Ear Infections: Minimizing Tinnitus & Preserving Auditory Function

The ear is made up of three parts: the inner ear, the middle ear, and the outer ear. Ear infections occur within the middle or outer part of the ear, and can be felt in one or both ears simultaneously. Although both children and adults can experience ear infections, they are more common in children. This is due to the different sizes and placement of anatomical structures found in the sinus and middle ear systems of children and adults. From ear wax to infection, can ear infections ultimately affect auditory health and cause and/or increase tinnitus?

Risk Factors For Infection

Risk factors of ear infection can include change in climate or weather, family history, exposure to smoke, attending day care, medical conditions including eustachian tube dysfunction and infection of the sinuses. Although abnormal bone growth can also be implicated, the natural structure of a child’s sinus cavity serves as a risk factor for infection, because the drainage pathways are more difficult to engage.

The Eustachian tube has more of a horizontal angle in babies and children and as we age, the Eustachian tube stretches out with our face to have more of a vertical angle orientation. This allows for better drainage of any  middle ear fluid in adults and less risk of sinus drainage working its way from the back of the throat up the Eustachian tube to enter the middle ear.

Outer Ear And Middle Ear Infection

Outer ear infections can include otitis externa, commonly known as “swimmer’s ear,” or fungal infections like Otomycosis, which cause inflammation of the external ear canal . These can be treated at home or with medical intervention from a doctor, but in rare cases, can lead to severe complications. Infections like these can trigger tinnitus, and are best looked at by a professional.

Middle ear infections can include otitis media, which occurs when there is a build-up of fluid behind the eardrum. An acute infection of this type is the most common form, and is not associated with acoustic neuroma, neck trauma, or other (more serious) types of illness or injury. It can, however, be associated with eustachian tube dysfunction.

The eustachian tube is a small passageway that connects the upper part of the throat to the middle ear. Its job is to supply fresh air to the middle ear, drain fluid, and keep air pressure at a steady level between the nose and the ear. An ear disorder involving the eustachian tubes is typically found in children; because the tube is smaller and level in children, fluid does not drain as readily from the space. Stagnant fluid is frequently at the root of infection in children.

Symptoms Of Infections In The Ear

Common signs for adults can include earache, drainage of fluid/pus from ear, trouble hearing and tinnitus. Symptoms in children are similar, but may also include earache, fever, tugging/pulling on ear, imbalance, fussiness, hearing loss, drainage, and loss of appetite.

Hearing loss due to infection is likely temporary, and tends to resolve entirely once the infection has cleared. Conductive hearing loss is such that sound is unable to pass through the ear sufficiently, so when fluid is relieved or drained, sound is able to penetrate and carry properly – resulting in improved sound signals and the restoration of normal hearing.

Sensorineural hearing loss typically occurs as age-related hearing loss, or as a result of exposure to loud sounds. This type of loss stems from auditory nerve damage of the inner portion of the ear and the hair cells found there.

In both cases, loss of hearing can lead to difficulty concentrating. This may be even more pronounced when background noises are present, as the sound the brain is able to interpret in basic or daily environments is highly limited. Hearing loss and tinnitus diagnosed following infection can also be related to temporarily damaged blood vessels or impaired blood vessels.

Diagnosing Infections In The Ear

It is important to seek medical advice if infection is present without a sign of improvement, if there is severe or prolonged pain, changes in hearing, or discharge of pus or fluid from the ear. All of these can indicate an inner ear disorder, a more severe illness or infection, or another, more serious, concern. When infection is persistent or severe, it may require antibiotic treatment.

To diagnose an infection, a doctor will utilize a lighted instrument, called an otoscope, to inspect the eardrum. Red or bulging eardrums indicate infection and inflammation. A pneumatic otoscope or tympanometry testing can also evaluate the mobility of the eardrum, and identify the presence (or lack) of fluid within the ear. This, too, can more fully identify the source of pain, inflammation, or discomfort, and provide a viable means of treatment.

Even if the inflammation seems mild, it is best to see a primary care physician, audiologist, or ENT for a hearing evaluation, physical inspection, and other diagnostic measurements to confirm or deny that infection is present, and develop the best treatment.

Tinnitus And Infections In The Ear

Tinnitus can occur as a result of many things: certain medications, neck or head injury, exposure to loud external noises, and even general ear problems without a specific root cause. Nevertheless, tinnitus can also develop as a result of hearing changes on the heels of infections of the ear. In these instances, tinnitus typically presents as hearing ringing, buzzing, or chirping during the illness.

Hearing loss can also trigger tinnitus, and infection in one ear or both has been known to trigger symptoms. A hearing test can determine if hearing loss due to infection is likely to be temporary or permanent, though many instances of infection and a medical history without hearing loss result in hearing restoration.

If tinnitus is already present before infection, infection may worsen tinnitus and lead to a spike in symptoms. It can also worsen any existing hearing loss or hearing changes. When infection is accompanied by blockages to the ear canals and/or the middle ear space, whether through fluid, earwax, dirt, or another foreign material, pressure in the ear changes and can also lead to a spike in tinnitus. When infection is the root cause, treating the infection typically results in the elimination of risk factors, and tinnitus symptoms resolve.

Tinnitus treatment can be the first step, but is often a peripheral concern. Because infections within the ear can cause extreme discomfort, they can lead to difficulty sleeping, concentrating, and in some cases, even social difficulty. Treating tinnitus is often a principal concern, but symptoms can easily resolve once the root source is addressed.

Managing Tinnitus

While recovering from an infection in the ear, there are methods individuals can use to try to manage symptoms. Some of these are simple, involving lifestyle modifications to manage high blood pressure and support general health and wellness. Others are more specific to tinnitus, including Tinnitus Retraining Therapy (TRT), sound therapy, Cognitive Behavioral Therapy (CBT), hearing aids or sound generators, and more, but all of these are unlikely to be necessary if the underlying condition is an infection.

Hearing aid use, CBT, and TRT are common tinnitus treatment options when the hearing loss or hearing changes are more permanent than a single infection. When tinnitus occurs as a result of an infection or other inner ear issue, individuals may feel more sensitive to sound and should avoid loud noise exposure as much as possible. Even loud music can increase the sensation of ringing or buzzing, and ear protection can be invaluable.

Recurrent Infections Of The Ear

Most inflammation and infection in the ear does not lead to long-term complications, but recurrent infection does have the potential to cause serious complications, including speech delays, impaired hearing, increases in infection, and damage to the eardrum. These issues can be further exacerbated by loud noises and damage to the inner ear.

Prolonged exposure to infected ears can result in more significant hearing loss or changes, and if the eardrum or structures within the ears are permanently damaged, hearing loss and tinnitus may also be permanently damaged. Should infants or toddlers be plagued by persistent infections, delays in speech, social, and developmental skills can all be the end result.

Untreated or nonresponsive infections can spread to nearby tissues, resulting in mastoiditis (infection of the mastoid, or the bony protrusion behind the ear), or meningitis (infection of tissues within the skull, including the brain, brain fluid, and membranes around the brain). While some eardrums can heal on their own, others can require surgical intervention, so it is important to pay close attention to all signs of serious infection, and seek medical care when appropriate.

Infections In The Ear And Tinnitus

Whether loud noise is the cause, or an infection is the root cause for someone to develop tinnitus, there are steps you can take to make sure the underlying cause is addressed, and tinnitus is resolved or managed effectively. People with infections or tinnitus symptoms should limit exposure to loud noises, wear ear protection when exposed to loud sounds, seek medical attention when symptoms of illness or injury arise, and ultimately utilize sound therapy, TRT, CBT, and other techniques to limit symptoms, improve quality of life, and potentially resolve tinnitus.