Infectious Ear Disease

Otitis Externa (ear canal infection)

Otitis externa is an infection or inflammation of the ear canal typically caused by bacteria. This is a common problem in swimmers due to prolonged moisture in their ears which creates a favorable environment for bacteria to grow and cause the infection. Use of q-tips can also pose a risk for otitis externa as this can traumatize the skin in the ear canal and introduce bacteria to the injured site. Hearing aids create a moist and dark environment in the ear canal and at times can also traumatize the lining of the ear canal allowing for bacteria to cause infection.

Typically patients with otitis externa will present with one-sided pain and tenderness of the external ear. The pain can be quite severe, and often times touching or moving the ear will increase this pain significantly. Patients also may have some drainage from the ear, but this is not as typical. Treatment includes topical ear drops and/or oral antibiotics. Occasionally, the ear canal may swell, necessitating a small wick to be placed in the canal until inflammation subsides.

Other canal infections can be caused by fungal or viral infections. Otomycosis is an infection of the ear canal caused by an overgrowth of fungal debris. This is a common problem in patients with hearing aids, as these create a warm moist environment, an optimal condition for fungal growth. Aspergillus is the most common fungus found in otomycosis. With the use of microscopy and cultures, your provider will be able to differentiate the cause of the infection and treat accordingly.

Necrotizing Otitis Externa

Necrotizing otitis externa is an infection of the ear canal that is more aggressive than normal otitis externa and directly related to an immunocompromised state. This is seen most frequently in patients with poorly controlled diabetes or those with HIV and AIDS. Necrotizing otitis externa starts as an infection of the ear canal, however can progress to involve the temporal bone and skull base. Therefore early diagnosis and proper treatment are crucial.

Symptoms are similar to those with otitis externa, however unilateral ear pain is generally severe despite treatment with pain medication and may prevent sleep. Some patients may experience high fever and diabetic patients may experience very high blood sugars that are difficult to control. Blood work will likely be drawn and the patient will be started on oral as well as topical antibiotics. Imaging of the head such as a CT, MRI or nuclear scan will also be performed to assess the extent of the disease. The patient may need to be referred to an infection disease specialist for intravenous antibiotic treatment. On the rare occasion that the disease is not responding to antibiotics, surgery may be indicated remove affected tissue and cells.

Acute Otitis Media (middle ear infection)

Acute otitis media is inflammation frequently following infection of the middle ear. It is usually caused by bacteria of infected secretions reaching the middle ear space through the eustachian tube, which connects to the sinuses. This can occur if the eustachian tube is not working properly, or from bacterial colonization of the nose. The most common symptoms seen with otitis media are ear pain and fever, particularly in younger children. On physical exam the eardrum may appear bulging, red, or white.

Treatment of the infection depends on the stage and severity, and may even consist of close monitoring for resolution. If resolution does not occur, or symptoms worsen, treatment with oral antibiotics or ear-drops, may be indicated. If a patient begins to experience recurrent acute otitis media, there may be a need to eliminate environmental factors such as smoke exposure or day-care attendance, or start on allergy medication.

Chronic Otitis Media

Chronic otitis media is a persistent infection of the middle ear characterized by fluid accumulation, drainage and/or pain lasting over 3 months. This infection is caused by the trapping of fluid behind the eardrum due to a malfunctioning Eustachian tube (drainage tract). Chronic otitis media can lead to hearing loss and/or eardrum perforation. It can also be a sign of a more complicated issue such as the presence of a skin cyst (cholesteatoma). Treatment of the infection may consist of ear-drops, topical powders, or oral medications.

In addition, it is very important to correct the cause of the problem by addressing the Eustachian tube. Eustachian tube dysfunction can be improved by allergy control or surgical intervention by placing pressure equalization tubes in the ear drums. In children, this is performed in the operating room. In adults this can be performed in the office by one of our trained providers.

Cholesteatoma of the ear

Cholesteatomas are an accumulation of dead tissue within the middle ear space. Eustachian tube dysfunction (blockage of the drainage path of the middle ear) creates an environment of decreased (negative) pressure within the middle ear, which causes the eardrum to retract. When the drum retracts, it can create a space for the pocketing of debris. This pocket can grow and become a nest of infection that erodes surrounding bones. Cholesteatomas are associated with symptoms of chronic ear drainage, pain, fullness, hearing loss, and dizziness. The retraction pocket of a cholesteatoma can be identified during an office visit but usually requires a CT scan for full evaluation and diagnosis.

In order to prevent further growth and progression of symptoms, treatment involves surgical removal. Following surgery, 30-50% of cholesteatomas recur due to continued Eustachian tube dysfunction. Therefore, it is important for continued follow-up appointments to be maintained in order to evaluate for re-occurrence. During surgery, it is often necessary to remove the bones of hearing due to erosion or involvement in the cholesteatoma. If this occurs, then a titanium ossicular prosthesis will replace the bones of hearing. In some cases of large cholesteatomas, it will be necessary to perform a second-look surgery during which the bones of hearing will be reconstructed with a prosthesis. After having a cholesteatoma, hearing may not return to “normal” but may be improved following its removal. Therefore, the primary goal of removal surgery is not to achieve baseline hearing but is to create a safe, infection free middle ear.

Mastoiditis

Mastoiditis is inflammation often resulting from infection of the mastoid air cells located behind the ear. When it occurs as a complication of a middle ear infection (otitis media) it may be life threatening if untreated. Fortunately since the modern use of antibiotics, the number of cases of otitis media progressing to mastoiditis has greatly decreased, and the condition is now considered rare. Symptoms of mastoiditis can mimic those of a middle ear infection including fever, ear pain, and a conductive hearing loss. Others may experience tenderness, redness, or swelling behind the ear. Based on symptoms and physical exam findings, if the clinician suspects mastoiditis, the diagnosis can be confirmed with CT imaging of the temporal bone.

Surgical treatment may include making an incision in the eardrum (myringotomy) or placing a pressure equalization tube in the eardrum to allow drainage of the middle ear. Also, intravenous antibiotic treatment may be indicated to quickly and effectively eradicate the infection. Treatment warrants close observation. If mastoiditis persists despite proper management, further surgical intervention to drain the infected contents of the mastoid air cells may be indicated and a mastoidectomy will be performed.