The external ear is the tube running from the ear opening to the tympanic membrane (eardrum) and is lined with epithelium much like the skin that covers the outside of the body. This is why many chronic or recurring ear infections are related to generalized skin disease (infection, allergy, hormonal imbalance, etc.).

The middle ear is a bony chamber lined with respiratory tract mucosa. It is separated from the external canal by the eardrum.

Besides being part of the hearing apparatus, the eardrum prevents bacteria, wax and other debris from entering the middle ear. Otitis externa (external ear infection), however, can easily damage and perforate the eardrum exposing the middle ear to contaminants from the external ear canal. Otitis media (middle ear infection) is much more difficult to treat than otitis externa as it is difficult for medication to get into the middle ear and difficult for pus and other fluids to get out.

The first step in treating otitis media involves meticulous cleaning of both the external canal and middle ear. Under light general anesthesia, a fiber optic scope permits visualization of the middle ear on a video monitor. Small catheters and other instrumentation can be passed through a working channel in the scope allowing removal of pus, wax and mucous. When the area has been thoroughly cleaned medications can be injected through a catheter directly into the middle ear.

Successful treatment of otitis media requires persistence and patience. After the middle ear is cleaned it can still produce exudate for some time. If exudate is allowed to remain the problem will not resolve. This means that sometimes several anesthetic and flushing procedures are needed. Persistent ear infections are sometimes secondary to other factors such as allergy or hormonal imbalance. Non-responsive patients may need to be tested for these conditions.

Remember—persistence and patience. The longer ear infections are allowed to continue the more difficult they become to resolve.