Ear infection is the most common childhood illness other than simple runny nose. Almost every child has had at least one ear infection by the time he or she is six, and for many children and their parents, frequent recurrences of these infections are a major problem. Further, there's always the worry that the complications of ear infections can impair the child's hearing and even delay learning to speak. Adults sometimes get ear infections too.
There are two main types of ear infections. Infection of the middle ear and eardrum is called otitis media. It is the more serious illness and is the type most often meant when a health professional diagnoses an "ear infection." Otitis externa, as its name implies, is infection of the outer ear or of the canal that leads to the eardrum. It is actually a skin infection similar to those occurring elsewhere on the body, but it can cause a great deal of ear pain and discharge. We'll discuss each type of ear infection separately.
Not all earaches are due to infections. During a cold many people complain that their ears feel stopped up or that they experience twinges of sharp, brief pains. These symptoms are generally mild. They are due to pressure differences on either side of the eardrum caused by the inflammation and fluid secretion that accompanies a cold. Pressure changes also account for earaches that happen in airplanes or in cars driving up or down a mountain. Some people get earaches whenever they are out in a cold wind or swim in cool water.
Otitis Media (Middle Ear Infection)
The middle ear, the space behind the eardrum, becomes infected during an episode of otitis media. The eustachian tube leads from the middle ear forward and downward, connecting the middle ear to the cavity behind the nose. Normally, the tube opens to allow fluids secreted by mucous cells in the ear to drain into the throat, and to allow pressure in the middle ear to become equalized with the pressure of the atmosphere. At other times, the eustachian tube should be closed to prevent fluids in the nose, which are full of microorganisms, from reaching the middle ear.
Ear infections develop when the eustachian tube opens and closes improperly, allowing germ-laden fluids from the nose and throat to enter but not depart from the middle ear. Inflammation resulting from a cold or allergy may cause this improper function, but in young children sometimes the tube is just too small and short to work properly.
As a middle-ear infection progresses, white blood cells and antibodies are secreted into the tissues and the middle-ear area, where they attack and kill infecting bacteria. As dead bacteria and white cells accumulate, pus forms and puts pressure on the ear drum. The thin eardrum membrane bulges outward, and pain increases as it is stretched. Eventually it may tear, allowing pus to drain to the external auditory canal. Don’t be alarmed if this happens (you’ll see pus or blood dripping out of the ear) this is the way the body expels the infected material, and usually a torn eardrum heals rapidly.
The symptoms of acute middle-ear infection are variable. A young child may seem to be in pain, often playing with or pulling at the ears. Older children or adults usually know if something is wrong with the ear, but sometimes even during a severe infection the ear just feels stuffed up. If the eardrum is ruptured, a discharge from the ear may be obvious, or the hair around the affected ear may be sticky or crusty.