Ear infections can be nasty, here’s what to avoid

I’M pleased to be back after taking a break from writing this column. The aim, as always, is to provide useful medical information that helps you to look after yourselves and make informed decisions about if, where and when to seek help. If I can be entertaining into the bargain, so much the better.

The column will be monthly from now on and I’m swinging back into action with a piece about a common but sometimes very unpleasant ailment.

Summer has ended (I know this because it’s getting dark earlier, I can hear the wind howling outside the window as I write this and I’ve worn three jumpers in as many days). No doubt many people will be returning from sun-drenched holidays abroad. After hours spent combating the heat by diving into swimming pools or battling the waves in the sea, a proportion of people will inevitably develop the condition known colloquially as “swimmer’s ear”.

Medically we refer to this as otitis externa and it can cause pain, itchiness, hearing loss and even generate gunky discharge. More common in children, though still fairly prevalent in adults, this ear infection can range from being a minor bother to being a seriously uncomfortable and occasionally chronic issue.

The name “otitis” comes from the Greek word for ear, otos, hence the name of one of the trustier items in a doctor’s kit bag — the otoscope. These are the long torches with a conical speculum on the end through which we can literally shine light on to what might be happening inside the ear.

And that’s what we’ll use to have a look if there’s a suspicion of something amiss. If gazing through one of these into a normal ear, a physician will see a tunnel (the ear canal), twisting and turning towards a thin membrane at the back. This is the tympanic membrane. If the membrane is nice and smooth, with an area of light shining off it (the light reflex), then it’s probably healthy. If it’s dull and bulging, it’s likely to be a bit red and inflamed as well. This means there’s probably fluid behind the eardrum (which there shouldn’t be). In this scenario, you’re likely dealing with an otitis media. If on the other hand the tympanic membrane looks fine, but the canal itself is looking a bit red, inflamed, or even covered in pus and discharge, that’s an otitis externa.

When looking in the ear, the physician might run into some wax as well. This is perfectly normal. In fact, I’d go so far as to say it is vital. It’s no surprise that the parts of our bodies that are open to the world are more prone to developing infections. We endure a constant bombardment of bugs every day. Naturally, our bodies have ways to counter these.

Our noses keep out larger debris with hairs and get rid of the smaller stuff that gets in by way of the mucus which we either sneeze out or swallow. It’s the wax that plays a big part in defending our ears from unwelcome guests. The wax is secreted by cells within the canal and catches bacteria that might otherwise get in, carrying them outwards. The wax is encouraged outwards by the conveyor belt-like motion of cells on the canal wall as they grow from inside to out. This is quite gradual but it means that, as soon as you stick a cotton bud or a finger inside, you’re ruining any progress that system has made. Add to that a compression of wax deeper in the canal and, at the very least, you’ll start finding it harder to hear in that ear.

It’s not just swimmers that experience otitis externa of course. It can be simply a case of bad luck but those who get the ear wet more frequently, clean their ears with cotton buds (as I’ve already mentioned, a big black mark in my book) or get too much soap or shampoo stuck inside on a regular basis are much more prone. Likewise, anyone with a naturally narrow ear canal is a bit more at risk and if you’re unlucky enough to have eczema this can also cause a scaling and breakdown of the tissue on the inside of the canal, interrupting the barrier that normally serves to keep the pathogens that cause the infection at bay. Most commonly, ear infections are bacterial. Of these, staphylococcus aureus, a bacterium that lives naturally on all of our skins, is a big player but there are many others. It could also be viral or even fungal. If viral, there is often not much one can do other than allow it to pass but drops with antibacterial or antifungal ingredients can be used to combat the other two.

If you’re susceptible to ear infections but are an Olympic swimmer (or just like to submerge gently) then you can use tight swimming caps or ear-plugs (make sure these are clean). If you want to reduce your risk further, avoid anything that might irritate the ear canal, including shampoo and soap, and smoky environments and, once again, don’t put anything in there. (Nothing smaller than your elbow as the saying goes.)

A piece of cotton wool covered in Vaseline at the entrance to the canal can be used as a barrier during a shower or if you’re caught in a monsoon, though don’t push it all the way in. If you’re really keen, you could even consider drying the canal with a hair dryer on a low setting. After all, the pathogens that cause infection love warm, moist environments.

If all else fails and an infection does develop, often it will clear on its own. Pain relief and time are all that is needed, particular when it is viral. If you also have a runny nose, fever and sore throat, the chances are it will be viral, in which case you just have to wait it out.

If your symptoms continue for three days or more, it might be worth trying some treatment. You can obtain ear drops containing acetic acid over the counter at your pharmacy. These help to fight the infection and allow things to calm down.

Of course, becoming a bit more stringent about keeping the ear dry at this stage is very important. If this does not work and the patient is aged between one and 17, you can speak to your pharmacist who can prescribe a medicated drop with either antibacterial or antifungal ingredients. Some of these also contain steroids which help to settle any inflammation. These are the same as the ones we prescribe as GPs so you do not need to get in touch with us.

If however, things are escalating or you are 18 or above, your pharmacist might direct you towards a GP so we can take a look. Particularly in chronic cases, it’s always worth just making sure the infection isn’t taking hold or even spreading into the surrounding bone — rare and dramatic-sounding but something worth ruling out! A swab can be taken in treatment-resistant cases to identify the bug we’re dealing with so we can target it in a more focused way.

If it turns out to be an otitis media, drops tend not to be as effective as they can’t reach the area and so on occasion oral antibiotics are needed. For children who suffer from recurrent otitis media, a gap can be surgically incised into the eardrum to allow all the gunk to discharge. Small plastic tubes, called grommets, are placed in the gaps in the eardrum to facilitate this. The idea is that they eventually fall out when their task is over and the eardrum heals over.

As a side note, I wondered why these were so named and it turns out it’s maritime in nature. Gourmer is a French word meaning “to curb”, apparently suggesting a means of fastening or controlling something. Hence rope rings and oar locks were referred to as grommets and the word was later extended to objects with holes or loops in them. (Young inexperienced surfers are also called grommets, I believe because lower ranking sailors used to be called the same.) Anyway, enough about grommets.

Ear infections can be really nasty and cause a lot of discomfort. Treated right, in a timely fashion, they don’t have to be. Pharmacies are normally your first port of call but, if all else fails, let us know and, armed with our otoscopes, we can take a look.