Ear infection (middle ear)
Definition:
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An ear infection (acute otitis media) is most often a bacterial or viral infection that affects the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. Children are more likely than adults to get ear infections.
Ear infections are often painful because of inflammation and buildup of fluids in the middle ear.
Because ear infections often clear up on their own, treatment often begins with managing pain and monitoring the problem. Ear infection in infants and severe cases in general require antibiotic medications. Long-term problems related to ear infections — persistent fluids in the middle ear, persistent infections or frequent infections — can cause hearing problems and other serious complications.
Symptoms:
The onset of signs and symptoms of ear infection is usually rapid.
Children
Signs and symptoms common in children include:
Common signs and symptoms in adults include:
Signs and symptoms of an ear infection can indicate a number of different conditions. It's important to get an accurate diagnosis and prompt treatment. Call your child's doctor if:
Causes:
An ear infection is caused by a bacterium or virus in the middle ear. This infection often results from another illness — cold, flu or allergy — that causes congestion and swelling of the nasal passages, throat and eustachian tubes.
Role of eustachian tubes
The eustachian tubes are a pair of narrow tubes than run from each middle ear to high in the back of the throat, behind the nasal passages. The throat end of the tubes open and close to:
Ear infections are more common in children, in part, because their eustachian tubes are narrower and more horizontal — factors that make them more difficult to drain and more likely to get clogged.
Role of adenoids
Adenoids are two small pads of tissues high in the back of the throat believed to play a role in immune system activity. This function may make them particularly vulnerable to infection and inflammation.
Because adenoids are located near the opening of the eustachian tubes, inflammation or enlargement of the adenoids may block the tubes, thereby contributing to middle ear infection. Inflammation of adenoids is more likely to play a role in ear infections in children because children have more active and relatively larger adenoids.
Related conditions
Conditions of the middle ear that may be related to an ear infection or result in similar middle ear problems include the following:
Complications:
Most ear infections don't cause long-term complications. Frequent or persistent infections and persistent fluid buildup can result in some serious complications:
Most ear infections don't need treatment with antibiotics. What's best for your child depends on many factors, including your child's age and the severity of symptoms.
A wait-and-see approach
Symptoms of ear infections usually improve with the first couple of days, and most infections clear up on their own within one to two weeks without any treatment. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach for the first 48 to 72 hours for anyone who is otherwise healthy and who is:
Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following:
Your doctor may recommend antibiotic treatment for an ear infection in the following situations:
Ear tubes
If your child has otitis media with effusion — persistent fluid buildup in the ear after an infection has cleared up or in the absence of any infection — your doctor may recommend a procedure to drain fluid from the middle ear.
During an outpatient surgical procedure called a myringotomy, a surgeon creates a tiny hole in the eardrum that enables him or her to suction fluids out of the middle ear. A tiny tube is placed in the opening to help ventilate the middle ear and prevent the accumulation of more fluids. Some tubes are intended to stay in place for six months to a year and then fall out on their own. Other tubes are designed to stay in longer and may need to be surgically removed.
The eardrum closes up again after the tube falls out or is removed.
Treatment for chronic suppurative otitis media
Chronic infection that results in perforation of the eardrum — chronic suppurative otitis media — is difficult to treat. It's often treated with antibiotics administered as drops. You'll receive instructions on how to suction fluids out through the ear canal before administering drops.
Monitoring
Children with frequent or persistent infections or with persistent fluid in the middle ear will need to be monitored closely. Talk to your doctor about how often you should schedule follow-up appointments. Your doctor may recommend regular hearing and language tests.
Definition:
An ear infection (acute otitis media) is most often a bacterial or viral infection that affects the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. Children are more likely than adults to get ear infections.
Ear infections are often painful because of inflammation and buildup of fluids in the middle ear.
Because ear infections often clear up on their own, treatment often begins with managing pain and monitoring the problem. Ear infection in infants and severe cases in general require antibiotic medications. Long-term problems related to ear infections — persistent fluids in the middle ear, persistent infections or frequent infections — can cause hearing problems and other serious complications.
Symptoms:
The onset of signs and symptoms of ear infection is usually rapid.
Children
Signs and symptoms common in children include:
- Ear pain, especially when lying down
- Tugging or pulling at an ear
- Difficulty sleeping
- Crying more than usual
- Acting more irritable than usual
- Difficulty hearing or responding to sounds
- Loss of balance
- Headache
- Fever of 100 F (38 C) or higher
- Drainage of fluid from the ear
- Loss of appetite
- Vomiting
- Diarrhea
Common signs and symptoms in adults include:
- Ear pain
- Drainage of fluid from the ear
- Diminished hearing
- Sore throat
Signs and symptoms of an ear infection can indicate a number of different conditions. It's important to get an accurate diagnosis and prompt treatment. Call your child's doctor if:
- Symptoms last for more than a day
- Ear pain is severe
- Your infant or toddler is sleepless or irritable after a cold or other upper respiratory infection
- You observe a discharge of fluid, pus or bloody discharge from the ear
Causes:
An ear infection is caused by a bacterium or virus in the middle ear. This infection often results from another illness — cold, flu or allergy — that causes congestion and swelling of the nasal passages, throat and eustachian tubes.
Role of eustachian tubes
The eustachian tubes are a pair of narrow tubes than run from each middle ear to high in the back of the throat, behind the nasal passages. The throat end of the tubes open and close to:
- Regulate air pressure in the middle ear
- Refresh air in the ear
- Drain normal secretions from the middle ear
Ear infections are more common in children, in part, because their eustachian tubes are narrower and more horizontal — factors that make them more difficult to drain and more likely to get clogged.
Role of adenoids
Adenoids are two small pads of tissues high in the back of the throat believed to play a role in immune system activity. This function may make them particularly vulnerable to infection and inflammation.
Because adenoids are located near the opening of the eustachian tubes, inflammation or enlargement of the adenoids may block the tubes, thereby contributing to middle ear infection. Inflammation of adenoids is more likely to play a role in ear infections in children because children have more active and relatively larger adenoids.
Related conditions
Conditions of the middle ear that may be related to an ear infection or result in similar middle ear problems include the following:
- Otitis media with effusion is inflammation and
fluid buildup (effusion) in the middle ear without bacterial or viral
infection. This may occur because the fluid buildup persists even after
an ear infection has resolved. It may also occur because of some
dysfunction or noninfectious blockage of the eustachian tubes.
- Chronic suppurative otitis media is a persistent ear infection that results in tearing or perforation of the eardrum.
Complications:
Most ear infections don't cause long-term complications. Frequent or persistent infections and persistent fluid buildup can result in some serious complications:
- Impaired hearing. Mild hearing loss that comes and
goes is fairly common with an ear infection, but it usually returns to
normal after the infection clears. Persistent infection or persistent
fluids in the middle ear may result in more significant hearing loss. If
there is some permanent damage to the eardrum or other middle ear
structures, permanent hearing loss may occur.
- Speech or developmental delays. If hearing is
temporarily or permanently impaired in infants and toddlers, they may
experience delays in speech, social and developmental skills.
- Spread of infection. Untreated infections or infections that don't respond well to treatment can spread to nearby tissues. Infection of the mastoid, the bony protrusion behind the ear, is called mastoiditis. This infection can result in damage to the bone and the formation of pus-filled cysts. Rarely, serious middle ear infections spread to other tissues in the skull, including the brain.
Most ear infections don't need treatment with antibiotics. What's best for your child depends on many factors, including your child's age and the severity of symptoms.
A wait-and-see approach
Symptoms of ear infections usually improve with the first couple of days, and most infections clear up on their own within one to two weeks without any treatment. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach for the first 48 to 72 hours for anyone who is otherwise healthy and who is:
- Six months to 2 years of age with mild symptoms and an uncertain diagnosis
- More than 2 years old with mild symptoms or an uncertain diagnosis
Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following:
- A warm compress. Placing a warm, moist washcloth over the affected ear may lessen pain.
- Pain medication. Your doctor may advise the use of
over-the-counter acetaminophen (Tylenol, others) or ibuprofen (Motrin,
Advil, others) to relieve pain. Use the drugs as directed on the label.
Because aspirin has been linked with Reye's syndrome, use caution when
giving aspirin to children or teenagers. Although aspirin is approved
for use in children older than age 2, children and teenagers recovering
from chickenpox or flu-like symptoms should never take aspirin. Talk to
your doctor if you have concerns.
- Eardrops. Prescription eardrops such as antipyrine-benzocaine (Aurodex) may provide additional pain relief. To administer drops to your child, warm the bottle by placing it in warm water. Put the recommended dose in your child's ear while he or she lies on a flat surface with the infected ear facing up. Benzocaine has been linked to a rare but serious, sometimes deadly, condition that decreases the amount of oxygen that the blood can carry. Don't use benzocaine in children younger than age 2 without supervision from a health care professional, as this age group has been the most affected. If you're an adult, never use more than the recommended dose of benzocaine and consider talking with your doctor.
Your doctor may recommend antibiotic treatment for an ear infection in the following situations:
- Children under 6 months old with a probable diagnosis of ear infection
- Children 6 months to 2 years old with a certain diagnosis of ear infection
- Anyone with a probable ear infection and moderate to severe ear pain
- Anyone with a probable ear infection and a fever over 102.2 F (39 C) or higher
Ear tubes
If your child has otitis media with effusion — persistent fluid buildup in the ear after an infection has cleared up or in the absence of any infection — your doctor may recommend a procedure to drain fluid from the middle ear.
During an outpatient surgical procedure called a myringotomy, a surgeon creates a tiny hole in the eardrum that enables him or her to suction fluids out of the middle ear. A tiny tube is placed in the opening to help ventilate the middle ear and prevent the accumulation of more fluids. Some tubes are intended to stay in place for six months to a year and then fall out on their own. Other tubes are designed to stay in longer and may need to be surgically removed.
The eardrum closes up again after the tube falls out or is removed.
Treatment for chronic suppurative otitis media
Chronic infection that results in perforation of the eardrum — chronic suppurative otitis media — is difficult to treat. It's often treated with antibiotics administered as drops. You'll receive instructions on how to suction fluids out through the ear canal before administering drops.
Monitoring
Children with frequent or persistent infections or with persistent fluid in the middle ear will need to be monitored closely. Talk to your doctor about how often you should schedule follow-up appointments. Your doctor may recommend regular hearing and language tests.
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