Types of Ear Infections

Ear infections occur in the outer or middle ear. Middle ear infections (otitis media) happen when fluid is trapped behind the ear drum. These are often complications of viral upper respiratory infections (colds). They can be painful and transiently affect hearing. Outer ear infections (otitis externa) occur in the skin of the ear canal from the drum to the outside of the ear. These result from either chronic skin conditions such as eczema, dermatitis, or from opportunistic bacterial or fungal growth after chronic water exposure

Middle ear Infections

Children are especially prone to middle ear infections because their natural middle ear drainage pathways, i.e. Eustachian tubes, are shorter, smaller, less vertical. 

This allows for bacteria from the nose and sinuses to travel up the Eustachian tube to middle ear, get trapped, and cause an infection. Otitis media is not caused by swimming or water exposure. Eighty-five percent of all children have one episode of otitis media by 15 months of age. Many of these will resolve in time without complication and are managed well by primary care physicians. Others are more frequent, more symptomatic, utilize many antibiotics, or result in hearing impairment that necessitates an ENT for management. 

You can’t always stave off an ear infection, but there are steps you can take to reduce the chances of your child developing one. These include breast-feeding your baby (if possible), making sure they are up-to-date on vaccinations, practicing good hygiene (e.g., regular hand-washing), keeping your child away from tobacco smoke, and enrolling them in as small a day care or preschool facility. 

Many children with time and patience, especially if their symptoms are minimal, can be supported with medicines and will outgrow their otitis media without surgery. Others will find the symptoms significant enough that ear tube surgery becomes a more attractive option. 

Outer ear Infections (Otitis externa or Swimmer’s Ear)

The skin in the outer ear has a unique environment. Small amounts of bacteria and fungus live on it ordinarily (Eww) and usually do not cause a problem. Frequent water exposure creates an environment where organisms, that are usually harmless, multiply and create inflammation that may be itchy, irritating, and in some cases, very painful. This is more common in people who are old enough to swim. If you tug on the outer ear of a child with swimmers ear it will cause pain. Sometimes the skin, both in front and behind the ear, will become red and tender. It also can hurt when they open their mouth. Swimmers ear is treated with topical antibiotic drops. Outer ear infections are usually caused by different bacterial than middle ear infections and do not respond to most antibiotics given for middle ear infections. Some outer ear infections are fungal and will not respond to typical topical antibiotic drops. Cultures taken in Dr. Sipp’s office can be helpful in differentiating how to treat this problem. The American Academy of Otolaryngology Head and Neck Surgery publishes a nice guideline for this ailment.

Problems Caused by Middle ear infections

The majority of middle ear infections are transient and short lived and result only in some discomfort, fussiness, and decreased sleep. This may be harder to tolerate though if the episodes are more severe or closer together. Antibiotics are usually tolerated well, but they can cause GI upset, allergic reactions, and the bacteria associated with the infections can be less responsive to antibiotic treatment. Sometimes, the infection goes away, but the remaining middle ear fluid results in temporary hearing loss that could affect development. In rare circumstances, ear infections can spread to the bone behind the ear (mastoiditis) which requires more immediate treatment. While rare with todays vaccines, meningitis can still be caused by a middle ear infection.

Impact of outer ear infections

Most swimmer’s ear episodes respond quickly to topical antibiotic treatment. It can be very painful though and I have seen a child or two hospitalized for pain control. Aggressive pain management may be necessary to keep a child comfortable during recovery. Once a child has had swimmers ear, they are a little more prone to getting it again and Dr. Sipp can be helpful with strategies of prevention as well as treatment. Swimmers ear spreads to the bone behind the ear essentially only in the immunocompromised. Mostly swimmers ear creates painful and disappointing breaks from fun activities.