Ear infection (Middle Ear)

What is Ear Infection (middle ear)?

Acute otitis media is an ear infection that occurs in the middle ear. It is an area with an air-filled space behind the eardrum. It is more common for children to be infected with an ear infection than adults. Most treatment for ear infections tends to be ways to manage the pain and monitor the problem as ear infections usually will resolve on their own. Multiple ear infections can lead to hearing problems and other complications.

Signs and symptoms of an ear infection usually develop rapidly and vary in children and adults. For children, it may include ear pain, ear pulling or tugging, trouble in sleeping, fussiness, and excessive crying. The child may encounter trouble hearing or having trouble responding to sounds, unsteadiness, fever of 38 C (100 F), or more. Ear discharge, headache, or decreased appetite are also common symptoms of ear infections in children.

As for adults, common visible signs and symptoms are ear pain, ear discharge, or trouble hearing.

When to consult a doctor?

You need to contact your child's doctor to get a proper diagnosis if these mentioned symptoms last more than a day or if the symptoms occur with a child aged 6 months or less. Prompt treatment is also needed if the ear pain is severe or the symptoms cause irritation to your child after a common cold or other upper respiratory infection. If there is any evidence of fluid discharge, pus, or other bloody fluid from the ears, you also need to consult a doctor as it can imply a vast number of conditions.

Causes

Bacterium or viruses cause ear infections and are usually the result of illnesses such as colds, flu, or allergies. These illnesses cause symptoms like congestion or swelling of the nasal passages, throat, and eustachian tubes. Eustachian tubes run between the middle ears, at the upper throat, and behind the nose.

Other related conditions within the middle ear could be linked to an ear infection as well as those infections that produce similar problems in the middle ear.

• Otitis media with effusion is when there is a symptom of swelling or a liquid build-up in the middle ear without any infections from bacteria or viruses or fluid that still persisted after the infection had gone. It might occur due to the dysfunction or the blockage of the eustachian tubes.
• Chronic otitis media with effusion is when some fluid remains in the middle ears without any bacteria or virus infections. This results in the children becoming vulnerable to new ear infections and could be causing hearing problems.
• Chronic suppurative otitis media is an infection located in the ear that does not go away with regular treatments. This can lead to a perforated eardrum.

Risk factors

• Younger children (aged 6 months to 2 years) are prone to ear infections as their immune system is still developing. It also depends on the size and the shape of their eustachian tubes.
• Children who are in the group care setting are more likely to get colds and ear infections than those who stay at home, as they will be exposed to more infections and diseases.
• Breast-fed babies are more likely to have fewer ear infections than babies who are being bottle-fed.
• Other seasonal factors like allergies during fall or winter tend to have a higher risk of developing ear infections when there are high pollen counts.
• Those who are exposed to poor air quality such as tobacco smoke or air pollution will have a higher risk of ear infections.
• Ear infections are more commonly found in Alaskan Native heritage
• Children who have cleft palate symptoms may experience ear infections as their bone and muscle structures have made it hard for the eustachian tube to drain its fluid.

The ear infection diagnosis can be made based on the symptoms description and an exam. A lighted instrument called an otoscope will be used to look at the ears, throats, and nasal passage. The doctor will also listen to the breathing of your child with the use of a stethoscope.

The doctor will often use a specialized tool called a pneumatic otoscope for the ear infection diagnosis. The tool helps the doctor to see inside the ear and inspect if there is any fluid behind the eardrum. The method to use the tool is that the doctor will puff air softly against the eardrum which will cause it to move. There will be little to no movement in your child’s ear if the middle ear is filled with fluid.

Additional tests

Additional tests may be given to your child, if the condition fails to respond to other treatments or if there are other existing serious and long-term problems.

• Tympanometry is an examination that will measure the eardrum movement. The tympanometry works by closing off and adjusting the air pressure in the ear canal, which leads to the movement in the eardrum. The test helps measure the eardrum movement's ability as it provides an indirect pressure measurement within the middle ear.
• Acoustic reflectometry is an indirect measurement of fluids in the middle ear. The test measures how much the sound is reflected from the eardrum. If there is fluid in the middle ear, it will create more pressure which results in the eardrum reflecting more sound. The eardrum normally absorbs most of the sound in the normal condition.
• Tympanocentesis is when a doctor uses a small tube and pierces it into the eardrum to help with fluid drainage from the middle ear. The fluid will be tested for viruses and bacteria. This procedure is rarely being used, but it can be helpful if your child has not responded to other treatments.
• Your doctor may refer you to an audiologist, speech therapist, or developmental therapist for other tests if multiple ear infections or additional fluid buildup in the middle ear. Tests will be needed to assess skills relating to hearing, speech, language comprehension, or other developmental abilities.

What does each diagnosis mean?

• Acute otitis media is a diagnosis of an ear infection that occurs temporarily. If there is any sign of fluid in the middle ear, signs or symptoms of infection, and if these symptoms start suddenly, your doctor will more likely make this diagnosis.
• Otitis media with effusion is an infection when the doctor has found a trace of fluid in the middle ear, with no current signs or symptoms of infection.
• Chronic suppurative otitis media occurs when the doctor finds evidence of long-term ear infection resulting in the tearing of the eardrum. Chronic suppurative otitis media is often associated with pus draining from the ear.

Treatment

Generally, ear infections tend to resolve without antibiotic treatment. The appropriate treatment of ear infections for your child will depend on various factors ranging from age to severity.

Some ear infections usually resolve on their own within the first couple of days, and most of the other infections usually recover within one to two weeks without a need for any treatment. According to the American Academy of Pediatrics and the American Academy of Family Physicians, a wait-and-see approach is recommended as an option for children aged 6 to 23 months with mild middle ear pain located in one ear. The approach should be taken into consideration if the child’s pain occurs less than 48 hours and if the child has a temperature of less than 39 C. As for children aged 24 months and older, if the child has mild middle ear pain in one or both ears. The approach should be taken into consideration if the child’s pain occurs less than 48 hours and the temperature of the child is less than 39 C.

There is evidence suggesting that antibiotic treatment could be helpful for some ear infections in children. It is advised to discuss with your child’s doctor the benefits or risks of antibiotics as excessive use of antibiotics can cause antibiotic resistance.

There are some treatments that the doctor may prescribe to you to help manage the pain from the ear infection.

• The doctor may prescribe the use of pain medications, it consist of over-the-counter drugs with acetaminophen (such as Tylenol or others) or ibuprofen (Advil, Motrin IB, or others) for a pain reliever. The drugs must be taken as directed on the label.
• Anesthetic drops may be prescribed to help relieve the pain. It will be used only if there is no hole or tear in the eardrum.

The doctor may recommend the treatment of antibiotic therapy for the ear infection, if:

Children age 6 months and older have moderate to severe ear pain in either one or both ears. The pain lasts for at least 48 hours or the child has a temperature of 39 C or higher. Children age 6 to 23 months have mild middle ear pain in either one or both ears. The pain lasts for less than 48 hours and the child has a temperature of less than 39 C. Children aged 24 months and older have mild middle ear pain in either one or both ears. The pain lasts for less than 48 hours and the child has a temperature of less than 39 C.

Antibiotics are more likely to be prescribed to children younger than 6 months to treat acute otitis media right away with no need to wait for more time. The antibiotic should be taken as directed, even after the symptoms have subsided. Missing a dose of medication may lead to antibiotic resistance or recurring infections. Contact your doctor and discuss what you should do in case your child misses a dose of antibiotics.

Ear tubes

Your child’s doctor may recommend ear tubes to drain fluid from the middle ear if there are certain conditions such as a repeated and long-term ear infection (chronic otitis media). The procedure will also be given to your child if your doctor finds out that your child has otitis media with effusion or when there is a fluid that continuously builds up in the ear even after an infection has been resolved.

Your child may need to undergo a myringotomy which is an outpatient surgical operation when a surgeon makes a small hole in the eardrum. The surgeon will suction out the fluids from the middle ear. A tiny-sized tympanostomy tube will be placed to help ventilate the air to the middle ear. It will also help with the prevention of fluid buildup. Some of the tubes will be put in place for six months to a year and can fall off on their own. Some other tubes will be placed longer and require a surgical procedure to remove them. Your child’s eardrum will eventually close up afterward on its own after the tube has been removed.

Treatment for chronic suppurative otitis media

Chronic suppurative otitis media is a difficult infection in terms of treatment. Chronic suppurative otitis media causes a hole or tear in the eardrum. The doctor usually will prescribe antibiotics administered in the form of drops to treat this infection. Your doctor will tend to give instructions for fluids’ suction from the ear canal before any drops administration.

Monitoring

Consult with your doctor regarding the frequency of scheduling follow-up appointments. Your child’s doctor may recommend regular hearing and language tests to help monitor your child especially if he or she has frequent infections or continuous buildup of fluid in the middle ear.