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

Middle ear irritation or infection is known as otitis media. A cold, sore throat or respiratory infection can all cause it.

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

An infection of the middle ear, the air-filled area beneath the eardrum that houses the small 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 a sudden infection of the middle ear. The air-filled area between your inner ear and the eardrum is called the middle ear. It contains the fragile bones that let you hear by sending sound waves from your eardrum to your inner ear.

Your middle ear and the back of your throat are connected by canals called eustachian tubes. They keep fluid from building up in your middle ear space and control the air pressure in your ear.

Muffled hearing may result from fluid having a difficult time emptying from your middle ear space due to a malfunctioning eustachian tube. Middle ear fluid is another symptom of bacterial and viral ear infections. In these situations, the middle ear fluid is infected, which frequently results in discomfort in addition to hearing loss.

Which symptoms of an ear infection are present?

Ear infection symptoms frequently start after a cold. Among them are:

• Ear pain

• Appetite loss

• Trouble sleeping

• Difficulty hearing in the obstructed ear

• A sensation of pressure or fullness in your ears

• Your ear may discharge a yellow, brown, or white substance. (This could indicate a ruptured eardrum.)

If you have ear drainage, avoid putting anything in your ear canal. More harm may result from an object coming into contact with a burst or torn eardrum.




Infant and children:

since little children and infants can’t always articulate their symptoms, it’s crucial to understand the indications. A child with an ear infection may:

• Rub or tug on their ears

• Act fussy or cry more than normal

• Have a temperature ranging from 100.5 to 104 degrees Fahrenheit (38 to 40 degrees Celsius). (Ear infections and fevers affect half of children)

• Increase your snoring or start mouth breathing. An enlarged adenoids may be the cause of mouth breathing. (Adenoid are tiny tissue pads located behind your nose, above your neck, and next to your eustachian tubes.) Adenoids may become infected/inflamed with the same viruses or bacteria that cause ear infections

Refuse to eat during feedings. (Pressure in the middle ear fluctuates as your child swallows, creating greater pain and less desire to eat.)

Causes:

Ear infections are caused by viruses and bacteria. Ear infections frequently start after an upper respiratory infection, such as a cold. The eustachian tube allows the germs to enter your middle ear. 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.

Risk factors:

The following are risk factors for ear infections:

• Age: Ear infections are more common in infants and young children (ages 6 months to 2 years).

• History of the family: Ear infections may run in families.

• Colds: You are more likely to get an ear infection if you have a cold. Because they are more likely to be around children who have colds or other infectious respiratory conditions, children in daycare and group settings are more susceptible to ear infections.

• Chronic conditions: Immune deficiencies and long-term respiratory conditions (such as asthma and cystic fibrosis) can raise your chance of developing ear infections.

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

• Smoky surroundings and poor air quality: Your chance of developing an ear infection is increased by exposure to secondhand smoke and air pollution.

Complication:

The majority of ear infections don't result in chronic problems. In most cases, recurring or persistent ear infections are the cause of complications. Among the complications are:

• Hearing loss: During an ear infection, you may experience temporary hearing loss or changes in your hearing, such as muffled or distorted sounds. More severe hearing loss may result from recurring or persistent infections or harm to internal ear structures.

• Delays in speech and language development: For children to acquire language and develop speech, they must hear. Long-term hearing loss or muffled hearing may significantly delay development.

• Eardrum rip: A little tear in the eardrum occurs in 5–10% of children who have an ear infection. The tear usually goes away on its own. Your child may require surgery if it doesn't.

• Infection spread: Infections that go untreated or don't get better 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, which are membranes that protect your brain and spinal cord.

How do you diagnose an ear infection?

Based on your child's symptoms, a physical examination to look for cold symptoms, and an ear exam, the majority of medical professionals can determine whether your child has an ear infection. Your child's doctor will use an otoscope, a lit device, to examine your child's eardrum during the ear exam. An ear infection is indicated by a red, puffy, or irritated eardrum.

A pneumatic otoscope may be used by your child's healthcare practitioner to examine your child's middle ear for fluid. The eardrum should move back and forth when a puff of air is blown at it with a pneumatic otoscope. If there is fluid in your child's ear, it won't move easily.

Does my child need to take any further tests?
Other tests that your child might require include:

• 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 procedure enables the healthcare provider to extract middle ear fluid and analyze it for bacteria and viruses. If the infection has not been resolved by usual therapies, their physician might suggest tympanocentesis.

• Hearing tests: To find out if your child has hearing loss, an audiologist may conduct hearing tests. Children who have persistent or recurring ear infections or middle ear fluid that doesn't drain are more likely to experience hearing loss.

Treatment:

How an ear infection is treated depends on several factors,

• Such as your child's age

• The severity of the infection

• Whether it is a first-time, ongoing, or repeat infection

• Whether fluid stays in the middle ear for a long time

 Most ear infections go away on their own, but before prescribing treatment, your doctor may check on your child's condition to see if it gets better. If the infection doesn't go away, your child may need antibiotics or surgery. In the interim, pain medications can help with symptoms like ear pain.

Antibiotics:

If the ear infection is being caused by bacteria, your child may require antibiotics. Before administering antibiotics, medical professionals may wait up to three days to observe if a small illness goes away. Your child may need to start taking antibiotics right away if the infection is severe.

Guidelines for whether a child should be given antibiotics and when it's preferable to watch are provided by the American Academy of Pediatrics. The age of your child, the severity of their infection, and their temperature are all factors. The recommendations are summarized up in the table below.

In the following circumstances, following a period of initial observation, your doctor may recommend antibiotic treatment for an ear infection:

• Children aged 6 months and above who have had a temperature of 102.2 F (39 C) or higher or who have experienced moderate to severe ear pain in one or both ears for at least 48 hours.

• children aged 6 to 23 months who have a temperature below 102.2 F (39 C) and mild middle ear pain in one or both ears that lasts less than 48 hours.

• For children aged 24 months and up, a temperature below 102.2 F (39 C) and mild middle ear pain in one or both ears lasting less than 48 hours.

Antibiotics are more likely to be administered to children with confirmed acute otitis media who are younger than six months old without the initial observational waiting period.

Use the medicine as prescribed, even if your symptoms have subsided. Recurrent infections and bacterial resistance to antibacterial medications might result from not taking all of the prescribed treatments. Consult your physician or pharmacist about what to do you inadvertently miss taking a dosage.

Painkillers:

To ease 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. Regarding whether medications are safe for your child, heed the instructions of your healthcare professional.

Children should never be given aspirin. 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 go away with antibiotics, or hearing loss from fluid accumulation, they might require ear tubes. During a tympanostomy, the tubes are positioned by an ENT specialist. The process takes only about ten minutes. That day, your youngster can return home.

A tiny incision (cut) in your child's eardrum is used to introduce a small metal or plastic tube during a tympanostomy. A myringotomy is the process of draining the eardrum by perforating (piercing a hole into) it. After the tubes are inserted, fluid can drain and air can enter the middle ear.

 Prevention:

Here are some strategies to lower the risk of ear infections for both you and your child:

• Prevent respiratory illnesses such as colds. Prevent colds by being proactive, particularly in the first year of your child's life. Instruct them to cough or sneeze into their elbow and to wash their hands frequently. Don't let them share utensils, food, or glasses. Avoid big daycare centers till kids are older if at all possible.

• Steer clear of secondhand smoke. Stay away from secondhand smoke and don't let other people smoke near your kids.

• Give your infant breast milk (chest feed). Breastfeed your child for the first six to twelve months of life, if at all possible. Breast milk, often known as chest milk, has antibodies that combat germs and viruses that cause infections

• Your infant should be bottle-fed upright. Hold your infant up so their head is above their tummy if you are bottle-feeding them. Formula or other fluids may not flow backward and accumulate in their eustachian passages in this position.

• Maintain current immunizations. Make sure your child has received all of their recommended vaccinations, including their yearly flu shot for those six months and above. Inquire with your child's pediatrician about meningitis and pneumococcal disease vaccinations.

References:

• 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.

• Isaacson GC. Overview of tympanostomy tube placement, postoperative care, and complications in children. https://www.uptodate.com/contents/search. Accessed March 22, 2021.

• 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.

• 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.

• 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.

• 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.