Ear canal infections (otitis externa) typically occur after swimming (water gets trapped in the ear canal, helping bacteria to grow), with cerumen (ear wax) build up, extended hearing aid use, and trauma to the ear canal skin. Ear canal infections are best treated with cleaning of the ear canal under a microscope by an ear specialist and antibiotic/steroid ear drops, sometimes in conjunction with an ear wick. An ear wick is a small sponge that is placed into the ear canal, prevents it from closing off completely, and allows the drops to remain until the infection and swelling resolves. Malignant otitis externa is a particularly severe type of outer ear infection that usually involves the organism pseudomonas aeruginosa and primarily occurs in poorly controlled diabetics. It typically requires inpatient admission to a hospital and intravenous antibiotics to resolve.
Middle ear infection (otitis media) can occur in both children and adults, but more commonly in children. Most ear infections are caused by bacterial infections, and sometimes do not need oral antibiotics to resolve. However, when an ear infection persists, becomes recurrent, or does not respond to antibiotics, a minor procedure known as myringotomy (with or without placement of a ventilating tube) is done to remove the fluid, obtain a culture, and provide a route for ear drops to enter the middle ear and directly treat the infection.
Inner ear infections (labyrinthitis) are usually caused by a virus rather than bacteria. They may follow an upper respiratory infection or other viral illness and the most common symptom is dizziness. They are treated with oral steroids (not antibiotics) and sometimes antiviral medication, and they usually resolve within a few weeks. Ramsay-Hunt syndrome is a more severe type of inner ear infection, caused by the herpes virus, and may involve visible blisters around the ear or on the neck or face, ear pain, drainage, hearing loss and facial nerve weakness. Treatment includes high-dose steroids and antiviral medication.
Sometimes even with appropriate treatment, an ear infection develops into a perforation (hole) in the eardrum or cholesteatoma (cyst of skin debris in the middle ear) and may require an operation. The infection may also spread into the pneumatized (filled with air) bone behind the ear called the mastoid. These infections can be acute or chronic, and an operation called tympanoplasty with mastoidectomy may be performed to remove the infection, repair the ear drum, and remove the cholesteatoma.
A tympanoplasty is an operation to repair the ear drum using a graft (tissue from another area).
A mastoidectomy is an operation to eradicate infection and disease (including cholesteatoma) from the mastoid bone by drilling it out. It is done through an incision behind the ear.
An ossicular chain reconstruction is an operation to repair the ossicles (tiny hearing bones between the ear drum and inner ear) using a prosthesis (artificial bone made of plastic or metal) in cases where they have been damaged by infection or disease.
These procedures are often performed together, and Dr. Paul Shea specializes in them. There are three objectives to this type of operation:
- Eradicate infection and disease
- Give the patient a “safe” ear (an ear that is impervious to water)
- Restore or improve hearing
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