Earache & Ear Infection

I Have an Earache.  Is it an Infection?

Not all earaches are infections although that is a common cause.  Some earaches are unrelated to the ear itself and are referred through nerve pathways.  Common causes of this referred ear pain include TMJ/TMD (temporomandibular muscle or jaw disorder), neck or shoulder problems, dental problems and problems in the throat.  Have you ever noticed that your ear sometimes hurts when you have a sore throat?

The ear is divided into three major parts.  The outer portion consists of the visible ear (the pinna or auricle) and the less visible ear canal.  The visible part of the ear is designed as a sound receiver that funnels sound waves into the ear canal towards the ear drum (tympanic membrane).  Both parts can get infected although infection in the canal is by far more common.  Otitis externa, or outer ear infection, is often associated with a scratch in the thin skin and moisture; it is commonly known as swimmer’s ear.  It can be very painful and often needs a small sponge to be inserted to help deliver ear drops to the deep part of the canal.  Most times, ear drops alone will take care of the problem.

The middle ear includes the ear drum.  It seals off a space containing three tiny bones (ossicles—the hammer or malleus, the anvil or incus, and the stirrup or stapes).  The space is lined by a membrane that can become inflamed or infected causing fluid or pus to fill it, as long as the ear drum is intact.  If the ear drum ruptures, fluid can escape and drain from the ear canal.  This condition is known as a middle ear infection (or otitis media) with or without perforation.  Ear drops can be applied to an infection in the middle ear through a hole in the ear drum or through a tube which has been surgically placed to create a small opening in the ear drum.  If the ear drum is intact, oral antibiotics (antibacterials) are often prescribed.

The inner ear is deep in the skull, completely invisible to the eye, even with a microscope.  It functions as the receptor for sound that has been delivered through the outer ear and amplified by the middle ear.  Like the nerve ending in your skin are receptors for touch, the nerve endings for sound waves are deep in your skull bone and are receptors for sound.  Along with hearing, the inner ear is very important in your sense of balance and motion.  Infections are relatively uncommon in the inner ear compared with the middle or outer ear.  They are less likely to be painful; instead, they may cause a loss of hearing and spinning dizziness.

Can An Ear Infection Cause Hearing Loss?

Most ear infections, when treated appropriately, do not cause hearing loss.  Some infections, especially non-bacterial infections, may go away on their own.  In some cases, however, an ear infection may not clear normally.  Some may require multiple courses of antibiotics while others will enter a more chronic state resulting in fluid left behind in the middle ear.  The remaining fluid may not be infected but is part of an inflammatory response.  It can be produced because of ongoing inflammation or fail to drain or resorb appropriately.  When fluid remains in the middle ear, the ear drum cannot move correctly.  This can be easily measured in the office with a tiny puff of air, usually taking only a few seconds.  This fluid prevents some of the normal function of the middle ear and can cause a mild to moderate hearing loss.

If the fluid drains naturally, or if it is surgically drained, most of the time all hearing is restored.  It is very rare that this goes on to cause a severe hearing loss although it can result in changes in the ear’s development that can eventually contribute to problems later on.  It can also cause more minor hearing problems that are only noticeable on a hearing test,