Ear Infections

The two common types of ear infection are otitis externa, often called swimmers’ ear, and otitis media.

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.

Ear Tubes (Myringotomy procedure)

This is usually a simple surgical procedure which is performed on adults in the office under local anesthesia. In the pediatric population it is usually necessary to have the child asleep in an operating room to ensure the patient is perfectly still. A microscope is utilized to make a very small incision in the eardrum (tympanic membrane). The fluid behind the eardrum is suctioned out. This small hole would close too quickly if left alone and fluid would likely re accumulate. Therefore, a small ventilation tube is placed in the tympanic membrane to keep the hole open. These are made out of an inert material, typically Teflon or stainless steel. A standard tube will last for several months or occasionally several years. This allows for air to enter the middle ear space and bypasses the poorly functioning Eustachian tube. The tube often falls out spontaneously but can be removed, often in the office, once the membranes behind the tympanic membrane have had a chance to heal.

Ear Wax

This is a common and annoying problem for many patients. Although occasionally due to pushing wax in with a Q-tip, most often it is just one of those things that some people are prone to. A narrow ear canal can be a contributing factor. People can attempt to flush their own ears out with a simple mixture of warm tap water and hydrogen peroxide in a 50/50 mix. A bulb syringe is utilized. If there is any history of eardrum perforation this technique should not be performed. For many people, they will need to visit a physician for cleaning. With good lighting and the right equipment it is a straightforward procedure. A variety of apparatus including small metal scoops, irrigation, and suction are used to clean the ear canal.


This procedure involves the repair of a hole or perforation of the eardrum. The hole can be the result trauma to the ear or from the middle ear infection with spontaneous perforation. The hole becomes a source for bacteria to enter the middle ear and cause recurring infections. If the whole is large enough, it affects the ability to hear properly. Audiologic testing can gauge the severity of the hearing loss.

The repair procedure typically involves using a person’s own fascia which is harvested from a muscle in the scalp. With the use of a microscope, the eardrum is lifted and the fascia graft is positioned behind the eardrum and in the perforation. At the same time, or possibly in a separate procedure, the ossicles (small ear bones) can be repaired or replaced to restore hearing. This procedure is performed in an operating room setting. Overnight hospitalization is usually not necessary.

Ear Lobe Repair

An ear lobe tear is a fairly common injury as the result of heavy earrings or accidental tearing when an earring catches on clothing. The pierce hole becomes too large to hold any earring or pulls right through the lobe causing an unsightly cleft. This can be repaired as an office procedure under local anesthesia. The skin within the hole or cleft is removed and the wound edges are repaired with a cosmetic surgical technique. It is possible to place a new hole in the ear lobe once the ear has sufficiently healed.

The information posted on this page is provided as general, background information in the spirit of service to the reader. In no way should it be interpreted as medical advice. While the practice of Robert Feld, MD, LLC, attempts to convey accurate and current information on this site, this information may contain typographical errors, technical errors, or may at some point become out-of-date. You are advised to confirm the accuracy of any information presented on this site before relying on it in any way.

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When you make an appointment with Dr. Feld, you will see Dr. Feld, not a physician assistant or nurse practitioner.

(631) 673-6868