We’re all familiar with the pain of a brutal ear infection. Even though we associate these infections with childhood, they can sneak back up on us in our adult years. Charles Elmaraghy, chief of Nationwide Children’s Hospital’s Department of Otolaryngology, offers his words of wisdom on how to address ear infections through all stages of life.
Healthy New Albany: Why do ear infections mostly impact children?
Charles Elmaraghy: Ear infections can occur in both children and adults; however, children have some predispositions that make the incidence of infections higher. First, anatomically, the Eustachian tube – a conduit that allows humans to equalize middle ear pressure and connects the middle ear to the nasopharynx (the transition from the nose to the throat) – is shorter and flatter in children than in adults, which allows for upper respiratory infections to spread to the ear very easily. Also, children have immature immune systems, so the overall frequency of upper respiratory infections is higher. In addition, children are often around other children in day care settings, which facilitate infections.
HNA: What are the main causes of ear infections in adults?
CE: Ear infections can occur in adults, but they are certainly less common. It may be the result of a severe viral upper respiratory tract infection or sinusitis. Other factors that may predispose adults to ear infections are exposure to or use of cigarettes, environmental allergies and blockage of the Eustachian tube. Some causes of ear infections can be altered, such as day care and exposure to cigarette smoke. Good hand hygiene also limits the spread of viruses, which are a known factor in otitis media (a group of inflammatory diseases of the middle ear). Adults and children with recurrent ear infections should be evaluated for underlying issues such as blockage of the Eustachian tube, untreated allergies and immunodeficiency in some cases.
HNA: At what point should you seek medical attention for an ear infection?
CE: Persistent ear pain, drainage from the ears and loss of hearing in adults and children should be evaluated by a physician.
HNA: What are some of the risks that come with an untreated ear infection?
CE: For some select children and adults, antibiotics are not always necessary to resolve an ear infection. Untreated ear infections can result in severe issues such as meningitis; spread to the bone behind the ear, called mastoiditis; and perforation of the ear drum and spread to the inner ear, called labyrinthitis, which results in hearing loss and dizziness.
HNA: We’ve been told cotton swabs aren’t the safest way to clean out earwax from our ears. How should we clean our ears?
CE: In general, most children and adults do not need a formal process to clean their ears other than taking a bath or shower and drying their ears with a towel. The ear canal is capable of expelling excessive wax, and it is only necessary to clean the outside part of the ear. Adults and children who form wax impactions (which can result from pushing it deeper into the canal in a territory the ear is unable to clear) may need their primary care physician to flush out their ear or to have an ENT specialist remove it.
HNA: How can you tell the difference between an ear infection and the common cold?
CE: The common cold has general symptoms such as runny nose, sneezing, fever, cough and mild sore throat and typically lasts less than 10 days. Ear infections can have rapid onset and typically cause ear pain, hearing loss, fever or ear drainage. Often, the common cold precedes an ear infection, so symptoms may overlap. In adults, an ear infection typically has ear-specific symptoms such as ear pain or muffling of sound in the infected ear. In children, ear infections may have non-specific symptoms such as fussiness, loss of appetite and difficulty sleeping.
HNA: What are some over-the-counter medications to help treat ear infections or manage the pain until you get the chance to see a doctor?
CE: Symptomatic relief can be achieved by using ibuprofen or acetaminophen in appropriate dosages. There is no role for decongestants or vitamin supplementation.
HNA: What are some misconceptions patients often have about ear infections?
CE: A common misconception is the ear can be the source of an infection that spreads to the nose, throat or lungs. Typically, it is the opposite, and the upper respiratory infection that is causing the cough, runny nose and sore throat is also the source of the ear infection.
Charles A. Elmaraghy, MD, is Chief of the Department of Otolaryngology at Nationwide Children’s Hospital and an active faculty member in the Department of Otolaryngology and an Assistant Professor of Clinical Otolaryngology at The Ohio State University College of Medicine. He is board certified and received his fellowship training at Children’s National Medical Center in Washington, D.C. in pediatric otolaryngology. His career highlights include graduating summa cum laude at The Ohio State University, achieving the highest USMLE Step 1 score in the nation in 1998, being valedictorian at The Ohio State University College of Medicine in 2000 and achieving the highest score in the nation in 2004 on the annual otolaryngology in-service examination. His career interests include sinus surgery, airway problems, head and neck masses and general pediatric otolaryngology. Currently, he is in charge of otolaryngology resident education at Nationwide Children’s Hospital. He has authored national publications and is academically active at Nationwide Children’s Hospital.
Hannah Bealer is an editor. Feedback welcome at ssole@cityscenemediagroup.com.
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