"Earache" or Ear Infection?

Many ear infections cause earache, but not all earaches are caused by an infection. This is an important distinction, since antibiotics are often needed to treat ear infections, but are not required for earaches that are not caused by an infection, or even for certain types of ear infection. Let's look at several conditions that can cause earaches.

Causes of earache: The pain of earache results from inflammation and swelling of the structures that make up the ear, including the external ear canal, the tympanic membrane (ear drum), and the middle ear. One of the most common causes for mild earache is a buildup of fluid in the middle ear in association with a viral upper respiratory tract infection, such as the common cold. Even if the trapped fluid behind the eardrum is not infected, the pressure causes it to bulge and throb. As with other manifestations of a cold, mucus in the middle ear and associated earache usually clears on its own. On occasion, however, mucus in the middle ear along with blockage of the tube that drains the middle ear (Eustachian tube) sets the stage for the development of a bacterial infection. This is called acute otitis media and is the most common cause for an earache that requires antibiotics.

Another fairly common cause for earache, particularly in the summer when swimming is a common pastime, is otitis externa, or "swimmer's ear". Bacteria that cause swimmer's ear are able to grow and multiply easily in the warm moist environment of the external ear canal. Like bacterial otitis media, swimmer's ear, is treated with antibiotics, although they are usually delivered topically (ear drops) rather than by mouth.

Inflammation of the ear drum, known as myringitis, may be due to localized infection or trauma. Local trauma to the ear drum can occur from damage by a foreign object like a Q-tip or paper clip used to remove wax or an insect. The ear drum can also be ruptured, a condition known as "barotrauma", from changes in pressure due to scuba diving, flying in an airplane, or due to an explosion or very loud noise. A less common cause for earache is "referred pain" from some other condition, such as tooth decay or temporomandibular joint dysfunction.

Distinguishing minor earaches from ear infections: A question that arises commonly, particularly in children, is how to tell an earache, such as one caused by a viral upper respiratory tract infection, from the more serious bacterial middle ear infection. Here are a few clinical clues to help tell these two apart:

• The pain produced by acute otitis media is generally more severe and persistent than that caused by a viral infection.
  
• Serious ear infections are usually associated with fever, sometimes as high as 104 degrees F.
  
• Fluid draining from the ear, particularly if it is yellow or green, often indicates that the eardrum has ruptured, a feature suggestive of bacterial otitis media.


• Hearing loss or vertigo (a sense of spinning) indicates that there may be a more serious problem than simple earache.

When one or more of these features are present, it is important to see a doctor for evaluation.

Diagnosing an ear infection: When an ear infection is suspected, the doctor examines the ear with an instrument called an otoscope. Through the otoscope, the ear canal and ear drum can be inspected. If an ear infection is present, the eardrum may be red or bulging. The doctor can also check for the presence of fluid in the middle ear by blowing a small amount of air against the ear drum and watching for movement. If fluid is present, the eardrum will not move back and forth. Another diagnostic tool for evaluating eardrum movement is called tympanometry.

Self-care of earaches: Although there are numerous "home remedies" described for treating simple earache, such as placing slightly warmed olive oil in the ear canal, the safest treatment is to apply a warm, moist cloth over the affected ear and take a mild analgesic such as acetaminophen or ibuprofen. In certain cases, physicians may prescribe ear drops containing benzocaine (e.g. Auralgan) which works by numbing the sensory nerves of the ear drum.

Preventing ear infections: The following steps can help prevent earaches or ear infections:

• Avoid exposure to second-hand smoke. This has been shown to cause thousands of ear infections in children each year.
  
• Ear infections may occur after a case of the flu which can be prevented with an annual flu shot.
  
• Avoid putting objects in the ear such as a paper clip or hair pin. Even cotton-tipped swabs can irritate or damage the skin of the external ear canal.
  
• Use a drying agent in the ears after bathing or swimming. Commercially available products to prevent swimmer's ear include Swim Ear and Star Otic. "Homemade" ear drops can be made by mixing one ounce each of white vinegar and isopropyl (rubbing) alcohol.
  
• Control allergies. Inflammation and blockage of the Eustachian tube caused by allergies is a contributing factor to ear infection.
  
• Mouth breathing or snoring in children may be caused by large adenoids which can contribute to recurrent ear infections. In this case, an examination by an otolaryngologist for consideration of surgery to remove the adenoids may be necessary.
  
• If bottle feeding your baby, avoid bottle propping which can cause formula and other fluids to flow back into the Eustachian tubes.

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