Anatomy of an Ear Infection

An ear infection is one of the most common childhood conditions. Many of those children who develop an ear infection typically end up developing many more subsequent infections. The mainstream medical treatment for an ear infection is a round of antibiotics. Unfortunately, when a child continues to develop ear infections, the treatment does not change. The only change comes in the strength of the antibiotic. It can be frustrating to put your child through one round of antibiotics after another in hopes that they will somehow stop developing ear infections. The good news is that there is another approach that can have amazing results without the use of medications. This article will explore the anatomy of an ear infection and how chiropractic can help end the cycle of infections and antibiotics.

Anatomy

Here is a picture that shows the outer ear, middle ear, and inner ear. The external auditory meatus, or ear canal is part of your outer ear. This is the canal where you develop ear wax. Ear wax is part of the immune system. It is a good thing. You will find more when your immune system is active and trying to protect the body. When the immune system fights off the threat and is less active then the wax is resorbed without any problems.  Next, there is the tympanic membrane, or the eardrum. This is a thin membrane that vibrates when sound enters the ear. The vibration then causes three little bones in your middle ear to vibrate and transmit this vibration to the cochlear nerve so you hear sound. The middle ear also has the semicircular canals that are part of your vestibular system. These canals are filled with fluid and the shifting of this fluid helps you to sense where you are in space. Proper stimulation of these canals allows you to have good balance. While abnormal stimulation of the canals can lead to vertigo. The middle ear then drops into the eustachian tube. This cartilaginous tube opens to your pharynx, right behind your soft palate. The eustachian tubes help you equalize pressure within your ear so you can hear properly and the fluid in your semicircular canals can move and function properly. The outer ear and middle ear are mostly surrounded by bone and fascia. As you move further inward towards the inner ear and the eustachian tube there is more soft tissue and fascia as well as several muscles that attach to and surround the eustachian tube. There are four muscles that attach to the eustachian tube, but two are mostly responsible for opening the eustachian tube during swallowing. These muscles of the soft palate are the tensor veli palatini and the levator veli palatini. The former is innervated by cranial nerve 5 and the later cranial nerve 10, the vagus nerve.

Infection

Most ear infections that you are going to have are in the middle ear, behind the eardrum. You can see in the first picture that there is a little pocket behind the eardrum where fluid can build up and provide an environment for bacteria, virus or fungus to grow. (It is important to note that most ear infections have a viral and bacterial component.) Typically the middle ear does not have fluid in it. Any fluid would drain down the eustachian tube into the throat so there would not be any environment for an infection to occur. However sometimes the eustachian tube can not equalize pressure effectively and fluid builds up. This occurs more often in the early years of childhood because the eustachian tubes start out more horizontal as infants and become more vertical as you grow.

There are several things that can lead to this build up of fluid. One is a misalignment in the upper cervical spine. Misalignment causes inflammation in the joints of the spine as well as in the muscles and soft tissue that attach to the bones that are misaligned and not moving properly. This inflammation can press in on the eustachian tubes making it harder for them to drain fluid from the middle ear. Another cause can be a lack of proper motion in the cranial bones. Cranial bones surround the ear canal and eustachian tube. The cranial bones move in a rhythmic motion along with the soft tissue that attaches to them. If the cranial bones are not moving, the soft tissue and fascia attached to them lack motion. Therefore fluid is allowed to build up and not drain with the movement of the soft tissue. A more and more prevalent cause for the eustachian tube not being able to drain properly is a tongue tie. Tongue ties affect the soft tissue within the mouth and throat. Tongue ties affect the natural resting position of the tongue as well as the fascial tension within the mouth and throat. This altered tongue position and the increased tension in the soft tissue of the throat make it harder for the eustachian tubes to equalize pressure in the middle ear and drain any fluid that may develop there. Cranial nerve dysfunction that typically accompanies a tongue tie also causes soft palate dysfunction as well as dysfunction within the muscular function of the muscles of the pharynx and larynx which includes the muscles that attach to the eustachian tube.

Chiropractic Care

Chiropractic adjustments can help with all of these things. A spinal adjustment helps align the upper cervical spine and balance the musculature. Cranial work and myofascial release helps improve cranial motion and reduces soft tissue tension allowing for better drainage of the middle ear. Upper cervical adjustments and cranial adjustments also help to stimulate the vagus nerve and improve cranial nerve function so that the musculature of the pharynx, including those that attach to the eustachian tubes, as well as the soft palate can function properly and therefore help the eustachian tube to open, equalize pressure, and drain any fluid from the middle ear. Regular chiropractic adjustments allow the body to function optimally and prevent the development of fluid in the middle ear. Therefore preventing the environment for bacterial, viral, or fungal growth and infection.

Ruptured Eardrum and Tubes

Sometimes when the pressure produced by an infection in the middle ear is too much, the eardrum ruptures. This is ok. There is no cause for alarm. Typically your child will be crying and screaming about how much pain they are in, then all of a sudden they feel fine. This is usually an indication that the eardrum has ruptured. You can look and see if there is fluid or pus coming out of the ear. This is normal. Don’t put anything into the ear, you want to avoid anything that may lead to further infection. Usually I recommend essential oils around the ear or a cotton ball with essential oils placed or taped right on the outside of the ear canal. Usually if the eardrum has ruptured the fluid is not draining down the eustachian tube properly so avoid liquids or oils in the ear. It usually takes a few weeks to fully heal, but when it does you will not even notice that it happened. There is usually not even a scar on the eardrum.

Ear tubes are typically the last resort of typical medical treatment for recurrent ear infections. A small slit is put in the eardrum where a plastic tube is placed. The eardrum then heals around the tube. This allows for air to flow from the outer ear to the middle ear. This allows for better equalization of pressure as well as a possible route for fluid to flow out if it begins to build up. However, unlike the eustachian tube which slants downward to allow gravity to pull fluid down from the middle ear, the outer ear is higher than the middle ear and fluid would have to flow upward to drain out of the middle ear. Therefore, if the eustachian tubes are still blocked or not draining, fluid can still pool in the middle ear and provide the environment for infection. Tubes are also foreign plastic to the body. This means that eventually the body will reject the tubes and they will fall out. Typically tubes last only a few years at best before the body pushes them back out. Therefore, even with tubes, chiropractic care is still necessary to allow for proper function of the eustachian tube, pharynx and all the surrounding soft tissue, connective tissue and bone.