There are two kinds of common ear infections that can affect both children and adults. It is true that children suffer more often from these conditions than do adults and there is a reason for this.
First however, let’s look into the ear and learn about the two kinds of infections. The ear is divided into sections. We have the outer ear that sticks out and looks, well, like an ear. In the center of the ear is the opening to the ear canal into which travel the sound waves we hear. The ear canal is divided into the external portion and the middle ear by the eardrum. The eardrum, or tympanic membrane, vibrates as the sound waves strike it. It transfers those vibrations to the small bones of the middle ear. The vibrations continue through those tiny bones to the inner ear, which is the actual sensory mechanism that transfers the vibrations into nerve signals that then go to the brain. Today we are discussing infections of the external ear canal and the middle ear, but not the inner ear.
As long as the eardrum is intact and has no hole in it, water, dirt, and germs do not get past it into the middle ear. The middle ear is connected to the outside however, by the Eustachian tube, which leads into the back of the throat.
The two most common ear infections involve the external portion of the ear canal and the middle ear. Both of these infections cause pain and both can cause drainage from the ear.
An infection of the external ear canal is called Otitis Externa by the doctors, but the rest of us call it Swimmer’s Ear. It often, but not always, can be caused by getting irritating or dirty water in the ear. Otitis Externa is actually an infection of the skin of the ear canal and can be caused by a scratch when you try to get that wax out or take care of an annoying itch. Because the infected and tender skin of the ear canal is attached to our ear, Swimmer’s Ear is painful when you tug or move the ear around. The canal becomes red, swollen and often drains pus.
Speaking of wax, why do we have it? Earwax, or cerumen, is sticky, so most dirt and debris that may get into our ears will stick to it and be trapped. The wax also sticks to the ear canal skin which slowly grows in an outward spiral direction carrying the wax with it ever so slowly to the opening of the ear where it falls out every once in a while. So, earwax is actually the body’s own ear cleaning mechanism.
The other common ear infection is Otitis Media, or infection of the middle ear. Unlike Otitis Externa, infections of the middle ear don’t hurt when you tug on the outer ear. They still hurt quite a bit all on their own. Fluid, pus, and pressure build up in the middle ear and the eardrum becomes red and painful. How do these occur when no germs can get past the eardrum? The Eustachian tube functions as a connection to the outside world so the middle ear can equalize the air pressure inside itself. This is necessary because the pressures outside change with the weather and with altitude changes. The flexible eardrum would bulge out or be pushed inwardly if the pressures behind it were not equal with the outside world. We have all experienced this problem when our ears pop during air travel. The Eustachian tubes drain minute amounts of mucus out of the middle ear constantly. The mucus is a bit sticky, but thin, and it carries any germs that may have gotten into the middle ear out and back down into the throat. Unfortunately, with allergies and colds, the Eustachian tube can become swollen. When this happens, pressures do not equalize and germs aren’t moved out, allowing them to take hold and infect the middle ear.
The reason children seem to get more middle ear infections than adults is that their Eustachian tubes are very small and more easily blocked by swelling. Additionally, their facial anatomy causes the tubes to lie more horizontally than the adult’s does and this makes it harder to continually drain the fluid and germs from the middle ear. As their faces grow and take on the more elongated and oval appearance of the adult, they “outgrow” their ear infections because the Eustachian tubes are more vertical.
If the pressure and pus build up too much in the middle ear, the eardrum can rupture allowing the pus to drain. This will often cure the infection and usually brings immediate pain relief. We generally prefer to treat the infection with antibiotics before this happens, hopefully preventing it and the severe pain that leads up to it. Painful ear with fever usually indicates middle ear infection. If the ear is very tender to tugging, then it is probably Swimmer’s Ear. Both benefit from antibiotic therapy. See your doctor.
David Welch, DO, FACOEP, is a board certified emergency medicine specialist with 20 years experience. He is the owner/operator of Ultimate Urgent Care Center and Medical Director for Tristate Careflight. For more information please visit http://www.urgentcarecentersaz.com
