Otitis Media

Definition
Middle ear infections, also known as otitis media, are among the most common
illnesses of early childhood. Three out of four children have had at least one ear
infection by age 3, according to the National Institute on Deafness and Other
Communication Disorders.

Although ear infections worry parents and make children uncomfortable, most ear
infections clear up on their own within a few days. Most children stop having ear
infections by age 4 or 5.

Adults rarely get middle ear infections. The treatments for adult ear infections are
similar to those for children, although surgery is seldom necessary.

Symptoms
Ear infections in children can be hard to detect, especially if your child is too young to
say, "My ear hurts." Knowing what to look for can help. Children with ear infections
may:

 Complain of pain in their ears

 Tug or pull at their ears
 Cry more than usual
 Have trouble sleeping
 Fail to respond to sounds
 Be unusually irritable
 Develop a fever of 100 F (38 C) or higher
 Develop a clear fluid that drains from the ears
 Have headaches

Don't stick anything in your child's ears to check for an ear infection.

Adults who have a middle ear infection may have these symptoms:

 Earache
 Fever of 100 F (38 C) or higher
 A feeling of blockage in the ear
 Dizziness
 Temporary hearing loss

When to see a doctor

Ear infections aren't usually an emergency — but they can make you or your child
uncomfortable. If the signs and symptoms last longer than a day, call a doctor. In
children younger than age 2, watch for sleeplessness and irritability after an upper
respiratory infection, such as a cold.
If you see a discharge of blood or pus from the ear, call your family doctor or
pediatrician. This could mean your child has a ruptured eardrum. While this might
seem like an urgent emergency, the rupture of the eardrum may actually relieve your
child's pain, and you can usually safely see the doctor within a day or two for
treatment.

If your child has been diagnosed with an ear infection, call the doctor if your child's
signs and symptoms don't improve or they get worse after three days.

Causes

Ear infections usually start with a viral infection, such as a cold. The middle ear lining
becomes swollen from the viral infection, and fluid builds up behind the eardrum.

Ear infections can also be associated with blockage or swelling in the narrow
passageways that connect the middle ear to the nose (eustachian tubes). When fluid
gets trapped in the middle ear when the eustachian tubes become blocked during a
cold, it can cause ear pain and infection.

Because children's eustachian tubes are narrower and shorter than those of adults, they
are more likely to develop ear infections than do adults.

Another factor in ear infections is swelling of the adenoids. These are tissues located
in the upper throat near the eustachian tubes. Adenoids contain cells that normally
fight infection. But sometimes the adenoids themselves get infected or enlarged,
blocking the eustachian tubes. Infection in the adenoids can also spread to the
eustachian tubes.

In addition, children don't have fully developed immune systems. So it's easier for
them to develop many illnesses, including colds and ear infections.

Risk factors
Major risk factors for middle ear infections in children include:

 Age. Children between ages 6 and 18 months are the most susceptible to ear
infections, although ear infections are common from ages 4 months to 4 years.
 Group child care. Children cared for in group settings are more likely to get
colds and ear infections than are children who stay home, because they're
exposed to more viruses causing colds, which may then cause or complicate
an ear infection.
 Feeding position. Babies who drink from a bottle while lying down tend to
have more ear infections than do babies who are held upright during feedings.

Both children and adults are affected by these risk factors:

 Season. Ear infections are most common during the fall and winter.
Sometimes, seasonal allergies may also congest your sinuses, making you or
your child more likely to develop a middle ear infection.
 Reduced air quality. Children exposed to tobacco smoke or higher levels of
air pollution are at higher risk of ear infections.
 Family history. Your child's risk of ear infections increases if another
member of the family has had ear infections.
 Race. American Indians and Inuits from Alaska or Canada tend to have more
ear infections.

Complications
Many ear infections clear on their own after about three days with no complications.
However, long-lasting or recurrent ear infections can lead to:

 Short-term hearing loss. Fluid buildup can temporarily affect hearing. That's
because it's harder for the eardrum and the tiny bones in the middle ear to send
sound vibrations through fluid.
 Long-term hearing loss. Usually the fluid disappears on its own in a few
weeks. But sometimes it remains in the middle ear for months, which can
damage the eardrum and bones in the middle ear. Persistent middle ear fluid
was once thought to contribute to speech or developmental delays in children,
but researchers now say this isn't true.
 Ruptured eardrum. During ear infections, fluid and pus may press against
the eardrum. This can be painful. Rarely, the pressure ruptures the eardrum. If
this happens, you may see a discharge of pus and blood from the affected ear.
This can be alarming. But the rupture actually relieves the pain, and in most
cases the eardrum heals on its own. If the eardrum ruptures repeatedly and
doesn't heal, surgical repair may be needed.

Untreated ear infections can also lead to a type of sinus infection known as
mastoiditis, which affects a space in the bone of the skull that's behind your ear.
Rarely, infections can move from the ear to other parts of the head.

Preparing for your appointment

There are no special preparations for an appointment to diagnose a middle ear
infection. If you or your child has had ear infections in the past, be sure to tell the
doctor. Your doctor may try a new treatment if past treatments haven't worked.

Tests and diagnosis

The doctor will examine you or your child and ask some questions about the ear
infection. During the exam, the doctor will look for inflammation in the middle ear
with a lighted instrument known as an otoscope.

The doctor may also use an instrument called a pneumatic otoscope, which allows
him or her to gently puff air on the eardrum. Normally this causes the eardrum to
move. Any fluid in the middle ear will prevent that movement.

Sometimes additional, often pain-free tests for ear infections are recommended -
especially if you or your child has had fluid in the middle ear for some time:

 Tympanometry. This test measures eardrum movement. A soft plug is

inserted into the opening of the ear. The plug includes a device that changes
air pressure inside the ear.
 Acoustic reflectometry. During this test, the doctor uses a hand-held
instrument to project sounds of varying frequencies into the ear. How the
sounds are reflected off the insides of the ear can tell the doctor how much
fluid is inside the ear.

Based on the test results, you or your child may be diagnosed with:

 Acute otitis media (AOM). In AOM, parts of the ear are infected and
swollen, and fluid and mucus are trapped inside the ear.
 Otitis media with effusion (OME). Effusion refers to fluid. In OME, fluid
stays in the ear after the infection has cleared up. The presence of fluid
increases the risk of a new infection, and you or your child may need
additional treatments to clear the fluid from the ear.

Treatments and drugs

Many cases of ear infection don't need treatment such as antibiotics. What's best for
your child depends on many factors, including your child's age, medical history and
the type of ear infection.

A wait-and-see approach
Before prescribing antibiotics, most doctors will wait to see if the infection clears up
on its own. The American Academy of Pediatrics and the American Academy of
Family Physicians recommend a wait-and-see approach for the first 72 hours for
children who:

 Are older than age 6 months

 Are otherwise healthy
 Have mild signs and symptoms or an uncertain diagnosis
Most ear infections clear on their own in just a few days — and antibiotics won't help
an infection caused by a virus. In fact, about 80 percent of children with middle ear
infections recover without antibiotics. Adults' ear infections also may clear on their
own.

Your family doctor or pediatrician may recommend an over-the-counter pain reliever

such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to help
with the pain from the infection.

If your child doesn't have drainage from the ear or ear tubes, prescription eardrops
containing numbing medication may be an option, too. The drops won't cure the
infection, but they may relieve pain. Warm the drops slightly by placing the bottle
containing the drops in warm water. Then gently lay your child on a flat surface with
his or her infected ear facing up. Don't give the drops with your child in your arms or
on your lap.

Antibiotic therapy
Treatment with antibiotics is recommended for each of these groups of people:

 Children younger than 6 months old

 Children and adults who have had two or more ear infections in the past 30
days

Some doctors believe people who have otitis media with effusion (OME) should also
be given antibiotics. However, it's not universally agreed that antibiotics are necessary
or will work to prevent an ear infection for people with OME.

The first choice antibiotic of many doctors is amoxicillin, although other antibiotics
are effective if you or your child is allergic to amoxicillin.

If the medication is effective, you or your child should start feeling better in a few
days. Be sure to take the antibiotic for the full length of the prescription. Stopping
medication too soon could allow the infection to come back.

Remember, antibiotics won't help an infection caused by a virus — and the overuse of
antibiotics contributes to strains of the bacteria that resist these medications. Side
effects from the medications — such as vomiting, diarrhea and allergic reactions —
are possible as well.

Drainage tubes
If fluid in your child's ear is affecting his or her hearing or recurrent ear infections
don't respond to antibiotics, your child's doctor may suggest surgery. Surgery is not a
common treatment for adults.

The most common surgery for ear infections is a myringotomy and the insertion of
tubes in your child's ears. During this procedure, which requires general anesthesia, a
surgeon inserts a small drainage tube through your child's eardrum. This helps drain
the fluid and equalize the pressure between the middle ear and outer ear.
Your child's hearing should improve immediately. As your child grows, the tubes
normally will come out on their own and the drainage holes will heal — often within
a year. In the meantime, your child may need to wear special earplugs in the pool and
bathtub to keep water out of his or her ears.

Some children continue to have ear infections after surgery. Sometimes this leads to
another set of tubes. If the ear infections continue after age 4, the surgeon may
recommend removing your child's adenoids.

Lifestyle and home remedies

You can also get some relief from ear infections at home. You can try:

 Over-the-counter medications. If your child is uncomfortable, ask the doctor

about using an over-the-counter pain reliever such as acetaminophen (Tylenol,
others) or ibuprofen (Advil, Motrin, others). Use the correct dose for your
child's age and weight. Don't give aspirin to anyone younger than age 16, due
to the risk of Reye's syndrome — a rare but serious condition. Giving over-
the-counter cough or cold medications is also not recommended for children
age 2 and younger.
 A warm compress. It also may help to place a warm, moist cloth over the
affected ear.
 Distractions. When caring for your child, plan some low-key activities, such
as reading books aloud or playing board games. And don't underestimate the
benefits of some extra cuddling.
 Home monitoring. If your child has repeated middle ear infections, you might
consider getting a monitor, such as EarCheck, to check if your child has fluid
in his or her ears. To use these monitors, you place the probe of the monitor in
your child's outer ear canal. The monitor will make several chirping sounds
that will reflect off the membranes inside your child's ear. Based on the
reading, you can figure out if the fluid level in your child's ears is cause for a
visit to the doctor.

Prevention
You can reduce your child's risk of ear infections with a few simple steps.

 Keep your child away from sick children. If you can, limit the time your
child spends in group child care. A child care setting with fewer children may
help.
 Protect your child from secondhand smoke. Make sure that no one smokes
in your home. Away from home, stay in smoke-free environments.
 Breast-feed your baby for at least six months. Breast milk contains
antibodies that offer protection from ear infections.
 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.
 Ask your child's doctor about the pneumococcal vaccine (Prevnar).
Prevnar is intended to prevent serious, life-threatening infections, such as
 pneumonia and meningitis. Prevnar might reduce the risk of ear infections as
well.
 For adults, try over-the-counter decongestants or allergy medications. If
your sinuses are congested because of allergies or colds, talk to your doctor
about using allergy medications or over-the-counter decongestants to reduce
your risk of future ear infections.