CONDITIONS
Otitis Media (Middle Ear Infection)
What is otitis media?
Otitis media is an infection of the middle ear, the air-filled space behind the eardrum. Middle ear infections are more common in children than adults.
An acute ear infection starts over a short period and is painful. Ear infections that last a long time or come and go are called chronic ear infections.
The ear has three parts:
- The outer ear: This is the visible part of the ear. It consists of the pinna (the visible part of the ear) and the ear canal (also called the external auditory canal), a tube-like structure that leads to the eardrum. The outer ear helps to collect sound waves.
- The middle ear: This is the space behind the eardrum, a thin membrane separating the outer ear from the middle ear. Inside the middle ear are three tiny bones called the ossicles: the malleus, incus, and stapes. These bones amplify and transmit sound vibrations from the eardrum to the inner ear. The eustachian tube also connects the middle ear to the back of the throat, which helps equalize air pressure and drain fluid from the middle ear.
- The inner ear: The inner ear is where the hearing and balance organs are located. It consists of two main parts: the cochlea and the vestibular system. The cochlea is shaped like a snail shell and is responsible for hearing. It contains tiny hair cells that convert sound vibrations into electrical signals sent to the brain via the auditory nerve. The vestibular system consists of three semicircular canals and the vestibule, which help maintain balance.
What causes otitis media?
The eustachian tube stretches from the middle of each ear to the back of the throat. Usually, it drains fluid from the middle ear. But if it gets blocked, fluid can build up, leading to infection.
Ear infections are common in babies and children because their eustachian tubes can easily get blocked. Ear infections can also happen in adults, but not as often as in kids.
Anything that makes the eustachian tubes swollen or blocked leads to more fluid building up behind the eardrum. Some causes include:
- Allergies
- Colds and sinus infections
- Too much mucus and saliva from teething
- Infected or large adenoids (lymph tissue in the throat)
- Tobacco smoke
Ear infections are more common in children who spend a lot of time drinking from a sippy cup or bottle while lying on their back. Milk might go into the eustachian tube, raising the chance of an ear infection. Getting water in the ears would not cause a sudden ear infection unless there is a hole in the eardrum.
Other factors that can increase the risk of ear infections are:
- Going to daycare
- Traveling to places with different altitudes or climates
- Living in a cold area
- Being around smoke
- Not being breastfed
- Using pacifiers
- Recently, having an ear infection
- Recently, being sick with any illness can weaken the body’s ability to fight infection.
- Having a birth defect leading to deficiency in eustachian tube function
What are the symptoms of otitis media?
Symptoms of an acute ear infection in older children or adults include:
- Ear pain
- Feeling like ears are full
- General feeling of being unwell
- Stuffy nose
- Cough
- Feeling tired
- Vomiting
- Diarrhea
- Hearing loss in the affected ear
- Fluid draining from the ear
- Not feeling hungry
Infants and small children
Since small children and infants cannot always tell how they are feeling, it is important to watch for signs of an ear infection. A child with an ear infection may:
- Pull or tug on their ears.
- Cry more than usual or seem cranky.
- Have a fever between 100.5 to 104 degrees Fahrenheit. About half of children with ear infections get fevers.
- Start breathing through their mouth more or snore louder. This might mean their adenoids are swollen. Adenoids are a small patch of tissue at the back of the throat behind the nose and near eustachian tubes.
- Refuses to eat. Swallowing can make ear pain worse, so they might not feel like eating.
How is an ear infection diagnosed?
The ENT doctor will take medical history and ask about symptoms.
ENT doctor will use an instrument called an otoscope to look inside the ears. This exam may show areas of marked redness, bulging of the tympanic membrane, discharge from the ear, air bubbles or fluid behind the eardrum, or a hole (perforation) in the eardrum.
A hearing test may also be done if there is a long-lasting history of frequent ear infections.
How is otitis media treated?
Some ear infections can go away without antibiotics. Managing pain and giving the body time to heal is often enough:
- Apply a warm cloth or warm water bottle to the ear that hurts.
- Use over-the-counter ear drops for pain relief. The doctor can also prescribe some ear drops for pain relief.
- Give over-the-counter medicine like ibuprofen or acetaminophen for pain or fever.
- Children younger than six months of age with fever or ear infection symptoms should see a doctor. Older children can be watched at home if they do not have a fever over 102°F, severe pain, or other serious symptoms.
If the infection does not get better or if it gets worse, see the doctor immediately to see if antibiotics are needed.
ANTIBIOTICS
Viruses or bacteria can cause ear infections. Antibiotics would not help if a virus causes it. Most doctors would not give antibiotics for every ear infection. But all children under six months with an ear infection get antibiotics.
The doctor might give antibiotics if the child:
- Is under two years old
- Has a fever
- Looks sick
- Does not improve in 1-2 days
If antibiotics are prescribed, take them every day and finish all of the medicine. Do not stop when symptoms go away.
SURGERY
If the usual treatment does not work or if a child has many ear infections in a short time, the doctor might suggest ear tubes:
- If a child over six months has had three or more ear infections in six months or more than four in a year.
- If a child under six months has had two ear infections in 6-12 months or three in 24 months.
- If the infection does not go away with treatment.
A tiny tube is put into the eardrum to let air in and fluids out. The tubes usually fall out on their own. If not, the doctor can remove them.
If adenoids are big, the doctor might remove them if ear infections keep happening.
Can otitis media be prevented?
To reduce the child’s risk of ear infections, the following measures can be taken into consideration:
- Parents and children should wash their hands well and often to lower the risk of catching a cold.
- Choose daycares with fewer than six children to decrease the chances of colds or other infections.
- Avoid secondhand smoke, which can increase the number and severity of ear infections.
- Breastfeed the baby for at least six months to help prevent the development of early episodes of ear infections.
- When bottle-feeding, hold the child upright so that their head is higher than their stomach. This helps prevent formula or other fluids from flowing back and collecting in their eustachian tubes.
- Keep children’s vaccinations up to date.
In conclusion, otitis media, or ear infections, can be challenging, especially for young children. However, many cases can be managed effectively with proper care and attention. The risk of ear infections can be reduced by following preventive measures, such as maintaining good hygiene practices, avoiding exposure to smoke, and ensuring vaccinations are up to date.
References
- Penn Medicine. Ear Infection (Middle Ear). Available from: https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/ear-infection-middle-ear. Accessed on 30th April 2024
- Cleveland Clinic. Ear infection (otitis media). Available from: https://my.clevelandclinic.org/health/diseases/8613-ear-infection-otitis-media Accessed on 30th April 2024
- Mayo Clinic. Ear infection (middle ear). Available from: https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616. Accessed on 30th April 2024
