William W. Forgey, MD
Body System Symptoms and Management - Ear
Updated: Nov 12, 2020
Excerpt from The Prepper's Medical Handbook. Page reference numbers point to more in-depth treatment and self-reliant care available within the book.
Problems with the ear involve pain, loss of hearing, or drainage. Traumas involving the ear could include lacerations, blunt trauma and hemorrhage (bleeding) in the outer ear tissue, and damage from pressure changes to the eardrum (barotrauma) from diving or high altitude, explosions, or direct blows to the ear. See table 3-5 for signs and symptoms.
Pain in the ear can be associated with a number of sources, as indicated in table 3-5.
The history of trauma will be an obvious source of pain, as mentioned. Most ear pain is due to an otitis media infection behind the eardrum (tympanic membrane), or to otitis externa infection in the outer ear canal (auditory canal). It can also be caused by infection elsewhere (generally a dental infection, infected tonsil, or lymph node in the neck near the ear). Allergy can result in pressure behind the eardrum and is also a common source of ear pain.
A simple physical examination and additional medical history will readily (and generally accurately) distinguish the difference between an otitis media or otitis externa infection, as well as sources of pain beyond the ear. Pushing on the knob at the front of the ear (the tragus) or pulling on the earlobe will elicit pain with otitis externa. This will not hurt if the patient has otitis media. The history of head congestion favors otitis media.
A swollen, tender nodule in the neck near the ear would be an infected lymph node. If the skin above the swelling is red, the patient probably has an infected skin abscess. The pain from an abscess is so localized that confusion with an ear infection is seldom a problem. One or more tender lymph nodes can hurt to the extent that the exact source of the pain may be in doubt. Swollen, tender lymph nodes in the neck are usually associated with pharyngitis (sore throat), severe otitis externa, or infections of the skin in the scalp. The latter should be readily noted by examination—palpate the scalp for infected cysts or abscesses.
Dental caries, or cavities, can hurt to the extent that the pain seems to come from the ear. They can ordinarily be identified during a careful examination of the mouth. If an obvious cavity is not visualized with a light, try tapping on each tooth to see if pain is suddenly elicited (see Dental Pain, page 109.)
Outer Ear Infection
Outer ear infection of the auditory canal (otitis externa), the part of the ear that opens to the outside, is commonly called swimmer’s ear. The external auditory canal generally becomes inflamed from conditions of high humidity, accumulation of ear wax, or contact with contaminated water. Scratching the ear after picking the nose or scratching elsewhere may also be a source of this common infection.
Prevent cold air from blowing against the ear. Warm packs against the ear or instilling comfortably warm sweet oil or even cooking oil can help. Provide pain medication. Obtain professional help if the patient develops a fever, the pain becomes severe, or lymph nodes or adjacent neck tissues start swelling. Significant tissue swelling will require antibiotic treatment. At times a topical ointment will suffice, but with fever or swollen lymph or skin structures, an oral antibiotic will be required.
Triple antibiotic ointment with pramoxine from the Topical Bandaging Module will work fine for outer ear infections. This is not approved by the FDA for this use, as ear infections are serious, and it is not intended that nonphysicians treat this condition without medical help. From the Rx kit, one could use the Tobradex ophthalmic drops. These medications should be applied with the ear facing up and, in the case of the ointment, allowed to melt by body temperature. This may take 5 minutes per ear. Place cotton in the ear to hold the medication in place. Instill medication 4 times daily and treat for 14 days. If the canal is swollen shut, a steroid ointment may also be used in between applications of the other ointments. From the Topical Bandaging Module, use the hydrocortisone 1% cream in addition to the triple antibiotic ointment. Tobradex contains enough steroid to be adequate for these purposes.
Swollen tissue and/or fever also require an oral antibiotic. From the Rx Oral/Topical Medication Module, use doxycycline, 100 mg twice daily, or Levaquin, 500 mg daily. Provide the best pain medication that you can. From your Non-Rx Oral Medication Module, use 1 or 2 Percogesic tablets every 4 hours.
Middle Ear Infection
Middle ear infection (otitis media) presents in a person who has sinus congestion and possibly drainage from allergy or infection. The ear pain can be excruciating. Fever will frequently be intermittent, normal at one moment and over 103°F (39°C) at other times. Fever indicates bacterial infection of the fluid trapped behind the eardrum. If the eardrum ruptures, the pain will cease immediately and the fever will drop. This drainage allows the body to cure the infection, but will result in at least temporary damage to the eardrum and decreased hearing until it heals.
There is no increased pain when pulling on the earlobe or pushing on the tragus (the knob in front of the ear) in this condition, unless an outer ear infection is also present. If you were to look at the eardrum with an otoscope, it would be red and bulging out from pressure or sucked back by a vacuum in the middle ear.
You do not need an otoscope to diagnose this condition. Many people will complain of hearing loss and think they have wax or a foreign body in the ear canal, when they actually have fluid accumulation behind the eardrum. Consequently, ear drops and washing the ear will not help improve this condition. Beside pain, the key to the diagnosis is head congestion and fever.
There is little that can be accomplished without medication. Protect the ear from cold, position the head so that the ear is directed upward, and provide warm packs to the ear. While drops do not help cure this problem, some pain relief may be obtained with drops of warmed sweet oil (or even cooking oil) in the ear.
Treatment will consist of providing decongestant, pain medication, and oral antibiotic. A good decongestant and pain reliever from the Non-Rx Oral Medication Module is Percogesic, 2 tablets 4 times daily. Rx pain medication is given as needed, as indicated in the previous section. Only the Rx Oral/Topical Module has the proper antibiotics to treat this condition. Use doxycycline, 1 tablet twice daily, or Levaquin, 500 mg daily, generally for 5 to 7 days.
If the pressure causes the eardrum to rupture, the pain and fever will cease, but there will be a bloody drainage from the ear. Hearing is always decreased with the infection and will remain decreased for some time due to the ruptured eardrum. This generally heals itself quite well, but treat with decongestant to decrease the drainage and allow the eardrum to heal. Avoid placing drops or ointments in the ear canal if there is a chance that the eardrum has ruptured, as many medications are damaging to the inner ear mechanisms.
Foreign Body Ear Injury
These are generally of three types: accumulation of wax plugs (cerumen), foreign objects, and living insects. Wax plugs can usually be softened with gently warmed oil. This may have to be placed in the ear canal repeatedly over many days. Irrigating with room temperature water may be attempted with a bulb syringe, such as the one recommended for wound irrigation in the Topical Bandaging Module. If a wax-plugged ear becomes painful, treat as indicated in the section on otitis externa (Outer Ear Infection, page 55).
The danger in trying to remove inanimate objects is the tendency to shove them farther into the ear canal or to damage the delicate ear canal lining, thus adding bleeding to your troubles. Of course, rupturing the eardrum by shoving against it would be an unnecessary disaster. Attempt to grasp a foreign body with a pair of tweezers if you can see it. Do not poke blindly with anything. Irrigation may be attempted as indicated above.
A popular method of aiding in the management of insects in the ear canal is the instillation of lidocaine to kill the bug instantly, prior to attempting removal.There are reports of lidocaine making a person very dizzy, especially if it leaks through a hole in the eardrum into the inner ear.This dizziness is very distressing and may result in profound vomiting and discomfort. It is self-limiting, however, and should not last more than a day if it does transpire. An alternative method is to drown the bug with cooking or other oil, then attempt removal. Oil seems to kill bugs quicker than water. The fewer struggles, the less chance for stinging, biting, or other trauma to the delicate ear canal and eardrum. Tilt the ear downward, thus hoping to slide the dead bug toward the entrance, where it can be grasped. Shining a light at the ear to coax a bug out is probably futile.
Rupture of the eardrum (tympanic membrane perforation) can result from direct puncture, from explosions, and from the barotrauma of diving deep or rapid ascent to high altitude. Being smacked on the ear can also rupture the eardrum, an event that can easily happen during horseplay.
If suffering from sinus congestion, avoid diving or rapid ascents of altitude in vehicles or airplanes. Congestion can lead to blockage of the eustachian tube. Failure to equilibrate pressure through this tube between the middle ear and the throat, and thus the outside world, can result in damage to the eardrum. In case of congestion, take a decongestant and pain medication combination such as Percogesic, 2 tablets every 4 hours, until clear. Cancel any diving plans if congested. Also, if a gradual pressure squeeze is causing pain while diving, the dive should be terminated.
When flying, blocked eustachian tubes will cause more pain upon descent than ascent. When going up, the pressure in the inner ear will increase and blow out through the eustachian tube. When coming down, increased outer atmospheric pressure is much less apt to clear the plugged tube, and a squeeze of air against the eardrum will result. Try to equalize this pressure by pinching the nose shut and gently increasing the pressure in your mouth and throat against closed lips. This will generally clear the eustachian tube and relieve the air squeeze on the eardrum. Do not overdo this; that can also be painful. If barotrauma results in eardrum rupture, the pain should instantly cease. There may be bloody drainage from the ear canal. Do not place drops in the ear canal, but gently wipe away any drainage or frequently change cotton plugs used to catch the bloody fluid.
Temporomandibular Joint (TMJ) Syndrome
TMJ syndrome is actually a problem of the jaw, but the pain radiates into the ear so often that we will consider it primarily as a source of ear pain. The temporomandibular joint is the hinge joint of the jaw, located just in front of the ear. You can easily feel it move if you place a fingertip into your ear canal. When this joint becomes inflamed, it will frequently cause ear pain. It will then be painful to apply fingertip pressure directly on the joint. No swelling should be noted. Tenderness is increased with chewing, and pain and popping or locking may be noted when opening the jaw widely. The pain radiates into the temple area, and when severe, the entire head hurts.
Treatment is with local heat. The use of ibuprofen or Percogesic can be very helpful. Do not eat foods that are hard to chew or that require opening the mouth widely.