Ear Problems

What causes ear problems?

Otitis media is by far the most common ear problem. It is the result of an infection or inflammation in the middle ear, usually caused by a viral or bacterial infection. The middle ear is an air-filled cavity, which lies between the outer ear and inner ear. It is connected to the back of the throat by a small tube called the eustachian tube which  keeps the pressure on both sides of the ear drum equal. In response to infection, the eustachian tube fails to open properly, preventing air from reaching the middle ear. This leads to the build-up of fluid in the middle ear, which eventually can thicken and become “gluey”… hence the name “glue ear”. The build-up of fluid in the middle ear prevents the eardrum and ossicles (tiny bones which vibrate to allow sound to pass) from moving properly, leading to hearing loss. The fluid build-up, if severe, causes pressure in the middle ear which is very painful.

Children are especially prone to otitis media, as their eustachian tubes are smaller, straighter and shorter, making it very easy for bacteria and viruses to make their way into the middle ear. With age, children become less prone to this problem and it is less common in adults.

Who’s at risk?

The risk of otitis media is increased by:

• A family history
• Exposure to cigarette smoke, eg. passive smoking
• Mixing with other children where colds are common, eg. day care, an older sibling at school
• History of allergy problems.

Prevention and treatment

1. Otitis media
Symptoms of otitis media include ear pain, fever, irritability and crying. Babies and small children may wake in the night with pain. Hearing is usually reduced. Sometimes children may have no symptoms other than irritability or lethargy. With glue ear there may be no symptoms at all, just failure to hear well. Delayed language development can indicate glue ear. Glue ear is diagnosed by your GP looking into the ear or by school or clinic testing with Tympanometry.

2. Other common ear problems

• Outer ear infection (otitis externa) – the skin of the ear canal becomes inflamed as a result of a trauma such as scratching, or eczema or contact with water (swimmers ear). While this can be painful and may give a watery discharge, there is no hearing loss, and the problem is treated with eardrops.
• Perforated eardrum – can be a complication of a middle ear infection, head injury, loud noise or a foreign body into the ear canal, eg. an earbud. The eardrum usually heals itself with a return to normal hearing but sometimes needs surgical patching.
• Balance problems (vertigo) – the vestibular system lays inside the inner ear, as five different fluid-filled sections. Each section detects movement of the head, and tells your brain of the activity. Problems with the vestibular system can lead to vertigo, dizziness and nausea/vomiting – similar to seasickness.

3. Antibiotics and ear infections
While it is still common practice to prescribe antibiotics for acute otitis media, research suggests that milder cases will resolve spontaneously.

4. Glue ear and grommets
Persistent episodes of acute otitis media and “glue ear” may be treated with grommets. Usually grommets are inserted if a child has experienced six or more episodes of otitis media in one year or there is persistent hearing loss. Grommets are small plastic tubes which are inserted through the eardrum to allow air into the middle ear, and the trapped fluid to drain into the eustachian tubes. Once inserted, grommets last for 6-15 months and expel themselves spontaneously. After surgery, which is performed under a short-acting general anaesthetic, most children experience improved hearing and a reduction in otitis media attacks. Most children have no post surgical pain, and further insertion of new grommets is only required in around 25% of children.

5. Mastoiditis
This is an infection of the mastoid bone of the skull. The infection is usually caused by a middle ear infection which spreads to the mastoid bone. This condition is most common in children. Symptoms include swelling behind the ear, redness of the ear or behind the ear, fever and headache. This condition is difficult to treat and often requires repeated or long-term treatment with antibiotics. If antibiotics do not work, surgery is required to remove a part of the mastoid bone and drain the infected area.