Ear infections are a common experience for children and adults alike, though their presentation can vary with age. Ear infections can involve either the middle ear, or the ear canal, and both can cause pain, fever, drainage, and changes in hearing. While these infections can often be treated without referral to an ear specialist, they can sometimes become more serious, and need oral antibiotic, topical antibiotics, or surgery by an ear specialist to treat and resolve.
Middle ear infection (otitis media) can occur in both children and adults, but more commonly in children. Most ear infections are caused by viral or bacterial infections, and sometimes do not need oral antibiotics to resolve. However, when an ear infection persists, becomes recurrent, or does not respond to medical therapy, a minor procedure known as myringotomy with or without tube placement is done to remove the fluid, obtain a culture if appropriate, and provide a route for ear drops to enter the middle ear and directly treat the infection.
Ear canal infections (otitis externa) typically occur after swimming (water gets trapped into the ear canal, helping bacteria 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 and ear drops, sometimes in conjunction with an ear wick. An ear wick is a small sponge that is placed into the canal, and allows the drops to remain in the ear canal, bathing and soothing the infected canal. The wicks are changed frequently to help the infection resolve faster.
Sometimes even with appropriate care, an ear infection, or related condition such as a hole in the eardrum or cholesteatoma (skin in the middle ear) may need surgery to resolve. In these circumstances, an operation called tympanoplasty with mastoidectomy may be performed to treat the infection, hole in the ear drum, and/or cholesteatoma. A tympanoplasty is surgery that repairs the ear drum, and a mastoidectomy opens up and removes the bony air cells in the area just behind the ear canal (mastoid). These are done to remove disease, eradicate the infection, and ultimately improve hearing.