Middle Ear Infection (Otitis Media): Symptoms, Causes, Diagnosis, Treatment & Prevention

 

A virus or bacteria that affects the area behind your child's eardrum can cause an ear infection, often known as acute otitis media. One of the symptoms could be earache, which could make your child very fussy or irritable. Ear infections frequently go away on their own. Children may require ear tubes, antibiotics, or painkillers sometimes.

An infection of the middle ear, the air-filled cavity behind the eardrum that contains the tiny vibrating bones of the ear, is known as an ear infection (also known as acute otitis media). Ear infections are more common in children than in adults.

What is acute otitis media, or an ear infection?

Acute otitis media, another name for an ear infection, is an unexpected infection in the middle ear. The air-filled area between your inner ear and the eardrum is called the middle ear. It contains the little bones that allow you to hear by sending sound waves from your eardrum to your inner ear.

The canals known as eustachian tubes run from the back of your throat to your middle ear. They keep fluid from building up in the middle ear area and control the air pressure inside your ear.

A malfunctioning eustachian tube makes it difficult for fluid to exit your middle ear, which can result in muted hearing. Middle ear fluid can also result from bacterial or viral ear infections. In these situations, the middle ear fluid is infected, which frequently results in discomfort in addition to hearing loss.

What symptoms of an ear infection are present?

An ear infection's symptoms frequently start after a cold. Among them are:

•  Ear pain
• Appetite loss.
• Difficulty falling asleep.
• Difficulty hearing in the obstructed ear.
• An ear pressure or fullness sensation.
• Yellow, brown, or  white drainage from your ear. (This may mean that your eardrum has broken.)
• Don’t place anything in your ear canal if you have drainage from your ear. An item touching a torn (ruptured) eardrum can cause more damage.

Infants and children

It's critical to notice the symptoms in small children and infants because they may not always be able to express themselves. An ear infection in a child can cause:

• Give them a little rub or tug.
• Weep more than normal or behave fussily.
• Possess a fever that ranges from 38 to 40 degrees Celsius, or 100.5 to 104 degrees Fahrenheit. (Ear infections cause fever in half of youngsters.)
• Start inhaling through your mouth or snore more loudly. Breathing through your mouth could indicate swollen adenoids. (Adenoids are tiny tissue pads that are located behind your nose, above your neck, and next to your eustachian tubes.) The same germs or viruses that cause ear infections can also inflame or infect adenoids.

Why can ear infections be caused?

Ear infections are caused by viruses and bacteria. Ear infections frequently start as a result of upper respiratory diseases, such as colds. This is how the germs enter your middle ear:

 Via the eustachian tube. Once inside, the bacteria or virus may cause swelling in your eustachian tubes. Infected fluid in your inner ear and poor eustachian tube function can result from the swelling blocking the tube.

Is there a spread of ear infections?

Although the virus or bacteria causing the infection is communicable, ear infections themselves are not. Ear infections are caused by a variety of bacteria and viruses, including those that cause the flu and colds.

Which factors put one at risk for ear infections?

Some of the risk factors for ear infections are:

• Age: Ear infections are more common in babies and young children (between 6 months and 2 years old).

• Family history: ear infections can run in families.

• Colds: Experiencing a cold heightens the likelihood of acquiring an ear infection. Children who attend daycare centers and playgroups are more likely to come into contact with other children who are sick with colds or other respiratory infections, which increases their chance of developing ear infections.

• Chronic illnesses: Long-term conditions that affect the immune system and chronic respiratory disorders (including asthma and cystic fibrosis) can make you more susceptible to ear infections.

• Ethnicity: Compared to children from other ethnic groups, Native American, Alaska Native, and Hispanic children experience a greater number of ear infections.

• Smoky surroundings and poor air quality: Being around secondhand smoke and air pollution increases your chance of developing an ear infection.

What complications might ear infections cause?

Most ear infections don't result in persistent problems. If issues arise, they are typically caused by recurrent or persistent ear infections. Among the complications are:


Hearing loss: During an ear infection, it's possible to experience transient hearing loss or changes in your hearing (such as muffled or distorted sounds). Greater degrees of hearing loss can be brought on by persistent infections or harm to the inside components of your ear.

Delayed speech and language development: to learn language and form speech, children must hear. Any amount of time spent with muffled or lost hearing might seriously impede growth.

Eardrum torn: A little rip in the eardrum occurs in 5–10% of children who have an ear infection. The tear usually heals itself. Should it not, your youngster might require surgery.

Spread of the infection: Infections that are left untreated or that do not go well on their own have the potential to spread. The bone behind your ear may become infected (mastoiditis). Meningitis can occasionally result from an infection that spreads to the meninges, the membranes that surround the brain and spinal cord.

Diagnosis:

How is an infection in the ear diagnosed?
Based on your child's symptoms, a physical examination to look for cold symptoms, and an ear exam, most medical professionals can determine whether your child has an ear infection. Your child's doctor will use an otoscope, a lit instrument, to examine your child's eardrum during the ear exam. An ear infection is indicated by an eardrum that is swollen, red, or inflamed.

The medical professional treating your child might use a pneumatic otoscope to look for middle ear fluid. The eardrum should move back and forth when a pneumatic otoscope sprays a puff of air at it. If your child has fluid in their ear, it will not move easily.

Are there any other tests that my child might require?

There's a chance your youngster needs more testing, like:

Tympanometry: This examination looks for fluid in your child's middle ear by measuring air pressure.

Acoustic reflectometry: This test looks for fluid in your child's middle ear by using sound waves.

Tympanocentesis: This treatment enables the doctor to take fluid out of your child's middle ear and examine it for bacteria and viruses. If their infection hasn't been treated by other therapies, their physician can suggest tympanocentesis.

Hearing tests: To ascertain whether your kid has hearing loss, a healthcare professional known as an audiologist can perform hearing tests. Children who have middle ear fluid that doesn't drain or who have recurrent or persistent ear infections are more likely to experience hearing loss.

How do you treat an ear infection?

Treatment is based on a variety of variables, such as:

• The age of your child.
• The severity of the infection.
• The type of infection (repeat, continuous, or first occurring).
• If fluid stays in the middle ear for an extended period.
• Ear infections frequently go away on their own. Before recommending treatments, your doctor might keep an eye on your child's condition to see if it gets better. If your child's illnesses don't go away, they can require surgery or antibiotics. Painkillers can assist with symptoms like ear ache in the meantime.

Antibiotics:

If bacteria are the cause of your child's ear infection, they may require antibiotics. Before administering antibiotics, medical professionals may hold off for up to three days to check if a moderate illness resolves on its own. If the infection is severe, your child might be required to take antibiotics immediately.

Guidelines for when a child should be given antibiotics and when it's best to watch are provided by the American Academy of Pediatrics. Your child's age, the intensity of their infection, and their body temperature are among the variables. The recommendations are summarized in the table below.

Painkillers:

To treat pain and lower fever, your doctor could suggest over-the-counter (OTC) medications such as ibuprofen (Advil®, Motrin®) or acetaminophen (Tylenol®). They might recommend ear drops to relieve pain. Observe your physician's guidance regarding the medications that are appropriate for your child.

Give children no aspirin at all. Reye's syndrome is a potentially fatal illness that can be brought on by aspirin.

Tympanostomy tubes, or ear tubes:

If your child has recurrent ear infections, infections that don't get better with medication, or hearing loss from fluid accumulation, they might require ear tubes. During a tympanostomy, the tubes are inserted by an ENT expert. It is a quick operation that takes about ten minutes. That day, your child can return home.

A tiny incision (cut) in your child's eardrum is used by the healthcare professional to introduce a small metal or plastic tube during a tympanostomy. A myringotomy is a technique that involves piercing and draining the eardrum. After being inserted, the tubes allow fluid to drain and allow air to enter the middle ear.

The tube is often left in place for a period of 12 to 18 months. It can come loose on its own or your child might require surgery to get rid of it. The hole in your child's eardrum will heal and shut after the tubes are removed.

Prevention:

The following measures can lower the chance of ear infections for you or your child:

Defend against respiratory diseases such as colds. Take preventative measures to avoid colds, particularly in your child's first year of life. Instruct them to frequently wash their hands and to sneeze or cough into their elbows. Don't let them share utensils, glasses, or food. Wait until kids are older to attend large daycare centers, if at all possible.

Avoid secondhand smoke. Keep your children away from secondhand smoke and don't let anyone else smoke near them.
Feed your child via breast milk (chest feed). Breastfeed your infant for the first six to twelve months of life, if at all possible. Breast milk, or chest milk, contains antibodies that combat infection-causing germs and viruses.
Feed your infant with a bottle while standing up. When feeding your infant from a bottle, make sure their head is higher than their stomach. By positioning them in this way, formula or other fluids can be kept from recirculating and building up in their eustachian tubes.

Maintain current vaccinations. Make sure your child has received every recommended immunization, including the annual flu shot for those six months of age and up. Consult your child's pediatrician regarding meningitis and pneumococcal vaccinations.

References:

• Thomas M, Bomar PA. Upper Respiratory Tract Infection (https://www.ncbi.nlm.nih.gov/books/NBK532961/). 2022 Jun 27. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022 Jan-. Accessed 6/6/2023.

• Ear infections in children. National Institute on Deafness and Other Communication Disorders. https://www.nidcd.nih.gov/health/ear-infections-children. Accessed March 19, 2019.
  
  

• American Academy of Pediatrics (healthychildren.org). Ear Infection Questions (https://www.healthychildren.org/English/tips-tools/symptom-checker/Pages/symptomviewer.aspx?symptom=Ear%20Infection%20Questions). Accessed 6/6/2023.

• Danishyar A, Ashurst JV. Acute Otitis Media (https://www.ncbi.nlm.nih.gov/books/NBK470332/). 2022 Jan 21. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022 Jan-. Accessed 6/6/2023.

• American Academy of Pediatrics (healthychildren.org). Middle Ear Infections (https://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/Middle-Ear-Infections.aspx). Accessed 6/6/2023.

• Rosenfeld RM, Tunkel DE, Schwartz SR, et al. Clinical practice guideline: tympanostomy tubes in children (update) (https://pubmed.ncbi.nlm.nih.gov/35138954/). Otolaryngol Head Neck Surg. 2022;166(1_suppl):S1-S55.Accessed 6/6/2023.

• Merck Manual, Consumer Version. Overview of Middle Ear Infections in Young Children (https://www.merckmanuals.com/home/children-s-health-issues/ear,-nose,-and-throat-disorders-in-children/overview-of-middle-ear-infections-in-young-children). Accessed 6/6/2023.