Ear infections

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management

Definition

Ear infections encompass infections of the outer, middle, or inner ear, commonly leading to pain, hearing impairment, and in some cases, systemic symptoms.

Aetiology

  • Otitis externa (swimmer’s ear): caused by bacterial (Pseudomonas aeruginosa, Staphylococcus aureus) or fungal infections.
  • Acute otitis media: commonly due to Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.
  • Chronic otitis media: associated with recurrent infections and tympanic membrane perforation.
  • Labyrinthitis: viral or bacterial infection affecting the inner ear.

Pathophysiology

  • Otitis externa results from inflammation of the external auditory canal due to infection or irritants.
  • Otitis media develops when eustachian tube dysfunction leads to fluid accumulation and secondary bacterial or viral infection.
  • Inner ear infections can cause vestibular dysfunction, leading to vertigo and imbalance.

Risk Factors

  • Recent upper respiratory tract infections.
  • Swimming or excessive moisture exposure.
  • Use of hearing aids or earplugs.
  • Allergic rhinitis.
  • Immunosuppression (e.g., diabetes, HIV).

Signs and Symptoms

  • Otitis externa: ear pain, pruritus, discharge, tenderness of the tragus.
  • Acute otitis media: ear pain, fever, hearing loss, bulging tympanic membrane.
  • Chronic otitis media: persistent otorrhoea, hearing impairment.
  • Labyrinthitis: vertigo, nausea, sensorineural hearing loss.

Investigations

  • Otoscopy: visualise tympanic membrane and assess for signs of infection.
  • Tympanometry: evaluates eustachian tube function.
  • Swab for microbial culture: in persistent or severe otitis externa.
  • Pure tone audiometry: assess hearing loss.
  • MRI/CT scan: if complications such as mastoiditis or intracranial spread are suspected.

Management

1. Otitis Externa:

  • Topical antibiotics: otomize ear spray, ciprofloxacin or neomycin ear drops.
  • Analgesia: paracetamol or ibuprofen.
  • Avoid water exposure: keep ears dry.

2. Acute Otitis Media:

  • Analgesia: paracetamol or ibuprofen.
  • Antibiotics: amoxicillin in bacterial cases, delayed prescription if mild symptoms.
  • Ventilation tubes (grommets): in recurrent cases.

3. Chronic Otitis Media:

  • Regular aural cleaning.
  • Topical antibiotics for flare ups.
  • Surgical intervention for tympanic membrane repair if necessary.

4. Labyrinthitis:

  • Vestibular suppressants: prochlorperazine for symptom control.
  • Corticosteroids: may be beneficial in viral labyrinthitis.
  • Antibiotics: if bacterial cause suspected.

5. Referral:

  • ENT specialist: for recurrent infections, hearing loss, or complications.
  • Audiology: for persistent hearing impairment.
  • Neurology: if vertigo persists despite treatment.
Ear, nose and throat, ENTmypanotesEar infections