Definition

With this condition, the middle ear becomes infected and inflamed. The middle ear is located behind the eardrum.

The Middle Ear

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Causes

Bacteria and viruses (most common) cause this condition. Common bacteria include:

    
  • Streptococcus pneumoniae (most common)
  • Haemophilus influenzae
  • Moraxella (Branhamella) catarrhalis
  • Streptococcus pyogenes (less common)
  • Risk Factors

    Middle ear infections are more common in the winter. These factors increase your chance of developing middle ear infection:

        
  • Recent viral infection (eg, cold or flu )
  • Recent sinusitis
  • Age: babies and toddlers
  • Attendance at day care
  • Exposure to second hand smoke, usually cigarette smoke, but also from cooking and wood-heating
  • Babies who are formula-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
  • Pacifier use
  • 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:

        
  • 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
  • Tympanocentesis—used to drain fluid or pus from the middle ear using a needle, also used to check for bacteria
  • Treatment

    Medication

    Antibiotics

        
  • oral antibiotics are commonly used to treat ear infections. Examples include:     
  • Amoxicillin
  • Amoxacillin/clavulanate
  • Cephalosporins ( cefprozil , cefdinir , cefpodoxime , ceftriaxone )
  • Sulfa drugs
  • Antibiotic-glucocorticoid ear drops may be used if ear drums rupture or you have ear tubes
  • Some 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 including.     
  • Nausea, stomach pain, and diarrhea are common.
  • Allergic reaction to the antibiotic.
  • Development of antibiotic resistence if used when not needed
  • It is important to discuss the risks and benefits of taking antibiotics with your doctor.
  • A virus causes a lot 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.
  • 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.
  • 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.
  • Decongestants and antihistamines are not recommended to treat an ear infection.

    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 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 if you or your child have chronic nasal congestion. Keep allergy symptoms well controlled.
  • Treat related conditions, such as GERD.
  • Practice good hand washing .
  • Make sure your child's vaccinations are up to date.
  • Consider getting a flu vaccine . Pneumococcal vaccine may prevent some ear infections caused by Pneumococcus, but the overall effect on ear infections is not known.
  • If your child has a history of ear infections, talk to the doctor about long-term antibiotic use.
  • Ask your doctor about tympanostomy tubes. These tubes help equalize pressure behind the eardrum and prevent fluid build-up and infection.