Middle Ear Infection
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Middle Ear Infection

(Acute Otitis; Ear Infection, Middle; Otitis Media)

En Español (Spanish Version)More InDepth Information on This Condition

Definition

With this condition, the middle ear becomes infected and inflamed. The middle ear is located behind the eardrum.

The Middle Ear

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Causes

This condition is caused by bacteria and viruses, such as:

  • Streptococcus pneumoniae (most common)
  • Haemophilus influenzae
  • Moraxella (Branhamella) catarrhalis
  • Streptococcus pyogenes (less common)

Risk Factors

These factors increase your chance of developing middle ear infection:

Tell your doctor if you have any of these risk factors.

Symptoms

Symptoms include:

  • Ear pain (babies may tug or rub at the ear or face)
  • Fever
  • Irritability
  • Hearing loss (may be only temporary, due to fluid accumulation)
  • Decreased appetite, difficulty feeding
  • Disturbed sleep
  • Drainage from ear
  • Difficulty with balance

Diagnosis

The doctor will ask about symptoms and medical history, and perform a physical exam. Most middle ear infections can be diagnosed by looking into the ear with a lighted instrument, called an otoscope.

The doctor will see if there is fluid or pus behind the eardrum. A small tube and bulb may be attached to the otoscope. This is to blow a light puff of air into the ear. The puff helps the doctor see if the eardrum is moving normally.

Other tests may include:

  • Tympanocentesis—used to drain fluid or pus from the middle ear using a needle, also used to check for bacteria
  • Tympanometry—measures pressure in the middle ear and responsiveness of the eardrum, also used to check for fluid or pus
  • Hearing test—may be done if you have had many ear infections

Treatment

Treatments include:

Medication

Antibiotics are commonly used to treat ear infections. Examples include:

  • Amoxicillin (Amoxil, Polymox)
  • Clavulanate (Augmentin)

Other medications sometimes used include:

  • Cephalosporins (cefprozil, cefdinir, cefpodoxime, ceftriaxone)
  • Sulfa drugs (Septra, Bactrim, Pediazole)

Since bacteria develop a resistance to antibiotics, doctors may take a "wait and see" approach. In some cases, your doctor may prescribe an antibiotic for your child and ask you to use the medication if the pain or fever lasts for a certain number of days. This approach has been effective.*

Some ear infections are caused by a virus. This type will not go away faster with antibiotics. Most middle ear infections (including bacterial ones) tend to improve on their own in 2-3 days.

Over-the-Counter Pain Relievers

Pain relievers can help reduce pain, fever, and irritability. These include:

  • Acetaminophen
  • Ibuprofen
  • Note: Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving a child aspirin.

Decongestants and antihistamines are not recommended to treat an ear infection.

Ear Drops

Ear drops may help decrease pain. If there is a chance that the eardrum has ruptured, do not use ear drops.

Myringotomy

Myringotomy is surgery done to open the eardrum. A tiny cut is made in the eardrum to drain fluid and pus.

Prevention

To reduce the chance of getting an ear infection:

  • Avoid exposure to smoke.
  • Breastfeed your baby for at least the first six months.
  • Try to avoid giving your baby a pacifier.
  • If you bottlefeed, keep your baby's head propped up as much as possible. Don't leave a bottle in the crib with your baby.
  • Get tested for allergies.
  • Treat related conditions, such as GERD.
  • Practice good handwashing.
  • Make sure your child has been vaccinated. The pneumococcal vaccine can reduce the risk of middle ear infections.
  • Consider getting a flu vaccine.
  • If your child has a history of ear infections, talk to the doctor about long-term antibiotic use. This is used in some cases.
  • Ask your doctor about tympanostomy tubes. These tubes help equalize pressure behind the eardrum.
  • Large adenoids can interfere with the eustachian tubes. Ask your child's doctor about having the adenoids removed.

RESOURCES:

American Academy of Otolaryngology, Head and Neck Surgery
http://www.entnet.org

National Institute on Deafness and Other Communication Disorders
http://www.nidcd.nih.gov

CANADIAN RESOURCES:

Caring for Kids
http://www.caringforkids.cps.ca/

Health Canada
http://www.hc-sc.gc.ca/index_e.html

References:

Acute otitis media. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated June 2008. Accessed July 28, 2008.

Behrmann R, Kliegman R, Jenson HB. Nelson Textbook of Pediatrics . 16th ed. Philadelphia, PA: WB Saunders; 2000.

Griffith HW. Griffith's 5-Minute Clinical Consult. Baltimore, MD: Williams & Wilkins; 1999.

Hurst DS, Amin K, Seveus L, Venge P. Evidence of mast cell activity in the middle ears of children with otitis media with effusion. Laryngoscope . 1999;109:471-477.

Otitis media (ear infection). National Institute on Deafness and Other Communication Disorders website. Available at: http://www.nidcd.nih.gov/. Published July 2003. Accessed July 29, 2008.

Phillips. Otitis media, milk allergy, and folk medicine. Pediatrics .1972;50:346.

*10/12/06 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Spiro DM, Tay KY, Arnold DH, Dziura JD, Baker MD, Shapiro ED. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA. 2006;296:1235-1241.

*9/23/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Coleman C, Moore M. Decongestants and antihistamines for acute otitis media in children. Cochrane Database of Systematic Reviews. 2008(3). CD001727. DOI: 10.1002/14651858.CD001727.pub4.



Last reviewed February 2008 by Elie Edmond Rebeiz, MD, FACS

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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