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 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:     
  • 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)
  • 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 .

    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.