INFECTIOUS DISEASE OF THE EARS

Cesar M. Mendoza, Jr., RMT, M. Bio. Ed.

INFECTIOUS DISEASE OF THE EARS

General Information:
There are three pathways for pathogens to enter the ear Through the eustachian (auditory)tube, from the throat and nasopharynx From the external ear By the blood or lymph

Usually bacteria are trapped in the middle ear when a bacterial infection in the throat and nasopharynx causes the euctachian tube to close Anaerobic condition in the middle ear, allowing obligate and facultative anaerobes to grow and cause pressure on the tympanic membrane (eardrum) Viral infections and allergies may also close to eustachian tube

OTITIS MEDIA infection of the middle ear

OTITIS EXTERNA- infection of the outer ear canal

ANATOMY OF THE EAR

Viral and Bacterial Ear Infection

Disease
Otitis Externa, External Otitis, Ear Canal Infection, Swimmers Canal.
Infection of the ear canal with itching Pain A maldorous discharge Tenderness, redness, swelling, and impaired hearing Most common during the summer swimming season Swimmers ear because it often results from swimming in water contaminated with Pseudomas aeruginosa

EAR CANAL INFECTION

Otitis Media, Middle ear Infection

Complication of the common cold. Persistent and severe earache

Temporary hearing loss

Bulging of the eardrum (tympanic membrane) Nausea, vomiting diarrhea, and fever in young children; may rupture of the ear drum, bloody discharge and then pus from the air.

SEVERE COMPLICATIONS
Including bone infection, permanent hearing loss and meningitis mat occur Most common in young children (between 3 mons and 3 years of age)

Normal Membrane Opaque with Inflammation Bulging Membrane

Chronic Inflammation

Late, Severe OM Resolving Infection

Additional Information
Etiologic Agent:
Escherichia coli
pseudomonas aeruginosa proteus vulgaris Staphylococcus rarely by a fungus, such as aspergillus

Mode of Transmission:
Contaminated swimming pool Indigenous microflora; articles inserted in ear canal for cleaning out debris and wax

Diagnosis:
Material from the infected ear canal should be sent to the microbiology laboratory for culture and susceptability

Etiologic Agent:
Otitis media may be caused by bacteria or viruses 3 most common causes are

Streptococcus pneumoniae (a gram positive diplococcus )

Haemophilus influenzae (a gram positive diplococcus)

Less common bacterial causes include streptococcus pyogens and staphylococcus aureus
Viral causes include measles virus, Para influenza virus, and respiratory syncytial virus (RSV)

Mode of Transmission:
Probably not communicable

Diagnosis:
If there is a discharge from the ear, a sample should be sent to microbiology laboratory for C&S
B- lactamase testing should be performed on isolates of H. influenzae and S. pneumoniae

Swimmer's Ear Overview

Swimmer's ear (also called otitis externa) is a painful condition of the visible or outer portion of the ear and ear canal (outer ear). The ear canal is a cylinder-shaped structure that extends from the outer part of the ear, above the ear lobe, all the way to the eardrum (tympanic membrane). The typical size of the canal is about 2.5 centimeters in length and 7-9 millimeters in width

Swimmer's Ear Causes

The skin lining the ear canal and outer ear serves as a barrier against infection from bacteria and fungi. The ear is protected against infection because the lining is slightly acidic. The lining is also a physical barrier that protects against excessive moisture. Any break in the skin lining can lead to infection, allowing bacteria or fungi to invade the outer ear.

The barrier can become broken and lead to an infection in the following ways
When you attempt to clean your ears with cotton-tipped swabs or other objects inserted in the ear, the skin lining of the ear canal may break. This can also remove the protective ear was from the ear canal. Excessive moisture in the ear canal from showering or swimming also alters the acidic environment of the ear canal, and allows for the invasion of bacteria or fungi. This is the reason this condition happens mainly in the summer months, and hence, is called swimmer's ear. Ear plugs, hearing aids, headphones, and other devices that may be inserted into the ear canal may increase the risk of swimmer's ear. Chemicals such as hair dyes, bleaches, and shampoos may irritate the ear canal and alter its protective properties. An infection can result.

Generally, any inflammation of the outer ear canal, such as infections, allergies, or skin conditions, can lead to swimmer's ear.

Swimmer's Ear Symptoms

The most common symptom of swimmer's ear is pain. Pain gradually begins over a day or two. The pain almost always involves only one ear. The pain is especially intense when the ear is touched or pulled. The ear canal may itch. The outer ear may be red, and in severe cases the ear canal may be swollen shut. The ear may drain. This drainage may be clear, white, yellow, or sometimes bloody and foul smelling. Some fluid may crust at the opening of the ear canal. With severe swelling or drainage, the person may have trouble hearing. Ringing in the ear (tinnitis)and dizziness or vertigo may also be present. Fever is generally not present. If there is a fever, it is not usually high.

Swimmer's Ear Treatment

Avoid any further trauma to the ear. Do not attempt to remove visible debris or drainage from the ear. Apply heat to the ear to control the pain at home. Warmth from a heating pad may provide some relief. Fold a towel in half and place it between the heating pad and the ear. Limit the use of the heating pad to short periods. The folded towel should help prevent accidental burning of the ear if the heating pad is too hot. If the person is not allergic to these, try a variety of over-the-counter pain medicines such as aspirin, ibuprofen (such as Advil), or acetaminophen (such as Tylenol). Nonprescription ear drops are not usually strong enough to cure the problem. Such drops are useful only for prevention of episodes after water exposure. Ear drops used for treatment of the condition must be obtained with a prescription from a doctor.

Prevention
Use of shower caps while bathing and earplugs while swimming will help keep water out of the ear canal The best earplugs are often soft balls of special wax. The wax can be purchased at most pharmacies. Simply roll a small ball of wax in your hands and press it into the outer ear Homemade ear drops also help prevent swimmer's ear after water exposure. Make a 50:50 mixture of white vinegar and rubbing alcohol for use after swimming or exposure to water. Apply 3-4 drops in each ear canal after swimming. This helps dry the canal and maintain the acidic environment of the ear canal. Avoid placing objects in the ear that can scrape or scratch the skin of the canal because this may cause an infection.