Understanding Ear Pain: Middle Ear Infections, Symptoms & Relief
- Victoria Wermers, RN,MSN,FNP, PMHNP
- Sep 16, 2024
- 4 min read
Updated: Jun 30
Otitis Media: Middle Ear Infections
Normal Eardrum - This is what your healthcare provider should see when looking in your ear --------------------->
Patients ask me what I see when I look in
their ears. The photo to the right is, generally, what a normal eardrum (tympanic membrane) looks like.
Overview
An ear infection can bring even the toughest person to their knees. I often tell my patients, "It's a shame we cannot see in our own ears because the problem can range from something very minor to a very major infection.
We could save ourselves a trip to a clinic by using an otoscope to look in our ears. These
are sold at various pharmacies and on Amazon for home use for those with frequent ear problems. One newer product is called Bebird. A patient told me about it, so I got one and it works pretty well (*this is NOT an advertisement): You put it just into the opening of your ear and it projects a picture of your eardrum onto your phone.
Understanding Ear Pain: Middle Ear Infections, Symptoms & Relief will help you determine the next steps.
Many things can cause ear pain. I will go through a few of the major problems here:
Often, otitis media is the sequelae of a sinus problem because the inner ear is connected to the sinus cavity. The photo to the left is that of a middle ear infection (otitis media).
The eardrum in otitis media is often very cloudy and usually quite red, and one cannot see the structures behind the tympanic membrane. It may appear whitish because there is pus behind the eardrum. This can put a lot of pressure on the eardrum. Because the infection is self-contained in the middle ear behind the membrane of the eardrum, drainage should not come out of your ear. If you notice this, you may have a ruptured eardrum (usually preceded by a great deal of pain), an infection of the ear canal (the tube leading to the eardrum), or you have been using ear drops which, often mixed with wax, come back out of your ear.
An inner ear infection often follows an upper respiratory/sinus or sometimes allergy problem because the back of the nose and throat are connected to the inner ear by a passageway called the eustachian tube.
The hallmark of this infection is ear pain. Often, it wakes a person up at night, especially kids. Some people do not feel pain but develop a fever that alerts them that something is wrong. They come to the clinic, we look in their ears and VOILA! An ear infection! Besides pain, there is sometimes short-term dizziness, hearing loss, and tinnitus (ringing). Some of these symptoms tend to get worse when you fly because of the pressure changes behind
your eardrum.
It is difficult for a provider to tell if a middle ear infection is bacterial or viral, so we often treat these with antibiotics if there is pain and the eardrum looks bad. In Europe, they do not give antibiotics immediately; they treat the pain until the infection goes away (unless it appears or becomes too severe). In light of antibiotic resistance, the latter approach is adequate unless the symptoms get too bad. There also a few other approaches a person might take.
Understanding Ear Pain: Middle Ear Infections, Symptoms & Relief
Treatment
Over-the-Counter Treatment of Middle Ear Infection
There are only a few over-the-counter medications that may help these infections.
Acetaminophen (common: Tylenol) - This is a pain medicine (but not anti-inflammatory). Used as directed over the counter, it may help with pain.
NSAIDS/Ibuprofen (common: Advil, Motrin)—This is an anti-inflammatory that may help with ear inflammation and pain. Use as directed over the counter.
A decongestant may help with discomfort by relieving fluid pressure behind your eardrum, but it does not eliminate an infection. You can try a nasal spray with oxymetazoline like Afrin or Neo-synephrine nasal spray (as directed over the counter), but use it ONLY UP THREE DAYS. It may help with ear pressure,
Pseudoephedrine (Sudafed) - an oral decongestant, may help (best not to use this if you have high blood pressure, and it might dry you out too much).
OTC Meclizine (common: Bonine) to help with dizziness and nausea if present with ear problems.
Natural Remedies for a Inner Ear Infection
Apply warm, moist packs to the lower outer ear (the area just below the ear for 15 minutes three to four times a day.
Hot Oil? I have had several patients ask me about instilling "hot oil" or sweet oil into the ear to try to make an ear infection go away. Some herbalists recommend tea tree oil, garlic, olive oil, or basil oil drops (all diluted in carrier oil). Oils may help swimmers' ear (an ear canal problem) and may be especially effective for earwax removal, but there is no evidence to prove that they work for an inner ear infection.
While ear drops work for ear canal infections (otitis externa), they do not work very well for a middle ear infection (otitis media) because the eardrum is impermeable to most substances. The drops cannot penetrate the eardrum to get to the middle ear infection.
Conventional/Prescriptive Treatment of an Inner Ear Infection
Antibiotics are the standard treatment for an inner ear infection. Usually, a course of penicillin or amoxicillin works very well. Omnicef or Z-pack is for those allergic to penicillin or those with cephalosporin sensitivities.
Low-dose prednisone usually works well for severe inflammation but has some potential side effects (like raising blood pressure, blood sugar, insomnia, and other potential side effects).
Ear Tubes (tympanostomy)—Even adults get ear tubes! This minimally invasive procedure by an ENT (ear, nose, and throat specialist) usually works very well for the frequent buildup of fluid behind the eardrum. Tubes are very useful for frequent ear infections.
The tubes are placed from the inner ear through the eardrum to the outer ear and act as a drain so fluid can escape. They are normally used in children, but can also be used in adults.
Still not sure? These related links offer tips on other potential causes of ear pain and discomfort:
Other Causes of Discomfort (fungal infections, insects)
