An overview of Ear Infection

An ear infection (sometimes called acute otitis media) is an infection of the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. Children are more likely than adults to get ear infections.

In an ear infection, narrow tubes that run from the middle ear to high in the back of the throat (eustachian tubes) can become swollen and blocked. This can lead to mucus build-up in the middle ear. This mucus can become infected and cause ear infection symptoms.

Because ear infections often clear up on their own, treatment may begin with managing pain and monitoring the problem. Sometimes, antibiotics are used to clear the infection. Some people are prone to having multiple ear infections. This can cause hearing problems and other serious complications.

Risk factors for ear infections include:

1. Age. Children between the ages of 6 months and 2 years are more susceptible to ear infections because of the size and shape of their eustachian tubes and because their immune systems are still developing.

2. Group child care. Children cared for in group settings are more likely to get colds and ear infections than are children who stay home. The children in group settings are exposed to more infections, such as the common cold.

3. Infant feeding. Babies who drink from a bottle, especially while lying down, tend to have more ear infections than do babies who are breast-fed.

4. Seasonal factors. Ear infections are most common during the fall and winter. People with seasonal allergies may have a greater risk of ear infections when pollen counts are high.

5. Poor air quality. Exposure to tobacco smoke or high levels of air pollution can increase the risk of ear infections.

6. Alaska Native heritage. Ear infections are more common among Alaska Natives.

7. Cleft palate. Differences in the bone structure and muscles in children who have cleft palates may make it more difficult for the eustachian tube to drain.

In many cases, doctors don’t know the cause of amblyopia. But sometimes, a different vision problem can lead to amblyopia.

Normally, the brain uses nerve signals from both eyes to see. But if an eye condition makes vision in 1 eye worse, the brain may try to work around it. It starts to “turn off” signals from the weaker eye and rely only on the stronger eye.

Some eye conditions that can lead to amblyopia are:

1. Refractive errors. These include common vision problems like nearsightedness (having trouble seeing far away), farsightedness (having trouble seeing things up close), and astigmatism (which can cause blurry vision). Normally, these problems are easy to fix with glasses or contacts. But if they’re not treated, the brain may start to rely more on the eye with stronger vision.

2. Strabismus. Usually, the eyes move together as a pair. But in kids with strabismus, the eyes don’t line up. One eye might drift in, out, up, or down.

3. Cataract. This causes cloudiness in the lens of the eye, making things look blurry. While most cataracts happen in older people, babies and children can also develop cataracts.

The onset of signs and symptoms of ear infection is usually rapid.

Signs and symptoms common in children include:

1. Ear pain, especially when lying down

2. Tugging or pulling at an ear

3. Trouble sleeping

4. Crying more than usual

5. Fussiness

6. Trouble hearing or responding to sounds

7. Loss of balance

8. Fever of 100 F (38 C) or higher

9. Drainage of fluid from the ear

10. Headache

11. Loss of appetite

Common signs and symptoms in adults include:

1. Ear pain

2. Drainage of fluid from the ear

3. Trouble hearing

Signs and symptoms of an ear infection can indicate several conditions. It's important to get an accurate diagnosis and prompt treatment. Call your child's doctor if:

1. Symptoms last for more than a day

2. Symptoms are present in a child less than 6 months of age

3. Ear pain is severe

4. Your infant or toddler is sleepless or irritable after a cold or other upper respiratory infection

5. You observe a discharge of fluid, pus or bloody fluid from the ear

The following tips may reduce the risk of developing ear infections:

1. Prevent common colds and other illnesses. Teach your children to wash their hands frequently and thoroughly and to not share eating and drinking utensils. Teach your children to cough or sneeze into their elbow. If possible, limit the time your child spends in group child care. A child care setting with fewer children may help. Try to keep your child home from child care or school when ill.

2. Avoid secondhand smoke. Make sure that no one smokes in your home. Away from home, stay in smoke-free environments.

3. Breast-feed your baby. If possible, breast-feed your baby for at least six months. Breast milk contains antibodies that may offer protection from ear infections.

4. If you bottle-feed, hold your baby in an upright position. Avoid propping a bottle in your baby's mouth while he or she is lying down. Don't put bottles in the crib with your baby.

5. Talk to your doctor about vaccinations. Ask your doctor about what vaccinations are appropriate for your child. Seasonal flu shots, pneumococcal and other bacterial vaccines may help prevent ear infections.

Your doctor can usually diagnose an ear infection or another condition based on the symptoms you describe and an exam. The doctor will likely use a lighted instrument (an otoscope) to look at the ears, throat and nasal passage. He or she will also likely listen to your child breathe with a stethoscope.

Pneumatic otoscope

An instrument called a pneumatic otoscope is often the only specialized tool a doctor needs to diagnose an ear infection. This instrument enables the doctor to look in the ear and judge whether there is fluid behind the eardrum. With the pneumatic otoscope, the doctor gently puffs air against the eardrum. Normally, this puff of air would cause the eardrum to move. If the middle ear is filled with fluid, your doctor will observe little to no movement of the eardrum.

Additional tests

Your doctor may perform other tests if there is any doubt about a diagnosis, if the condition hasn't responded to previous treatments, or if there are other long-term or serious problems.

1. Tympanometry. This test measures the movement of the eardrum. The device, which seals off the ear canal, adjusts air pressure in the canal, which causes the eardrum to move. The device measures how well the eardrum moves and provides an indirect measure of pressure within the middle ear.

2. Acoustic reflectometry. This test measures how much sound is reflected back from the eardrum — an indirect measure of fluids in the middle ear. Normally, the eardrum absorbs most of the sound. However, the more pressure there is from fluid in the middle ear, the more sound the eardrum will reflect.

3. Tympanocentesis. Rarely, a doctor may use a tiny tube that pierces the eardrum to drain fluid from the middle ear — a procedure called tympanocentesis. The fluid is tested for viruses and bacteria. This can be helpful if an infection hasn't responded well to previous treatments.

4. Other tests. If your child has had multiple ear infections or fluid buildup in the middle ear, your doctor may refer you to a hearing specialist (audiologist), speech therapist or developmental therapist for tests of hearing, speech skills, language comprehension or developmental abilities.

What a diagnosis means

1. Acute otitis media. The diagnosis of "ear infection" is generally shorthand for acute otitis media. Your doctor likely makes this diagnosis if he or she sees signs of fluid in the middle ear, if there are signs or symptoms of an infection, and if symptoms started relatively suddenly.

2. Otitis media with effusion. If the diagnosis is otitis media with effusion, the doctor has found evidence of fluid in the middle ear, but there are presently no signs or symptoms of infection.

3. Chronic suppurative otitis media. If the doctor makes a diagnosis of chronic suppurative otitis media, he or she has found that a long-term ear infection resulted in tearing of the eardrum. This is usually associated with pus draining from the ear.

Some ear infections resolve without antibiotic treatment. What's best for your child depends on many factors, including your child's age and the severity of symptoms.

A wait-and-see approach

Symptoms of ear infections usually improve within the first couple of days, and most infections clear up on their own within one to two weeks without any treatment. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach as one option for:

1. Children 6 to 23 months with mild middle ear pain in one ear for less than 48 hours and a temperature less than 102.2 F (39 C)

2. Children 24 months and older with mild middle ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C)

Some evidence suggests that treatment with antibiotics might be helpful for certain children with ear infections. On the other hand, using antibiotics too often can cause bacteria to become resistant to the medicine. Talk with your doctor about the potential benefits and risks of using antibiotics.

Managing pain

Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following:

1. Pain medication. Your doctor may advise the use of over-the-counter acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) to relieve pain. Use the drugs as directed on the label. Use caution when giving aspirin to children or teenagers. Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin because aspirin has been linked with Reye's syndrome. Talk to your doctor if you have concerns.

2. Anesthetic drops. These may be used to relieve pain if the eardrum doesn't have a hole or tear in it.

Antibiotic therapy

After an initial observation period, your doctor may recommend antibiotic treatment for an ear infection in the following situations:

1. Children 6 months and older with moderate to severe ear pain in one or both ears for at least 48 hours or a temperature of 102.2 F (39 C) or higher

2. Children 6 to 23 months with mild middle ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C)

3. Children 24 months and older with mild middle ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C)

Children younger than 6 months of age with confirmed acute otitis media are more likely to be treated with antibiotics without the initial observational waiting time.

Even after symptoms have improved, be sure to use the antibiotic as directed. Failing to take all the medicine can lead to recurring infection and resistance of bacteria to antibiotic medications. Talk with your doctor or pharmacist about what to do if you accidentally miss a dose.

Ear tubes

If your child has certain conditions, your child's doctor may recommend a procedure to drain fluid from the middle ear. If your child has repeated, long-term ear infections (chronic otitis media) or continuous fluid buildup in the ear after an infection cleared up (otitis media with effusion), your child's doctor may suggest this procedure.

During an outpatient surgical procedure called a myringotomy, a surgeon creates a tiny hole in the eardrum that enables him or her to suction fluids out of the middle ear. A tiny tube (tympanostomy tube) is placed in the opening to help ventilate the middle ear and prevent the buildup of more fluids. Some tubes are intended to stay in place for four to 18 months and then fall out on their own. Other tubes are designed to stay in longer and may need to be surgically removed.

The eardrum usually closes up again after the tube falls out or is removed.

Tympanostomy tubes

Ear tubes (tympanostomy tubes, ventilation tubes, pressure equalization tubes) are tiny cylinders, usually made of plastic or metal, that are surgically inserted into the eardrum. An ear tube creates an airway that ventilates the middle ear and prevents the accumulation of fluids behind the eardrum.

Treatment for chronic suppurative otitis media

Chronic infection that results in a hole or tear in the eardrum — called chronic suppurative otitis media — is difficult to treat. It's often treated with antibiotics administered as drops. You may receive instructions on how to suction fluids out through the ear canal before administering drops.

Monitoring

Children who have frequent infections or who have persistent fluid in the middle ear will need to be monitored closely. Talk to your doctor about how often you should schedule follow-up appointments. Your doctor may recommend regular hearing and language tests.

Most ear infections don't cause long-term complications. Ear infections that happen again and again can lead to serious complications:

1. Impaired hearing. Mild hearing loss that comes and goes is fairly common with an ear infection, but it usually gets better after the infection clears. Ear infections that happen again and again, or fluid in the middle ear, may lead to more-significant hearing loss. If there is some permanent damage to the eardrum or other middle ear structures, permanent hearing loss may occur.

2. Speech or developmental delays. If hearing is temporarily or permanently impaired in infants and toddlers, they may experience delays in speech, social and developmental skills.

3. Spread of infection. Untreated infections or infections that don't respond well to treatment can spread to nearby tissues. Infection of the mastoid, the bony protrusion behind the ear, is called mastoiditis. This infection can result in damage to the bone and the formation of pus-filled cysts. Rarely, serious middle ear infections spread to other tissues in the skull, including the brain or the membranes surrounding the brain (meningitis).

4. Tearing of the eardrum. Most eardrum tears heal within 72 hours. In some cases, surgical repair is needed.