“An ear infection,” we often hear parents say, “how can that be? I am so careful not to get water into her ear.”
Stop. Rewind.
First of all, it’s not you who causes the illness. Germs cause infections. Not parents.
When we doctors say “ear infections,” we usually refer to middle ear infections. Where exactly is the middle ear? When we look into the ear we peer down a tunnel called the ear canal. This part of the ear is considered the outer ear. At the end of the tunnel is a sealed door called the ear drum (The medical term for ear drum is “tympanic membrane.” We’ll stick with “ear drum”). Behind the ear drum is the middle ear. Unless the ear drum/door leading into the middle ear is open (from a rupture or from ear tubes), water cannot enter the middle ear.
Now picture yourself opening the door and walking through to the middle ear. When you stand in the middle ear you will see tiny bones which help with hearing. The middle ear is the space that fills with fluid and gives you the uncomfortable sensation of pressure when you have a cold. It is the same space that gives you discomfort when you are descending in an airplane. In the floor you will see a drain. This drain, called the Eustachian tube, helps drain fluid out into the mouth. “Popping” your ears by swallowing opens this drain when you are descending on a flight. If fluid (usually from a cold) sits long enough in the middle ear, it can become infected with bacteria and the pus causes pressure and pain.
Beyond the middle ear is the inner ear, which houses nerves needed for hearing. Because infections do not occur here, you never hear about this part of the ear (pun absolutely intended).
So, why do people talk about preventing ear infections by preventing water from getting into the ear? There is a type of ear infection called Swimmer’s ear or otitis externa which occurs in the outer ear. Swimmer’s ear usually results from a bacteria which grows in a damp environment. The water that causes this damp environment typically comes from a swimming pool, but can also come from lake, ocean, or even bath water. Swimmer’s ear can also be a result of anything that causes ear canal irritation such as eczema, hearing aids, or even beach sand.
To summarize:
Ear infection = middle ear infection
Swimmer’s ear = outer ear infection
Cause of ear infections = germs
So, are you to blame for either type of ear infection? No, but there are associated factors which you can modify.
To prevent middle ear infection:
- Wash hands to decrease spread of cold viruses.
- Limit exposure to second hand smoke
- Give all vaccines on time – pneumococcal bacteria can cause ear infections and ear infections are a complication of the flu –we have vaccines against these germs
- If your child suffers from allergies, talk to your child’s doctor about decreasing triggers in the environment and/or taking medications to prevent middle ear fluid build-up from allergies
We can help kids who contract a lot of ear infections by promoting middle ear fluid drainage before an infection occurs. Ear, nose, throat doctors (also known as ENTs or otolaryngologists) poke a hole in the ear drum leading to the middle ear and place a small tube in the hole. Through the myringotomy tubes, often referred to as “ear tubes,” fluid runs from from the middle ear out into the outer ear canal.
To prevent Swimmer’s ear, dry your children’s ears with a towel or blow gently with a hairdryer on cool setting after they are done swimming for the day or after they are out of the bath and well-dried off.
We wrote this post because of the many questions we often hear about ear infections and ear anatomy. Hope the information wasn’t too eerie. Or is that EARie?
Naline Lai, MD and Julie Kardos, MD
©2013 Two Peds in a Pod®