They can be caused by fluid entering the ear canal which leaves a moist environment in which germs can thrive. They can also be caused by cuts or abrasions in the ear canal, such as those caused by scratching with a Q-tip.

There is often drainage and intense pain upon touching the ear. Sometimes, if the infection is very severe, the entire ear canal can become completely swollen. Treatment often includes ear drops and/or an antibiotic. It is very important to keep the ears dry during the acute infection.

In my last article, I discussed eustachian tube dysfunction. The eustachian tube is the "pop-off valve" that releases the pressure between the ear and the nose.

If there is any congestion or swelling in the nose, the eustachian tube will not function efficiently. This type of congestion occurs during a cold or in the nose of someone who has allergies.

If the fluid that is normally made behind the ear drum cannot drain down the eustachian tube, it will remain behind the ear drum. If the fluid becomes infected, you have an acute otitis media, or middle ear infection. If the infection is great or if the pressure is very large, the ear drum may rupture. This is very painful.

Otitis media can happen to either adults or children. However, children are more prone to having eustachian tube dysfunction because of their anatomy.

The eustachian tube is at a 45 degree angle in adults. In children, this tube is located in a horizontal position. It gradually develops into the adult angle by approximately mid- childhood.

This is the reason that children should not feed from the bottle while lying down. The liquid can reflux via the mouth up through the eustachian tube to the region behind the ear drum. This liquid may cause an ear infection by bringing the genus from the mouth to the ear.

The eustachian tube is a passively-closed tube. It has to be actively opened. We unconsciously open it when we chew or yawn. This is the same action as when we "pop our ears" when coming down in an airplane or from the mountains.

The muscles that are used to open this tube are not very well developed in children. Thus, kids have difficulty equalizing their ear pressure via the eustachian tube.

The third reason that children are more prone to having problems with their eustachian tubes is that children have adenoids. Adenoids are lymph tissue, similar to the tonsils. The adenoids are located in the back of the nose in an area known as the nasopharynx.

The eustachian tubes open into a region that can be obstructed by adenoid tissue. Thus, large adenoid tissue can lead to obstruction of the eustachian tube openings and recurrent ear infections. Interestingly enough, adenoids usually shrink and disappear by approximately 16 years of age. Thus, adults don't often have problems with adenoids.

Most children tend to outgrow their ear infections when their anatomy resembles that of an adult. However, until that time, some children continue to have repeated ear infections. If the infections become extremely recurrent or persistent, the fluid behind the ear drum can significantly decrease their ability to hear.

They are essentially living life "underwater." This can lead to speech delay. In addition, repeated ear infections can lead to scarring of the ear drum which may cause permanent hearing loss.

The majority of middle ear infections are caused by a virus. When the cold resolves, the ear infection usually does as well. However, bacteria can superinfect the viral infection, and antibiotics are then needed to eliminate the ear infection.

If the ear drum actually ruptures, antibiotic drops in addition to antibiotic pills are often necessary.

Sometimes, in order to minimize the inflammation around the eustachian tube, decongestants (Sudafed) and steroids (Prednisone) are also used to treat ear infections. One very effective medication is a nasal steroid spray such as Flonase or Nasonex. They shrink inflammation in the nose. Thus, you are treating the ear via the nose.

These prescription sprays are not significantly absorbed in the bloodstream, but mainly in the nose, so they do not cause the side effects that other steroids may cause.

When medical therapy fails, a relatively simple surgical procedure is often done for children to try to equalize the pressure behind the ear drum. The surgery is called a myringotomy with tube placement.

A PE tube, or pressure equalization tube, is inserted into the ear drum. An incision is made in the drum and any fluid behind it is suctioned. Then the tube is placed in the incision site.

Essentially, air and fluid can flow in via the tube and then drain to the nose and throat via the eustachian tube. Sometimes this procedure is performed in adults who have eustachian tube dysfunction that does not respond to standard medical treatment.

If you think that you or your child have either otitis externa or otitis media, please consult your physician.

Ruwanthi Campano, M.D. is a board-certified otorhinolaryngologist (ear, nose and throat) /head and neck surgeon and facial plastic and reconstructive surgeon who practices in Ridgecrest. She can be reached by calling 371-7329 or at her Lancaster office at (661) 726-6277.

By Ruwanthi Campano, M.D.