Ear infection

Ear infections can be divided into Otitis Externa – the outer ear, including the ear canal, and Otitis Media – the middle ear, deep to the ear drum. They are both painful conditions, also causing hearing loss and discharge.
Otitis Externa can be caused by damage to the ear canal from using cotton buds etc. The whole outer ear (pinna) may become reddened and swollen, and it can spread to the skin of the face. Treatment is by clearing debris from the ear can using suction with a microscope, followed by administration of antibiotic and steroid ear drops. Sometime the ear canal is too swollen for drops to pass down, in this situation a tiny sponge ear wick is inserted under microscope control – this sucks iup the ear drops and allows them to travel down the ear canal. The condition usually settles 48H after treatment has been started.
Otitis Media often occurs in children. On examination a reddened, bulging ear drum is seen. It often causes a high temperature and can be associated with febrile convulsions (fits). There is little evidence that antibiotic tablets work for this, but if the patient is very unwell with a high temperature, Augmentin can be tried. Usually it settles with painkillers and time, often with a brief discharge from the ear as the ear drum ruptures. Complications include Mastoiditis, facial nerve palsey and brain abscess, thankfully these are very rare. Surgical treatment involves making a small hole in the ear drum (myringotomy) to drain the pus, which may be sent for culturing to see which bacteria are growing.

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Mike Dilkes MS FRCS(ORL-HNS), FRCSEd, FRCS

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