Ear infections are bacterial or viral infections affecting any of the three regions in your ear: the outer ear (otitis externa), the middle ear (acute otitis media), and the inner ear. These infections would typically clear up naturally in about 3 days, as the ear has a self-cleansing mechanism. There are instances where ear infections may persist beyond 3 days or reoccur many times, and sometimes temporarily damage the middle and inner ear.
Ear infections can be caused by viruses or bacteria that result from a blockage in your Eustachian tube, which is a small tube that runs directly from the back of your throat to your ears, causing fluid to build up in your middle ear. Blockages in your Eustachian tube are often attributed to allergies, colds, sinusitis, smoking, and changes in air pressure.
Ear infections can also be caused by infected adenoids. Adenoids are the glands on the roof of your mouth behind your nose. They are part of your immune system, protecting your body from infections. Infections from these glands can spread to your Eustachian tubes. Adenoids shrink as we get older, so it is more common to find children with infected adenoids.
Other factors like digging of the ears aggressively can also lead to ear infections. Digging of the ears can accidentally traumatise the skin, giving bacteria or fungi a chance to infect the broken skin.
In adults, ear infections may present as slight pain or discomfort inside your ear, a constant feeling of pressure inside your ear, fluid-like ear discharge, and/or hearing loss. In addition to adult-like symptoms, young children and infants may also display other signs like rubbing or pulling their ear, fever, not reacting to certain sounds, fussiness or restlessness, and/or loss of appetite.
Ear infections are generally painful and uncomfortable as a result of inflammation of fluid buildup within the ear. It would also be more painful if infections occur in both ears.
Children are generally more prone to ear infections because their Eustachian canal is shorter and more narrow. About 80% of children would have developed an ear infection, most commonly between the ages of 6 to 24 months. Infants who are bottle-fed also tend to have a higher incidence of ear infections.
While ear infections are not contagious, the upper respiratory viruses that cause the infection can spread more easily among children with immature immune systems. Hence, children in daycare centres are more prone to ear infections.
Other risk factors include those with compromised immune systems such as those with diabetes. They are also more prone to an aggressive form of infection.
In Singapore, the high humidity increases the risk of ear infections, especially fungal ear infections. The tropical climate makes it conducive for fungal organisms to thrive in our moist ear environment and tends to result in a lot of itching and pain.
Ear infections are diagnosed through physical examination by using an otoscope – a handheld tool that shines a small light inside the ear for a clearer picture of the condition of the ear canal and eardrum. The otoscope may produce a small puff of air into the ear to check for blockages.
A physical examination may be coupled with a hearing test to determine if there is hearing loss. Occasionally, a radiological imaging may be required to visualise the middle and inner ear to rule out any abnormal growth.
A gentle cleaning of the wax and debris within the ear canal, followed by application of steroid and antibiotics using an ear wick to reach the deeper part of the canal, will effectively address this condition. Repeated visits may be required for more severe infection and in diabetic patients.
Antibiotics are usually not prescribed because ear infections typically clear up on their own and antibiotics do not alleviate the symptoms, including helping to manage the pain. For pain management, oral medication may be prescribed instead.
Antibiotics may be prescribed if the ear infection persists for more than 3 days, there is fluid discharge from the ear, or there is a risk of complications (in the case of patients with existing medical conditions).
External ear infections can be treated with antibiotic ear drops. Topical steroid drops may be prescribed to help reduce the pain and swelling in the ear.
In children, antibiotics may be prescribed if the child is under 2 years old and has an infection in both ears. Children who suffer from recurrent ear infections due to chronically infected adenoids may undergo surgery to remove the adenoids.
Patients suffering from hearing loss may recover their hearing once the ear infection is healed. However, in cases involving irreversible damage to ear structure, hearing aids may be required. An audiologist will assist with sourcing for suitable hearing aids.