Two main types of ear infections I want to teach you about today. Middle ear aka otitis media and outer ear aka otitis externa.

Otitis media, middle ear, occurs most often in the winter but can be year round. It is typically from fluid backup into the middle ear from some type of inflammation. Often allergies or a cold make us more susceptible. These infections are very common in kids and less so in adults. The eustachian tubes (these drain the fluid from the ear to the back of the throat) in children have a sharper turn because the children are shorter. As we grow taller the tubes aim more straight down. For this reason children get fluid back up easier, and therefore more infections. In general children get more infections of all kinds.

Historically most of you were told these infections are bacterial and need to be treated with antibiotics. Reality is that more than half are actually viruses like common cold viruses. Most times they dont need antibiotics. I recommend to my pts to treat with max doses of ibuprofen and acetaminophen (aka tylenol). If you can control pain AND temp, then continue to be conservative. (keep temp below 100.4F). Lots of hydration, antihistamines, decongestants if old enough, breathing moist air. Anything to drain the ears is good. If pain is uncontrolled or fever stays up, then you have to get more aggressive and treat with oral antibiotics.

Otitis externa, outer ear, is a problem of the summer time. Essentially it happens from water exposure. When we get water into the outer ear it can cause infection. This can happen in hot tub, pool, but happens most often in lakes, ponds, rivers. There are, of course, more bacteria growing in natural water.

When someone (most often children) is going swimming and then gets ear pain, swollen ear canal, and discharge from the ear, that’s externa. These are almost always bacterial. Rarely something else. These typically will respond to antibiotic drops quickly. But they can get really bad in just a few hours when they first start. They happen on the weekends often since swimming occurs more on those days. So it’s good to have a Direct Primary Care doctor available to take care of you after hours!

To help prevent otitis externa, we used to use a mix of 50/50 hydrogen peroxide and rubbing alcohol after swimming. This helps to kill bacteria and dry out the water.

Thanks for reading.

Dr D