How To Stop Ear Infection Pain?

Understanding ear infection

Gambling with hearing and balance by ear pain is not accepted under any circumstances.  Complete eradication of ear infection, including its prevention, would get easier as a piece of cake once we are aware of its causes, specific regional ear location, progression as well as its complications. The ear is like a trumpet, so keep it clear to get its function.

Anatomy

The ear is a divided space with a balance of air and less fluid. Knowledge of the main anatomy of the ear is mandatory for understanding the causes of ear infections. It would be very feasible to understand that the gramophone is a mimicker of the ear with its three parts as seen in the figure below. 

The ear has an outer part (external ear) that looks like a long corridor leading to the eardrum (tympanic membrane).  This looks like the sound horn in the gramophone that ends in the sound box. Following is the middle ear which contains small bones that look like the needle, tonearm, and the handle of the phonograph.¹  Finally, it ends internally into the inner ear which is formed of fluid inside whirly pipes (cochlea and semicircular canals). This looks like the turntable of the gramophone with its space for keeping the cogs inside.²

Causes

The external and middle ear divisions, with the eardrum in-between, are more susceptible to getting infections, causing ear pain. The external ear can get any microorganisms or foreign objects from our external environment due to its communication with air.  Nevertheless, it produces a natural sticky trapping material called wax in addition to an increasingly narrowing diameter through its length, Forming the first line of defence against the invasion of any outer object to the inner side of the ear.³

However, accumulation of wax with any trapped object may end in solidified wax without clearance, causing irritation to the ear with consequent pain.⁴ This may result in a variety of outer ear infections either by hard wax ( glue ear / malignant otitis externa) or by water-mixed puffy wax (otitis externa / swimmer's ear) in addition to the inflammation of its underlying cartilage of the ear pinna (perichondritis).⁵

When sound first passes through the external ear canal, it ends up hitting the eardrum to cause its vibration.  The sound then passes through the middle ear cavity with a free movement of its bones through a vacuum room. The air pressure inside the middle ear room is maintained via the Eustachian tube, a tube that connects the middle ear to the external air (throat). Any change in the vacuum nature of the middle ear, such as less aeration or fluid accumulation,  would hinder its bone movement with less sound transmission, increased middle ear pressure, and non-moving eardrums.⁶ 

This change would result from blocking this eustachian tube. This blockage can result from a natural narrowing as seen in children and it can be infected by microorganisms such as viruses or bacteria from a nearby sore throat. On this occasion, less function is expected in the middle ear in addition to the pain from the pressure of uncycled air or fluid accumulation. This condition  is described as an inflammation of the middle ear under a term called otitis media. This occurs due to the invasion of this closed room by trapped bacteria that would never find a better place than a closed box with nasty water or less oxygen.⁷ 

The inner ear has the least infection rate among the ear parts, containing fluid kept inside tubes within a box similar to the tunnel box of the gramophone. However,  surgeries in the head and neck region may cause infection of the inner ear due to the exposure of this closed ear compartment to the contaminated external environment.⁸  

This may lead to infection of the fluid in the tubes of this box, leading to a possible weight-related pressure on the nearby nerves. For example, vestibular neuritis, which is the inflammation of the vestibular nerve of balance, may occur to cause dizziness and imbalance. Consequently, any disturbance in the inner ear is more interfering with balance than with hearing.⁹

It should be noted that sometimes ear pain is not solely caused by an ear infection. It can be caused by a nearby toothache, mouth infection, salivary glandular disturbance with a stone or infection, and even a sinus infection.¹⁰

Who is at risk?

It is fair enough to mention that some people can get ear infections more easily than others. This is controlled by their general health condition. For example, diabetic patients are more liable to infections due to their low immunity with high sugar levels that favor bacterial growth. Smoking is considered among those factors that negatively affect general health as well. 

Children, as mentioned before with narrow eustachian tubes or other anomalies (cleft palate), are generally among those vulnerable in addition to those breastfed as well as toddlers who use teething dummies. The latter group has a potential source of external irritants to the ear, resulting in their higher susceptibility to infection.¹¹

Symptoms of ear infection

How does it feel having ear infection

Life seems to be difficult for any person with an ear infection while having the following symptoms.¹²

• Ear pain has always been the main symptom of middle ear infection in both adults and children. Continuous crying may be the only presenting symptom of an ear infection since earache is difficult to be described by younger children
• Holding, tugging, or rubbing the ears in children
• Runny nose
• Restlessness
• Ear discharge, itching, and fever are among the symptoms. However, itching is more relevant to external ear infections 
• Redness and soreness of the skin that covers the ear in case of external ear infection.
• Loss of balance and vertigo can happen with inner ear infections

Complications

Despite the difficulties people can experience with ear infections, uncomparable complications may develop if not treated properly.  On the recurrence of these infections, the most severe of them is the loss of hearing. The perforation of the eardrum is among the scariest ones as it can interfere with hearing and progress to further infections of the middle ear bones as well as the erosion of the surrounding internal small skull bones. Fistula formation also represents one of the complications. It is an extension channel of the infected fluid (pus) to the external skin surface, leading to further skin infections as pustules or abscesses of the skin underlying tissue or bone.¹³

It is worth noting that infection of the inner ear can start with the loss of position awareness affecting the brain by causing clotting of its vessels and infections of its tissues.¹³

How to stop ear infection pain

The treatment of ear infections should be based on the underlying cause. Nevertheless, The intake of painkillers is useful within the therapeutic limits. However, the degree of pain relief should correspond to the level of pain. 

For example, a patient with nerve inflammation as a complication of ear infection can receive codeine or morphine.  However, the one with uncomplicated pain may only need one of those over-the-counter medications such as paracetamol or ibuprofen.¹⁴

Treatment and prevention

The usage of decongestants would relieve the high stress on the eardrum from outside ( inside the external ear canal), leading to less pain.¹⁵ In order to clear the obstruction of the Eustachian tube, acetylcysteine salts or saline can also be used resulting in less pressure on the eardrum from the inside. 

Some steroid ear drops may relieve pressure inside the ear canal due to their anti-inflammatory properties. They, therefore, can reduce ear swelling. Additionally, olive oil drops can be used for wax dissolving. However, they should not be used with eardrum perforation.¹⁶

Viruses are the main cause of ear infections in children, so the prescription of antibiotics is in vain unless the infection persists after a few weeks or evidence of bacterial infection has been revealed. 

In the presence of ear bacterial infection, amoxicillin or co-amoxiclav are the first drugs of choice, followed by erythromycin and clarithromycin. If there is ear discharge, a culture and sensitivity test is needed to determine the most appropriate antibiotic.¹⁷  

In severe cases, surgery may be an option for people who suffered from a middle ear infection three times in the last six months or four times in the last year, with one time in the last six months 18.  It involves the incision of the eardrum to drain the accumulated infected fluid behind it inside the ear cavity and inserting a draining tube called a gourmet tube to drain any more formed fluid.¹⁹ 

The complications of ear infections also require treatment. To avoid the spread of infection, the infected bone should also be removed. In the case of ear drum perforation, when the eardrum fails to heal, a surgical repair would be required. Recanalization of clotted vital vessels is also done by administration of clot dissolvent or surgery. 

The middle ear can be kept clear by keeping the eustachian tube opened by chewing gums, i.e. movement of the jaw while swallowing your saliva. This is called Valsalva maneuver for equalizing the pressure on both sides of the eardrum inside the middle and external ear. 

It is interesting that doing this procedure continuously for a week may be a very good remedy for clearing middle ear infections with fluid accumulation.²⁰

The prevention of ear infections, especially pain, is much easier than the treatment process. This starts with care for the ear as any other organ, keeping it clean and open. This includes the clearance of the external ear airway by preventing the accumulation of wax. This can be done through the regular usage of anti-wax drops and having a medically-guided ear wash regularly.  

It is very important to avoid scratching the exposed parts of your external ear, so avoid using your fingers to remove any wax or even itch your ear skin on its  irritation, due to the presence of germs on the hands. The unguided usage of the cotton pads may lead to entrapment of the cotton inside the narrow ear canal, which can be a source of bacterial accumulation with wax later.²¹ 

When to consult a medical specialist

Despite the high workload on the health care services during the COVID pandemic, there has been an emphasis on limiting contact with your doctor to certain conditions of ear infection. If any ear infection is suspected in a child less than 6 months, medical attention should be sought immediately.²² The alarming signs of ear infection that need a consultation by a medical specialist are

• Continuous fever
• Persistent ear pain
• Vomiting
• Nasal bleeding  
• Ear discharge

Summary

By the end of the day, infection of the ear has been vague for a long period due to its tiny and complicated structure. Nevertheless, it  should be clear now that ear infections resemble other body infections in having common features. The underlying cause needs to be identified to allow a proper strategy of treatment. An ear infection can also be prevented through some tips that were discussed in this article in addition to the alarming signs that need medical consultation.