309: Ear Inflammation + Ear Infection (How To Get Ear Pain Relief) w/ Dr. Haley Overstreet

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If you've ever struggled with ear pain, ear inflammation (that could be triggered by a sinus infection) or even an ear infection, this episode is for you!

Ear pain + inflammation can make you feel awful.

I've had clients struggle with an annoying, itchy ear rash as well as hidden ear infection (signs that you shouldn't ignore).

Because your ears, nose (and sinuses) + throat are all connected, this may help explain the weird pressure, discomfort, hearing issues, ear pain + more that you get (even if you're an adult)!

I've noticed that an increasing number of eczema clients (especially those with lots of allergies) seem to struggle with these issues, so it seemed like a perfect conversation for the Healthy Skin Show.

My guest today is Dr. Haley Overstreet. She is a highly accomplished physician with a passion for improving the lives of her patients. Beginning her medical journey in Family Practice, she later embarked on a specialized path focused on allergy and sinus care in 2017. Since then, Dr. Overstreet has successfully aided numerous individuals in conquering their allergy and sinus issues using innovative treatments such as allergy drops and ExACT Immunoplasty. Her expertise extends beyond patient care, as she also serves as Chief Quality Officer for Aspire Allergy & Sinus. In this capacity, Dr. Overstreet ensures the adoption of safety measures and proper protocols across all Aspire clinics nationwide.

Have you ever dealt with a major ear problem and found relief?  Tell me what worked for you or what didn't in the comments below!

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

In this episode:

  • Understanding the different parts of your ear + how it's connected to your sinuses + throat
  • What fuels ear inflammation (even in adults)
  • #1 reason people get fluid in their middle ear
  • Ear infection signs + symptoms (including bacterial, viral + fungal ear infection)
  • Are antihistamines safe for ear pain + inflammation?
  • Remedies for clearing sinus pressure (what's safe + what's not)


“Allergies are probably the number one reason when I have a patient who has fluid in their middle ear, that's usually why.” [06:01]

“External ear infections are treated oftentimes with drops and those are antibiotic drops. But if those are used enough, it actually can create an environment where yeast or fungal infections can set up.” [24:26]


Find Dr. Overstreet online | LinkedIn

Follow Aspire Allergy on Instagram

Healthy Skin Show 291: Can You Stop Eczema, Allergies + Asthma In Kids? w/ Dr. Chris Thompson

Healthy Skin Show 269: Allergy Testing: Everything You Need To Know w/ Dr. Stacy Silvers

Healthy Skin Show 265: Problem with Antihistamines That No One Tells You w/ Dr. Chris Thompson, MD

309: Ear Inflammation + Ear Infection (How To Get Ear Pain Relief) w/ Dr. Haley Overstreet FULL TRANSCRIPT

Jennifer Fugo (00:08.546)
Thank you so much, Dr. Overstreet for being here. I really appreciate it.

Haley Overstreet MD (00:12.77)
Thank you for having me.

Jennifer Fugo (00:14.83)
So we are gonna talk today about ear inflammation. And I have literally never talked about ear inflammation in the entirety of the podcast. No. No, I talk about a lot of rash issues, but I feel like there are people, definitely listeners who struggle with ear rashes and we can maybe touch on a little bit of like what the common rash is and can show up in the ears.

Haley Overstreet MD (00:25.222)
No? You don't just talk about it at parties?

Jennifer Fugo (00:44.958)
I find the inflammation piece inside the ear, like deeper inside of our head, really fascinating. And I think that it's something that could be helpful for listeners, especially those who might be having symptoms, but not connected to that. So why don't you tell us a little bit about what is ear inflammation? Like where does that happen? And we can then go into some of the whys, like what's triggering it.

Haley Overstreet MD (01:16.398)
Sure, so there's three parts to the ear. There's the inner ear. That's where you're seeing a lot of the, if you have patients who had vertigo, benign positional vertigo, that's inner ear. There's middle ear. That's kind of where I hang out the most. That's kind of where the bones that are connecting the eardrum to the inner ear are located, and then there's the external ear, which is the ear canal.

So inflammation can happen really anywhere in that, in those three different areas where I spend the most time, like I was saying, is in the middle ear, because that's oftentimes related to allergies, viruses, bacteria, things like that.

Jennifer Fugo (02:01.678)
So if we're thinking about just our ear, like all the listeners, and maybe those watching on YouTube, so we have this like outer ear structure, which I'm assuming is very important. We don't just have it for looks, right? It serves purposes, but the inner ear is more, so this area where you hang out, that middle ear, is like if you were to kind of stick your finger inside your ear, is that now where that area is, or is that a little deeper in?

Haley Overstreet MD (02:28.042)
It's a little deeper. So if you stick your finger in the ear, that's the ear canal. So that's the external ear. That's where like swimmer's ear and things like that happen. And then behind the ear drum, that's the middle ear.

Jennifer Fugo (02:42.97)
Oh, all right, we're getting an anatomy lesson everyone. This is important. It is important. So for somebody who has rash issues, I think it's a great place to just kind of start because it helps us ground the conversation and people who are struggling. The most common rashes that people experience with their ears, what would those be?

Haley Overstreet MD (03:03.426)
So the more common rashes are going to be either eczema or atopic dermatitis, and then also psoriasis can happen as well. And then it's not really a rash, but this is something that can happen are fungal infections and even bacterial infections in the outer ear. Those are, like I was saying, the swimmer's ear is a bacterial external infection of the ear canal, and then you can get fungal infections as well.

Jennifer Fugo (03:31.022)
Okay, so if we then go, I guess, can things cross the eardrum? Like is the eardrum a protective layer?

Haley Overstreet MD (03:40.522)
So it's usually a solid layer. So usually there's not a connection between the middle and the external ear unless we get a perforation or a hole in the eardrum and then of course, yes. But typically those are two separate individual structures. So sometimes I have patients who will say, you know, I'm having things drain from my ear and they think that it's coming from inside out and most of the time it's not.

Jennifer Fugo (04:10.09)
It's not. So this is like a more internal process when we get to that middle ear section, but you can correct, have inflammation in that area.

Haley Overstreet MD (04:22.886)
Absolutely. Yes.

Jennifer Fugo (04:24.586)
And so talk a little bit about how does that happen that you could have that, I assume it's the tissue becomes inflamed due to a variety of different factors.

Haley Overstreet MD (04:35.579)
Mm-hmm. So yes, so the where we see the most inflammation is in the eustachian tube and the eustachian tube is kind of a literally a tube that connects that middle ear to the throat and you know everything is connected our ears eyes nose and throat are all connected, and so anytime we get inflammation in any one of those areas It can extend to that eustachian tube which then extends into the middle ear and can back fluid up into the ear which can be really uncomfortable can create a lot of congestion type feelings, pressure sensation, and even pain.

Jennifer Fugo (05:12.542)
Would that potentially impact your ability to hear?

Haley Overstreet MD (05:17.35)
It can. It can kind of make it sound like I usually tell my patients if you've ever had that sensation like you're kind of in a tunnel or that you hear things louder on one side than the other or that you hear your heartbeat more on one side. All of that can be a result of this.

Jennifer Fugo (05:33.73)
Oh, wow. So what are, can you list out for us some of the most common reasons that you could end up with this inflammation of the middle ear area?

Haley Overstreet MD (05:45.53)
So you can get a middle ear infection, which is a bacterial infection, but then you can also have inflammation from viruses and then most commonly, especially in my part of the world, allergies. Allergies are probably the number one reason when I have a patient who has fluid in their middle ear, that's usually why.

Jennifer Fugo (06:10.358)
So how would an allergy, so, and I guess like, is it an allergy that, like an allergen you eat? So a food allergy, or is it like pollen allergies? Like what, how and what type of allergens could cause that?

Haley Overstreet MD (06:25.1)
Yeah. So these are good questions. Predominantly, it's gonna be an environmental allergen. So something that you're breathing in or inhaling. And like we were saying, everything's connected. So if we breathe something into the nasal passages, that creates inflammation because it's an allergen for that person, then that's gonna extend to the ear, it can extend to the eye ducts and create issues with eyes not being able to clear themselves of allergens so it can increase eye symptoms and watering. It can increase throat issues, all sorts of things. So any inflammation in one area, because they're all connected, can extend to the others.

Jennifer Fugo (07:06.466)
And how do you differentiate as a doctor? I mean, obviously you're doing your checklist of things and going through the symptoms and everything, but how do you differentiate the inflammation if say, it's like, how do you know if it's a bacterial infection versus, I don't know, let's just say a mold allergy. I don't know if a mold allergy could cause that, but maybe it could. I think that's on the environmental list from my understanding.

Haley Overstreet MD (07:30.886)
It is, yes. So usually it's the fluid that develops behind the middle ear. So if it's a, and this is not 100%, but definitely if it's a bacterial infection, oftentimes that's going to look different than if it's just an allergy causing inflammation. And I will say that you can have a bacterial infection set up on top of fluid that has developed because of allergies or other reasons. So, it's not always one or the other. Sometimes it starts as one and leads to a bacterial infection. But… Ultimately, if it's a bacterial infection, the fluid behind the ear kind of looks like pus. So it has that thick, white, opaque, even yellowish tint. And oftentimes you're gonna see a lot of more irritation, meaning redness and swelling in the ear and the eardrum as well. So bacterial infections are pretty good about making themselves known when we see them. They're really kind of jumping out at you. Now, if it's a virus or an allergen that's causing the inflammation, usually it's gonna be clear fluid or maybe a little bit cloudy, but it's not usually gonna be like a thick opaque.

Jennifer Fugo (08:49.166)
Okay, and in terms of seeing that fluid, because I'm just thinking to myself, like are you sticking a needle in my ear, or is this like, how do you see the fluid?

Haley Overstreet MD (08:59.754)
Yeah, so we look, I'm not sticking a needle in your ear, or at least not initially. Now there are certain conditions where they can tap the fluid, but most of the time when we're doing just a normal ear, nose, and throat exam, we're looking in the ear with a speculum that is attached, and by speculum I mean kind of a small plastic piece that's on the end of what's called an otoscope. And so it's kind of a magnifying glass with the light on it so that we're putting that speculum into the ear canal and then using that light and that magnifying glass to get a good look at the eardrum.

Jennifer Fugo (09:34.574)
Okay, so no, not necessarily are you getting poked. Okay, just thought I would ask, because I had this awful image in my head and I'm thinking to myself, do people really let somebody do that? But I guess if you had to do it, you would.

Haley Overstreet MD (09:54.078)
Yes, yes. There are a few conditions where an ENT will use a needle type structure to go through the eardrum, but it's not common.

Jennifer Fugo (10:04.934)
Okay, and so I actually want to ask, because we're having this conversation, like the most common individuals I think of in having ear infections and ear inflammation is little kids, but you can have this as an adult. Could you talk about the two different kind of groups and what the difference would be between both in terms of this ear inflammation?

Haley Overstreet MD (10:29.335)
Sure. With the younger children, and we always hear about ear tubes, it's very common for children to get ear tubes, that's an actual tube that is in the eardrum itself. And oftentimes this is more placed because of anatomy, where they're just not fully grown and things don't drain the way that we would like, and they're getting frequent ear infections in that way. Now, as we get older, it's less and less common to get ear infections or to need a tube like that. We call it a PE tube. And more and more common though to have a Eustachian tube dysfunction. A Eustachian tube is like we were talking about that tube that's draining that middle ear into the throat and that gets inflamed like we were saying earlier and backs the fluid up. So that's what's happening more commonly as we get older. And there are things that can be done such as Eustachian tuboplasty where there's stenting open the Eustachian tube as we get older. And one of my partners, that is what he has done in the past and is something that can really help for those patients who just continue to get that middle ear fluid.

Jennifer Fugo (11:40.098)
So with the fluid, if it was say an infection, I think my audience is probably gonna ask the question, like how does that happen? Is it because you maybe catch a cold or you get a sinus infection and it somehow goes the wrong way or does it come through the ear? Like how, just your understanding and your experience, how do you end up? Cause I'm thinking to myself, all right, if I have an eardrum and it covers the area and it hope, I'm thinking it probably would like keep the area safe from bacteria. How does the bacteria get there then to actually cause that issue?

Haley Overstreet MD (12:18.722)
So anytime we have fluid, sitting fluid, it kind of becomes a petri dish of sorts. So a lot of times, like we were saying, viruses and allergens may create the fluid or cause the fluid to sit there, but bacteria can set up on top of that. And we have bacteria all over our body at all times. This is something in our, you know, we are colonized with bacteria in our noses, on our skin, all over. Sometimes it's just creating that perfect scenario, and not all bacteria I will say, is a bad thing. It's actually a good thing to have a certain amount of bacteria or normal flora, but if we have fluid sitting there, it kind of just creates that perfect environment for the bacteria to not just be present, but actually proliferate. So bacteria is always there. It's just a matter of giving it the environment that it needs to become a problem, if that makes sense. I don't know if I explained that well.

Jennifer Fugo (13:23.463)
No, it does. It does. It does make sense. And I think too, what's challenging is that we're exposed to so many things every day and through so many surfaces, which is also too amazing testimony to like the human body and our amazing immune system and all the things that it has to keep track of. But if everything is connected. So we've got this tube inside. So you eustachion tube, I feel like I'm finally getting this anatomy piece of the ear. You get the station tube that's supposed to be draining into the throat. Okay. And then you've got the eyes that also drain into the throat. And then we also do have the nose which drains into the throat from my understanding. That's a lot of that's a lot you could end up with a pretty hefty head full like, or at least feeling like your head is full of inflammation at times if like, are there any particular? I mean, you were saying allergies for sure, but are there any like particular issues that you tend to see in patients where maybe they didn't think it was as big of a deal, but actually they have a lot going on in terms of that head inflammation?

Haley Overstreet MD (14:36.898)
Absolutely. So I see this every day where usually it's not limited to one area. Oftentimes they do have inflammation and they just don't understand how or where it's coming from. And so what I see every day, what's kind of my bread and butter so to speak, is when I have patients who are coming in and nasal congestion is usually where it starts because that is where we're inhaling these offending agents and allergens. And so when we breathe those in, we have these other structures, and just to give a little bit more anatomy, called turbinates inside the nose. And they're kind of these ridges of tissue on the outside walls of the nose that connect our nose to our sinuses, to our eyes and ears. So these are kind of important structures because they also humidify the air that we're breathing in. And so they're the first line of defense against these allergies, viruses, bacteria, and when they get inflamed, that's oftentimes where we start seeing the extension into the sinuses, which can give you that full feeling in the head. I hear my patients talk all the time about feeling pressure, pain, eye symptoms, eye pressure, headaches of course, and then even extending into ear pressure and sometimes pain as well, and then dizziness. That's something that we haven't yet talked about, but with all of this inflammation, we can also get dizziness or feeling just a little uneasy or lightheaded, so it can really be impactful to quality of life.

Jennifer Fugo (16:17.79)
And also, and I thought just came to me, is it possible if you did have an infection in your sinuses? Because some, I know especially people with eczema, for example, sometimes the dermatologist will actually swab up their nose and look for staph up in the nostrils. Is it possible if you had an actual infection up inside the nostrils, could that possibly impact some of these other areas as well?

Haley Overstreet MD (16:47.114)
So you can have a sinus infection that can impact your ears. Now, not to say that you can't get an ear infection at the same time as a sinus infection, but it's not necessarily a one-to-one correlation. So it's not to say, yes, you can often have symptoms on the side that you have your sinus infection, but it doesn't mean that that's also an infection. It's usually just, all right, yes, that inflammation is everywhere. So I don't know if that answered your question, but it's one of those things like, yes, you can have it in more than one place, but it's not always the case, because it does have to travel a decent amount, but that inflammation is usually there regardless.

Jennifer Fugo (17:25.33)
Now, if you have this inflammation, because I'm thinking about like with allergies in general, a lot of times antihistamines might be one of the things that is suggested, can an antihistamine also help with some of this ear inflammation? Obviously not if it's an infection because that's sort of a different process, but can an antihistamine help with the ear?

Haley Overstreet MD (17:48.67)
It can, because it helps kind of dry things up, so it can help with ears. The number one thing that I go to start is usually a nasal steroid spray, such as Flonase or Nasacort because like we said, everything's connected and that steroid is an anti-inflammatory and so it's something that can help calm down not only the nasal passages, but also help with the eustachian tube to calm down. So that's one thing that I frequently recommend if it hasn't yet been started. And then the other thing that I am a big, big proponent of is nasal rinses. So not just treating the symptoms, but also trying to prevent the symptoms. So, for nasal rinses, there's various forms of these. There's the Navage, which is kind of a battery operated system that cycles the water through the nasal passages. There is a water bottle form. Neil Med is a nice brand for that and Generics are fine too, but water bottles where it's nice because it's portable, it's inexpensive, you can carry it with you on trips, that kind of thing. And then there's also the tried and true neti pot, which you may have heard your grandmother talk about, where it's a literal pot. And all of these are really, really helpful because you wanna use distilled water and not tap water. We don't wanna put anything in there that's not already there, but, these can be really helpful if you're doing them on a regular basis in the evenings to get rid of those things that you're being exposed to all the time so that not only are you gonna treat symptoms because you're getting rid of those allergens and viruses and mucus and things like that, but it's also gonna prevent symptoms because if we're rinsing these things out on a regular basis they're not just sitting and festering and you know creating more inflammation and more mucus production. So that was a long answer, but nasal steroid sprays are my number one, and then nasal rinses along with those can be pretty tremendously helpful on helping with these symptoms.

Jennifer Fugo (19:59.306)
Now with the nasal rinses, because I think my listeners might find this interesting. So I love that you shared about the distilled water. I'm going to acknowledge the fact that I have never done one nor the neti pot because in my head I have this image of drowning, which I know is not accurate, but that's a me, it's a me problem, I admit it. But are there…

Haley Overstreet MD (20:23.926)
You're not alone.

Jennifer Fugo (20:26.482)
Are there other things that you should or should not add to that water? Like I'm thinking about, you know, there's a lot of information on the internet and I'm worried sometimes like people might think, let me add some essential oils to this. Like maybe some, like is it safe or not safe to add essential oils to the neti pot water?

Haley Overstreet MD (20:50.242)
That is a great, great question. I do not recommend adding the essential oils. They can have a really irritating effect when either ingesting, you know, being ingested or even topical application to that mucosa, which is pretty sensitive. And you can actually get quite the opposite effect happen. And then you're, you know, in worse condition than when you started. So I usually do not recommend adding essential oils to to any nasal rinses. You also can sometimes see colloidal silver and xylitol and other things that get added. I myself, I just recommend the saline nasal rinses. Occasionally, we as a prescribing physician will add an antibiotic or a steroid to those nasal rinses. But for just our listeners, I would say just plain saline rinses are great.

Jennifer Fugo (21:47.682)
So the distilled water, when you say saline, you mean the distilled water or is the saline something else?

Haley Overstreet MD (21:54.174)
So saline is what is created with the distilled water and then the little salt packets that come with the nasal rinses.

Jennifer Fugo (22:01.262)
Okay, perfect. I was going to ask you about the salt. I was pretty sure there was salt in there someplace. So this is good to know. Now another quick question on this. What if I'm very congested? Is a nasal rinse okay to do at that point even if my sinuses feel very clogged or is it better to wait until that congestion has subsided?

Haley Overstreet MD (22:23.83)
So I usually say it's still okay to try. I usually lean towards more of the water bottle nasal rinses because you have control over the pressure. And so it's, you know, do it to your comfort level, but I do recommend the water bottle kind if you are significantly congested so that you have control over, you know, how you're feeling with it.

Jennifer Fugo (22:48.958)
Okay. And is there any, are there any contraindications or like, Hey, you might want to stop or not do this in terms of the nasal rinses, like where maybe like they should actually can't reach out to their doctor about whether it's good to continue or not if like they're seeing something weird or there any things like that, that would be good to share.

Haley Overstreet MD (23:11.482)
Yeah, if you ever feel like that it's not getting from one side to the other. So anytime you're doing a nasal rinse, it should be coming in one side and coming out the other nostril. At any point if you feel like it's not coming through, and that can happen either way. Sometimes I get patients saying I can go from left to right but not right to left. Or if it's painful or if you're feeling a lot of burning, any of those would be indications that hey let's go see your doctor and talk about it.

Jennifer Fugo (23:39.698)
Okay, that is very, very helpful. And then I had one last question to sort of circle back to something you had said earlier. You had said that sometimes you can get like a fungal infection in the ear. Is that the middle ear or more the outside, outer ear area?

Haley Overstreet MD (23:56.318)
It's usually external, so the outer ear.

Jennifer Fugo (23:59.07)
Okay. And is that how do we like in terms of if you did have an infection in the outer ear, is it usually just like a culture like a swab that you would do to check for that type of differentiator?

Haley Overstreet MD (24:13.074)
Yeah, it's, you know, oftentimes I probably see it the most on patients who have had ear infections or they think they've had ear infections and they're prescribed a lot of ear drops. So you know, the external ear infections are treated oftentimes with drops and those are antibiotic drops. But if it's, you know, if those are used enough, it actually can create an environment where yeast or fungal infections can set up. And one thing that may tip you off that this is the case, and the patients don't always see this, is that you may have some drainage that is white in color. That's oftentimes related to a fungal ear infection. But yes, it's something that, you know, if a physician is looking in the ear, they can swab it if they need to.

Jennifer Fugo (25:07.726)
That is very helpful. Well, I just want to thank you so much for sharing all of this today. It was, I learned a lot. I learned a lot. I'm going to have to, I guess, revisit my bias on nasal washes.

Haley Overstreet MD (25:24.226)
I know, I have patients all the time who think that they're gonna waterboard themselves and I say, just I know that we're not excited about this, but I promise you it can be helpful and at least give it a try. It's something that it can very likely help the situation.

Jennifer Fugo (25:43.286)
Well, thank you so much. And you are every everyone can find you as a physician because you're in the group of physicians we've had Dr. Chris Thompson on the show Dr. Stacy Silvers. So you're in the same practices as them and you move from office to office. And so everybody if you're interested in reaching out to Dr. Overstreet, you can contact her at aspireallergy.com. And also too, I'm gonna put other links into the show notes so that people can find you as well. And I just thank you so much for being here and sharing all of this today. I really appreciate it.

Haley Overstreet MD (26:21.266)
Absolutely, you know, this is, you know, as a, you know, physician who is treating allergies, I see this all the time, and so anything that we can do, like I said, to improve quality of life, this is why we do what we do. And like I said, because allergies are such a huge part of a lot of these symptoms that patients are experiencing. The other thing I didn't mention is treating those allergies or finding out what you're allergic to and treating that can oftentimes be the long-term solution so that we're not having to use all of these medications or other treatments down the road. So that's one thing I didn't mention that is crucially important. That's very, very important that we actually find out what may be that source and start addressing that instead of just the symptoms.

Jennifer Fugo (27:14.231)
Well, thank you so much, Dr. Overstreet. I appreciate you and you sharing all of your knowledge and wisdom with everyone on the show.

Haley Overstreet MD (27:23.263)
Well, thank you so much for having me. I appreciate it Jennifer.

"Allergies are probably the number one reason when I have a patient who has fluid in their middle ear, that's usually why."