It is estimated that at least 2 out of 3 children have one or more ear infections until the age of three. Although this condition is more common in childhood, in can afflict people of all ages. The good news is that it can be treated and prevented. Find out how.
What is an ear infection?
‘Otitis’ is an inflammation or infection of the ear. This can be caused by a virus, fungi or bacteria, or due to disorders in the structures surrounding the ear, such as the Eustachian tubes, which connect the nose to the ears. Ear infections usually cause pain and fluid build-up, but they may also only exhibit hearing loss without earache (e.g. serous otitis media, frequent in children and caused by non-infected fluid build-up in the middle ear space).
Ear infections are quite common and can be treated with clinical help. However, an ear infection that is not properly treated or monitored can lead to serious complications, such as partial or temporary hearing loss, persistent fluid in the ear and cyclical infections. Some untreated ear infections can become chronic and progress to severe conditions, such as brain abscess and infection of structures near the ears (e.g. mastoiditis, facial paralysis).
What are the types of ear infection?
There are essentially two types of ear infection, which vary according to the affected part of the ear.
1. External otitis (or outer ear infection)
External otitis is an inflammation of the outer ear, the part that extends from the outside of the ear to the tympanic membrane. Various risk factors can cause an outer ear infection, such as frequent activities in the water, which is why this condition is also known as "swimmer’s ear" or “surfer’s ear”. This condition is quite common in people who spend a lot of time in damp environments that are favourable to the growth of bacteria or fungi, like swimming pools.
Aside from water, scratches or lesions in the ear canal can also facilitate the entry of microorganisms, triggering inflammation. This is the case, for example, in the use of cotton swabs or other objects used to try and dry the ears, which can injure the skin and facilitate the entry of bacteria.
2. Otitis media (middle ear infection)
As the name indicates, a middle ear infection affects the middle ear space and eardrum. This is the most common ear infection among children and it is also associated with inadequate ventilation of the ear, resulting in infection. Therefore, it is frequent in colds or nose and throat infections, as these prevent proper ventilation of the ear.
What are the principal causes of ear infection?
Ear infections can have several causes, depending on the specific part of the ear that is affected. The principal causes include:
Causes of outer ear infection
• Prolonged exposure of the ear canal to humidity, such as in cases of frequent swimming, bathing or exposure to damp conditions;
• Lesions or irritations in the ear canal caused by incorrectly inserting objects, such as cotton swabs;
• Bacterial or fungal infections in the outer ear canal.
Causes of middle ear infection
• Respiratory infections, such as colds and flus, which can lead to obstruction of the Eustachian tubes (narrow canals that connect the back of the nose to the ears), facilitating fluid build-up in the middle ear;
• Bacterial or viral infections, especially in children, due to shorter and more horizontal ear canals, which facilitates the entry of microorganisms;
• Allergies that cause inflammation of the respiratory tracts and middle ear.
What are the symptoms of ear infection?
The symptoms of ear infection can vary according to the specific type of ear infection and the affected part of the ear.
Symptoms of outer ear infection
• Intense pain in the affected ear;
• Itching of the outer ear canal;
• Redness and swelling of the outer ear;
• Ear sensitive to touch;
• Possible temporary hearing loss;
• Discharge from the ear.
Symptoms of middle ear infection
• Earache, which can be acute and intense;
• Feeling of pressure in the ear;
• Temporary hearing loss;
• Discharge from the middle ear;
• Fever (primarily in cases of bacterial infections);
• Irritability, especially in children.
How is ear infection diagnosed?
An ear infection is diagnosed by a physician, after taking a medical history and examining the patient’s ears. Different specialists can conduct this examination – General Practise and Family Physicians, paediatricians and, especially, ear, nose and throat (ENT) specialists (otorhinolaryngologists). The physician will examine the ear to check for signs of inflammation, redness, swelling or discharge. An otoscope may be used to inspect the ear canal and eardrum, thereby confirming the presence of fluid, inflammation or other problems.
If hearing loss is suspected, the physician may prescribe tests such as an audiometry, an exam that assesses the hearing ability at different frequencies. In more complex cases or to evaluate the extent of the infection, imaging exams may be performed, such as computerized tomography (CT) or magnetic resonance imaging (MRI).
