Ear infection (middle ear)

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.

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.

An ear infection is caused by a bacterium or virus in the middle ear. This infection often results from another illness — cold, flu or allergy — that causes congestion and swelling of the nasal passages, throat, and eustachian tubes.

Role of eustachian tubes

The eustachian tubes are a pair of narrow tubes that run from each middle ear to high in the back of the throat, behind the nasal passages. The throat end of the tubes open and close to:

  • Regulate air pressure in the middle ear
  • Refresh air in the ear
  • Drain normal secretions from the middle ear

Swollen eustachian tubes can become blocked, causing fluids to build up in the middle ear. This fluid can become infected and cause the symptoms of an ear infection.

In children, the eustachian tubes are narrower and more horizontal, which makes them more difficult to drain and more likely to get clogged.

Role of adenoids

Adenoids are two small pads of tissues high in the back of the nose believed to play a role in immune system activity. Because adenoids are near the opening of the eustachian tubes, swelling of the adenoids may block the tubes. This can lead to a middle ear infection. Swelling and irritation of adenoids are more likely to play a role in ear infections in children because children have relatively larger adenoids compared to adults.

Symptoms

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

Children

Signs and symptoms common in children include:

  • Ear pain, especially when lying down
  • Tugging or pulling at an ear
  • Trouble sleeping
  • Crying more than usual
  • Fussiness
  • Trouble hearing or responding to sounds
  • Loss of balance
  • Fever of 100 F (38 C) or higher
  • Drainage of fluid from the ear
  • Headache
  • Loss of appetite

Adults

Common signs and symptoms in adults include:

  • Ear pain
  • Drainage of fluid from the ear
  • Trouble hearing

When to see a doctor

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

  • Symptoms last for more than a day
  • Symptoms are present in a child less than 6 months of age
  • Ear pain is severe
  • Your infant or toddler is sleepless or irritable after a cold or other upper respiratory infection
  • You observe a discharge of fluid, pus or bloody fluid from the ear

Treatment

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:

  • 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)
  • 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.

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