Ear Infection

1 What is Ear Infection?

Ear infection or acute otitis media is an infection of the middle ear caused by bacteria or virus.

The middle ear is the part of the ear beyond the eardrum. The middle ear is an air-filled space, and when infection sets in, becomes filled with fluid. The pressure and inflammation caused by built-up fluid cause pain in the ears.

Children are more prone to ear infections than adults.

Ear infections typically clear on their own, but treatment may be needed to address pain. Severe infections and ear infections in infants require antibiotics.

Persistent or repeated ear infections must be addressed to prevent the risk of hearing problems and infection in the deeper parts of the ear.

2 Symptoms

Signs and symptoms of ear infections tend to develop rapidly.

In children, signs include ear pain (especially when lying down), tugging or pulling the ear, sleeping difficulties, crying and irritability, not responding to sounds, balance problems, high fever, the presence of fluid in the ear canal and loss of appetite.

Adults may experience ear pain, fluid draining out of the ears and reduced hearing.

Ear infection tends to have symptoms similar to other conditions.

You need to call a doctor if you or your child have severe ear pain, sleepless or irritable after a bout of colds, or if you see any fluid coming out of the ears.

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3 Causes

Bacteria or viruses, particularly those that cause respiratory infections like flu, colds and allergies, cause ear infections.

The middle ear is connected to the throat via the Eustachian tube, which drains secretions and equalizes air pressure. Infectious bacteria or viruses can travel through the Eustachian tubes and cause infection the middle ear. The presence of swelling, inflammation and mucus can also block the Eustachian tubes, blocking them and promoting the buildup of fluids in the middle ear that results in infection.

Ear infections are more common in children because their Eustachian tubes are narrower and more horizontal in profile, making drainage difficult and more likely to get clogged.

Adenoids are more active during childhood, and its role may explain why ear infections are common in children. Adenoids, a mass of lymphatic tissues at the back of the nose and throat, are located near the Eustachian tubes. Adenoids can swell when infected or inflamed, which can easily block the Eustachian tubes and cause ear infection.

Middle ear problems can also be caused by collapsed Eustachian tubes, causing fluids to be retained in the middle ear and cause inflammation without infection. This is called Otitis Media with Effusion, and this usually happens after ear infection has resolved.

Infections in other parts of the ear may also cause perforation of the eardrum resulting in drainage of fluids out of the ear canal.

4 Making a Diagnosis

Diagnosing and treating ear infections starts with a visit to a family doctor or a pediatrician. If ear infection persists or occurs frequently, you are likely to be referred to an otolaryngologist that specializes in ear, nose and throat conditions.

If your child can respond to questions, it can help if you ask questions the doctor is likely to ask before the appointment. This can help the child anticipate and give better responses to the doctor.

Try asking questions regarding:

  • Signs and symptoms felt, and when did it start
  • Presence of ear pain, and if the pain mild, moderate or severe

If you are the parent, you will have to describe if the child has symptoms such as ear pulling, difficulty sleeping, profound irritability, hearing difficulties, fever, discharge from the ear, and any signs of hearing impairment.

You also have to discuss with your doctor about recent episodes of flu and colds, seasonal allergies, past ear infection, and allergies to medicines like penicillin.

5 Treatment

Most cases of ear infection resolve on its own and do not need any treatment. Treating ear infections depend on factors like the age of the child and severity of symptoms. Antibiotics are not the first-choice treatment for most ear infections.

Ear infections usually improve within few days and clear up in one to two weeks without treatment.

Consider a wait-and-see approach if your child is:

  • Very young children aged 6 to 23 months old, mild pain in one ear only and fever less than 102.2 F (39 C) for less than 48 hours
  • Toddlers 24 months old and older, mild pain in one or both ears and fever less than 102.2 F (39 C) for less than 48 hours

You can lessen ear pain by placing a warm, moist cloth (warm compress) over the affected ear.

Medicines for ear infections include antibiotics and over-the-counter pain medications. Antibiotics may have benefit for ear infections but only use it with doctor’s supervision. Antibiotics can be harmful to your child if not used properly.

The doctor may prescribe antibiotics for the following situations:

  • Babies older than 6 months with moderate to severe pain in one or both ears lasting more than 2 days, or fever reaching 102.2 F (39 C) or higher
  • Children aging 6 to 23 months with mild pain in one or both ears lasting less than 2 days, and fever lower than 102.2 F (39 C)
  • Toddlers aged 2 years and above with mild pain in one or both ears lasting less than 2 days, and fever lower than 102.2 F (39 C)

Always use antibiotics as directed by the doctor. Make sure to call your doctor or pharmacist in case you missed or accidentally skipped a dose.

  • For pain, the doctor may prescribe acetaminophen (Tylenol) or ibuprofen (Motrin IB, Advil). Aspirin may also relieve pain, but must be used carefully when given to children and teenagers. Do not give aspirin if your child recently had flu or flu-like symptoms and chicken pox.
  • For recurrent ear infections, the doctor may insert ear tubes to drain fluid from the ear. Ear tubes are considered for cases with three infections in six months, or four in a year, or for otitis media with effusion. The doctor inserts ear tubes in a simple and short procedure called myringotomy, which involves creating a tiny hole in the eardrum. This allows insertion of a tiny tube to ventilate the middle ear and promote drainage of fluids to relieve congestion and inflammation. The tube stays in place for around six months to a year. Some ear tubes are designed to fall out on their own while others stay in longer and requires another procedure for removal. The hole in eardrum closes after the tube is removed.
  • For chronic suppurative otitis media, the doctor may prescribe antibiotic ear drops. You will have to suction fluids out of the ear before putting in ear drops, which will be taught to you in the clinic. Make sure to follow instructions.

The doctor may order language and hearing tests to your child. You will have to monitor and may have several appointments to the doctor, especially for severe and recurrent ear infections. Make sure to discuss your questions, concerns and symptoms to the doctor, and follow the schedule of follow-ups.

6 Prevention

You can prevent ear infections by:

  • Try to prevent or address cough, colds and other common illnesses, which are associated with ear infections. You can do this by teaching children to wash their hands frequently, not sharing eating and drinking utensils, and coughing or sneezing into their sleeves or handkerchiefs. Reducing time with large groups of people, especially when sick, can reduce the chances of you or your child catching diseases from others.
  • Tobacco smoke has deleterious effects on the respiratory system, especially on children. Make sure the premises where your child plays or sleeps is smoke-free. You have to make sure no one smokes in your home and stay in smoke-free environments.
  • Breastfeeding your baby can help reduce the risk of respiratory and ear infections because it bolsters the immune system. Also, leaving bottles in the baby’s mouth while lying down may cause milk to stay in the throat, causing irritation that may result to ear infections. Make sure the baby is in an upright position during bottle-feeding.
  • Keep up with the shots schedule. Vaccinations are helpful in preventing certain respiratory illnesses such as seasonal flu and pneumococcal infection, which can cause ear infections too.

7 Risks and Complications

Here are the risk factors for ear infection:

  • Children aged 6 months to 2 years old are prone to ear infections because the structure of their Eustachian tubes and still-developing immune systems.
  • Spending time in groups of people, like in child-care facilities with large groups of children, exposes you or your child to more infections.
  • Bottle-feeding is a common risk factor for ear infections because it allows milk to stay in the throat, especially when the baby is feeding while lying down.
  • High levels of air pollution.
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