From itching and a feeling of pressure to hearing and balance disorders to fever and unbearable pain – the spectrum of possible symptoms of inflammation of the ear is wide. Children in particular often suffer from ear complaints. Read here what causes ear pain and what you can do about the discomfort.
The ear – structure and functions
The ear is not only used for hearing, but also has an important function for our sense of balance. Its structure serves to accomplish both of these tasks:
Hearing: The cartilaginous pinna catches sound caused by acoustic signals. The external auditory canal conducts this to the eardrum, the boundary with the middle ear. Behind the eardrum is the air-filled tympanic cavity with the three auditory ossicles hammer, anvil and stirrup, the latter with a length of about three millimeters the smallest bone of the body. These bones attenuate or amplify sound and transmit it to the inner ear. The two entrances to it, the oval and round windows, are each closed with a membrane. The tympanic cavity has a connection to the pharynx – this “eustachian tube” ensures pressure equalization between the tympanic cavity and the outside air. In the inner ear, the sensory cells of the cochlea, a system of cavities, convert sound waves into electrical nerve signals and transmit them to the brain via the auditory nerve. Balance: The inner ear also contains the sensory receptors of the organ of balance, located in the vestibule and the arcades. They send information about the orientation and direction of the body in space at rest and in motion to the brain via the vestibular nerve. Together with information from the eyes and muscles, these ensure that we can keep ourselves straight. Inflammations of the ear are quite common. The causes are varied, and all parts of the ear can be affected.
Inflammation of the outer ear (otitis externa).
Ear furuncle is a deep purulent inflammation of a hair follicle in the ear canal, caused by certain bacteria. It is not uncommon for the infection to be made worse by the affected person attempting to manipulate the ear canal with cotton swabs or the like. Ear furuncle is very painful, the ear canal is often swollen shut and the lymph nodes in the area are enlarged. In painful auricular perichondritis, the cartilaginous membrane is inflamed. It occurs after injury or surgery to the ear. Ear canal eczema is an inflammation of the skin of the external ear canal caused by bacteria or fungi. Pre-existing skin damage, allergies, antibiotic therapy or diseases such as diabetes promote its development. The skin is reddened and the eczema may be dry and scaly or oozing. It often itches or hurts.
Acute otitis media acuta (inflammation of the middle ear).
Inflammation of the middle ear can occur suddenly (otitis media acuta) or over a long period of time (otitis media chronica). Acute otitis media usually occurs because of a disseminated infection with bacteria that have migrated through the eustachian tube from the pharynx into the middle ear. If there is a hole in the eardrum, the pathogens can also sneak in from the ear canal. Typical symptoms are stabbing pain in the ear, hearing loss, fever and headache. Ringing in the ears also occurs. If the pain suddenly subsides and pus is discharged to the outside, this indicates that the eardrum has been opened. The disease becomes dangerous when viruses (for example, in the case of influenza or measles) are the culprits. These like to spread to the inner ear or even the brain and may leave permanent damage. Aggressive bacteria or poor internal defenses can also lead to complications. The most common is mastoiditis, which is the spread of inflammation into the mastoid process.
Chronic otitis media
Chronic otitis media chronica is due to ventilation problems in the eustachian tube that lead to recurrent inflammation. There is a hole in the eardrum, which causes pus to drain. Therefore, the chronic form is not painful. However, it thus makes it very easy for the pathogens to keep moving into the middle ear and maintain the infection there. There is a risk that the constant inflammation will also spread to the bone and ossicles and destroy them. This results in permanent hearing loss.
Inner ear inflammation (labyrinthitis).
Inflammation in the inner ear is always the result of an injury, surgery or disease of the ear, such as a referred middle ear infection. Because the inner ear is also home to the organ of balance, it causes not only hearing loss and ringing in the ears, but also dizziness, nausea and vomiting.
Diagnosis of inflammation of the ear
The doctor will first listen to the medical history (anamnesis), including in particular whether there have been similar problems in the past. Then he will look at the affected ear and palpate its surroundings, including the lymph nodes. An important examination is otoscopy, which allows him to examine the ear canal and the eardrum with microscopic magnification. Functional impairments can be determined with a hearing test. Depending on the form and suspected cause, this may be followed by a thorough examination of the entire ear, nose, and throat tract, further hearing tests, x-rays, neurological examinations, and ear swabs.
Treating ear pain
Treatment varies depending on the part of the ear affected and the severity and course. Antibiotics are often used, and in some cases surgery is required. Triggering diseases such as allergies or diabetes must be considered.
- Inflammation of the outer ear: the doctor will carefully clean and disinfect the ear canal, often gauze strips soaked with antibiotics and/or cortisone are inserted. In case of fungal infections, antifungal agents are applied locally as drops or ointment. Decongestants and analgesics are applied on top. An abscess must be cut open.
- Acute otitis media: Every 3 to 4 hours, nasal drops are administered – preferably while lying down – which lead to the decongestion of the mucosa, including at the entrance of the eustachian tube, and thus improve ventilation. An antibiotic is important to combat the pathogens. However, this must be taken – ear drops or ointments are ineffective because they do not reach the tympanic cavity if the eardrum is intact. Paracetamol tablets (or suppositories in children) help against the pain and lower the fever. Irradiation with red light and inhalations with chamomile also relieve the discomfort. If the inflammation does not improve or there is a risk of complications, it may be necessary to make a small incision in the eardrum (paracentesis) and insert a tympanostomy tube to allow the fluid to drain. This also has the advantage that the pathogens can be isolated and the antibiotic therapy can be adjusted accordingly. If a mastoid inflammation has developed, it may need to be surgically cleared out.
- Chronic otitis media: if a purulent inflammation is present, antibiotics are given. The most important thing is to surgically close the hole in the eardrum after the inflammation has subsided. If the ossicles are already affected, surgical restoration is attempted. A bone conduction is removed or cleared out during surgery.
- Inner ear infection: antibiotics and circulation-enhancing agents are given. If the original source of infection is known, it must be removed. For example, in the case of otitis media, an eardrum incision is made, a cholesteatoma (a benign tumor of the middle ear) is removed, and in the case of inflammation of the mastoid process, it is surgically cleared out.
What must the sufferer pay attention to?
There are certain known risk factors that favor the development of acute otitis media. These include tobacco smoke and air pollution, sleeping with a pacifier in children, but also underlying diseases (for example, cleft palate), enlarged adenoids, dysfunction of the eustachian tube, a weakened immune system and allergies. Inflammations of the outer ear occur more frequently with repeated bathing or swimming, when water remains in the ear for a longer period of time and chlorine dries out the skin. Skin diseases and allergies as well as frequent irritation of the ear canal (for example by cotton swabs or earplugs) also increase the risk of infection. As far as possible, these risks should be minimized or eliminated. It has been shown that children who had their first middle ear infection at a very early age or in whose family ear infections are common are very likely to suffer from ear infections again and again.
