Ear Infection

An ear infection, an infection that occurs in the space behind the eardrum, is a common reason for your child to see a doctor. Ear infections occur when bacteria or viruses infect and trap fluid behind the eardrum, causing pain and swelling in the eardrum. Treatments include antibiotics, pain relief medications, and the placement of ear tubes.

OVERVIEW

What is an ear infection?

The commonly used term “ear infection” is medically known as acute otitis media, or a sudden infection in the middle ear (the space behind the eardrum). Although ear infections are one of the most common reasons young children go to the doctor, anyone—children and adults alike—can get an ear infection.

In most cases, ear infections resolve on their own. Your doctor may recommend a medication to relieve pain. If the ear infection gets worse or does not improve, your doctor may prescribe an antibiotic. In children younger than two years of age, ear infections usually require an antibiotic.

It’s important to see your doctor if you or your child has ongoing pain or discomfort to make sure the ear infection is getting better. Hearing problems and other serious effects can occur with ongoing ear infections, frequent infections, and when fluid builds up behind the eardrum.

Where is the middle ear?

The middle ear is behind the eardrum and is also home to the sensitive bones that help with hearing. These bones are the hammer, anvil and stirrup. Let’s look at the entire structure and function of the ear to provide the bigger picture: 

The ear has three main parts: outer, middle and inner.

• The outer ear is the outer ear flap and the ear canal (external auditory canal).
• The middle ear is the air-filled space between the eardrum and the inner ear. The middle ear contains sensitive bones that transmit sound vibrations from the eardrum to the inner ear. This is where ear infections occur.
• The inner ear contains the snail-shaped labyrinth that converts sound vibrations from the middle ear into electrical signals. The auditory nerve carries these signals to the brain.

Other parts nearby

• The Eustachian tube regulates air pressure in the middle ear and connects it to the upper part of the throat.
• Adenoids are small pads of tissue located above the throat, behind the nose, and near the Eustachian tubes. Adenoids help fight infections caused by bacteria that enter the mouth.

Who gets ear infection (otitis media) most?

Middle ear infection is the most common childhood illness (other than the common cold). Ear infections are most common in children between the ages of 3 months and 3 years and are common by age 8. Approximately 25% of all children have recurrent ear infections.

Adults can also get ear infections, but they are not as common as they are in children.

Risk factors for ear infections include:

• Age  : Babies and young children (6 months to 2 years old) are at greater risk for ear infections.
• Family history  : There may be a family history of ear infections.
• Cold  : A cold often increases the likelihood of an ear infection.
• Allergies  : Allergies can cause inflammation (swelling) in the nasal passages and upper respiratory tract, which can enlarge the adenoids. Enlarged adenoids can block the Eustachian tube, preventing ear fluids from flowing. This causes fluid to build up in the middle ear, causing pressure, pain, and possible infection.
• Chronic diseases  : People with chronic (long-term) diseases are more likely to develop ear infections, especially those with immune deficiency and chronic respiratory disease such as cystic fibrosis and asthma.
• Ethnicity  : Native and Hispanic children have more ear infections than other ethnic groups.

SYMPTOMS AND CAUSES

What causes ear infection?

Ear infections are caused by bacteria and viruses. Most often, an ear infection begins after a cold or other respiratory infection. The bacteria or virus travels to the middle ear through the eustachian tube (there is one in each ear). This tube connects the middle ear to the back of the throat. Bacteria or viruses can also cause swelling of the eustachian tube. This swelling can cause the tube to become blocked, allowing fluids normally produced to accumulate in the middle ear instead of being drained.

The fact that the eustachian tube in children is shorter and less inclined than in adults further exacerbates the problem. This physical difference makes it easier for these tubes to become blocked and difficult to drain. The trapped fluid may become infected with a virus or bacteria and cause pain.

Medical terminology and related conditions

Since your doctor may use these terms, it is important that you have a basic understanding of them:

• Acute otitis media (otitis media):  This is the ear infection described above. A sudden ear infection that usually occurs along with or shortly after a cold or another respiratory infection. Bacteria or viruses infect and trap the fluid behind the eardrum, causing pain, swelling/swelling of the eardrum, and resulting in the commonly used term “ear infection.” Ear infections may occur suddenly and go away within a few days (acute otitis media) or may reoccur frequently and over long periods of time (chronic middle ear infections).
• Otitis media with effusion:  This is a condition that can follow acute otitis media. Acute otitis media symptoms disappear. There is no active infection but fluid remains. Trapped fluid can cause temporary, mild hearing loss and also increases the likelihood of an ear infection occurring. Another cause of this condition is a block in the eustachian tube that is not related to an ear infection.
• Chronic suppurative otitis media:  This is a condition in which the ear infection does not go away even with treatment. Over time, this can cause a hole in the eardrum.

What are the symptoms of otitis media (middle ear infection)?

Ear infection symptoms include:

• Earache:  This symptom is evident in older children and adults. For babies who are too young to talk, look for signs of pain such as rubbing or pulling at the ears, crying more than usual, having trouble sleeping, or acting cranky/irritable.
• Loss of appetite:  This may be most noticeable in young children, especially during bottle feeding. The pressure in the middle ear changes as the child swallows, causing more pain and less desire to eat.
• Irritability:  Any ongoing pain can cause irritability.
• Poor sleep  : Pain may be worse when the child is lying down, as the pressure in the ear may worsen.
• Fever:  Ear infections can cause temperatures between 100° F (38 C) and 104° F. Approximately 50% of children have a fever along with an ear infection.
• Discharge from the ear:  Yellow, brown, or white fluid that is not earwax may leak from the ear. This may mean that the eardrum has ruptured (ruptured).
• Hearing problem:  The bones of the middle ear connect to nerves that send electrical signals (as sound) to the brain. Fluid behind the eardrums slows the movement of these electrical signals through the bones of the inner ear.

DIAGNOSIS AND TESTS

How is an ear infection diagnosed?

Ear Examination

Your doctor will look at your or your child’s ear using an instrument called an otoscope. A healthy eardrum will be pinkish gray and translucent (clear). If there is infection, the eardrum may become inflamed, swollen, or red.

Your doctor may also check fluid in the middle ear using a pneumatic otoscope, which blows a small amount of air into the eardrum. This should cause the eardrum to move back and forth. If there is fluid inside the ear, the eardrum does not move easily.

Another test, tympanometry, uses air pressure to check for fluid in the middle ear. This test does not test hearing. If necessary, if you or your child has long-term or frequent ear infections or fluid that does not drain from the middle ear, your doctor will order a hearing test performed by an audiologist to determine possible hearing loss.

Other controls

Your doctor will also check your throat and nasal passage for signs of upper respiratory tract infection and listen to your breathing.

Nonprescription acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) can help relieve earache or fever. Pain-relieving ear drops may also be prescribed. These medications usually begin to reduce pain within a few hours. Your doctor will recommend pain medications for you or your child and provide additional instructions.

Never give aspirin to children. Aspirin can cause a life-threatening condition called Reye’s Syndrome.

Earaches hurt more before going to bed. Applying a warm compress to the outside of the ear can also relieve pain. (This is not recommended for babies.)

Ear tubes (tympanostomy tubes)

Sometimes ear infections may persist (chronic), recur frequently, or fluid in the middle ear may persist for months after the infection has cleared (otitis media with effusion). Most children have ear infections by age 5, and some children have frequent ear infections. Significant symptoms of an ear infection in a child may include pain inside the ear, a feeling of fullness in the ear, muffled hearing, fever, nausea, vomiting, diarrhea, crying, irritability, and pulling of the ears (especially in very young children). . If your child has had frequent ear infections (three ear infections in six months or four infections a year), ear infections that don’t get better with antibiotics, or   hearing loss due to fluid buildup behind the eardrum , you may be a candidate. for ear tubes. Ear tubes can provide immediate relief and are sometimes recommended for young children who are developing speech and language skills. You may be referred to an ear, nose and throat (ENT) specialist for this outpatient surgical procedure. Myringotomy with placement of an ear  tube. During the procedure, a small metal or plastic tube is inserted through a small incision (cut) in the eardrum. The tube allows air into the middle ear and allows fluid to drain. The procedure is very short – about 10 minutes – and this procedure has a low complication rate. This tube usually stays in place for six to 12 months. It usually goes away on its own, but it can also be removed by your doctor. The outer ear will need to be dry and free of dirty water such as lake water until the hole in the eardrum is completely healed and closed.

What are the harms of fluid accumulation in your ears or recurring or ongoing ear infections?

Most ear infections do not cause long-term problems, but when they do occur complications can include:

• Hearing loss:  Mild, temporary hearing loss (muffled/distorted sound) often occurs during an ear infection. Ongoing infections, repeated infections, and damage to the internal structures of the ear due to fluid accumulation can cause more significant hearing loss.
• Delayed speech and language development:  Children need to hear to learn language and develop speech. Muffled hearing or hearing loss for any length of time can significantly delay or hinder development.
• Rupture in the eardrum:  A rupture in the eardrum may develop due to the pressure caused by the long-term presence of fluid in the middle ear. About 5% to 10% of children with ear infections develop a small tear in the eardrum. If the tear does not heal on its own, surgery may be required. If you have ear discharge/discharge, do not insert anything into your ear canal. Doing so could be dangerous if an accident occurs involving the item coming into contact with the eardrum.
• Spread of infection:  An infection that does not go away on its own, is not treated, or does not fully resolve with treatment can spread outside the ear. The infection can damage the nearby mastoid bone (the bone behind the ear). In rare cases, the infection can spread to the membranes surrounding the brain and spinal cord (meninges) and cause meningitis.

PREVENTION

What can I do to prevent ear infections in myself and my child?

Here are some ways to reduce your or your child’s risk of ear infections:

• smoking. Studies have shown that secondhand smoking increases the likelihood of ear infections. Make sure no one is smoking at home or in the car – especially when children are around – or at your day care facility.
• Check for allergies. Inflammation and mucus caused by allergic reactions can block the Eustachian tube and make ear infections more likely.
• Prevent colds. Reduce your child’s exposure to colds during the first year of life. Do not share toys, food, cups or utensils. Wash your hands frequently. Most ear infections start with a cold. Try to postpone the use of large daycares for the first year if possible.
• Breastfeed your baby. Breastfeed your baby for the first 6 to 12 months. Antibodies in breast milk reduce the rate of ear infections.
• Feed the baby with the bottle at a right angle. If you are bottle feeding, hold your baby at a right angle (head above the stomach). Feeding in a horizontal position can cause formula and other fluids to flow back into the eustachian tubes. Allowing a baby to hold his or her own bottle can also cause milk to leak into the middle ear. Weaning your baby from the bottle between 9 and 12 months will help stop this problem.
• Watch for mouth breathing or snoring. Constant snoring or mouth breathing may be caused by large adenoids. These can contribute to ear infections. Examination by an ear, nose and throat specialist and even adenoid surgery (adenoidectomy) may be required.
• get vaccinated. Make sure your child’s vaccinations are up to date, including the annual flu shot (flu shot) for those 6 months and older. Also ask your doctor about pneumococcal, meningitis, and other vaccines. Preventing viral infections and other infections helps prevent ear infections.

APPEARANCE / PROGNOSIS

What should I expect if I or my child has an ear infection?

Ear infections are common in children. Adults can take it too. Most ear infections are not serious. Your doctor will recommend over-the-counter medications to reduce pain and fever. Pain relief may begin several hours after taking the medication.

Your doctor may wait a few days before prescribing an antibiotic. Many infections go away on their own without the need for antibiotics. If you or your child takes an antibiotic, you should start to see improvement within two to three days.

If you or your child has ongoing or frequent infections, or if fluid remains in the middle ear and compromises hearing, ear tubes may be surgically placed in the eardrum to allow fluid to flow through the Eustachian tube as it normally should.

If you have any concerns or questions, never hesitate to contact your doctor.

LIVE TOGETHER

When should I return to my doctor for a follow-up visit?

Your doctor will let you know when you should return for a follow-up visit. At this visit, your or your child’s eardrum will be examined to make sure the infection is gone. Your doctor may also want to test you or your child’s hearing.

Follow-up examinations are very important, especially if the infection has caused a hole in the eardrum.

When should I call the doctor about an ear infection?

Call your doctor immediately if:

• You or your child develops a stiff neck.
• Your child is acting lethargic, looks or acts very sick, or doesn’t stop crying despite best efforts.
• Your child’s gait is not steady; He is very weak physically.
• Your or your child’s ear pain is severe.
• You or your child has a fever above 40° C (104° F).
• Your child’s face shows signs of weakness (look for a crooked smile).
• You see bloody or pus-filled fluid flowing from the ear.

Call your doctor during business hours if:

• Fever persists or returns 48 hours after starting antibiotics.
• Earache does not get better three days after taking antibiotics.
• Earache is severe.
• You have any questions or concerns.

Why do children get ear infections so much more than adults? Does my child always get ear infections?

Children are more likely than adults to get ear infections because of:

• In young children, the eustachian tubes are shorter and more horizontal. This shape encourages fluid to collect behind the eardrum.
• Children’s immune systems, which are among the body’s infection-fighting system, are still in the developing stage.
• Adenoids in children are relatively larger than in adults. Adenoids are small pads of tissue located above the throat, behind the nose, and near the Eustachian tubes. Because they swell to fight infection, they can block normal ear drainage from the Eustachian tube into the throat. This fluid blockage can lead to a middle ear infection.

Most children stop getting ear infections by age 8.

Do I need to cover my ears if I go out with an ear infection?

No, you don’t need to cover your ears when going out.

Can I swim if I have an ear infection?

There is no harm in swimming as long as there is no tear (perforation) in your eardrum or discharge from your ear.

Can I travel by plane or be at high altitudes if I have an ear infection?

Air travel or a trip to the mountains is safe, although temporary pain during takeoff and landing is possible when flying. Swallowing liquids, chewing gum during landing, or having the child suck on a pacifier will help relieve discomfort during air travel.

Are ear infections contagious?

No, ear infections are not contagious.

When can my child return to normal daily activities?

Children can return to school or nursery as soon as the fever subsides.

What are the other causes of earache?

Other causes of earache include:

• Sore throat.
• The baby’s teeth are coming out.
• Infection of the lining of the ear canal. This is also called “swimmer’s ear”.
• Pressure in the middle ear due to allergies and colds.

TREATMENT

How is an ear infection treated?

Treatment of ear infections depends on age, the severity of the infection, the nature of the infection (first-time infection, ongoing infection, or recurrent infection), and whether fluid remains in the middle ear for a long time.

Your doctor will recommend medications to relieve you or your child’s pain and fever. If the ear infection is mild, depending on the child’s age, your doctor may choose to wait a few days to see if the infection goes away on its own before prescribing an antibiotic.

Antibiotics

If bacteria is thought to be the cause of the ear infection, antibiotics may be prescribed. Your doctor may want to wait up to three days before prescribing antibiotics to see if a mild infection clears up on its own as the child grows. If you or your child’s ear infection is severe, antibiotics may be started right away.

If your doctor prescribes an antibiotic, take it exactly as directed. You or your child will begin to feel better within a few days of starting treatment. Even if you feel better and your pain is gone, do not stop taking the medicine until you are told to stop. The infection may come back if you don’t take all the medications. If the antibiotic prescribed for your child is liquid, be sure to use a measuring spoon designed for liquid medications to ensure you give the correct amount.

A hole or tear in your eardrum due to a severe infection or an ongoing infection (chronic suppurative otitis media) is treated with antibiotic ear drops and sometimes using a suction device to remove fluids. Your doctor will give you specific instructions on what to do.

Pain medications