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Middle Ear Infection

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

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

In most cases, middle ear infections are caused by viruses. In other cases, specific bacteria may be the cause.

Risk Factors

Middle ear infections are more common in infants and toddlers. They occur more often during the winter months. Other factors that may increase your chance of developing middle ear infection include:
  • Recent viral infection, such as a cold or the flu
  • Recent sinusitis
  • Attendance at day care
  • Exposure to second hand smoke, usually cigarette smoke, but also from cooking and wood-heating
  • Babies who are formula-fed
  • Medical conditions that cause abnormalities of the eustachian tubes, such as cleft palate or Down syndrome
  • History of allergies, such as environmental or food allergies
  • Gastroesophageal reflux disease (GERD)
  • Babies whose mothers drank alcohol while pregnant
  • Pacifier use

Symptoms

A middle ear infection may cause:
  • 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. A physical exam will be done. 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:
  • 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
  • Tympanocentesis—used to drain fluid or pus from the middle ear using a needle, also used to check for bacteria

Treatment

Medication

Some doctors may take a wait and see approach. In some cases, the doctor may prescribe an antibiotic (oral or ear drops) 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 in decreasing unnecessary antibiotic use. Since viruses cause most ear infections, antibiotics won't make the infection go away faster. Most middle ear infections, including those caused by bacteria, tend to improve on their own in 2-3 days.
Other medications may include:
  • Pain relievers
  • Fever reducers
  • Anesthetic ear drops
Note: Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving your child aspirin.
Decongestants and antihistamines are not recommended to treat ear infections.

Surgery

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

Prevention

To help reduce the chance of getting a middle ear infection:
  • Avoid exposure to smoke.
  • Breastfeed your baby for at least the first 6 months of life.
  • Try to avoid giving your baby a pacifier.
  • If you bottle-feed, 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 if you or your child have chronic nasal congestion. Keep allergy symptoms well controlled.
  • Treat related conditions, such as GERD.
  • Practice good hand washing hygiene.
  • Make sure your child's vaccinations are up to date.
  • Consider getting a flu vaccine . Pneumococcal vaccine may prevent some ear infections, but the overall effect on ear infections is not known. If your child has a history of ear infections, talk to the doctor about long-term antibiotic use.
  • Ask your doctor about tympanostomy tubes. These tubes help equalize pressure behind the eardrum and prevent fluid build-up and infection.

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

References

Acute otitis media (AOM). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 2, 2014. Accessed August 18, 2014.

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.

Ear infections in children. National Institute on Deafness and Other Communication Disorders website. Available at: hhttp://www.nidcd.nih.gov/health/hearing/pages/earinfections.aspx. Updated February 2013. Accessed August 18, 2014.

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

Side Effects. Antibiotics. Side Effects website. Available at: http://side-effects.org/antibiotics. Accessed August 18, 2014.

10/12/2006 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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 http://www.ebscohost.com/dynamed: 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.

6/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C. Topical analgesia for acute otitis media. Cochrane Database Syst Rev. 2009;(2):CD005657.

7/21/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Pavia M, Bianco A, Nobile CG, Marinelli P, Angelillo IF. Efficacy of pneumococcal vaccination in children younger than 24 months: a meta-analysis. Pediatrics. 2009;123:e1103-1110.

11/30/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Coker TR, Chan LS, Newberry SJ, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA. 2010;304(19):2161-2169.

12/16/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Azarpazhooh A, Limeback H, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev. 2011;11:CD007095.

3/18/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed : van Dongen TM, van der Heijden GJ, Venekamp RP, Rovers MM, Schilder AG. A trial of treatment for acute otorrhea in children with tympanostomy tubes. N Engl J Med. 2014;370(8):723-33

3/31/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Vernacchio L, Corwin MJ, et al. Xylitol syrup for the prevention of acute otitis media. Pediatrics. 2014 Feb;133(2):289-295.

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