Middle Ear Infection

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The ear is divided into three main parts, outer, middle and inner. The outer ear is the canal from the outside to the eardrum. Wax can accumulate here, and the infections collectively known as otitis externa, swimmer's ear or tropical ear are the most common ones to occur.

The middle ear contains three tiny bones that transmit the vibrations of the eardrum to the hearing mechanism which constitutes the inner ear. There is a small tube (the Eustachian tube) connecting the middle ear to the back of the nose, and infection can enter the middle ear from there. If the tube becomes blocked with phlegm, pressure may build up in the middle ear, causing intense pain that often develops during the night. Until the blockage is relieved, and the pressure drops, the pain will continue.

If phlegm and mucus fill the middle ear, the condition is known as 'glue ear'. If this 'glue' or other fluid within the middle ear becomes infected, the patient has otitis media ('otic' refers to the ear, '-itis' means infection, and 'media' means middle). Infection can also spread from the outer ear to the middle ear.

The patient experiences the sudden onset of severe pain, often at night, and will usually have a fever. Pressure on the outside of the ear aggravates the pain. Children are far more commonly affected than adults.

Treatment involves antibiotics by mouth and medications to dry up phlegm. It is sometimes necessary for an ear nose and throat specialist to perform a small operation on the eardrum to relieve the pressure.

If the otitis media is left untreated or progresses rapidly, the bulging eardrum may burst, and blood and pus will ooze out of the ear canal. The pain may be relieved by a rupture of the eardrum, but effective continuing treatment with antibiotics is essential to ensure that the eardrum repairs itself completely. This normally occurs in one or two weeks. If the hole in the eardrum fails to heal after several months, it may be necessary to have a small operation in which the eardrum is repaired using a tiny skin graft. Rarer complications of otitis media include a spread of the infection into the surrounding bone, or into the bloodstream or brain.

Prevention is always better than cure, and using cold treatments to clear away the excess secretions at an early stage may prevent the blockage of the tube and infection in the middle ear. Any child who complains of ear pain must be seen by a doctor at the earliest opportunity.

Children who have recurrent ear infections or glue ear may require a tube to be inserted through the eardrum to allow the constant equalisation of pressure. These tubes are known as grommets, and their insertion is one of the simplest and most common operations required in children.

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