What to Do About Ear Infections

This is part 2 of the series on the ear, covering the middle ear infections that cause young children and their parents so much pain.

Rob Lamberts, MD,
September 16, 2009
Episode #014

OK it’s time to cover the ears again. Uh, no…don’t cover your ears.  I strongly suggest that you leave your ears uncovered while I cover them…I mean talk about them. On a previous podcast I talked about swimmer’s ear, and today I’ll cover…uh…discuss the middle ear. You know, the part of the ear that gets infected a lot in little kids.

How many times do I have to tell you that this podcast is for informational purposes only? My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.

Middle Ear Infections

Some of my astute listeners out there are probably thinking: "Hey, Dr. Rob, did you say middle ear infection? I thought the infection my kids got was an inner ear infection."

Well, I am not mistaken; I did mean to say middle ear infection. There are three sections of the ear: external, middle, and inner. The external ear is everything on the outside of the eardrum. Some people have generous servings of external ear. The middle ear is a space behind the eardrum that amplifies its vibrations and transmits them to the inner ear. The inner ear takes those vibrations and sends them to your brain so you can perceive sound.

The middle ear is actually a lot like Middle Earth, except it doesn’t have a “-th” at the end. It’s a magical place.

Why Do Your Ears Hurt When You Fly?

The condition of the middle ear is key to hearing well. To transmit sound to the inner ear, the eardrum must vibrate; and one of the keys to getting a normal vibration is for the pressure to be equal on both sides of the eardrum. To equalize pressure, the body uses a little tube called the Eustachian tube, which connects the middle ear to the back of the nasal passages. Yawning or chewing makes the Eustachian tube open up, which is why you can make your ears “pop” when you do these things.

If you’ve been on an airplane, you’ve probably noticed your ears feel funny during take-off and landing. That is because the cabin pressure changes, which decreases the ability of your eardrum to vibrate. If you look around the cabin, you’ll notice everyone yawning or chewing gum. That is basically a Eustachian tube festival. Yippee.

Why Do Your Ears Get Plugged When You Are Sick?

Viruses and allergies can make your nose congested by causing the nasal walls to be swollen. The Eustachian tube connects directly to the back of the nasal passages, and so its walls also get swollen get plugged. That’s why a head cold can make everything sound muffled. That’s your Eustachian tube getting plugged, making it harder for your eardrum to vibrate. That also happens because mucous builds up in the middle ear since it can’t escape out the Eustachian tube.

Why Do Ear Infections Hurt?

Okay loyal listeners, let’s see if you paid attention to the antibiotic podcast. What happens when mucous is sitting around in a warm, dark place—like your middle ear? Very good! Bacteria grow, resulting in the dreaded middle ear infection. These bacteria multiply, causing inflammation and pressure inside the ear, with the end result: pain.

Why Are Ear Infections More Common in Babies?

So why do babies and young children get so many middle ear infections? There are several reasons. The first is that babies’ heads are shaped differently, making it harder for their Eustachian tubes to drain. This is made worse by the fact that babies spend a lot of time lying down.

Another reason is that they get sick a lot. Babies’ bodies are getting used to a world full of germs and learning how to fight them off. Some are better at this than others.

The final reason is reflux, or spit up. Babies do this a lot, and even when it’s not coming out of the mouth and landing on bystanders, it’s often happening at the back of their throats, hitting the Eustachian tubes. Scientists have actually found stomach enzymes in the ear fluid of young children with ear infections. That is probably a major reason some babies have more ear infections than others.

How Do You Treat Ear Infections?

So how are middle ear infections treated? If you ask any person (or doctor for that matter), they’ll say ear infections are treated with antibiotics. But my faithful listeners should know better, remembering from the antibiotic podcast that a significant percentage of ear infections will actually clear up without antibiotics.

If I find an ear infection on a routine exam of a child who is not sick, I usually don’t treat it. But if a child (or adult, for that matter) has significant pain and/or fever with it, the standard of care is still to use an oral antibiotic.

Unfortunately, some people get lots of ear infections, requiring repeated use of antibiotics. Need I remind you that this can cause evil mutant armies of resistant bacteria to emerge?

Ear Tubes and Ear Infections

For people with repeated ear infections, ear tubes may be good to consider. These tubes go through the eardrum and do the job of the Eustachian tubes, equalizing the pressure and allowing the fluid to drain out of the middle ear. Two of my kids got tubes; believe me, they work incredibly well. They have the added benefit of decreasing the use of antibiotics because they greatly reduce the number of middle-ear infections.

What to Do if Your Eardrum Ruptures

I remember watching an episode of Tarzan when I was a kid. He went too deep in the water when doing something like wrestling a hippo, and ruptured his eardrums. Blood came out of his ears. I was traumatized. I thought he’d never hear again short of a miracle. I am still recovering from that trauma.

Well, the good news for Tarzan is that ruptured eardrums are usually no big deal. Sometimes the pressure produced by an infection causes the eardrum to rupture. This is kind of like the body making its own ear tubes, allowing the infected fluid to drain out of the ear. The relief of the pressure can actually take away the pain. So a good clue that an eardrum has ruptured is a sudden relief of pain along with ear drainage. You may want to see your doctor if this happens, but it’s nothing to panic about.

I need to mention that traumatically rupturing an eardrum is more serious than a pressure-induced rupture because it can damage the bones in your ear. Don’t stick things in your ear. I could quote the common admonition: never stick anything sharper than your elbow in your ear, but I don’t want anyone hurting their shoulders trying to do it.

So here are my quick and dirty tips regarding middle ear infections:

  1. It’s ok to wait. If you or your child is not in bad pain or running a fever, it’s OK to let an ear infection go. Many will get better without antibiotics.

  2. 2.      Use acetaminophen or ibuprofen for the pain. You can also use pain relief eardrops, but don’t use them if you suspect a perforation or if your child has tubes.

  3. Don’t demand antibiotics. Again, overuses of antibiotics is often much more dangerous than infection.

  4. For repeated infections requiring multiple antibiotics, ask if ear tubes are appropriate.

That pretty much covers…uh… wraps up middle ear infections.

If you have topics you want me to cover, send them to housecalldoctor@quickanddirtytips.com. You can follow me on Twitter at @houscalldoc, and join the party at my Facebook page, where I answer listener questions, talk more in depth about podcast topics, and generally have a raucous time.

Catch you next time! Stay Healthy!