problem occurs behind the eardrum where fluid can accumulate and get infected. The fluid prevents the eardrum from vibrating adequately and causes reversible hearing loss. If the fluid remains without becoming infected it is called serous otitis media. When the fluid becomes infected it is referred to as acute otitis media. The underlying problem, particularly in children, is with the eustachian tube. This is a connection between the middle ear and the back of the throat, above the palate. This structure is responsible for equalizing pressure. In children the eustachian tube is shorter and more horizontal than in adults. This makes it easier for bacteria to travel from the back of the nose and adenoids in the nasopharynx into the middle ear and trigger infection. Allergy and enlarged adenoids can be contributing factors to otitis media. The medical treatment involves antibiotics if there is infection. Decongestants are not effective in resolving the fluid. In older children or adults, oral cortisone medication may be used to reduce inflammation in the eustachian tube and allow the fluid to drain. Unfortunately there is no way to change the shape of the eustachian tube. As young children grow, they may “grow out” of frequent infections as the eustachian tube function improves.
When otitis media persists it can cause problems in addition to the hearing loss. Over time, the fluid weakens the tympanic membrane as well as the small bones behind this structure that transmit sound vibration to the inner ear. Perforation and conductive hearing loss may result and these can require surgical treatment to correct. Therefore, if the middle ear fluid fails to resolve with medical treatment, it is recommended to remove the fluid in a procedure called myringotomy and ventilation tube placement.