Ear Infections

By Dr. Loretta Lanphier, ND, CN, HHP, CH

Ear infections are one of the most common forms of infection found in the human body. They are rarely serious, but can be very upsetting to young children and to their parents, especially if the parents are inexperienced rookies. However, they keep the pediatricians busy, so therefore play an important role in the economy. In all seriousness, ear infections usually take care of themselves, but there are some things we should be aware of concerning possible complications, prevention, and treatment of them.

What Are Ear Infections?

Ear infections are the result of bacteria, viruses, or fungi that result in inflammation of the middle or outer ear. They are most often found in children and young adults, and in fact are one of the most common of all childhood illnesses. It is estimated that up to 75-85% of all children under the age of 3 will have at least one ear infection, and some many more than that. They are generally not serious, although they may be quite painful or uncomfortable for the child, and most clear up on their own in several days. However, some ear infections can be more serious and have the potential to lead to hearing loss and other more critical infections.

There are basically two major types of ear infections: middle ear, and outer ear. The causes and symptoms are unique for each one, so let’s take a look at them individually.

Middle Ear Infections

Officially known as otitis media, middle ear infections are most often found in children and infants between the ages of 6 months and 6 years. They are caused by either viral or bacterial agents, and they involve inflammation of the middle ear that leads to fluid accumulating behind the eardrum.

Perhaps a little basic knowledge of the structure of the middle ear will help us to understand ear infections better. The ear canal leads from the visible part of the outer ear, to the tympanic membrane, which is commonly known as the eardrum. The middle ear is the space on the other side of the eardrum. Sound waves from outside the body travel down the ear canal, causing the eardrum to vibrate. A complex set of tiny bones (the malleus, incus, and stapes, or the hammer, anvil, and stirrup, as they are often called) are also set in motion from the vibration of the eardrum, and they are involved in transmitting the sound waves to the inner ear and from there to the brain so that the sounds can be interpreted and differentiated. The eustachian tubes are other structures in the ear that sometimes play a role in ear infections. They run from the middle ear to an organ called the nasopharynx that is responsible for, among other things, delivery of inhaled air from the nose to the lungs. The eustachian tubes serve multiple purposes, one of which is to equalize the air pressure in the middle ear with that of the air outside the body.

What Causes Middle Ear Infections?

The infections can arise from bacterial or viral sources, but the majority of them are viral. They usually are a side effect of another viral infection or Upper Respiratory Infection (URI) that is caused by a virus, such as a cold. The middle ear becomes infected and causes inflammation of the eardrum, which results in fluid building up behind the eardrum. The eustachian tubes can also be involved. When they get infected, it becomes easier for fluid to accumulate in the middle ear. Children’s eustachian tubes are not fully developed, and are shorter and narrower than those of adults. Thererfore, kids are more prone to get infections in their eustachian tubes.

Sometimes middle ear infections can lead to infection of organs located in the upper throat called the adenoids. These members of the immune system family contain cells called lymphocytes that are involved in the body’s infection fighting process. However, sometimes the adenoids themselves become infected and inflamed. When this happens, they often swell and can block the eustachian tubes, and thus further complicate the infection.

One complication that can arise from a middle ear infection is called otitis media with effusion (OME). This condition is characterized by fluid retention in the middle ear even after the infection has subsided. OME increases the risk of recurring infections, and can sometimes contribute to hearing loss as well.

Certain risk factors that contribute to a higher incidence of middle ear infections include:

  • Age: Young children do not yet have a fully functional immune system, so they are more susceptible to all kinds of infections, including ear infections. If an infant gets his or her first ear infection before the age of 6 months, they are more likely to suffer chronically from middle ear infections.
  • Air quality: Individuals, especially children, who are exposed to second hand smoke or highly polluted air, are more likely to get the URIs that often lead to ear infections.
  • Race: For reasons that are not well understood, Native Americans and Eskimos from Canada and Alaska have a higher incidence of middle ear infections than Caucasians.
  • Environment: People that are exposed to others with URIs are more likely to come down with them and the associated ear infections than people who are not exposed. An example would be children in a school or daycare setting.
  • Family history: Ear infections seem to run in families, but the dynamics of how this actually comes about have not been studied thoroughly enough to identify them yet.
  • Time of year: The number of middle ear infections increases during the fall, winter, and early spring. These times also coincide with the “cold and flu” season.
  • There are a couple of factors that reduce the risk of middle ear infections. They are both related to how babies are fed:

ü       Breastfeeding protects infants from ear and other infections. Mother’s milk contains antibodies that naturally fight infection and compensate for the baby’s immature immune system.

ü       If you bottle feed, hold your baby in an upright position rather than laying them down. Less ear infections occur if you do this. The reason has to do with a baby’s underdeveloped eustachian tubes.

What Are the Symptoms of Middle Ear Infections?

Many kids are too young to tell us that their ear hurts, so there are certain signs to watch out for in your child:

  • Tugging at their ears
  • Unresponsive to sounds
  • Fever
  • Headaches
  • Fluid drainage from the ear(s)
  • Difficulty sleeping
  • Unusual irritability
  • Excessive crying

Most middle ear infections will clear up on their own, but complications can occur. These can include short-term or long-term hearing loss, and a ruptured eardrum. Ruptured eardrums may exhibit fluid or puss drainage from the ear, but the wound will usually heal itself in a few days. The rupture will also often relieve a significant amount of pain for the child.

What’s the Best Way to Treat Middle Ear Infections?

Beware of practitioners who want to immediately throw antibiotics at an ear infection. Most of them are viral in nature, and therefore won’t respond to antibiotics. And you don’t want to overexpose your child to antibiotics because there are negative side effects, and it also decreases their effectiveness.  Wait-and-see is the best attitude. Most infections will resolve themselves. Self-care remedies such as a heating pad, or garlic oil mixed with equal parts of glycerin and olive oil can help relieve the symptoms. Try 1-3 drops every three hours.

Outer Ear Infections

These types of ear infections, officially known as otitis externa, are also referred to as swimmer’s ear. They involve infection of the ear canal that runs from the outer ear to the eardrum. They are less common than middle ear infections, and most often affect older children and young adults. They are called swimmer’s ear because one of the factors that are behind the cause for outer ear infections is excessive moisture in the ear canal. The other main factor is abrasions or irritations in the ear canal. These breaks in the skin make it easier for bacteria and fungi to infect the area.

What Causes Outer Ear Infections?


Moisture plus mild abrasions plus bacteria is the formula for an outer ear infection. Swimming in polluted water is probably the most common way a person is exposed to infectious bacteria. The abrasion factor can come about through excessive cleaning of the ears. Not only can this cause minor breaks in the skin that are opportunities for bacteria to infiltrate, but the removal of the wax causes a compounding effect. Don’t be too much of a clean freak when it comes to wax in your ears. It is a natural protectant against moisture and it also provides friendly bacteria which helps to prevent infection. Thus, moderation in regards to wax removal is recommended.

What Are the Symptoms of Swimmer’s Ear?


It is fairly easy to recognize. Common symptoms include:

  • Swelling of the ear
  • Pain and tenderness, sometimes severe.
  • Redness
  • Warmness around the ear
  • Discharge from the ear: often watery, yellowish, and malodorous.
  • Itching, due to flaky skin within the ear canal
  • Minor hearing loss, due to blockage of the ear canal.
  • Increased pain upon moving the head or touching / pulling the ear.

What Treatments Are Available for Outer Ear Infections?


Most swimmers’ ear infections are easier to treat than middle ear infections, and they too will usually clear up in a few days on their own. It’s best to watch the infection, and if it seems to be getting better rather than worse, just ride it out. Red flags would include an expanding area of redness and tenderness, which seems to be getting stronger. Any ear infection has the potential to spread to critical areas such as the brain if left unchecked, and that can become a very serious situation.

Prevention is the best approach, especially if you or your family have a history of ear infections. Wear earplugs or a shower cap when swimming or bathing. It is very important to keep the ear canal dry. Some folks like to use an eyedropper to put several drops of white vinegar in their ear after swimming. This is a great way to kill potential germs.

Ear infections of any kind are usually not a major health issue, but they can become problematic for some people, especially those with a compromised immune system or for sickly children. It is best to take whatever precautionary measures you can to avoid them. One of the best ways to do this is to maintain a healthy, active lifestyle, so that your immune system stays strong and productive.



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