Ear pain (otalgia) is a very common problem, particularly in children, and because the pain is often caused by a build-up of pressure inside the middle ear, normal (and even prescribed) painkillers are often not effective. Only reducing the pressure will ease the pain.
It is often difficult to tell if a child has an ear infection, but this trick may help. If moving the outer ear causes pain, a middle ear infection is a possibility. If pressure on the tragus (the firm lump of cartilage immediately in front of the ear canal) causes pain, an outer ear infection is possible. If neither causes pain, an ear infection is unlikely.
A direct injury to the ear from a blow or fall may cause bleeding, bruising, swelling and pain to the ear and surrounding tissues.
Wax is normally produced in the ear canal by specialised glands, and slowly moves out of the canal to keep it clean. If excess amounts of wax are produced, dirt or dust gets into the canal, water swells the wax in the canal, or attempts are made to clean the canal with a cotton bud or other implement, the wax may become swollen, hard and tightly packed in the canal to cause pain and deafness.
Otitis externa (swimmer's ear) is a bacterial or fungal (tropical ear) infection of the ear canal. The ear becomes very painful, and as the infection progresses, a smelly discharge usually develops.
Middle ear infections (otitis media) are a very common cause of temporary deafness in children that if left untreated, may progress to a permanent partial loss of hearing. The ear is painful, the child is feverish, and when a doctor examines the ear, a red bulging eardrum can be seen.
If phlegm from the nose enters the middle ear cavity through the Eustachian tube, or other secretions accumulate in the cavity, it is difficult for them to escape back through the Eustachian tube to the back of the nose, particularly if the adenoids which surround the opening of the tube into the nose are swollen. This is glue ear, and may be responsible for recurrent infections in the ear, deafness and low-grade ear discomfort.
A Eustachian tube blocked with phlegm will prevent pressure equalisation between the middle ear and the outside if there is an altitude change (eg. taking off in an aircraft) or pressure change (eg. scuba diving). Intense pain will be felt in the ear because of distortion of the sensitive eardrum with the pressure difference. In the worst cases, the eardrum will burst, the pain will ease, but the ear will be deaf until the ear drum heals.
If bacteria or viruses enter the sinuses, an infection (sinusitis) may result and thick pus is produced. The sinuses becomes very painful and tender, then waste products from the infection enter the blood stream, and cause a fever, headaches and the other unpleasant sensations of any major infection. It is quite easy for the infection to spread through the Eustachian tube from the back of the nose to the middle ear.
The common cold (coryza) may be caused by one or more of several hundred different viruses. It may cause a sore throat, runny nose, cough, fever, headache, earache and general tiredness.
The sensory nerves that supply the teeth run along the top and bottom jaws to a point just in front of the ear where they enter the skull. Any infection or disease of a tooth can inflame the nerve running from that tooth, but the pain may be felt in the ear because of the course the nerve follows to the brain. Babies who are teething often pull at their ears because of this phenomenon.
Less common causes of earache include a foreign body in the ear canal (eg. a small toy, nut, insect), mastoiditis (infection in the bone behind the ear), a furuncle (boil in the ear), a cholesteatoma (foul smelling growth in the ear canal), and parotitis (infection of the parotid salivary gland).
There are many uncommon and rare causes of ear pain.
See also GLUE EAR; OTITIS EXTERNA; OTITIS MEDIA
The medical term for an ear discharge is otorrhoea. An ear may discharge wax, blood, pus, serum (the pale yellow liquid part of blood without the cells) or cerebrospinal fluid (CSF - the fluid that surrounds and supports the brain).
The most common substance to be discharged is wax, and if a patient has a fever, the higher temperature may melt the wax in the ear canal, allowing it to flow out more easily than normal.
If there is a foreign body in the ear canal (eg. a small toy, nut, insect), the irritation may cause pain, bleeding, dermatitis (and a watery discharge of serum) and infection with pus formation.
Otitis externa (swimmer's ear) is a bacterial or fungal (tropical ear) infection of the ear canal. The ear becomes very painful, and as the infection progresses, a smelly discharge usually develops.
Middle ear infections (otitis media) are a very common cause of temporary deafness in children that if left untreated, may progress to a permanent partial loss of hearing. The ear is painful, the child is feverish, and when a doctor examines the ear, a red bulging eardrum can be seen. If the drum bursts, pus will discharge from the ear, but the pain will diminish.
Other causes include a furuncle (a boil in the ear), weeping dermatitis or eczema in the ear canal, a severe head injury in which the skull around the ear is fractured (some of the cerebrospinal fluid that surrounds and supports the brain may leak into the ear canal) and rarely, tumours or cancers in the ear canal will discharge and bleed.
See also EARACHE
See OTITIS EXTERNA; OTITIS MEDIA
Technically, ear wax is known as cerumen. It is secreted naturally in the outer ear canal by special glands, and slowly moves out to clear away dust and debris that enters the ear. It also acts to keep the skin lining the canal lubricated and to protect it from water and other irritants. The ear is designed to be self-cleaning, and attempts to clean it may pack the wax down hard on the eardrum or damage the ear canal.
Ear wax may cause problems if excess is produced, the wax is too thick, the ear canal is narrow, or the person works in a dusty and dirty environment. When wax builds up on the eardrum, it cannot transmit vibrations on to the inner ear, and so causes varying degrees of deafness, itching, and sometimes pain. Water entering the ear during bathing or swimming may cause the wax to swell.
In babies, cerumen is rarely removed. If essential, itmay be removed by suction or fine forceps, but syringing is only done in older children and adults. The use of wax-softening drops (eg. docusate sodium) may be necessary to facilitate the removal of particularly large or hard accumulations of wax.
Ear wax normally causes no problems, and merely fulfils its cleaning role, but sometimes an infection may start in the skin of the outer ear canal under the wax causing significant pain.
The term eczema describes a large number of skin diseases that cause itching and burning of the skin. The many different forms of eczema also have innumerable causes, both from within the body (eg. stress) and outside (eg. allergies, chemicals).
The appearance of eczema depends more on its position on the body, duration, severity and degree of scratching than the actual cause. Typically it appears as red, swollen, itchy skin that is initially covered with small fluid-filled blisters that quickly break down to a scale or crust.
No investigations are usually necessary, but a biopsy is can be diagnostic.
Treatment depends upon cause of eczema, but steroid creams and tablets are commonly used.
The main complication is a secondary bacterial infection of the skin
See also DERMATITIS; SEBORRHOEIC ECZEMA;
Encephalitis is any infection or inflammation of the brain tissue.
Symptoms may be very varied and depend on the part of the brain affected, but may include headaches, convulsions, paralysis, poor coordination, vision abnormalities, other abnormal sensations, twitching and a loss of consciousness.
The diagnosis and treatment depends on the form of encephalitis present, but is often difficult.
See also MENINGITIS; REYE SYNDROME
The epiglottis is a piece of cartilage that sticks up at the back of the tongue to stop food from entering the windpipe (trachea) when swallowing. Epiglottitis is an uncommon bacterial infection (most commonly by Haemophilus influenzae B - HiB) of the epiglottis that is an acute medical emergency requiring urgent hospitalisation, as it can swell up rapidly and block the throat. Infection is most common in children under five years of age who develop a very sore throat, fever and obvious illness. In young children, if the epiglottis swells excessively, or is disturbed by trying to eat solids or by the tongue depressing stick of a doctor examining the mouth, it can cover the windpipe completely and rapidly cause death through suffocation. For this reason a doctor will give the throat only a cursory examination before arranging the immediate transfer of the child to hospital. If the airway is obstructed in hospital, an emergency tracheotomy (an operation to make a hole into the wind pipe through the front of the neck) is performed to allow the child to breathe.
The diagnosis is confirmed by a side-on X-ray of the neck that shows the swollen epiglottis. Throat swabs are taken to identify the infecting bacteria, and sometimes blood tests are also performed.
Antibiotics are given to cure the infection and paracetamol to reduce fever and pain. Some hospitals routinely anaesthetise children and put a tube through the mouth or nose and down the throat to prevent the airway from blocking. The infection usually settles in a few days, and provided there has been no airway obstruction, the outcome is excellent. A series of vaccinations against Haemophilus influenzae B (HiB) is now routinely given to all children starting at two months of age.
See also HAEMOPHILUS INFLUENZAE B INFECTION