Ear infection is the most common childhood illness other than simple runny nose. Almost every child has had at least one ear infection by the time he or she is six, and for many children and their parents, frequent recurrences of these infections are a major problem. Further, there’s always the worry that the complications of ear infections can impair the child’s hearing and even delay learning to speak. Adults sometimes get ear infections too.
There are two main types of ear infections. Infection of the middle ear and eardrum is called otitis media. It is the more serious illness and is the type most often meant when a health professional diagnoses an “ear infection.” Otitis externa, as its name implies, is infection of the outer ear or of the canal that leads to the eardrum. It is actually a skin infection similar to those occurring elsewhere on the body, but it can cause a great deal of ear pain and discharge. We’ll discuss each type of ear infection separately.
Not all earaches are due to infections. During a cold many people complain that their ears feel stopped up or that they experience twinges of sharp, brief pains. These symptoms are generally mild. They are due to pressure differences on either side of the eardrum caused by the inflammation and fluid secretion that accompanies a cold. Pressure changes also account for earaches that happen in airplanes or in cars driving up or down a mountain. Some people get earaches whenever they are out in a cold wind or swim in cool water.
Otitis Media (Middle Ear Infection)
The middle ear, the space behind the eardrum, becomes infected during an episode of otitis media. The eustachian tube leads from the middle ear forward and downward, connecting the middle ear to the cavity behind the nose. Normally, the tube opens to allow fluids secreted by mucous cells in the ear to drain into the throat, and to allow pressure in the middle ear to become equalized with the pressure of the atmosphere. At other times, the eustachian tube should be closed to prevent fluids in the nose, which are full of microorganisms, from reaching the middle ear.
Ear infections develop when the eustachian tube opens and closes improperly, allowing germ-laden fluids from the nose and throat to enter but not depart from the middle ear. Inflammation resulting from a cold or allergy may cause this improper function, but in young children sometimes the tube is just too small and short to work properly.
As a middle-ear infection progresses, white blood cells and antibodies are secreted into the tissues and the middle-ear area, where they attack and kill infecting bacteria. As dead bacteria and white cells accumulate, pus forms and puts pressure on the ear drum. The thin eardrum membrane bulges outward, and pain increases as it is stretched. Eventually it may tear, allowing pus to drain to the external auditory canal. Don’t be alarmed if this happens (you’ll see pus or blood dripping out of the ear) this is the way the body expels the infected material, and usually a torn eardrum heals rapidly.
The symptoms of acute middle-ear infection are variable. A young child may seem to be in pain, often playing with or pulling at the ears. Older children or adults usually know if something is wrong with the ear, but sometimes even during a severe infection the ear just feels stuffed up. If the eardrum is ruptured, a discharge from the ear may be obvious, or the hair around the affected ear may be sticky or crusty.
Many children with recurrent ear infections have their own characteristic symptom patterns parents learn to recognize early in the illness. Unusual irritability, emotional sensitivity, or clinginess may accompany ear infection, and sometimes a child’s mood changes are the only evidence of the problem. There may be a high fever, but ear infections often occur without any fever at all. Sometimes the child vomits or has diarrhea because of an ear infection, with no sign that something is wrong with the ears. In most cases, if nothing else is responsible, these digestive symptoms clear up rapidly.
The diagnosis of an ear infection depends on accurate visual examination of the eardrum performed with an otoscope, a magnifying lens and light that illuminates the drum and external canal through a small speculum that fits into the canal. A normal eardrum has a pearly gray, slightly shiny appearance and looks delicate and translucent. During an infection the most characteristic change is outward bulging of the eardrum due to buildup of pus inside. The eardrum becomes thickened and more opaque and often looks quite red. Redness of the drum, however, may be caused by fever, crying, or cold, and a diagnosis of otitis media should never be made on the basis of a red eardrum alone.
Traditionally, physicians have held that antibiotics effectively treat ear infections and prevent complications. However, many scientific studies over the past 25 years contradict such beliefs. In one large study of children with acute otitis media, those treated with antibiotics actually recovered at a slightly lower rate than those who were not. (Froom, et al, 1990). Another found that children with chronic otitis maintained on prophylactic (preventative) antibiotics were two to six times more likely to have recurrent acute infections than those on placebos (Catankin, et al, 1991). Recently, John Bailar, M.D., a Harvard professor and editorial board member at the New England Journal of Medicine, comprehensively reviewed the scientific literature on the treatment of otitis with antibiotics. He concluded that the available research, “… seems to demolish the conclusion that antibiotics improve the outcome [in otitis media]” (Bailar, 1995).
In any case, be watchful if otitis media is diagnosed. Serious acute complications of middle-ear infection are rare but do occur. These include mastoiditis, infection of the bony area just behind the ear. Be alert for any redness, tenderness, pain, or swelling in this area and report these symptoms immediately to your health practitioner. Mastoiditis can become a chronic problem and result in hearing loss and erosion of the bone.
Meningitis and other infections of the central nervous system may result from acute otitis media if the infection spreads through the blood stream to bony structures. Symptoms of these problems include severe or persistent headache, stiff neck, persistent vomiting, and marked change in mood or alertness.
The most common complications of middle-ear infections are the chronic ear problems that often follow. Serous otitis media, accumulation of a translucent noninfectious fluid in the middle ear, interferes with normal motion of the eardrum and the tiny middle ear bones so that hearing is reduced.
Homeopathic constitutional treatment is often effective with chronic serous otitis. Antihistamines and decongestants are worthless, though they are often prescribed. Conventional treatment for persistent hearing loss due to serous otitis involves surgical insertion of polyethylene tubes into the eardrum to allow drainage of middle-ear fluid. These tubes seem to improve treated ears’hearing for a few months, and this may be very important to the child who is at a crucial stage of language development. Research has shown, however, that there is no long-term improvement in hearing when tubes are inserted, and eardrums in which tubes have been placed tend to become scarred. We believe that the tubes should be inserted for serous otitis only when there is a significant, documented hearing problem, when the risks of the surgery are clearly understood, and when the goal of treatment is improved hearing within a short period.
General Home Care
General recommendations for any infectious illness apply to people with acute middle-ear infections; they should rest, have plenty of liquids, and be comforted. A heating pad or hot washcloth applied to the ear may help reduce pain.
To help prevent ear infection, avoid nursing or bottle feeding children when they are in a lying position; gravity may allow milk or juice to run into the eustachian tubes, encouraging infection. Allergies may predispose an individual to ear infection by causing inflammation and fluid buildup; identification of the substances that trigger allergic reactions for that person can be helpful.
Beyond Home Care See “Beyond Home Care” that follows “Otitis Externa.”
Otitis Externa (Outer Ear Infection)
External ear infections are essentially skin infections involving the canal that leads from the outer ear to the eardrum, The symptoms of external ear infections often include much ear pain and throbbing due to inflammation. The pain is characteristically aggravated by moving the outer ear, so a helpful way to differentiate between middle ear and external ear infections is to pull on the earlobe. Both types of ear infections can be present at the same time, so you should still use the guidelines in “Beyond Home Care” to decide if medical consultation is needed. Often the ear canal is quite itchy during an external ear infection. If you look into the canal, you can see that it is red and scaly or wet, and a thick discharge may be present. There is usually no fever or general symptoms of illness.
External ear infections do not endanger the organs of hearing, although the discharge and swelling may reduce hearing for a time. As with all skin infections, there is some small danger that the infection will spread aggressively. Rapidly spreading redness or swelling of the outer ear or nearby skin is a danger sign, as is onset of fever.
General Home Care
Gently wash out the accumulated scaling and discharge by placing a piece of cotton soaked in dilute vinegar (half water/half vinegar) or Burow’s solution (available at drug stores) in the ear canal, leaving it there for eight to twelve hours. Make sure you can pull the cotton out easily again. Then briefly rinse the canal with warm water, using a bulb syringe. Let the ear drain after this, but put in a drop or two of the vinegar solution every eight hours or so.
Beyond Home Care
Get Medical Care Immediately:
- if earache is accompanied by severe weakness, loss of alertness, severe headache, or stiffness of the neck.
Get Medical Care Today:
- if a baby begins to pull or rub her ears;
- for any definite earache or any ear discharge in a child under seven years old;
- for anyone with severe earache, especially if it’s accompanied by fever or ear discharge;
- if there is tenderness or redness in the bony area behind the ear;
- if there is sudden, significant decrease in hearing with or without pain.
See Your Practitioner Soon:
- if an older child or adult has had mild ear pain or discharge lasting longer than one or two weeks;
- if mild hearing loss lasts longer than two weeks.
Homeopathic Medicines for All Ear Infections
The following descriptions apply to children with ear infections, but the indications for adults are the same. Most of the descriptions of physical-exam findings (color and shape of the eardrum) apply to otitis media, but all the other symptoms are applicable to those with both middle-ear infections and otitis externa. You can also use these descriptions to treat the person with a earache due to something other than infection.
Many of these medicines share similar symptoms. For example, Silica, Hepar sulph., and Mercurius are all equally indicated by the presence of painfully swollen lymph nodes in the head and neck that commonly occur with ear infections. If no medicine is strongly indicated, start with either Pulsatilla, if the child is more clingy than usual, or Hepar, if the child is somewhat irritable or severe pain is the predominant feature of the illness.
Casetaking Questions for Earaches
Character of the symptoms:
- Does the pain extend into the throat, neck, or behind the ear?
- Describe the color and consistency of any discharge from the ear.Modalities:
- At what time of day is the pain at its worst?
- Is the ear tender or sensitive to touch?
- How does heat and cold affect the pain?
- How is the pain affected by stooping or bending over, motion in general, and lying down? Does it help to lie on the affected ear?
- Does swallowing make the pain worse?Other symptoms:
- What is the color and consistency of any nasal discharge?
- Is perspiration or salivation increased? (See the appropriate articles if the earache is accompanied by runny nose, cough, sore throat, or any other symptoms.)Remedy Summary for Earaches
Give the medicine: every 3-6 hours for 2-3 days, stopping when there is definite improvement; repeat when symptoms begin to get worse again, or if no further improvement has occurred after twelve hours. When to try another medicine: if there is no significant improvement after 12-24 hours
- Earache beginning suddenly with intense pain, with few prior symptoms of a cold (no thick or colored nasal discharge) Confirmatory symptoms
- Bright red outer ear, ear canal, or eardrum without pus formation
- Accompanied by sudden high fever (see chapter 3)
- Ear pain extending down into the neck, or accompanied by sore throat or facial pain.
- Early stages of earaches before pus has formed; symptoms similar to Belladonna but not as sudden or severe
- Alternatively, give if Belladonna seems indicated but hasn’t helped.
Hepar sulph. Essentials
- Sharp, severe earache
- Earache accompanied by thick, colored discharge from nose or ears
- Irritability Confirmatory symptoms
- Chilliness and aversion to the cold or uncovering; desire for warmth
- Earache worse in cold or open air or from cold applications better from warmth; worse at night
- Mild disposition; craves affection and physical contact
- Yellow to green thick discharge from the nose or ears Confirmatory symptoms
- Ear pain worse at night and in a warm room.
- Worse in general from warmth, wants fresh air
- Little or no thirst
- Extreme irritability; the child screams and cries angrily, doesn’t want to be touched or comforted, and may strike out
- Severe ear pain Confirmatory symptoms
- The child calms down when carried
- Earaches during teething
- Symptoms are worse when stooping or bending over and improved by warmth or being wrapped in warm covers
- Clear nasal discharge, usually of watery consistency
- Another common earache remedy after pus has formed in the middle ear Confirmatory symptoms
- Earache worse from warmth and worse at night
- Profuse, bad-smelling perspiration, head sweats
- Increased salivation, bad breath, puffiness of the tongue
- Symptoms are worse when stooping or bending over and improved by warmth or being wrapped in warm covers
- Later stages of an earache
- Physical weakness and tiredness
- Chilliness, desire for warm covering Confirmatory symptoms
- Mild and whimpering disposition but less interested in affection than the
- Pulsatilla patient
- Pain behind the ear in the region of the mastoid
- Sweating about the head or on the hands or feetBelladonna is the most commonly indicated homeopathic medicine during the early stages of an ear infection or earache, especially when the illness begins suddenly with few prior cold symptoms, Within an hour or two the child is in intense pain. He may have had a watery runny nose for a short while, but the mucus isn’t cloudy, colored, or thick. The outer ear, ear canal, or eardrum may be bright red, but pus hasn’t formed and the eardrum is still normally shaped. A sudden high feveroften begins about the same time as the earache. The ear pain may extend down into the neck, and there may be associated sore-throat or facial pain.Ferrum phos. is used in much the same way as Belladonna, in the early stages of suddenly occurring earaches not yet accompanied by pus formation. The onset is not quite as sudden, the fever is not so high, and the overall condition of the child is a little less intense. You can also give Ferrum phos. if you’ve already tried Belladonna and it still seems indicated, but hasn’t worked. Chamomilla is indicated chiefly by the effects of the illness on the child’s mood, and less so by particular symptoms. Children for whom Chamomilla is indicated are extremely irritable. They scream and cry angrily, do not want to be touched, and can’t be comforted. They may ask for things that they then reject, and they are likely to hit you for crossing them at all or for no apparent reason. Sometimes the child can be calmed by being carried. The earache generally doesn’t come on as quickly as in the Belladonna case, but the pain is severe and the child may scream. The symptoms may be made worse by stooping or bending over and improved by warmth or being wrapped in warm covers. A discharge from the ear is less typical of Chamomilla than of other medicines discussed later. There is usually a watery runny nose and, less often, a very thick discharge. As with Belladonna, the nasal mucus is usually not colored. Whatever the particular symptoms, though, be sure to consider Chamomilla for the child who is in severe pain, especially if he is extremely irritable.
Another commonly effective medicine is Pulsatilla. In contrast to Chamomilla, it is indicated for children who are sweet, placid, loving, and mild during the earache. The Pulsatilla child may be irritable, but the irritability is weak and whiny, not violent as is the Chamomilla or Hepar child. Pulsatilla children want to be held and cuddled and are comforted when given affection. They too may scream with the pain but are just as likely to weep piteously. Pulsatilla is more frequently indicated for ear infections that develop after cold symptoms have been persistent for a few days. The nasal discharge has become thick and yellow to green in color. Though pain may be fairly severe, sometimes there seems to be no pain at all. Examination often shows a red, swollen eardrum and a buildup of pus in the middle ear. A thick yellow-green discharge may be seen at the external canal. The pain is typically worse at night and in a warm room. There may be a sensation of pressure in the ear. The child may or may not be feverish but tends to feel uncomfortably warm and wants fresh air. She is noticeably less thirsty than usual, even with a high fever. In any case, the strongest indication for Pulsatilla is the characteristic mildness and clinginess of the child.
Silica is also indicated for the middle and later stages of a cold accompanied by an ear infection. The child who needs Silica also is mild and whimpering but is less loving and less interested in affection than the Pulsatilla child. Also characteristic of children for whom Silica is indicated are marked physical weakness and tiredness. The illness seems to have really worn them out. They are definitely chilly and want warm covering. They may have sweat about the head or on the hands or feet. If there is pain in the ear, it may be intense but usually not as severe as the pain of some of the other medicines. It tends to occur at night and is made worse by cold applications, moving, sitting for a long time, and noise. Silica is the remedy most prominently indicated for pain behind the ear in the region of the mastoid, though many other medicines also cover this complaint. There may be itching in the ear (also symptoms of Hepar sulph. and Mercurius) or a stopped-up sensation. The examination may show inflammation and pus formation, and there may be drainage of pus or watery fluid from the ear. A nasal discharge, of any character, often accompanies the infection.
The physical symptoms indicating Hepar sulph. are similar to those of Silica but more intense. Again, this is a remedy best given during the middle and late stages of colds and ear infections, when a thick, colored nasal discharge often precedes or accompanies the earache and when inflammation in the middle ear has progressed to the point that pus has formed. You should think of Hepar when the child is intensely, even violently irritable about everything. Although this emotional state is similar to that described for Chamomilla, the child is a little less expressive, is less prone to scream constantly or hit, doesn’t have such a strong aversion to being held, and is less likely to throw away things she asked for. But the Hepar child lets you know, in no uncertain terms, that she is angry. Hepar is indicated for children who are very chilly-cold air or coldness of any sort makes them uncomfortable and provokes symptoms. The child wants the heat turned up, and she wants lots of blankets. The earache is usually severe and is worse at night. It is also made worse by cold air, open air, and cold applications and is improved by warmth and bundling up.
Mercurius is also indicated for earaches after pus formation has occurred. The child needing Mercurius is somewhat irritable and may act impulsively or hastily, or he may be less alert than when normal. He may be generally bothered by heat or cold or both, but this particular earache is typically made worse by warmth, especially the warmth of the bed. Pain is worse at night. Characteristic Mercurius symptoms also include profuse and offensive perspiration, head sweats, increased salivation, bad breath, puffiness of the tongue, and trembling or twitching.
The information provided here is not only applicable to children but to most people with earaches.
By Dana Ullman MPH, CCH