Ear infections

Ear infections

The ear is made up of three parts. The outer ear includes the part you can see and the canal that leads to the eardrum. The middle ear is separated from the outer ear by the eardrum and contains tiny bones that amplify sound. The inner ear is where sounds are translated to electrical impulses and sent to the brain.

Any of these three parts can become infected by bacteria, fungi or viruses. Children are particularly prone to middle ear infections (otitis media). It is estimated that around four out of five children will experience a middle ear infection at least once.

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Ear infections are diagnosed by physical examination and laboratory analysis of pus or discharge. In some cases, CT scans may also be taken.

Types of ear infection include:

• otitis externa
• otitis media – acute or chronic
• serous otitis media
• infectious myringitis
• acute mastoiditis
• vestibular neuronitis
• herpes zoster of the ear.

The function of the Eustachian tube

The ear is connected to the back of the nose via the Eustachian tube. This tube equalises air pressure inside the ear, and funnels secretions from the middle ear into the throat. The walls of the Eustachian tube lie flat against each other to prevent the migration of bacteria or other germs into the ear from the nose and throat.

Whenever we swallow, a small muscle flexes and opens the tube, allowing air pressure equalisation and the drainage of secretions. If the Eustachian tube is blocked, secretions and associated bacteria build up inside the middle ear. This can cause ear infections, mild deafness and an increased likelihood of a ruptured eardrum.

The symptoms of an ear infection depend on the type, but may include:

• earache
• mild deafness or the sensation that sound is muffled
• ear discharge
• fever
• headache
• loss of appetite
• itchiness of the outer ear
• blisters on the outer ear or along the ear canal
• noises in the ear – such as buzzing or humming
• vertigo (loss of balance).

Vestibular neuronitis

The inner ear contains the organs of balance – the vestibular system. It includes three fluid-filled loops (semi-circular canals) which respond to the rotation of the head. Near the semicircular canals are the utricle and saccule, which detect gravity and back-and-forth motion. When the head is moved, signals from these organs are sent via the vestibular nerve to the brain where it is processed

Vestibular neuronitis is inflammation of the vestibular nerve, probably caused by a viral infection. The main symptom is sudden and dramatic vertigo, which may be accompanied by nausea and vomiting. The eyes may also involuntarily flutter towards the affected side of the head.

Treatment options for vestibular neuronitis include:

• medications, including antihistamines
• anti-nausea medications
• vestibular physiotherapy – to help your brain to compensate or retrain.

Serous otitis media

Serous otitis media is known as glue ear. Children aged between six months and two years of age are most vulnerable to this type of ear infection. Glue ear commonly develops after a middle ear infection, and is characterised by the build-up of fluid and pus within the middle ear. Treatment options include antibiotics.

If antibiotics fail, or if the child is plagued by repeated attacks of glue ear, surgery to insert small drainage tubes (grommets) may be needed.