Alternative Names acute ear infection, purulent otitis media
Definition Acute otitis media is a bacterial or viral infection, or inflammation of the middle ear.
What is going on in the body? The ear is divided into three parts: the outer ear, middle ear, and the inner ear. The eustachian tube connects the middle ear to the nasal cavity. The eustachian tube keeps equal ear pressure between the eardrum and the outside of the body. Any secretions formed in the middle ear flow into the nasal cavity through this tube. An ear infection almost always begins with swelling of the eustachian tube. Secretions in the middle ear cannot clear because of the swelling. Air pressure behind the eardrum is not equal to that outside. As a result, a vacuum is created.
A cold is often the cause of inflammation. The cold virus affects the sinus lining and nasal cavities as well as the lining of the eustachian tube and middle ear. When the swollen tube does open, bacteria enter the tube and the middle ear. Bacteria multiply, causing an acute infection.
Allergies can also cause eustachian tube swelling and ear infections. Individuals who have very small or poorly functioning tubes are at a higher risk for infections. This is why children and infants are more likely to develop ear infections. Children with head and face abnormalities often have eustachian tube problems. This includes children with Down syndrome and cleft palate. A cleft palate is a condition from birth where the roof of the mouth is not closed. In some individuals, the eustachian tubes fail to close. Bacteria in the nose can more easily travel to the middle ear, so these people are more prone to ear infections.
What are the signs and symptoms of the condition? The symptoms of otitis media vary depending upon the age of the child. Infants may:
become more restless
sleep more poorly
awaken frequently during the night
cry inconsolably
run a fever
tug or bat at the ear
In a child, symptoms of an ear infection can include:
fever
ear pain
loss of balance
drainage from the ear
intensely red eardrum
fluid behind the eardrum
If the infection is more severe, the eardrum may bulge out. There may be pus behind the eardrum. If the drum has ruptured, there is often clear or pus-like material in the ear canal.
What are the causes and risks of the condition? There are a variety of causes and risks of ear infections. Young children under the age of 3 to 4 are often affected. Young children are also more prone to colds. Those at greater risk for ear infections include:
What can be done to prevent the condition? If a child has abnormalities of the eustachian tube, there is often no way to prevent the disease. These children often need ventilation tubes placed through their eardrums to bypass the poorly functioning eustachian tube.
There are methods to help prevent infections:
Preventing colds is important. Avoiding other sick children and frequent hand washing can reduce the spread of cold viruses.
A child fed before bedtime or awaked at night for a feeding should be held with its head above the stomach. This prevents formula or juice from pooling around the eustachian tube openings. It is thought that when fluid sits around the opening of the eustachian tube, bacteria grow, resulting in ear infection.
Parents of children at risk of developing ear infections should not smoke. If parents cannot stop smoking, they should not smoke around children.
Children who have a history of frequent ear infections should get the influenza A vaccination and pneumonia vaccine.
Allergies should be treated promptly.
Children who get ear infections frequently with colds should:
take oral decongestants, such as pseudoephedrine.
avoid milk products while cold symptoms are present.
sleep with their heads elevated.
use salt-water rinses.
avoid using over-the-counter antihistamines, such as diphenhydramine or chlorpheniramine, for treating colds. These medications thicken secretions and increase the risk of infection in the pooled secretions.
Should ear infections continue in spite of preventive efforts, there are several different forms of medical or surgical approaches. If the ear infections are with colds, starting an antibiotic at the same time the cold starts can be helpful. Antibiotics do not treat the viral infection. They reduce the bacteria where the eustachian tubes drain.
Another option is a small dose of a preventive antibiotic. Preventive doses of antibiotics are usually given daily during the cold season. For those who worry about having their children on a daily dose of antibiotics or those children who have tried preventive antibiotics and still have recurrent ear infections, myringotomy with tube placement is an option. A myringotomy involves surgery to make a small opening in the eardrum to allow the fluid to drain. A small tube is inserted to keep the opening working. The tube eventually falls out, and the opening will then heal. Removal of adenoids in children over two years is also helpful.
How is the condition diagnosed? An acute infection is diagnosed by checking symptoms and a physical examination. Hearing may be reduced as a result of inflammation of the middle ear and/or fluid behind the eardrum.
What are the long-term effects of the condition? Fortunately, there are very few long-term effects if the infection is properly treated. In rare cases, an infection may cause damage to the nerve of the inner ear. This can result in deafness. A very small percentage of eardrum ruptures do not heal and need surgery. If an ear infection becomes complicated by meningitis or brain abscess, there can be neurologic problems.
What are the risks to others? There are no risks to others. The condition is not contagious.
What are the treatments for the condition? Up to 60% of cases of acute otitis heal without antibiotics. Antibiotics are usually used to reduce the symptoms, make the child more comfortable, and prevent serious complications. Amoxicillin is most commonly prescribed. If the child does not respond to the amoxicillin, the dose may be doubled or the antibiotic may be changed. If a child does not respond to antibiotics, a myringotomy may be performed.
What are the side effects of the treatments? Side effects depend on the antibiotic used. Antibiotics may cause stomach upset, diarrhoea and, in some cases, an allergic reaction.
What happens after treatment for the condition? If the infection has been properly treated, the fluid behind the eardrum usually goes away with time. As long as there is fluid present, there will be some hearing loss. Once the fluid goes away, hearing will return to normal. If the fluid lasts for more than 3 months, it will probably not go away. A myringotomy for tube placement is usually recommended at that time.
How is the condition monitored? The condition is mostly monitored by the child's symptoms. A return visit to the doctor should be made at the end of the antibiotic therapy, to be sure the infection has cleared up. The following symptoms require immediate medical attention:
ear drainage
facial weakness
dizziness
failure to respond to antibiotics
symptoms of meningitis, such as a stiff neck, severe vomiting, and worsening sleeplessness
Author: Mark Loury, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
