What is otitis media?
Otitis media is a bacterial or viral infection of the
middle ear (the space behind the eardrum). Middle ear infections often occur as
a complication of a cold, allergies, nose and throat infection, or enlarged
adenoids (glands at the top of the throat). Middle ear infections usually clear
up without complication or long-term effects.
The ear structure and function
There are three main parts of the ear: outer, middle,
and inner. The outer ear is the orifice outside of the body. The middle ear
houses delicate bones that aid in hearing, and the inner ear holds organs that
control hearing and balance. The Eustachian tube regulates air pressure within
the middle ear, connecting it to the back of the nose and throat.
What are the symptoms of otitis media?
Ear infections can be painful. Trapped fluid puts
pressure on the eardrum, causing it to bulge. Other symptoms include:
- Ear pain: This symptom is obvious in older children and adults, but
for children who cannot yet speak, you should watch for other signs, like
irritability or excessive crying.
- Loss of appetite: This may be most apparent in young children,
especially during bottle feedings. Pressure changes in the middle ear as the
child swallows, causing more pain and less desire to eat.
- Irritability: Any kind of persistent pain may cause irritability in
children and adults.
- Poor sleep: Pain may be more persistent when lying down as fluid is shifting.
- Fever: Ear infections can cause temperatures up to 104°F.
- Drainage from the ear: Yellow, brown, or white fluid that is not
earwax may seep from the ear. This may indicate the rupture of the eardrum.
- Difficulty hearing: Bones of the middle ear connect to the nerves
that transmit electrical signals as sound to the brain. Fluid behind the
eardrums slows down movement of these electrical signals through the inner ear bones.
Who is most likely to get middle ear infections?
Middle ear infection is more common in children and is
the most prevalent childhood illness other than a cold. Ear infections occur
most commonly between age 3 months and 3 years and are common until age 8.
One-fourth of all children will have repeated ear infections; and five to ten
percent will develop a hole on the eardrum from fluid pressure. This hole
usually heals in one week.
For many reasons, children usually get more ear
infections than adults. First, they usually get more colds and respiratory
infections than adults. Second, the Eustachian tube is shorter and has less of a
slope in children than in adults.
Other contributing factors for middle ear infections include the following:
- Age: Infants and young children are more susceptible to ear infections.
- Sex: Boys tend to get ear infections more often than girls.
- Heredity: The tendency to get ear infections can be hereditary (runs in the family).
- Colds: Having colds often increases the chances of getting an ear infection.
- Allergies: Allergies cause inflammation of the nasal passages and
upper respiratory tract, which can cause blockage of the Eustachian tube or enlargement of the adenoids.
- Chronic illnesses: People with chronic illnesses are more likely to
develop ear infections, especially patients with immune deficiency and
chronic respiratory disease, such as cystic fibrosis and asthma.
What are the causes of middle ear infection?
- Acute otitis media. Allergies, colds, respiratory infections, and
inflamed or enlarged adenoids can block the bottom of the Eustachian tube,
allowing normally produced fluids to build up in the middle ear. Trapped
fluid can become infected by a virus or bacteria, causing pain and swelling of the eardrum.
- Otitis media with effusion. Symptoms of acute otitis media will
disappear, but the fluid may remain. Trapped fluid may cause temporary and
mild hearing loss. This is called otitis media with effusion and may last for up to 3 months.
How is otitis media diagnosed?
When an ear infection is suspected, the doctor or
nurse will examine the ear using an instrument called an otoscope. A healthy
eardrum will be pinkish gray in color and translucent. If infection is present,
the eardrum may be inflamed, swollen, or red. The doctor may also check the
fluid in the middle ear using a pneumatic otoscope, which blows a small amount
of air at the eardrum. This should cause the eardrum to move back and forth. The
eardrum will not move as readily if fluid is present inside the ear.
Another useful diagnostic tool is tympanometry, a test
that uses sound and air pressure to check for fluid in the middle ear. It cannot
test hearing. If needed, the doctor will order a hearing test (performed by an
audiologist) for a patient who has persistent ear infections to help determine
the presence and extent of hearing loss.
How is otitis media treated?
Many middle ear infections will resolve on
their own, while some ear infections need to be treated with an antibiotic. Your
physician will determine if your child needs to be treated with an antibiotic
for an ear infection. Permanent damage to the ear or to the hearing is very
rare. Treatment methods include the following:
- Observation without antibiotics
Your doctor may determine that your child has
a middle ear infection but does not need to be treated with antibiotics,
depending on the age of your child and the severity of the infection.
Many ear infections will resolve on their own without antibiotic
treatment. Your physician will instruct you on what you should expect in
terms of duration of symptoms.
Antibiotics, prescribed by your doctor, may be needed to kill the
bacteria that are causing the ear infection. Do not forget to take or give
it in regular doses until the bottle is empty, even if the pain and fever
are gone. Finishing the medicine will keep the ear infection from flaring up
- Follow the instructions on the prescription regarding proper storage
and the proper dose. Use a measuring spoon for liquid antibiotics to be
sure that you give the right amount.
- Call the doctor if fever and pain are not gone within 2 days of
starting the antibiotics.
Antibiotics may cause nausea, diarrhea,
rashes, or yeast infections and may also interact with other
medications. Rarely, allergic reactions can occur. There is the
potential that bacteria will, over time, develop a resistance to
frequently used antibiotics. Be sure to tell your doctor about your
medical history and any over-the-counter and prescription medications
that you are currently taking.
- Pain relief
Acetaminophen or ibuprofen can help relieve earache or fever until the
antibiotic takes effect. These medications usually control the pain within 1
to 2 hours. Earaches tend to hurt more at bedtime. Using a warm compress on
the outside of the ear may also help relieve pain. This is not recommended
The ears do not need to be covered when going outside. Swimming is okay
as long as there is no perforation (tear) in the eardrum or drainage from
the ear. Air travel or a trip to the mountains is safe, although temporary
pain is possible during takeoff and landing. Swallowing fluids, chewing on
gum during descent, or having a child suck on a pacifier will help relieve
discomfort during air travel. Children can return to school or day care as
soon as the fever is gone. Ear infections are not contagious.
If fluid remains in the ear for more than 3 months, your doctor may want
to insert small metal or plastic tubes through the eardrum to equalize
pressure between the middle and outer ear. This outpatient procedure is
usually performed on children and can be done under general anesthesia. The
tubes will remain in from 6 to 12 months and normally fall out on their own.
The outer ear will need to be kept dry and free of water until the holes
have closed completely.
Children should be scheduled for a return appointment
3 to 4 weeks after an ear infection. At that visit, the physician will examine
the eardrum to be certain that the infection is resolving. Your physician may
also want to test the child’s hearing. Follow-up exams are very important,
particularly if the infection has caused a hole in the eardrum.
Middle ear infections have few complications or
long-term effects. It is especially important that children with middle ear
infection have appropriate follow-up with their physicians.
Possible long-term effects of middle ear infection include:
- Inner ear infection
- Scarring of the eardrum
- Hearing loss
- Mastoiditis (infection of the skull behind the ear)
- Meningitis (infection in the tissues around the brain and spinal cord)
- Speech development problems in children
- Facial paralysis
Call your child’s physician immediately if:
- Your child develops a stiff neck.
- You child acts very lethargic, responds poorly, or is inconsolable.
Call your child’s physician during office hours if:
- The fever or pain is not gone after your child is diagnosed with an ear infection.
- You have any questions or concerns.
Preventing middle ear infections in adults and children
There are ways to help prevent the onset of ear
infections in children and adults. Often, altering the environment at home is
all that is necessary, but sometimes surgery is needed, too. If some of the
following precautions apply to you or your child, follow them or talk to your
doctor about them.
- Avoid contact with second-hand tobacco smoke, also known as passive
smoking. Passive smoking increases the frequency and severity of infections.
Be sure no one smokes in your home or at a day care. No one should smoke in
the house or car, especially when children are present.
- Control allergies. Inflammation caused by allergies is a contributing
factor to ear infection, especially if you or your child have other
allergies, such as eczema.
- Reduce your child’s exposure to colds during the first year of life.
Most ear infections start with a cold. Try to delay the use of large day
care centers during the first year by using a sitter in your home or a small
home-based day care.
- Breastfeed your baby during the first 6 to 12 months of life. Antibodies
in breast milk reduce the rate of ear infections.
- Avoid bottle propping. If you bottle-feed, hold your baby at a 45-degree
angle. Feeding in the horizontal position can cause formula and other fluids
to flow back into the Eustachian tubes. Allowing an infant to hold his or
her own bottle also can cause milk to drain into the middle ear. Weaning
your baby from a bottle between 9 and 12 months of age will help stop this problem.
- Watch for mouth breathing or snoring. Constant snoring or breathing
through the mouth may be caused by large adenoids. These may contribute to
ear infections. An exam by an otolaryngologist, and even surgery to remove
the adenoids (adenoidectomy), may be necessary.
Questions to ask your doctor or your child’s doctor
- Should I give my child or myself medication? If so, for how long and at
what times of the day?
- How should I store the medication? Does it need to be refrigerated?
- When will my child (or I) start to feel better?
- Do I need to make a follow-up visit?
- Should I keep my child home from school or daycare? If so, when can she or he return?
- Should the child be restricted from any activities? If so, which ones?
- Are there certain foods or liquids to avoid?
- Which over-the-counter medications, such as pain relievers, do you recommend?
- Which symptoms should I report?
- National Institute on Deafness and Other Communication Disorders. Hearing, Ear Infections, and Deafness.
www.nidcd.nih.gov/ Accessed 1/12/2012
- Centers for Disease Control & Prevention. Get Smart: Know When Antibiotics Work: Ear Infections
www.cdc.gov/ Accessed 1/12/2012
- American Academy of Otolaryngology-Head and Neck Surgery. Fact Sheet: Chronic Otitis Media (Middle Ear Infection) and Hearing Loss.
www.entnet.org/ Accessed 1/12/2012
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