NORMAL STRUCTURE AND FUNCTION
The middle ear is an air-filled cavity which lies between the external and inner ear. It contains the three bones of hearing: malleus (hammer), incus (anvil), and stapes (stirrup). The eardrum and these bones transmit sound vibrations to the inner ear. The middle ear cavity is connected to the back of the nose (near the adenoids) via the eustachian tube which acts as a pressure equalising valve. The air in the middle ear is continually being absorbed into the bloodstream, thus if normal pressure is to be maintained, this air must be replaced. Consequently a normal eustachian tube will open momentarily every time we swallow to allow a small amount of air into the middle ear.
What is Otitis Externa ?
Otitis externa is an inflammation, irritation, and/or infection of the outer ear and ear canal. In Australia, it is a fairly common condition, affecting mostly teenagers and young adults.
What causes Otitis Externa ?
The most common cause of otitis externa is a bacterial infection, but fungi may also be involved. Patients frequently describe a history of recent water exposure (especially swimming in polluted water) or mechanical ear trauma (scratching, use of a cotton bud, or foreign objects in the ear). Further, the skin of the outer ear may be predisposed to infection by various chemicals such as shampoos, hair sprays and hair dyes.
What are the Symptoms of Otitis Externa ?
· drainage from the ear (yellow, yellow-green, pus, foul smelling)
· ear may feel blocked
· itching of the ear or ear canal
· hearing loss
· ear pain (tender to touch & may worsen on head movement)
· noise in the ear (tinnitus)
The ear and ear canal may become red and swollen. Consequently, the ear canal may become very narrow and the ear drum may be difficult to visualise.
It is important to keep water out of the ear during the infection and for 3-4 weeks after it has been cured (Your doctor will give you more precise times for your condition). A large cotton ball with Vaseline may be applied during showers.
Treatment is a combination of careful cleaning and the use of medicated ear drops. Microscopic cleaning aims to physically remove the debris in the ear canal which is a combination of dead skin and organisms. Ear drops are usually a combination of an antibacterial (+/- antifungal) and a steroid (eg Locacorten-Vioform, Sofradex, Kenacomb Otic, Cipro HC) or they may be an antibiotic alone (eg Soframycin, Ciloxan, Genoptic). Occasionally an antifungal alone (eg Canesten) may be used. When applying the drops, it is important to lie on the opposite ear, gently “pump” the drops into the ear (by pushing on the skin in front of the ear canal 5-10times), and continue to lie on the opposite ear for 10 minutes. This will ensure that the drops get into the deep parts of the infected canal. (Do not “pump” the drops in if there is a wick…see below)
In resistant cases or when the ear canal is closed, a wick may need to be inserted. This is usually made up of compressed sponge which will “soak in” the drops that are being used, holds the drops in contact with the skin of the canal, and will help open the ear canal by gently expanding. Subsequent repeated cleaning may be necessary to remove debris from the deep parts of the ear canal, as the canal opens. Another wick may also be necessary.
In more severe cases, a systemic antibiotics (oral or IV depending on the patient's condition) may be necessary. Pain medication may be used if pain is severe. Warmth to the ears may reduce pain.
(NB: There is a theoretical risk that if there is a hole in the eardrum, then ear drops may injure the inner ear. In most cases the risk of the infection itself and its possible complications, outweigh the risk of the drops, thus they may be prescribed. If you have any concerns discuss this with your doctor).
Once the infection is cured, you need to protect your ears from further damage. Avoid scratching your ears. Do not insert cotton buds or other objects into the ear. The problem with cotton buds is that they pack the ear wax and/or debris deeper in the narrow ear canal, irritate the thin skin of the ear canal, and can make it "weep" or bleed.
If it is safe, your doctor may prescribe a prolonged course of drops (AQUAEAR) that aim to change the pH of the ear canal to a more acidic environment. This will prevent growth of micro-organisms. Three drops twice a day and four drops after showering for 1 month is usually sufficient. These eardrops are sold without prescription
If water enters your ear after showering, swimming, hair washing, etc., apply 4-6 drops of AQUAEAR into the ear (provided there is no hole in the ear drum) and turn that ear down to let the water/drops run out. A hair dryer on low setting, held at a safe distance (not to heat the face) may be used. The hairdryer alone is safe if there is a hole in the ear drum.
Some individuals have itchy, flaky ears or ears have wax build up. These are very likely to develop swimmer's ear. These people should be especially careful about using AQUAEAR as described whenever water gets trapped into the ears. These people may benefit from having their ears cleaned each year.
Itchiness of the ear is most commonly due to a prolonged skin inflammation (chronic dermatitis) of the ear canal, a condition similar to dandruff in the scalp; the wax is flaky, dry, and plentiful. Sometimes it may be caused by a fungus or allergy. Interestingly some foods (eg greasy foods, sugar and starches) may aggravate the condition, thus patients may try to avoid these. A steroid eardrop maybe prescribed to be used for a few days at bedtime when the ears itch.
Excerpted from material prepared by the Michigan Ear Institute, Farmington Hills, MI, USA - August 2001
Please note: The above is intended as a general guideline only for Dr. Becvarovski’s patients.
This material should not be used for purposes of diagnosis or treatment without consulting a physician.
Each patient is an individual and should be treated accordingly.
Please contact our rooms if you are concerned or require any further information.
Dr Zoran Becvarovski MBBS, FRACS
Consulting Rooms Hospital Appointments
St George Private Medical Complex St George Public Hospital
Suite 7A, Level 5, St George Private Hospital
1 South Street Kogarah 2217 Hurstville Community Private Hospital
Telephone: 9553 0066
Fax: 9553 0444