Definition
With this condition, the middle ear becomes infected and inflamed. The middle ear is located behind the eardrum.
Causes
This condition is caused by bacteria and viruses, 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 forumula-fed
- Medical conditions that cause abnormalities of the eustachian tubes, such as:
- Cleft palate
- Down syndrome
- 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)
Other medications sometimes used include:
- 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.
Some ear infections are caused by a virus. 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 .
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 bottlefeed, 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.