Ears 101: What Causes Ear Infections?

A depiction of the difference between a normal and infected ear. (Source: http://www.drugs.com/health-guide/middle-ear-infection-otitis-media.html)

A drawing showing the difference between a normal and infected ear. (Source: http://www.drugs.com/health-guide/middle-ear-infection-otitis-media.html)

Ear infections are very common in childhood. In fact, the National Institute on Deafness and Other Communication Disorders (NIDCD) estimates three out of four children will have at least one ear infection by the age of three. In our last Ears 101 post we talked about what an ear infection is and the different types. Now I bet you’re wondering, “What causes an ear infection?”

Ear infections develop when the Eustachian tube becomes swollen or blocked, inhibiting its ability to properly drain fluid from the middle ear. The Eustachian tube can become blocked because of swelling or congestion due to an upper respiratory infection, a common cold, allergies, or even irritants like cigarette smoke.

If the Eustachian tube is blocked, fluid can accumulate in the middle ear, creating a warm, moist environment that is perfect for any present bacteria to start to multiply. This is sufficient to produce an ear infection on its own. To make matter worse, negative pressure created by a blocked Eustachian tube can also lead to direct extension of infectious agents from the nose and throat to the middle ear.

There are two primary culprits in ear infections: bacteria and viruses. The majority of ear infections are bacterial, however viruses play a complex role in the ear infection story. Some viruses can create the conditions that lead to bacterial ear infections by creating inflammation, blockage and fluid build up in the Eustachian tube, which allow bacteria to proliferate.

Ear infections are more common in children than adults because their Eustachian tubes are shorter, narrower and positioned horizontally which makes draining fluid more difficult. As children get older, the angle increases, thus children sometimes “grow out of” ear infections.

Many thanks to Dr. Sloane Sevran, a Pediatrician in Encino, CA, for her editing contributions on this post. Have any ear questions you’d like to see answered on the blog? Post them in the comments section.

Disclaimer: This information is meant for educational purposes only; none of the above information should be viewed as medical advice, diagnosis or treatment.

Ear Pic of the Week: Atelectatic Tympanic Membrane

Dr. Stephanie Moody-Antonio, an Otolaryngology specialist practicing in Norfolk, VA brings us this week’s Ear Pic of the Week. The diagnosis: Atelectatic Tympanic Membrane. We asked Dr. Moody-Antonio a few questions to help us learn more about this condition.

Patient's left eardrum captured by the CellScope Oto.

Patient’s left eardrum captured by the CellScope Oto.

The patient's right eardrum as captured by the CellScope Oto.

The patient’s right eardrum as captured by the CellScope Oto.








Q: What is an atelectatic tympanic membrane?
Dr. Moody-Antonio: It’s a thin eardrum, usually as a result of chronic negative middle ear pressure.

(CellScope: Negative middle ear pressure is caused by a blocked Eustachian tube and absorption of air from the middle ear space.)

Q: What causes this condition?
Dr. Moody-Antonio: Eustachian tube dysfunction.

Q: What are the symptoms?
Dr. Moody-Antonio: Usually asymptomatic, but over time may contribute to erosion of the incus (as can be seen in the picture), hearing loss, & development of cholesteatoma.

Q: How is it treated?
Dr. Moody-Antonio: It can be treated with observation, myringotomy and tube, cartilage graft tympanoplasty, or other surgical techniques.

Q: CellScope: Does it affect hearing?
Dr. Moody-Antonio: Yes, if it results in erosion of the incus.

Thanks again, Dr. Moody-Antonio for sharing these great images and for teaching us about atelectatic tympanic membrane!

The Top Ten Outstanding Pioneers

The CellScope Oto Pioneer program is in full swing, and we have last week’s leader board to share! These docs amaze us with their passion for incorporating new technologies like the Oto into their practice to enhance the patient experience. Our Pioneer program now spans 48 states and Puerto Rico; 9 of the those states are represented in the TOP TEN:

  1. Sloane Sevran (Encino, CA)
  2. Edward Lewis (Rochester, NY)
  3. Amanda Harding (Johnstown, CO)
  4. Chris McCarthy (Spartanburg, SC)
  5. Brian Policano (Clarksburg, WV)
  6. Jessica Kaplan (San Francisco, CA)
  7. Anne Carter (South Pasadena, FL)
  8. Richard Han (Englewood, NJ)
  9. Mark Kelley (Holland, MI)
  10. Stephen Rashleigh (Savannah, GA)

Many docs are closing in on the top 10, so if you’re searching for your name to no avail or are just kicking off your stint as a Pioneer, keep them coming! We have so many stars this week, it was hard to resist not including another 10 or 15 Pioneers who are holding their ground, conducting over 25 exams per week.

Keep up the good work, Pioneers!

Who will be on the leader board next week? Will you make the cut?

Interested in using the Oto in your practice? Find out how to become a Pioneer here.

Pioneer Sticker

Pioneer Spotlight: Elias Milgram, MD

Dr. Elias Milgram runs a pediatrics practices in Aventura, FL and recently joined the CellScope Oto Pioneer Program. Originally from Venezuela, Dr. Milgram has been treating young patients for over 39 years. As a CellScope Oto Pioneer, he has had an opportunity to learn some new tricks, principally turning his smartphone into a connected, digital otoscope!

Dr Milgram

We recently interviewed Dr. Milgram to learn more about his experience with the Oto and mobile health in general. Here’s what the doctor had to say:

CellScope: How did you hear about the CellScope Oto?
Elias Milgram: I was forwarded an e-mail by a friend/colleague.

CS: What led you to join the Oto Pioneer Program?
EM: I have always been involved in teaching about ear exams and ear pathology. This was a great opportunity to do that with my patients!

CS: How have you integrated the Oto in your practice?
EM: Since receiving it, I have been using it with many of my patients.

CS: What do your patients think of the Oto?
EM: The parents are all amazed by the technology and being able to see inside their children’s ears!

CS: How has the Oto impacted your practice so far?
EM: Positively, without a doubt!

CS: From your perspective, how do you see mobile health technology changing healthcare in the next 5 or 10 years?
EM: I can foresee many useful apps making the practice of medicine easier and facilitating patient communication.

And to that we say, let’s make it happen! Thank you, Dr. Milgram, for sharing your experience so far!

Interested in using the Oto in your practice? Find out how to become a Pioneer here.

Pioneer Sticker

Ear Pic of the Week

A crusted over ear tube captured by the Oto.

An encrusted ear tube captured by the Oto.

This ear isn’t a pretty sight, but it definitely caught our eye! Curious as to what was happening in this ear, we asked Ms. Beverly Garber to give us the scoop for this week’s Ear Pic of the Week.

The patient is a 22 year-old woman with a history of eustachian tube dysfunction and who has previously had T-tubes. The dark, protruding figure in the center of the photo is a pressure equalization tube that is crusted over, rendering the tube ineffective.  Ms. Garber also noted the presence of granulation tissue surrounding the tube. Granulation tissue is made up of newly formed connective tissue and small blood vessels that aid in the healing process of a wound.

Thanks for sharing, Ms. Garber!

Ms. GarberA.N.P.-C, is an Adult Nurse Practitioner who specializes in general Otolaryngology from Davis, CA and is a CellScope Oto Pioneer.

The Oto in Mexico & The Flying Doctors

Dr. Kahn examining an ear of a patient in Mexico.

Dr. Kahn examining an ear of a patient in Mexico.

One of our CellScope Oto Pioneers, Dr. Jonathan Kahn, sent us this photo (above) last week; it was so great we just needed to share it!  Dr. Kahn explained that the photo shows him examining a patient in Mexico with his CellScope Oto.

Dr. Kahn travelled to Ensenada, Mexico as a volunteer with the nonprofit organization Los Medicos Voladores (The Flying Doctors). Along with a group of dentists and other health professionals, the group provided free care to orphans and villagers in a small local community outside of Ensenada.

In the clinics, Dr. Kahn saw a number of patients with ear problems, mainly otitis externa and otitis media. He kindly wrote, “the Cellscope device was helpful in explaining the medical problem and treatment. Thanks again for letting me use this fun and useful device!”

Thank You, Dr. Kahn for sharing this great photo! We work hard to see moments like this happen and it sure does bring a big smile to our faces.

Dr. Kahn is Associate Chief Head and Neck Surgery at Kaiser Walnut Creek.

Want the CellScope Oto to conduct ear exams in your clinic? Become a CellScope Pioneer!

Pioneer Sticker

Ears 101: Ear Infections

Last week, we introduced the Ears 101 series and explored the basic anatomy of the ear. This week we are going to talk about those pesky ear infections! Namely, we want to know what do people actually mean when they talk about an ear infection?

The phrase “ear infection” is used commonly and without much distinction, but there are actually two different varieties of ear infections: otitis media and otitis externa. Otitis media refers to inflammation in the middle ear, whereas otitis externa is inflammation in the external ear canal (see anatomy basics). For now, we will explore otitis media since it is the type most people are speaking about when they say “ear infection.”

So, we’ve learned that otitis media is inflammation in the middle ear, but what is behind the inflammation?

Usually, the culprit is either bacteria or fluid build-up in the middle ear. There are two main distinguishable subtypes with their own unique symptoms to lookout for:

1. Acute otitis media (AOM), the most common type of ear infection, is caused by bacteria entering into the middle ear through fluid build-up in the eustachian tube.

Signs and symptoms of an AOM include: redness and pain, a bulging tympanic membrane, fever, and fussiness or trouble sleeping in younger children. Both adults and children can get an AOM, but they occur more frequently in children. Commonly, an AOM develops after a cold, sore throat, or an upper respiratory infection.

A photo of an acute otitis media (AOM) captured by the CellScope Oto.

A photo of an acute otitis media (AOM) captured by the CellScope Oto.

2. Otitis media with effusion (OME) is referred to as the silent otitis media because often patients don’t exhibit any symptoms. An OME exhibits inflammation without infection and is characterized by fluid build-up (or effusion) in the eustachian tube, which can be thin or thick and gooey. The thick fluid is oddly referred to as ear glue.

Signs and symptoms of an OME include the feeling of stuffiness in the ear or “being underwater”. There is usually no pain associated with an OME and it can come before or after a bout with AOM.

A photo of otitis media with effusion (OME) captured by the CellScope Oto.

A photo of otitis media with effusion (OME) captured by the CellScope Oto.

Now that we’ve cleared up the mystery behind the words “ear infection” and uncovered the different subtypes of otitis media, we can move on to tackle the burning question, “what causes ear infections?” in the next installment of Ears 101.

Have an ear question you’d like answered? Submit your questions in the comments.

Disclaimer: This information is meant for educational purposes only; none of the above information should be viewed as medical advice, diagnosis or treatment.