ear aches

A pain in the ear

http://www.telegraphindia.com/1160905/jsp/knowhow/story_106287.jsp

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Your Health - Dr. Gita Mathai

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Earaches are what the word describes - a pain in the ear. What the word fails to convey is just how debilitating the attack can be. This is especially true in young children, whose inability to localise the discomfort can lead to prolonged, unexplained crying with fever.

The pain is most often due to a problem in the middle ear (otitis media). This is a small space with three bones (ossicles), the malleus, incus and stapes. The confined space is closed to the outside by the eardrum. Infections cause a build up of secretions (viral) and pus (bacterial), which is unable to escape. This causes excruciating pain. It can press on the ear drum, causing it to bulge. It can eventually burst, discharging the fluid.

The ear, nose and throat are all connected by the Eustachian tube that is situated behind the throat. An infection in any three can cause an earache. Allergies, or viral and bacterial infections can cause the nose to be blocked. In children the inner tonsil (adenoid) may become infected. This can swell, blocking the Eustachian tube.

In bottle-fed infants, milk can enter the Eustachian tube, which is shorter and straighter in infants. This can be caused by the infant sucking too rapidly from the bottle (unlike the breast where the flow is naturally regulated), lying flat while sucking (not at the recommended 45° angle), being put to sleep with a feeding bottle or holding the bottle and feeding themselves.

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Once infection sets in, there is fever and severe pain. The eardrum bulges and can be seen by physicians using an "otoscope". The child may be irritable and refuse to eat as any movement of the jaw aggravates the pain. There may even be temporary loss of hearing or balance. If the infection is not treated adequately and in time, it can recur or become chronic. It can even spread to the base of the brain.

The skin of the external ear canal can become infected because of excessive dampness caused by swimming, rain, allergies, eczema, or if the ear canal is damaged by hearing aids, buds, hairpins or even earphones.

The pinna of the external ear can get infected. This occurs in people who participate in contact sports such as wrestling and boxing, if small scratches occur to the ear or if the skin is pulled off. People may also have multiple ear piercings, with some holes being in the cartilage of the ear. Infection and damage can occur, especially if the procedure was unsterile. The infection can spread rapidly and affect the whole ear. It can become a bag of pus. Even if the pus is drained surgically, the ear may become deformed with multiple bumps forming a "cauliflower ear."

To prevent ear infections:

♦ Use a cup and spoon to feed children. If you must use a bottle, prop the child up at 45° angle. Do not use pacifiers.

♦ Yearly immunisation prevents flu, which predisposes children to ear infection. Common bacteria (Haemophilus influenza,
Streptococcus pneumoniae) which cause ear infection in children can also be prevented by immunisation.

♦ Avoid exposure to cigarette smoke. Even second hand smoke on hair and clothes precipitates infection.

♦ Do not damage the ear by placing foreign objects in it.

♦ Dry out the ear canal with a hair drier after swimming.

♦ If flying causes ear ache, use decongestant nose drops before boarding the flight.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in