Mother Effing Ear Infections - How Do They Work?!

April 26, 2022 6:34 PM

Is there anything more I could be doing for my current ear infection? YANMD, but... AYAD? or NP/RN/PA/long-sufferer with ear infections with wisdom from your own personal experience and ENT? I've had tons of ear infections, but this is a doozy. Extra intensity because I'm holed up in a hotel, waiting for this gorram thing to retreat enough to let me fly home. Many cool, fun, but potentially gross snowflakes below.

I've poked around the otitis media articles on a number of prominent health authorities' websites, and actually just discovered this excellent UpToDate article before posting - it's great! But I don't really see any action items to take from it.

I'm going to provide an awful lot of detail, and the most likely answer I know is: rest, hydrate, take your meds. But if there's any medically-sound-but-off-the-beaten-path advice, or advice for talking to health professionals if/when my second-line treatment fails, that would be great.

Background: I am a grown-ass adult human being who gets tons of ear infections. They almost always happen together with medium-severity upper-respiratory crud, and often if one ear gets infected, the other will follow.

I had an era in my twenties/early thirties when ear infections were pretty common, sometimes multiple times a year, usually with pressure and pain reducing dramatically with draining and feeling 70-80% by day 5 or 6 of a 10-day course of antibiotics. I had one eardrum rupture on a flight in my early twenties. (That still is the most painful thing that has ever happened to me.) I haven't had one in... five years? The last one was also around the time of a big flight, and although I flew with some remaining light pressure in the infected ear, it wound up being ok (thank you, Dreamliner).

What's happening now: Last Wednesday, an ear infection came on just like they usually do - intense, blinding pain for a few hours, then the sweet relief of (what I understand to be) a perforation opening and bloody pus draining out. No redness or swelling around the ear (apart from what gets caused by perpetual washcloth poultices), and just a little tenderness. Multiple-tone ringing, and everything sounded like a horror movie, off-key and twangy. Very typical. (Apart from the fact that I had almost no upper-respiratory crud. My family was full of people with colds, and I had been taking lots of precautions - open windows, washing hands, hydrating, resting. I *did* lose my voice, and I did get a light, nonproductive nighttime cough, so it all makes sense nonetheless. We all tested - and I continue to test - negative for COVID.)

I'm on the opposite coast to where I live, and so I went to an urgent care. They prescribed me 500mg of amoxicillin, 2x/day for 7 days. I said, Not Augmentin? They said, No, just this. After 2.5 days, no improvement, pressure began building again, and I went back to urgent care. They said it looked bad and switched me to Augmentin 875 amox/125 clav acid. They said they couldn't see a perforation or infection in the canal, and therefore that ear drops wouldn't be indicated.

After another 2.5 days, no improvement, pressure began building yet again. I called into my health system and was recommended to use Flonase to try to bring down swelling from inside, as well as to ask for a Z-pack. Go into urgent care. Both ears are now infected. GAH. Thankfully, one is imperceptible to me. The other is not fun - full, pressure, sore, hard to "crackle" with swallowing or moving my jaw.

I am now on my third antibiotic in a week, on day 2 of 3 days of 500mg of azithromycin. I can "crackle" my eustachian tube in the bad ear more routinely, but not all the time. No fever, an achy ear but not much pain or tenderness to the touch.

I definitely understand that my first treatment was inadequate (even the urgent care noted that their database recommends putting people on Augmentin from the start), and that switching drugs several times probably hasn't been great for me. But I'm beginning to feel panicky about how long this is taking, and my hotel bills are mounting.

I have never felt this shitty at seven days, except in the one instance that I was an idiot and took Cipro in the middle of the night in a foreign country because ear-infection pain is awful and I had nothing else I could do, not even a washcloth and hot water. A doctor appropriately chastised me, prescribed Augmentin, and then cut me off when it didn't work - it took about a month for the feeling of fullness/soreness and ringing to recede.

I am lucky: my partner and I will be able to cover this cost. But SHEESH would I like to figure out how to get healthy and be able to get home (I've thought about Amtrak, but mildly-sick that wouldn't be good for my health, and it's actually over $1000 for a sleeper).

I know I fear barotrauma more than the average bear (having often had nasty earaches for days after a badly-pressurized flight, and once a wild feeling of carbonation in my sinuses that was Not Nice, on top of the exploded eardrum), and will definitely be using nasal spray and Earplanes when I do fly. The Valsalva maneuver has been painful and contributed to earaches and at least one infection in my life, and the hold-nose-and-swallow one doesn't do anything at all when my ears are infected.

I'm eating blueberries and greens and oranges and raw ginger and soup soup soup with mushrooms and hot peppers. I haven't found my preferred level of garlic in the take-out landscape yet but am still looking. I'm drinking Vitamin Water and water-water and ginger tea all day. I'm spritzing my nose with (aerosol) sterile saline; I'm on an allergy med in case that's contributing (most recent NP saw post-nasal drip and "cobblestone appearance" in my throat).

I'm trying to sleep as much as possible, which is easy because I'm feeling wicked low-energy. Tonight I decided to try lymphatic drainage massage around my eustachian tube area, and it seemed to help a little (the bad ear went from no crackle to crackling). heading in for a follow-up on Thursday, but it's still with an urgent care - my health plan is limited outside my home state, and my PCP's next availability is next Friday (for a referral to an ENT on the coast where I'm currently staying).

For all those who made it this far, thanks! I've seen really insightful advice from actual medical professionals and seasoned patients alike on these kinds of questions on AskMe, and appreciate your time.

posted by rrrrrrrrrt to Health & Fitness (15 answers total)

The only thing I've found helpful for ear infections that isn't on the comprehensive list of stuff you're already doing is a generous slathering with Savlon cream (a soothing, non-irritant and fairly gentle antiseptic, active ingredients: chlorhexidine hydrochloride 1mg/g, cetrimide 5mg/g) before sleeping, mainly because it seems to soften things up and make it easier for a pus pocket to burst its way open. I wouldn't expect it to help with an infection as deep in as yours sounds like it is, though.

Best of luck - ear infections are just fucking miserable things to live through.
posted by flabdablet at 7:11 PM on April 26, 2022

I have a similar history to you. Flonase has no effect on my ear infections, the only spray I've had good luck with is Astelin.
I also stopped taking antihistamines because a surprising number of them have earache or the like as a rare or uncommon side effect. Decongestants do help, if you can get real Sudafed in your current state.
posted by fiercekitten at 7:28 PM on April 26, 2022

Best answer: I've gotten relief by using a cheap drugstore back massager and holding it against the head just behind and slightly under the infected ear. Massage for a long time and add heat if you can. It seems to help with drainage and eases pain. Good luck; you sound miserable. 🙁
posted by mezzanayne at 8:29 PM on April 26, 2022 [1 favorite]

Best answer: Ugh. Sounds like you're planning to stay put, but I just wanted to say that Amtrak (or driving) may not be a good idea if there are mountains to cross. I once flew with a bad cold, hurt my ears on the descent, and then had to travel again soon for work before I was recovered. Because it was a short trip I thought that Amtrak would work. I hadn't considered the mountains on my route, and the pressure change on my ears really hurt. Maybe you could find an Airbnb that would be cheaper than the hotel.
posted by pinochiette at 8:31 PM on April 26, 2022 [1 favorite]

Anecdotal. I’ve read accounts from at least 2 people who credited quitting dairy with clearing up their ear issues. Did it really? Who knows. Would it be worth trying for 30 days as an experiment? Hells yes. Of course, you may not eat dairy now. In that case, I’m so sorry, I hope you feel better soon, I got nothin else.
posted by Glinn at 8:41 PM on April 26, 2022 [1 favorite]

I used to have chronic sinus infections. They are a lot less frequent now. What has helped:

1. Completely cut dairy from my diet
2. 25 mg diphenhydramine hcl (benadryl) before bed every night
3. Air filter in bedroom + changing sheets and pillowcases often (dust mite allergy)
4. When it does flare up into infection-like symptoms, prednisone has been very effective in curtailing things without antibiotics
5. Get enough sleep

What has not helped:

1. Neti pot makes things worse!
2. Oxymetazoline (Afrin) - Awesome congestion relief for a few hours, and then the congestion comes back with a vengeance
3. Flonase. I know this is supposed to help, but I haven't found any correlation between regular Flonase use and sinus symptoms
posted by qxntpqbbbqxl at 9:20 PM on April 26, 2022 [1 favorite]

Sinus rinses (do NOT squeeze hard to try to get it into the ear if you, like me, use a NeilMed bottle) and Nasacort (not Flonase) seem to help me as preventatives.

It helps me a lot to lie on the opposite side, or the less affected one, and apply a warm compress to the affected ear. A wet washcloth is fine if you don’t have any kind of heat pack. A cotton ball covering the ear canal can also help.

If you’re doing these things already, apologies — I missed it in your narrative. Also would like to note that a close relative got the worst ear infection of her life as a result of intentionally letting water get in her ears in the shower over several months.
posted by verbminx at 12:54 AM on April 27, 2022

Rhinocort was super helpful in eliminating ear pressure/ encouraging drainage for me. It worked where other sprays didn't. It felt like a miracle cure for the five years it worked. Bonnie (meclizine) usually helps my vertigo. Seemed like it worked fairly quickly to me (24hrs or so).
posted by bindr at 5:11 AM on April 27, 2022

You need a referral to an ENT.
posted by flimflam at 7:14 AM on April 27, 2022 [1 favorite]

ENT for sure. I needed ear drops with steroids when I was having chronic ear infections. You should also get checked for cholesteotoma when you are seen. In short term I’d ask your primary to prescribe steroid ear drops - I never got relief from just oral antibiotics when I was having a lot of ear infections. Fee better.
IANAD- this is just from my experience.
posted by leslies at 9:15 AM on April 27, 2022

I don’t know the brand names and active ingredients for nose spray in your country, but what has helped me is nose spray with Xylometazoline as active ingredient.
posted by meijusa at 9:16 AM on April 27, 2022

Best answer: I can only really comment on what the medical evidence shows. Ear infections are actually sort of poorly understood. Many practitioners are in fact moving away from prescribing antibiotics initially because: 1) most ear infections clear on their own and clear at the same rate as with antibiotics; 2) the actual prevalence of bacterial ear infection is unknown, but is probably pretty low -- a lot of ear infections are viral, or probably more commonly, a combination of bacterial and viral. Ear infections often occur after or with URI, as virus moves from the throat into the middle ear. That can make a ripe environment for bacterial growth, and so treatment gets quite complicated. Doctors will still often throw antibiotics at it to do something, but it's not necessarily evidence-based practice.

People recommend everything from stuffing your ears with garlic to not drinking milk. I have no idea whether those things work, but there certainly is not evidence to suggest that they do.

Some people are more susceptible to ear infections - likely because of the orientation of their eustachian tube (this is why babies get them so often). The most effective treatment for chronic ear infection, even in adults, is tubes. It sounds more like you have repeated acute infections, however, so tubes may not be indicated. An ENT can assess this.

Otherwise, unfortunately, the typical treatment is time and rest.

IANAMD, but I am an audiologist and I see a lot patients with ear infections.
posted by Lutoslawski at 10:12 AM on April 27, 2022 [5 favorites]

If you haven't already added Mucinex to your drug cocktail, it's worth a try. It helps me to thin the gunk so that it can drain out and not stick in/block the Eustachian tubes as easily. It also helps me to avoid sinus and ear infections when I have a URI. Drink a ton of water with it.
posted by quince at 1:36 PM on April 27, 2022

Response by poster: Thank you so much to everyone who has answered! quince, I laughed out loud when I read your comment, because I just took my night-shift Mucinex. Guaifenesin is a dear old friend. Glinn/qxntpqbbbqxl, my dad actually stopped all dairy to curb post-nasal garbage, and I’m trying it for a few weeks as a test - thanks for the encouragement.

Marking as best answers those that were newest, information-wise, to me - I deeply appreciate all your advice and well-wishes. Off to the last hot washcloth and ear-massage of the day!
posted by rrrrrrrrrt at 7:18 PM on April 27, 2022 [2 favorites]

Nthing the vibrator suggestion. I've found vibrating massage super helpful for both ear and sinus infections. Seems to break the stuff up and get it flowing.
posted by Jacqueline at 11:59 AM on April 28, 2022 [1 favorite]