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Ear Diseases

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Posted by on Wednesday, September 8, 2010, 0:52
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Outer Ear and Eardrum

Object Penetrating The Eardrum

Just about any object devised by man or nature has been pushed into the ear and caused damage to the eardrum. Depending on the size of the object, its sharpness, and depth of penetration, the trauma can range from mild and reparable, to serious damage to the ossicles in the middle ear, the inner ear, or even the brain itself.

Ear Diseases
Ear Diseases

The latter depth often causing death. Needless to say, if any blood or whitish discharge (see BSF, below) occurs after an object is pushed into the ear, a trip to the emergency room is mandatory.

Basilar Skull Fracture (BSF)

A BSF cause is quite self-evident: A fall or blunt trauma to the side of the head may produce secondary symptoms and drainage out of the ear.  With a basilar skull fracture and outer ear discharge, a discharge from the ear (otorrhea) may be clear and watery. This is different than the whitish color of a discharge consistent with a fungal infection.  If the discharge is tested in the lab, and glucose is found, it means that the liquid surrounding the brain – cerebrospinal fluid (CSF) is leaking through the aural (ear) system. If you have had a serious head accident in the past 2 weeks, this condition is extremely serious and life-threatening and you should go to the emergency room immediately.

Symptoms of a serious bsf may include a bloody discharge from a burst ear drum. If the ear drum has not yet been broken, blood may accumulate in the middle ear cavity and either put pressure on the ear drum or drain through the Eustachian tube into the throat. If you have had the head trauma and you are coughing up blood, immediately go to the emergency room.

Other serious BSF symptoms are: cranial nerve palsies (tremors and twitching of the facial muscles), passing out (unconsciousness), ear aches and headaches.

Otitis Externa (Outer Ear Infection)

Otitis externa occurs when the skin of the ear canal becomes inflamed. This may happen due to any of the following conditions:

* The lining or the outer ear canal has been irritated by scratching or continual Q-tip (cotton bud) use
* A skin condition such as eczema
* A fungal infection is present
* A bacterial infection is present
* A viral infection is present

Otitis Externa is also associated with high humidity, warmer temperatures, swimming, local trauma, and hearing aid use or hearing protector use.

Otitis Externa (Outer Ear Infection)

Disease/Disorder Name: Otitis Externa
ICD-9: 380.1
ICD-9 Description: Inflammation of the skin of the ear canal and tympanic membrane

Otitis externa occurs when the skin of the ear canal becomes inflamed. This may happen due to any of the following conditions:

*

The lining or the outer ear canal has been irritated by scratching or continual Q-tip (cotton bud) use
*

A skin condition such as eczema
*

A fungal infection is present
*

A bacterial infection is present
*

A viral infection is present

Otitis Externa is also associated with high humidity, warmer temperatures, swimming, local trauma, and hearing aid use or hearing protector use.

*

Itchiness and/or a white watery discharge (otorrhea) – usually an indication of a fungal infection. The discharge may dry overnight around the outside of the ear. There is usually little or no hearing loss. This type of otitis externa is also called swimmer’s ear. It is usually indicated by continual itching of the outer ear. The white watery discharge is the normal detritus of active fungal growth in the damp parts of the outer ear.

*

Pus-like discharge – can indicate a bacterial or viral infection. There is no easy way to check if the affected area is caused by a bacterial or viral infection without taking a swab and having it tested in a lab. See your doctor. With either a bacterial or viral cause there will be more redness and swollen features on the outer ear and ear canal, and as shown above, a swollen and red ear drum. This condition may also indicate otitis media (middle ear infection).

*

Other indicators of the bacterial/viral infection type are headaches and continual draining from the Eustachian tube to the back of the throat, which does not taste very nice. A bacterial or viral infection usually will not cause a whitish discharge from the ear, but may cause a pus-like discharge from the middle/inner ear (otitis media).

Treatments for Otitis Externa

General palliative treatment

*

Apply warm, moist compresses, heating pads, or hot water bottles to the ear to relieve inflammation and pain
*

Take ONE ibuprofin or aspirin every 4 hours for pain (no more) – (break in half for children under 12 years old)
*

Have someone gently clean the draining ear with a damp cloth

Treatment for Fungal Causes of Otitis Externa (a.k.a Swimmer’s Ear)

Note: This remedy should only be used if it known that there is no opening of the eardrum (i.e. no burst eardrum or continuous pus discharge from the middle/inner ear)

Home remedy: A known effective home remedy for “swimmer’s ear” (the fungal infection kind) is to make the canal environment slightly acidic. Obtain some powdered boric acid and a pint of ethyl alcohol (not methyl alcohol which is the more common kind) from your local pharmacy. Take a large pinch of the boric acid and drop into into the 1 pint of ethyl alcohol. After shaking well, take an eyedropper full of the mixture and fill the ear canal with the mixture. Let sit for a minute, then turn the head to drain out. Do it one more time and wipe any excess liquid off. Do this three time a day for 5 days. In the mornings, you will notice the dried mixture will cake on the bottom of the ear. Just wipe off with a damp cloth.

Another home remedy is to use apple cider vinegar instead of the boric acid solution. Use the same procedures as above.

Why do these home remedies work? Fungal infections thrive in damp dark environments where the pH is above 7.0 (Basic). Both the above treatments drop the pH below 7.0 to about 6.2 – 6.8 making the environment acidic. Fungus cannot live or thrive in an acidic environment where the pH is below 7.0

Daily regimen: While you have a fungal ear infection, UNDER NO CIRCUMSTANCES LET WATER OR SOAP INTO THE EAR WHEN YOU TAKE A SHOWER. After a week you should be fine. If it does not clear up in a week, see your doctor. Your doctor may prescribe a silver nitrate gel which is known to be effective against stubborn chronic fungal otitis externa.

Note: If you are a swimmer and want to continue swimming with the infection present, before each swim, dip a small amount of cotton in the boric acid solution (or apple cider vinegar) and gently plug up the ear with the cotton. You can also smear the outside of the cotton with vaseline to provide a water resistant seal. After each swim pull out the cotton and treat each ear as above. Do not use ear plugs as they will irritate the ear canal. IF YOU ARE A DIVER, DO NOT DIVE UNTIL THE INFECTION CLEARS UP  ( 7-10 days).

Treatment for Bacterial Causes of Otitis Externa:

Note: This remedy should only be used if it known that there is no opening of the eardrum (i.e. no burst eardrum or continuous pus discharge from the middle/inner ear)

Note: make sure you know the problem has a bacterial and not a viral cause… antibiotics are useless against a viral infection.

Over The Counter non prescription (OTC) topical antibiotics may do the job, but not always. If you do purchase an antibiotic gel, try to get one with a multiple antibiotic formula. Take a Q-tip (cotton bud) and squeeze a liberal amount of the gel onto the end and carefully push the gel into the ear. Do not push the cotton bud more than 1/2″ unto the canal! Using multiple applications of the gel, you can gently “push” the gel into the ear canal one after the other until the gel fills the ear canal completely. Another way is to squeeze the gel directly out of the tube into the ear canal. The 1/2″ rule applies here also. When you feel the gel touch your eardrum you know the canal is completely full of the antibiotic gel. Be gentle! Do not jam the gel in. Leave enough room for a cotton plug. Put a rolled up cotton plug gently into the ear to keep the gel in the ear canal. During the day, some of the gel will melt and ooze out of the ear canal. Just wipe it off with a damp cloth. Apply twice a day for 5 days. If after 5 days the condition persists, see a doctor. Your physician may prescribe a stronger antibiotic oral protocol, and/ or a shot before you leave the office.

Treatment for Viral Causes that mimic Otitis Externa:

If you have a known viral infection that has caused symptoms similar to otitis externa, or even a middle ear infection (mimics otitis media) or inner ear infection (mimics various inner ear infections), there is not much you can do except to minimize the pain. Ibuprofen or aspirin three times a day may help, and a warm compress or hot water bottle on the ear may provide some relief. You may have to suffer for 5-7 days until the viral infection has passed. Under no circumstances take antibiotics as they are not effective against a viral infection.

Rarer causes that mimic otitis externa are:

Aural polyps (Pimples in the Ear)

Aural polyps are growths that occur within the outer ear canal. They look like bumps or pimples. If left untreated they can produce a smelly pus and, perhaps, blood-streaked discharge. If left to grow (happens very rarely), they can completely block the ear canal causing a hearing loss. These polyps can also be treated with a topical antibiotic the same as for Otitis Externa.

Contact Dermatitis (allergies)

A common cause of chronic otitis externa that is not readily diagnosed by a physician is one or more skin allergies, specifically contact dermatitis from foreign objects – earrings, cosmetics, shampoos, and hearing aids or ear plugs. Usually this type of allergy causes just itching with minimal inflammation or discharge. However, more serious reactions can inflame the ear canal to the extent that it becomes blocked. In very rare cases, the person with a contact dermatitis in the ear canal reacts so violently that they go into what is called an anaphylactic shock, and if not immediately treated with a shot of an anti-histamine such as hydrocortisone or adrenaline, can die within a few minutes (very, very, very rare).

The only way to cure a mild dermatitis reaction of the ear canal is by a process of elimination. List the items that have come in contact with the ear and ear canal over the past week and eliminate all of them if you can. Then, one by one, every 3-4 days, add one back into contact with the ear or ear canal. The 3-4 day time period will allow any allergic reaction to re-occur. If there is an allergic reaction within the 4 day period, then you know the cause and stop using agent.

Food Allergies

Food allergies are another possible cause of irritation in the ear canal as with any other area on the skin and the hardest to track down. Again, the most effective method is through a process of elimination. Because it is hard to stop eating everything at once, the best thing to do if there is continual re-occurrences of otitis externa is to visit an allergist and get a full battery of tests of common foods (if possible). However, allergists often have few tests for food allergies and usually give the same advice as we have given with contact dermatitis. Start eliminating foods one at a time (of course, without starving :) )

Eczema or Psoriasis

If you suffer from eczema or psoriasis, it is possible for an outbreak to occur in the ear canal. There is no easy cure for this condition and the only treatment in the narrow ear canal will be warm oil or some other liquid to keep the skin soft and hope the natural action of the ear and ear wax, sloughs off the dead skin cells.

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