2 weeks ago I developed an ear infection in one ear. This began without any fever, cold symptoms, or allergies. The onset of the pain was rapid, within a matter of 2 hours, and was very severe, leaving me in agony the entire night...I would compare the pain to what I felt with a spinal tap when I was 5. I have never been prone to ear infections, having had only 2 previous ones when I was 5 years old. I am 21 now. I tried several otc pain medications that night, but nothing helped.
The following morning I sought treatment, and was prescribed Biaxin 500mg to take bid. The doctor also prescribed Auroto drops for the pain, although it had somewhat subsided by then. I followed his instructions.
The following week I returned, and the infection had not abated. The doctor switched treatments and prescribed Augmentin 500mg to be taken tid. I have been on this since Wednesday. It is now Sunday morning, and there is still pressure and pain in the affected ear, and there is some hearing loss in that ear, which I am hoping is temporary, due to the fluid build up and not to damage within the ear, specifically to the eardrum and the cochlia. I return to my doctor Tuesday morning for further evaluation. He also intends to check the tympanic membrane by doing a tympanogram, although I don't know exactly what that entails. Within the entire time of infection, I have not had any fever higher than 99.7, and most times it is completely normal at 98.6. Nor have I had any congestion which would indicate presence of a cold or allergy. The only symptoms are the ear symptoms.
This is getting kind of old, and I'd like to know if you might have any suggestions on how this should be treated when I return to the doctor. Thanks a lot
Answer ----------------
The symptoms you describe are consistent with a diagnosis of acute otitis media, an infection of the middle ear. The middle ear is located behind the ear drum. It is an air-filled chamber which contains the 3 ossicles (ear bones) responsible for transmitting sound from the ear drum to the inner ear where the sound energy is converted into electrical impulses and then sent to the brain via nerve pathways. The air-pressure in the middle ear is regulated by the eustachian tube which connects the middle ear with the upper part of the throat (nasopharynx). Ear infections may develop when bacteria or viruses enter the middle ear through the eustachian tube or when infections extend from the sinuses or throat to involve the eustachian tube. Usually this occurs via air-borne transmission of organisms from an infected individual. The lining of the eustachian tube may then become swollen and congested thus interfering with air-pressure regulation inside the middle ear. Failure to properly ventilate the middle ear results in resorption of the gases in the middle ear which are replaced by fluid. The fluid may then act as nutrient for bacteria resulting in infection inside the middle ear.
Typically acute ear infections cause deep pain without any tenderness of the outer ear. Often there is associated fever, but not always. There may also be swollen and/or tender lymph nodes in the neck. There is also usually some degree of hearing loss or change in quality of hearing. The diagnosis can usually be easily made by simply examining the ear with an otoscope.
There are 3 basic types of bacteria that are well-known to cause the vast majority of middle ear infections (Streptococcus, Hemophilus Influenza, and Moraxella Branhamella). Not every antibiotic is capable of killing all 3 bacteria in every instance of infection. Furthermore, the emergence of resistant organisms is increasing rendering some antibiotics commonly used in the past ineffective. Since the only reliable method of determining exactly which bacteria is causing an infection requires an invasive procedure - puncturing the ear drum to obtain a sample of pus for culture- treatment of ear infection is usually empiric in nature. That is, antibiotic selection is based on awareness of the most common organisms - initially broad spectrum antibiotics such as amoxicillin or erythromycin are appropriate in most cases and will still cure the majority of cases. They are low cost and have relatively few side effects. If initial therapy fails (usually determined by failure to improve after 3-7 days), then extended spectrum antibiotics are used such as lorabid, cefzil, biaxin, etc which are more costly.
It is important to note that middle ear fluid not uncommonly persists for some time after actual infection has resolved. In other words, the presence of middle ear fluid does not necessarily mean that infection persists. The difference between non-infected middle ear fluid and pus can usually be determined by examining the ear drum. Non-infected middle ear fluid can cause symptoms such as pressure and hearing loss, however the presence of such fluid does not necessarily mean continued antibiotics are necessary. With time, the eustachian tube typically recovers normal function causing the middle ear fluid to resolve without any additional medication. However this may take several weeks in some cases. If middle ear fluid fails to resolve after 2-3 months, myringotomy with possible tube insertion might be recommended whereby the fluid is drained surgically. In an adult this is a 10 min. outpatient procedure done under local anesthesia with very low risk. In children there are more conservative criteria used for insertion of tubes since this typically requires general anesthesia. The established guidelines for pediatric tube insertion may be found on the internet at the following URL: http://isis.nlm.nih.gov/ahcpr/ahcprc.html
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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