Ear infection (middle ear)
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A middle ear infection, also known as acute otitis media, is an inflammation of the air-filled area behind the eardrum where the tiny vibrating bones of the ear are located. Ear infections are more common in children than in adults.
The eustachian tubes, which are small tubes that connect the middle ear to a high point in the back of the throat, may swell and get clogged as a result of an ear infection. This may cause middle ear mucous to accumulate. This mucus may become infected and result in symptoms of an ear infection.
Since ear infections frequently go away on their own, pain management and problem-monitoring may be the first steps in treatment. Antibiotics may occasionally be used to treat infections. Multiple ear infections can be a frequent problem for some people. This may lead to major issues including hearing loss.
Symptoms
The signs and symptoms of an ear infection typically appear quickly.
Symptoms in children
Common child signs and symptoms include:
- Ear pain, particularly while lying down
- Pulling or tugging on the ear
- Sleeping problem
- A fever of at least 100 F (38 C).
- Fluid discharge from the ear
- Cry more often than normal
- Irritability
- Difficulty hearing or reacting to sounds
- Loss of balance
- Headache
- Diminished appetite
Symptoms in adults
Typical adult warning signs and symptoms include:
- Pain in the ear
- Fluid discharge from the ear
- Hearing problem
A number of illnesses might be indicated by the signs and symptoms of an ear infection. It’s crucial to have quick treatment and a precise diagnosis. Contact your child’s physician if
- The symptoms persist for more than a day.
- Symptoms manifest in an infant under 6 months of age.
- Severe ear pain
- Following a cold or another upper respiratory infection, your infant or toddler is restless or cranky.
- You notice a fluid, pus, or bloody fluid coming from the ear.
Causes
A bacterium or virus in the middle ear causes an ear infection. This infection frequently develops as a result of another sickness, such as a cold, the flu, or an allergy, which enlarges and congests the nasal passages, throat, and eustachian tubes.
Middle ear
The hammer, or malleus; the anvil, or incus; and the stirrup, or stapes, are the three tiny bones that make up the middle ear. The bones are kept out of the outer ear by the eardrum. The middle ear connects to the upper portion of the throat and the back of the nose by a tiny passageway known as the eustachian tube. Your inner ear includes a snail-shaped structure called the cochlea.
Function of eustachian tubes
A pair of small tubes called the eustachian tubes extend from each middle ear to a high spot in the back of the throat, behind the nasal passages. The throat end of the tubes open and shut in order to:
- Control the middle ear’s air pressure
- Refresh air in the ear
- Drain the middle ear of its secretions.
Eustachian tubes that are swollen and then plug themselves might result in fluid accumulation in the middle ear. The symptoms of an ear infection may develop if this fluid is infected.
The eustachian tubes are more horizontal and narrower in youngsters, which makes it harder for them to drain and increases the likelihood that they will become clogged.
Function of adenoids
Two tiny tissue pads called adenoids are located high on the back of the nose and are thought to influence immune system function.
Adenoids are located close to the eustachian tubes’ opening, so swelling could prevent the tubes from opening. A middle ear infection may result from this. Due to the fact that children’s adenoids are larger than adults’, adenoid’s swelling and irritation are more likely to contribute to childhood ear infections.
Related issues
The following middle ear conditions might cause comparable middle ear issues or be connected to ear infections:
- Otitis media with effusion, without a bacterial or viral infection, the middle ear swells and fluid accumulates (effusion). This could take place because the fluid buildup continues even after the ear infection has subsided. It could also be brought on by eustachian tube dysfunction or a non-infectious obstruction.
- Chronic otitis media with effusion, happens when fluid in the middle ear persists and keeps coming back without bacterial or viral infection. Children become more prone to ear infections and their hearing may suffer as a result.
- Chronic suppurative otitis media, an ear infection that does not clear up after being treated as normal. This may result in an eardrum hole.
Risk factors
The following are risk factors for ear infections:
- Age. Because of the size and structure of their eustachian tubes and because their immune systems are still maturing, children between the ages of 6 months and 2 years are more prone to ear infections.
- Race. Native Alaskans are more likely to have ear infections.
- Family history: It’s possible for ear infections to run in families.
- Colds: Ear infections are more likely to occur if you have a cold.
- Chronic diseases: Your risk of ear infections can be increased by long-term illnesses like immunological deficiencies and chronic respiratory conditions (such cystic fibrosis and asthma).
- Cleft palate. The eustachian tube may drain more slowly in children with cleft palates due to differences in their bone structure and muscles.
- Infant feeding. Compared to breastfed newborns, babies who drink from a bottle, especially when lying down, are more likely to get ear infections.
- Seasonal factors. The fall and winter months are when ear infections are most prevalent. When pollen counts are high, those with seasonal allergies may be more susceptible to ear infections.
- Taking care of children in groups. Compared to children who stay at home, children in group settings are more likely to get colds and ear infections. Children who are in groups are more likely to contract illnesses like the common cold.
- Air pollution. Ear infections can become more likely if you are exposed to tobacco smoking or a lot of air pollution.
Diagnosis
Based on the symptoms you list and an examination, your doctor can typically determine if you have an ear infection or another problem. The doctor will probably examine the ears, throat, and nasal tube using a lit equipment called an otoscope. He or she will probably use a stethoscope to listen to your child’s breathing as well.
Pneumatic otoscope
A pneumatic otoscope is frequently the only specialist tool a physician needs to identify an ear infection. With the use of this tool, the doctor may examine the ear and determine whether the eardrum is filled with fluid. The medical professional softly blows air on the eardrum using the pneumatic otoscope. Normally, the eardrum would move in response to this airburst. Your doctor will see little to no eardrum movement if the middle ear is fluid-filled.
Additional tests
If there is any dispute regarding the diagnosis, if the ailment hasn’t responded to prior treatments, or if there are other serious or long-lasting issues, your doctor may order more testing.
- Tympanometry. This examination gauges the eardrum’s movement. The device, designed to seal the ear canal, regulates air pressure within it, thereby inducing movement of the eardrum. The tool measures how effectively the eardrum moves and gives a proximate reading of middle ear pressure.
- Acoustic reflectometry. This test examines the amount of sound that is reflected back from the eardrum, which is a proximate indicator of middle ear fluid levels. The majority of sound is typically absorbed by the eardrum. However, the eardrum will reflect more sound as pressure from the middle ear fluid increases.
- Tympanocentesis. Rarely, a doctor may perform a treatment called tympanocentesis that involves inserting a small tube through the eardrum to drain fluid from the middle ear. The fluid is examined for germs and viruses. If an infection hasn’t reacted well to previous treatments, this may be useful.
- Other tests. Your doctor could recommend an audiologist, speech therapist, or developmental therapist for tests of hearing, speaking skills, language comprehension, or developmental ability if your kid has experienced multiple ear infections or fluid buildup in the middle ear.
Types of middle ear infection diagnosis
- Acute otitis media. Typically, the term “ear infection” refers to acute otitis media. If there are indications of fluid in the middle ear, if there are symptoms or signs of an infection, and if the symptoms began quite rapidly, your doctor will probably make this diagnosis.
- Otitis media with effusion. Although there are no current signs or symptoms of infection, the doctor has discovered evidence of fluid in the middle ear.
- Chronic suppurative otitis media. The eardrum was torn as a result of a protracted ear infection. Typically, this is connected to pus dripping from the ear.
Treatment
Some ear infections heal on their own without the need for antibiotics. The optimal course of action for your child will depend on a variety of variables, such as their age and the severity of their symptoms.
An observation approach
The majority of ear infections resolve up on their own within one to two weeks without any medication, and symptoms typically get better within the first few days. A wait-and-see strategy is suggested as one choice for the following by the American Academy of Pediatrics and the American Academy of Family Physicians:
- Children aged 6 to 23 months with a temperature under 102.2 F (39 C) and mild middle ear pain in one ear for less than 48 hours.
- Kids aged 24 months and older who have experienced minor middle ear pain in one or both ears for less than 48 hours and who have a body temperature below 102.2 F (39 C)
According to some data, some kids with ear infections may benefit from receiving antibiotic treatment. On the other side, overusing antibiotics can result in microorganisms developing drug resistance. Discuss the potential advantages and disadvantages of using antibiotics with your doctor.
Pain management
Your doctor can provide you advice on how to treat an ear infection pain. These might include the next:
- Pain medication. Your doctor can suggest using acetaminophen or ibuprofen over-the-counter to reduce discomfort. Use the medications as recommended by the label. Exercise caution when administering aspirin to children or adolescents. Because aspirin has been associated with Reye’s syndrome, it should never be given to children or teenagers who are recuperating from chickenpox or flu-like symptoms. If you are worried, discuss it with your doctor.
- Anesthetic drops. If there is no hole or tear in the eardrum, they can be utilized to ease pain.
Antibiotic
Following a first period of observation, your doctor might suggest antibiotic therapy for an ear infection in the following circumstances:
- Children aged six months and older who have experienced moderate to severe ear pain in one or both ears for at least 48 hours or who have a temperature of at least 102.2 F (39 C).
- Children 6 to 23 months with mild middle ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C).
- Kids aged 24 months and older who have experienced mild middle ear pain in one or both ears for less than 48 hours and who have a body temperature below 102.2 F (39 C).
If acute otitis media is verified in a child under the age of six months, antibiotics are more likely to be administered without the initial observational waiting period.
Use the medicine as advised, even if your symptoms become better. Failure to finish the prescription can result in recurrent infections and microorganisms that are resistant to antibiotics. What to do if you unintentionally miss a dosage should be discussed with your doctor or pharmacist.
Ear tubes
Your child’s doctor might suggest a procedure to drain fluid from the middle ear if your child has specific disorders. The doctor may advise this operation if your child has persistent fluid buildup in the ear after an infection has cleared up (otitis media with effusion) or recurrent, long-lasting ear infections (chronic otitis media).
An outpatient surgical procedure known as a myringotomy allows the physician to suction fluids from the middle ear by making a tiny hole in the eardrum. For the purpose of ventilating the middle ear and preventing the accumulation of more fluid, a small tube (tympanostomy tube) is inserted into the orifice. Some tubes are designed to remain in place for four to 18 months before naturally detaching. Some tubes may require surgery to be removed because they are made to stay in longer.
After the tube is pulled out or removed, the eardrum typically shuts up once more.
Treatment for chronic suppurative otitis media
Chronic suppurative otitis media is a chronic infection that causes a hole or tear in the eardrum and is challenging to treat. Antibiotics are frequently used to treat it when given as drops. Before giving drops, you can be given instructions on how to suction fluids out of the ear canal.
Monitoring
Children who frequently get sick or who have middle ear fluid that doesn’t go away need to be properly monitored. How frequently you should make follow-up appointments should be discussed with your doctor. Your doctor might advise routine hearing and language evaluations.
