Ear Infections and Disorders

Otitis media—commonly referred to as an ear infection—is infection or inflammation located in the middle ear. Although primarily a disease that occurs in children, otitis media can affect adults as well. Inflammation usually begins when infections—due to sore throats, colds, or other respiratory problems—spread to the middle ear. These infections cause fluid buildup behind the eardrum.

Symptoms of Acute and Chronic Ear Infections (Otitis Media)

• Pain in one or both ears
• Fever
• Fluid draining from ear(s)
• Muffled or dull hearing
• Sore throat may be present
• Pressure and fullness in the ears

Treatment for Acute and Chronic Infections of the Middle Ear (Otitis Media)

• Nasal or oral decongestants
• Oral antihistamines
• Nasal steroids to relieve nasal congestion and enable the eustachian tube to open
• Pain medications such as acetaminophen or ibuprofen
• Ear tubes (See more information below about ear tubes)
• Antibiotics may also be prescribed, either as ear drops or taken by mouth

Learn more about otitis media.

Swimmer's ear (otitis externa) is a painful inflammation and infection of the ear canal.

A rare but serious infection called malignant external otitis or skull base osteomyelitis can develop if bacteria invade the bones inside the ear canal and spread to the base of the skull. Not many people get this infection—it is mainly seen in older adults who also have diabetes, people who have HIV and children who have impaired immune systems—but it can be fatal.

Causes of Infections of the Ear Canal

Swimmer's ear may develop when water, sand, dirt or other debris gets into the ear canal. Since it often occurs when excess water enters the ear canal, a common name for this inflammation is "swimmer's ear."

Symptoms of Infections of the Ear Canal

• Drainage from the ear
• Pain
• Hearing loss from the ear canal being swollen shut
• Ear fullness or pressure
• Ringing in the ears (tinnitus)
• Itching
• Fever
• History of preceding trauma to the ear

Treatment for Infections of the Ear Canal

• Pain medication
• Cleaning and debridement of the ear canal
• Topical medications (ear drops)
• Antibiotics including topical and oral if needed
• Antifungal medication if needed
• Cleaning ear flushes

Mastoiditis is an inflammation or infection of the mastoid bone which is part of the skull and is located behind the ear. Mastoiditis may be mild or very serious. It generally occurs when a recent middle ear infection (otitis media) spreads into the mastoid bone.

Symptoms of Mastoiditis

• Pain, redness or swelling behind the ear
• Ear pain
• Protruding ear lobe due to swelling of mastoid bone
• Fever
• Irritability
• Headache
• Hearing loss

Complications of Mastoiditis

• Hearing loss
• Serious infection in nearby tissue
• Facial nerve damage
• Inner ear problems
• Meningitis or inflammation or infection of the covering of the brain and spinal cord

Treatment for Mastoiditis

• Antibiotic medication
• Draining the middle ear
• Tympanostomy or ear tubes may also be placed (See information below)

Learn more about mastoiditis.

An abnormal skin growth in the middle ear behind the eardrum is called cholesteatoma. Cholesteatoma can be a birth defect (congenital), but it more commonly occurs as a complication of chronic ear infections.

Causes of Cholesteatoma

How a cholesteatoma forms is not fully understood. But poor function in the eustachian tube leads to negative pressure in the middle ear. This pulls a part of the eardrum (tympanic membrane) into the middle ear, creating a pocket or cyst that fills with old skin cells and other waste material. The cyst can become infected and may get bigger and break down some of the middle ear bones or other structures of the ear, affecting hearing, balance, and possibly function of the facial muscles.

Symptoms of Cholesteatoma

• Drainage from the ear
• Hearing loss in one ear
• Aural fullness and pressure: “clogged ear” sensation
• Facial weakness if growth is large
• Dizziness

Complications of Cholesteatoma

• Brain abscess
• Deafness is one ear
• Dizziness (vertigo)
• Facial paralysis from damage to the facial nerve
• Meningitis
• Persistent ear drainage
• Spread of the cyst into the brain

Treatment for Cholesteatoma

Cholesteatoma usually continue to grow if not removed. Surgery is effective, but you may occasionally need the ear cleaned by a health care provider. Additional surgery may be needed if the cholesteatoma comes back.

Tinnitus is the sound of ringing, roaring, buzzing, hissing, or clicking that occurs inside the head. The sounds may come and go, be continuous, occur in one or both ears, and vary in pitch. Currently, more than 50 million people in the United States suffer from some degree of tinnitus. According to the American Tinnitus Association at least 2 million experience it so severely that it interferes with their daily activities.

Causes of Tinnitus

• Damage to the nerve endings in the inner ear
• Stiffening of bones in the middle ear
• Advancing age
• Exposure to loud noises
• Allergy
• High or low blood pressure
• Tumor
• Diabetes
• Thyroid problems
• Head or neck injury
• Reaction to certain medications
• Wax buildup
• Jaw misalignment

Learn more about tinnitus.

Treatment for Tinnitus

Although there is no cure for tinnitus, there are several options available that can help patients with symptoms.

• If you are in the new onset period of tinnitus (less than six months), you should know that, for most patients, tinnitus improves over time and most people do not go on to have persistent, bothersome tinnitus.
• If your otolaryngologist finds a specific cause for your tinnitus, he or she may be able to offer specific treatment to eliminate the noise. This may include removal of wax or hair from the ear canal, treatment of middle ear fluid or treatment of arthritis in the jaw joint.
• Some patients with hearing loss and tinnitus have a modest improvement in coping with the tinnitus using hearing aids with or without built-in ear-level maskers. Sound therapies that involve simple things like background music or noise or specialized ear-level maskers may be a reasonable treatment option. The effects of tinnitus on quality of life may be improved by a course of counseling with cognitive behavioral therapy (CBT), which usually involves a series of weekly sessions led by a trained professional.
• Tinnitus can be so bothersome that it causes depression or anxiety; additionally, in a patient with depression and/or anxiety, it may be very difficult to tolerate the additional burden of tinnitus. Consultation with a psychiatrist or psychologist with treatment directed to the underlying condition can be beneficial.
• Routine prescription of medications (including antidepressants, anticonvulsants, anxiolytics, or intratympanic injection of medications) is not recommended for treating tinnitus without an underlying or associated medical problem that may benefit from such treatment.
• Dietary supplements for tinnitus treatment are frequently advertised on the internet, television and radio. There is no evidence that any of these supplements (including ginkgo biloba, melatonin, zinc, lipoflavonoids, and vitamin supplements) are beneficial for tinnitus.
• Acupuncture may or may not be helpful in tinnitus; there are not enough quality studies of this treatment for tinnitus to make a recommendation.

Your eardrum is a thin membrane between your outer and middle ear. Sound waves entering your ear cause the membrane to vibrate, which enable you to hear. An injury or infection can cause your eardrum to tear (rupture). This creates a perforation (hole) that may affect your hearing.

Causes of Perforated Eardrum

• Ear infections
• Pressure from an ear infection
• Putting an object, such as a cotton swab or pencil, into the ear
• A very loud noise (such as a gunshot) close to the ear
• Rapid changes in air pressure, which can occur during scuba diving or traveling at high altitudes
• A slap or blow to the ear

Treatment for Ear Drum Perforation

• Before attempting any perforation correction, a hearing test should be performed.
• The benefits of closing a perforation include prevention of water entering the middle ear while showering, bathing, or swimming (which could cause ear infection), improved hearing, and lessened tinnitus. It also may prevent the development of cholesteatoma (skin cyst in the middle ear), which can cause chronic infection and destruction of ear structures. (See section above on cholesteatoma.)
• If the perforation is very small, an otolaryngologist may choose to observe the perforation over time to see if it will close on its own. He or she might try to patch the eardrum in the office by touching the edges of the eardrum with a chemical to stimulate growth and then placing a thin paper patch on the eardrum. Usually with closure of the eardrum, hearing is improved. Several patches may be required before the perforation closes completely.
• If your physician feels that a paper patch will not provide prompt or adequate closure, or if paper patching does not help, surgery may be required. There are a variety of options for treatment, but most involve placing a patch across the perforation to allow healing.
• Surgery is typically quite successful in repairing the perforation, restoring or improving hearing and is often done in the otolaryngologist’s office.

Labyrinthitis is irritation and swelling of the inner ear. It happens when the labyrinth, which is responsible for hearing and balance, gets swollen and inflamed. Thus, it can cause vertigo and hearing loss.

Causes of Labyrinthitis

The cause of labyrinthitis is not entirely clear. Labyrinthitis can happen after a viral infection or, rarely, after an infection caused by bacteria. It is often triggered by an upper respiratory infection, such as the flu or a cold. Less often, it may start after a middle ear infection.

Symptoms of Labyrinthitis

• Sudden vertigo, a feeling that you are spinning or whirling
• Dizziness
• Hearing loss
• Ringing sound in your ears (tinnitus)
• Nausea and vomiting
• Difficulty walking

Exams That May Be Prescribed

Your otolaryngologist will perform physical examination and will determine if more tests are needed. Such tests may include:

• Hearing test
• Videonystagmography (NMG) to determine cause of dizziness or balance disorder
• Head CT-scan
• Head MRI

Treatment for Labyrinthitis

Most often labyrinthitis goes away on its own. In some cases, your otolaryngologist might prescribe steroid medicines which may help you get better more quickly. Other medicines can help to control the nausea and vomiting caused by vertigo.

You will receive a thorough diagnostic examination to evaluate if you have an ear infection or disorder and determine what course of treatment is needed. Careful monitoring and the involvement of an experienced otolaryngologist are important to the successful outcome for patients with ear, nose and throat disorders and conditions.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests. The day of surgery, you will be taken care of in the operating room by otolaryngologist, anesthesiologists and nurses who specialize in surgery for patients with ear infections and disorders. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by experienced surgical and nursing staff.

Learn more about your hospital stay, patient-centered care and returning home.

Brigham and Women's Hospital provides a multidisciplinary approach to patient care by collaborating with colleagues who have extensive experience in diagnosing and treating ear, nose and throat disorders and conditions. In addition, patients have full access to BWH's world-renowned academic medical community, with its diverse specialists, and state-of-the-art facilities.

Our Otolaryngology-Head and Neck Surgery Team

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