Definition
With this condition, the middle ear becomes infected and inflamed. The middle ear is located behind the eardrum.
Causes
Bacteria and viruses cause this condition, such as:
- Streptococcus pneumoniae (most common)
- Haemophilus influenzae
- Moraxella (Branhamella) catarrhalis
- Streptococcus pyogenes (less common)
Risk Factors
These factors increase your chance of developing middle ear infection:
- Recent viral infection (eg, cold )
- Recent sinusitis
- Age: babies and toddlers
- Season: winter
- Attendance at day care
- Babies who are formula-fed
- Medical conditions that cause abnormalities of the eustachian tubes, such as:
- History of allergies (environmental allergies, food [milk] allergies )
- Gastroesophageal reflux disease (GERD)
- Babies whose mothers drank alcohol while pregnant
- Exposure to second hand smoke, usually cigarette smoke, but also from cooking and wood-heating
Tell your doctor if you have any of these risk factors.
Symptoms
Symptoms include:
- Ear pain (babies may tug or rub at the ear or face)
- Fever
- Irritability
- Hearing loss (may be only temporary, due to fluid accumulation)
- Decreased appetite, difficulty feeding
- Disturbed sleep
- Drainage from ear
- Difficulty with balance
Diagnosis
The doctor will ask about symptoms and medical history, and perform a physical exam. Most middle ear infections can be diagnosed by looking into the ear with a lighted instrument, called an otoscope.
The doctor will see if there is fluid or pus behind the eardrum. A small tube and bulb may be attached to the otoscope. This is to blow a light puff of air into the ear. The puff helps the doctor see if the eardrum is moving normally.
Other tests may include:
- Tympanocentesis—used to drain fluid or pus from the middle ear using a needle, also used to check for bacteria
- Tympanometry—measures pressure in the middle ear and responsiveness of the eardrum, also used to check for fluid or pus
- Hearing test —may be done if you have had many ear infections
Treatment
Treatments include:
Medication
Antibiotics are commonly used to treat ear infections. Examples include:
- Amoxicillin (Amoxil, Polymox)
- Clavulanate (Augmentin)
- Cephalosporins ( cefprozil , cefdinir , cefpodoxime , ceftriaxone )
- Sulfa drugs (eg, Septra, Bactrim, Pediazole)
Since bacteria develop a resistance to antibiotics, doctors may take a "wait and see" approach. In some cases, your doctor may prescribe an antibiotic for your child and ask you to use the medication if the pain or fever lasts for a certain number of days. This approach has been effective.
While antibiotics may be effective, it is also important to keep in mind these medicines can cause a number of side effects. Nausea, stomach pain, and diarrhea are common. Also, a person may have an allergic reaction to the antibiotic. It is important to discuss the risks and benefits of taking antibiotics with your doctor.
A virus causes some ear infections. This type will not go away faster with antibiotics. Most middle ear infections (including bacterial ones) tend to improve on their own in 2-3 days.
Over-the-Counter Pain Relievers
Pain relievers can help reduce pain, fever, and irritability. These include:
- Acetaminophen
- Ibuprofen
- Aspirin
- Note : Aspirin is not recommended for children or teens with a current or recent viral infection. This is because of the risk of Reye's syndrome . Ask your doctor which other medicines are safe for your child.
Decongestants and antihistamines are not recommended to treat an ear infection.
Ear Drops
In children, ear drops that have a local anaesthetic (eg, ametocaine, benzocaine , or lidocaine) can help decrease pain, especially when the drops are used with oral pain relievers. If there is a chance that the eardrum has ruptured, do not use ear drops.
Myringotomy
Myringotomy is surgery done to open the eardrum. A tiny cut is made in the eardrum to drain fluid and pus.
If you are diagnosed with an ear infection, follow your doctor's instructions .
If you are diagnosed with an ear infection, follow your doctor's instructions .
Prevention
To reduce the chance of getting an ear infection:
- Avoid exposure to smoke.
- Breastfeed your baby for at least the first six months.
- Try to avoid giving your baby a pacifier.
- If you bottle-feed, keep your baby's head propped up as much as possible. Don't leave a bottle in the crib with your baby.
- Get tested for allergies.
- Treat related conditions, such as GERD.
- Practice good hand washing .
- Make sure your child's vaccinations are up to date. The pneumococcal vaccine can prevent middle ear infections.
- Consider getting a flu vaccine .
- If your child has a history of ear infections, talk to the doctor about long-term antibiotic use. This is used in some cases.
- Ask your doctor about tympanostomy tubes. These tubes help equalize pressure behind the eardrum.
- Xylitol is a natural sugar that is used as a sweetener in gum, candy, and other types of food. Eating food with xylitol on a regular basis may help to reduce your risk of ear infections.
