1 week post ear infection — see an ENT or wait?
July 9, 2024 8:44 AM   Subscribe

I had a sore throat and an ear infection in 1 ear last week. I'm on day 7 of amoxicillin, which my PCP prescribed. Ear and throat no longer hurt, but my ear feels squishy, like it is clogged or has liquid inside.

When I blow my nose, the ear unclogs for a second and feels good but then clogs again immediately. It's also itchy inside and making my throat feel itchy (ya know that feeling where you can't scratch your throat so you swallow hard over and over and you keep pressing on your ear to try to scratch it inside? Ugh. It could be allergies though, because I am allergic to dust mites and cats and we have cats. I take Zyrtec daily.).

Should I wait and see if things get better? Or go see an ENT? Or my PCP? My insurance doesn't require a referral to see a specialist so I am thinking of seeing an ENT instead of my PCP, just in case the ENT can do anything for me in the office and might have more experience with ear infections.
posted by dabadoo to Health & Fitness (6 answers total)
Sounds to me like your Eustachian tube is still quite inflamed.

Ear infections are often resistant to oral antibiotics because the skin is so thin and the blood vessels correspondingly tiny; when I've had them it's usually taken a double course of antibiotics to clear them up completely. In your shoes I'd have my PCP take another look at it and would expect to end up with an extended amoxil prescription.
posted by flabdablet at 9:33 AM on July 9

Hello! I am a grown-ass adult with a preternatural tendency to get ear infections (see this previous Ask).

What you’re describing is typical for me - it often takes up to two weeks for my “normal” pressure and hearing to return. This sucks; ear infections suck; I’m so sorry!

During my last major bout (which took almost a month to resolve, ugh), I dug into this medical reference article and learned a lot. For one, apparently the medical community is now thinking that many middle ear infections may be viral, rather than bacterial in origin. This might explain why sometimes antibiotics clear things up in a few days and sometimes they seem to do nothing at all. A number of doctors are now NOT prescribing antibiotics at the first sign of an infection, but using a wait-and-see approach, advising rest, fluids, all the general advice for viral upper-respiratory crud.

All of this said, if it’s easy to get an appointment, it might be a good thing to talk to an ENT, just for the confidence of hearing from a specialist. I never had allergies as a kid, but during that major bout two years ago was surprised to find out that everything was being aggravated by post-nasal drip, which was most likely caused by allergies (I now know I’m allergic to dust mites, hooray). I know you’re already taking allergy meds (and may be seeing an allergist), but an ENT might have new thoughts about your symptoms or advice for health habits going forward. Sometimes medical reassurance that there’s nothing more I can do is really helpful for me.

If you are interested in unsolicited advice, the things that work best for me for mitigating crappy feelings and speeding recovery are:

Guaifenesin (Mucinex) throughout the duration of symptoms. It helps thin mucus secretions, which is what makes it work as an expectorant, but this also helps my sinuses/Eustachian tubes drain. It doesn’t tend to have side effects either, which is great. I try to avoid anything intended to decongest, like Sudafed (a stimulant) or medicated nasal sprays like Afrin (a stimulant) or Flonase (a steroid). The stimulants work by causing blood vessels to constrict, which dries out/shrinks mucus membranes but also means they get *less* circulation, which is the opposite of what you want to heal. The steroids work by telling your immune system to chill out, which is also not good for actually healing.

Sterile saline nose spray used kind of like a neti pot, tipping over a sink and spraying into one nostril at a time to try to get liquid into and then out of my sinuses. I have never successfully used a neti pot, often because my nose is so backed up that no water will go through. It also doesn’t seem like a great idea to have backwash from one nostril potentially going into the other. I see a lot of advice to use the pressurized steel cans of just sterile saline, since hand-pump sprays like Xyliclear can actually pull liquid back inside, again leading to contamination.

Gargling with warm/hot salt water also helps loosen up gunk in my sinuses.

Hot, wet compresses on my ear help relieve pain and often lead to at least some temporary drainage. I usually put towels down on the bed and then lie down with the hot washcloth under my ear, since you don’t want water trickling in.

Massage: I do gentle massage on the area where my lymph nodes get swollen, under my ears and up under my jaw. It feels bizarre, but has sped up drainage on multiple occasions. (I take inspiration from the fact that lymphatic drainage massage is used in clinical cancer care.) Also, thanks to MetaFilter user mezzanayne, I have a most ingenious addition to the toolkit: using a vibrator! It does give me some ringing in my ears, but it helps relieve some pressure, and my ENT says it can help and won’t hurt. I go under/around my ears, over my temples, my eyebrows, my cheekbones, along the sides and bridge of my nose (pinching my nostrils and holding my breath for the discomfort of a vibrating nose).

I tend to avoid dairy when I’m sick, and take in lots of hot, spicy things - super-strong fresh ginger tea, hot water with a dried spicy pepper thrown in (capsaicin can both help kill baddies and confuses nerves, which helps relieve pain), to help with that itchy feeling in the throat/ears.

Feel better soon!
posted by rrrrrrrrrt at 11:28 AM on July 9 [12 favorites]

If it were my ear, I would get a bulb syringe, and make up a jar of warm saline and use that to gently irrigate my ear. Like when you use saline to rinse your sinuses, that can make you a lot more comfortable - OR it can sting like billy-o. But that's what I'd do, if it were my ear. I give it another couple of days before I tried to chase down another doctor to look at it. I would immediately stop trying to clean my ears if it were painful.

Ear feeling squishy is not like ear in significant pain. I'd be assuming that my ear infection left my ear full of mucus and ear wax, generated during the infection, and not be too worried about it.

If it was driving me crazy because it felt wrong and I didn't have a bulb syringe and I didn't have an opportunity to get one, I'd take a hot bath and submerge both my ears in it so only my face and my knees stuck out of the water, and like like that for twenty minutes to encourage it to drain.

I'd also check my glands around my ear and neck and jaw to see if they were swollen, and if they were, especially if they were painful, I would move up the opportunity to get a doctor to look into it.

Sometimes people try to sleep on their side with the affected ear on a hot water bottle, to see if that will encourage it to drain, or at least make the stuffed up there-is-something-foreign-in-my-ear feeling better.
posted by Jane the Brown at 12:51 PM on July 9

My whole family have weak heads, so this is something we've dealt with a lot. If you are not in pain and don't have a fever, you might try adding an OTC decongestant to the antibiotic and antihistamine you are taking already. Look for pseudoephedrine (which you have to sign for at the pharmacy if you are in the U.S., but don't need a prescription for) rather than phenylephrine (which you can get straight off the shelf). Lots of data shows that phenylephrine is no better than a placebo. A decongestant will help dry out the fluid in the inner ear.

I second the rec for Mucinex/guaifenesin. Our ENT suggested Mucinex DM, the "cough and congestion" variant--I think because suppressing any cough might also help reduce inflammation. OTC pain relievers like ibuprofen will also help bring down swelling.

Personally, I would at least call my GP before seeking out a specialist, but the main thing is to see SOMEONE if you don't feel better when you're out of amoxicillin. It might come down to who has an appointment available first.

I hope you feel better soon! The whole drainage/pressure system in our heads is so bizarre.
posted by helpthebear at 12:19 PM on July 10

Strangely I spent a long time today watching "Dr. Adam Fields" videos that I found while googling a similar ear-related topic. I would def try out the two ear and three sinus videos (Which I did today also).
posted by bquarters at 6:32 PM on July 10

The Wax Whisperer is very consistent about saying that putting water in an infected ear is a bad idea. One of many: 1,507 - Fully Blocked Infected Dead Skin Removal due to Otitis Externa (Mr Neel Raithatha aka The Wax Whisperer, YouTube, 21m; cw: ear canal endoscopy). Explanation of water risks starts at 12m3s.
posted by flabdablet at 1:47 AM on July 11 [1 favorite]

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