An Overview of Middle Ear Infection

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There are a few kinds of ear infections, but otitis media is the most common. It occurs when fluid and pus build up in the middle ear, causing ear pain. This is often due to a cold or allergies that can block drainage, introduce bacteria or viruses, and cause inflammation. Ear infections are much more common in young children but can occur in adults as well. Most can be easily treated with or without antibiotics, but ear tube placement may be recommended for chronic otitis media.

Otitis media with effusion (OME) is seen when there is fluid in the ear (often following a cold) but no active infection. An infection of the outer ear is called otitis externa (swimmer's ear).

Symptoms

For adults and older children, the most obvious symptom indicating otitis media is pain. Children often run a fever with ear infections, but not always. These symptoms usually appear after a cold or nasal congestion.

Babies and young children experience pain but they cannot tell their parents about their discomfort, so it's important to look for non-verbal clues that they may have an ear infection. These include:

  • Pulling on the ear
  • Crying more than usual
  • Difficulty sleeping
  • Drainage from the ear
  • Problems with balance or hearing
  • Decreased appetite
  • Unexplained fever

An ear infection is not necessarily an emergency for children, as long as the pain can be controlled. The American Academy of Pediatrics promotes an approach of treating the pain and waiting for two to three days to see if it goes away, as it usually will. You should check with your doctor as to when the child needs to be seen. Adults should call their doctor when experiencing ear pain or other symptoms and see whether they should wait or come in for an examination.

Symptoms of chronic otitis media may include hearing loss, chronic ear drainage, balance issues, facial weakness, deep ear pain, headache, fever, confusion, fatigue, and drainage or swelling behind the ear.

A frequent complication of otitis media is a ruptured eardrum due to the pressure of the accumulated fluid and pus, and you may experience vertigo. Rare complications include the infection spreading to the mastoid bone (mastoiditis) or other areas. Chronic otitis media in children can lead to hearing loss and impair speech and language development.

Causes

Though different kinds of ear infections can cause some similar symptoms, their causes differ.

A blockage of the eustachian tube that links the back of your throat with your middle ear sets the scene for otitis media. The tube can't drain the middle ear if you have increased inflammation, mucus, or congestion as often happens with an upper respiratory infection or allergic rhinitis. Bacteria or viruses can then multiply in the middle ear and cause an ear infection

Children between ages 6 months and 2 years are at the biggest risk because their eustachian tubes are less capable of draining fluid in the inner ear and they are more susceptible to upper respiratory infections due to their immature immune systems. Babies who have not been breastfed for at least the first six months of life, who bottle feed while laying down, or use a pacifier beyond age 6 months are also at increased risk for an ear infection.

Smoking and exposure to second-hand smoke increase the risk. Other risk factors include cleft palate and other craniofacial disorders, enlarged adenoidsnasal polyps, and mucosal diseases such as sinusitis. 

Chronic otitis media (COM) indicates that fluid is present in the middle ear for six or more weeks. It's a condition that generally occurs over many years among people who have frequent ear trouble.

OME can also happen if you come down with a cold or a sore throat and fluid accumulates in the middle ear due to swelling, but there is no active infection. The fluid usually goes away on its own within four to six weeks. It tends to occur more often in kids between the ages of 6 months and 3 years old. More boys are affected than girls.

Swimmer's ear (otitis externa) is different from otitis media in that bacteria multiply in water that is trapped in the outer ear canal. Swimming, naturally, is a common risk factor, but inserting fingers or cotton swabs into the ear can also contribute to this.

Diagnosis

Accurate diagnosis of an ear infection requires a visit to your healthcare provider. He or she will use a special instrument (otoscope) to look inside the ear to determine what type of ear infection may be present. Imaging usually isn't needed. However, if you have recurrent middle ear infections, a CT scan or MRI may be done to look for structural abnormalities or abscesses.

Treatment

Many middle ear infections clear up by themselves after a couple of days. Your doctor can advise you as to whether watching and waiting or a treatment is recommended.

Over-the-counter ibuprofen or acetaminophen can be used for ear pain. Once a doctor makes the diagnosis of an ear infection, antibiotics will be prescribed according to guidelines based on age and other criteria. Amoxicillin is the first-line choice because it covers the most common bacterial agent. Other antibiotics are used if you are allergic to penicillin. Ear drops with a topical anesthetic may also be prescribed to help with ear pain.

If your child has chronic otitis media, your doctor may recommend having small tubes placed in his or her ears to help drain the fluid that is building up. Although this is a very common and fairly simple procedure, there are risks involved with any type of surgery or anesthesia and the decision should be one that is carefully evaluated by both the parents and physician.

Caregiving and Coping

Coping with an ear infection can be frustrating, whether it is your own or your child's. If antibiotics are prescribed, it is important to remember that you will typically not see any difference in symptoms for at least 24 to 48 hours. This means there could still be a fever and significant ear pain during that time. A child may continue to be fussy and have difficulty sleeping. Use pain relievers if needed and as directed; you may also try applying a warm or cool cloth to the affected ear.

Distractions such as videos, books, and games can take a child's focus away from the pain and discomfort. If you have spent too long with a fussy child, enlist help so you can take a break.

It is also extremely important to take all of the prescribed medication. Not finishing prescribed antibiotics can lead to more resistant bacteria and cause the infection to persist.

A Word From Verywell

Ear infections are a common part of childhood. Talk with your healthcare provider about what you should do if you see the symptoms in your child. For both you and your child, reduce exposure to secondhand smoke or stop smoking. Be sure to take steps to prevent colds and influenza, including getting recommended vaccinations and the annual flu shot.

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