In a perfect world, the inner ear is sealed from the outer ear by the ear drum. In other words, you can have infection inside the ear, outside the ear, or both.
‘Otitis Media’ is an infection inside/behind the ear drum. 70-80% of these are VIRAL infections. Antibiotics do not work on viral infections, all you can do is treat the symptoms, use time & mother nature, and be Dr. Mom/Dad. The other 20-30% either are bacterial infections from the get go, or start off as viral infections and develop a secondary bacterial infection.
There is NO test to PROVE viral vs. bacterial other than getting a sample of the infection from behind the ear drum. Fevers, green pus, clear fluid, extreme pain – all can be caused by either viral or bacterial infections. ‘Strep throat’ swabs can be helpful in identifying bacterial infections though. If that comes back negative, the chance of the infection being viral is much higher and a ‘treat the symptoms/wait/watch’ approach is generally followed.
Pain control is CRITICAL. Adults do not give kids enough credit for how terribly bad an ear infection can hurt. Ibuprofen or acetaminophen MAY be enough, I often use codeine as well for a couple of days for kids that are suffering.
Antibiotics that are given for viral infections, or given for bacterial infections but not used as directed, may result in the development of resistant bacteria – those that no longer are killed by the antibiotic. Many of our antibiotics now have serious resistance issues country and even world-wide, and this is due for the most part from use of antibiotics when the patient had a viral rather than bacterial infection. Many patients/parents become VERY upset if they/the kid doesn’t get an antibiotic for their ear infection/cold/’flu’ whatever… despite the fact that it’s probably a viral infection.
“Doc, how long will it take for me to get well?”
“Two weeks if you take antibiotics, 14-days if you don’t.”
Sometimes either type will result in the eardrum bursting. This produces almost immediate relief as the pressure comes off, although it can be pretty scary. Most of the time the eardrum heals without problems, occasionally not.
The NUMBER 1 reason kids continue to get ear infections is (drum roll please)… a parent or caregiver smoking! Smoking ‘outside’ ‘only when the kid is in bed’ etc. DOES NOT matter… if they can smell the smoke (even on clothing), the nicotine byproducts paralyze the microscopic hairs in the respiratory tract (called cilia), kids can’t clear the snot out of their system as well, the snot acts as food for the germs, the second hand smoke products also impair the immune system, and off you go…
The NUMBER 2 reason is… not getting the HIB vaccine!. H. influenza B is responsible for most of the 20-30% bacterial ear infections noted above not caused by Strep!
The NUMBER 3 reason is… Eustachian Tube Dysfunction! These are the tubes that drain the inner ear to the area above the roof of the mouth. If the tissue in the area of the tubes (like Adenoids & Tonsils, which are Lymph Gland infection filters) swell up, the tubes can become blocked, pain ensues, and the germs multiply like mad in the blocked tube and ear.
Otitis Media is usually treated with pain & fever control, decongestants to try and open up the Eustachian tubes, fluids, rest, increasing the humidity in the living area, immune system boosters & proper nutrition, time, and Dr. Mom/Dad. If a bacterial infection is shown by throat swab, or suspected by history/clinical exam/etc. antibiotics may be prescribed along with above. It is CRITICAL that if antibiotics are started, they are finished on-time, according to the directions.
‘Otitis Externa’ is an infection outside the eardrum. It is much more likely to be viral, or even fungal. Exposure to dirty water (hot-tubs, rivers, lakes, community pools, etc) is one common cause, as is getting water in the ear canal and sitting – making a growth area for germs. The NUMBER 1 cause though is… kids sticking snotty fingers in their ears & planting the germs right there, LOL. Nose To Ear Disease… it often produces drainage even with an intact eardrum. Green foul smelling goo is characteristic of a certain type of bacterial infection usually found in dirty water. Clearish/milky discharge is more likely viral, but all bets are off in the external ear.
These generally are treated with ear drops, that may or may not contain a steroid as well, to reduce pain and swelling. Washing with Hydrogen Peroxide (3% household ONLY!), vinegar, olive (sweet) oil, or various combos is often helpful and soothing. Any medicine, be it RX or over the counter, should only be used if the eardrum is intact, unless it is a special type. Application of meds into the middle ear can result in hearing loss, pain, etc. The best way to tell is to look.
A simple ‘otoscope’ is available for about $10 in pharmacies. Practice with it on healthy folks and you will quickly get a feel for ‘normal.’ Holes in the eardrum are usually accompanied by pain at time of rupture with relief after it bursts, loss of hearing or ‘hollow’ sounds, and drainage. Holes are usually very obvious on inspection with a scope. Next time you are at your doctors, ask for a lesson on using your scope.
Other measures as above should also be used. Again, pain control matters, and finishing the medicines as directed REALLY matters!
Ear infections are a classic example of where the art & science of medicine cross. Distinguishing between a viral and bacterial infection is sometimes impossible in the exam room. Ya makes your best guess and does the best you can. In any case, always insist on effective pain and symptom control for the patient in balance with their symptoms, push the fluids, give their body every chance to get better – it’s trying very hard to do so, and finish any antibiotics that are started!