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Middle Ear Infection

more about Middle Ear Infection

Serous otitis media, otitis media

  • The part of the ear that we can see is called the outer ear.  It is connected to an external canal, which is then separated from the structures of the middle ear by a thin drum-like membrane called the eardrum (tympanic membrane).  The middle ear is filled with air and is connected to the back of the nose by a tube-like canal called the eustachian tube.  The other parts beyond the middle ear are the inner ear (cochlea, semicircular canal) and the auditory nerves (carries messages to the brain).
  • Otitis Media refers to an infection of the middle ear that normally follows Flu or a cold.  Otitis Media (OM) can affect people at any age, but it is more common in children under the age of 7.
  • Most infants and toddlers will have between four to six ear infections during the first few years of life.

  • 20-40% of the cases of bacterial infections may have little or no symptoms.
  • In infants, there is irritability, poor feeding, or loss of appetite.  These may be the only symptoms for the first few months of life.
  • In cases without bacterial infection, there may be a mild decrease in hearing or a feeling of heaviness in the ear.
  • In most cases of acute OM there is:
    1. Flu, cold, sinus, throat, allergies, and earaches.
    2. The bone behind the ear (mastoid bone) may hurt if it is pressed.
    3. Decreased hearing
    4. Fever may or may not be present.
    5. If the eardrum is punctured, Fluid may leak out (otorrhea)
    6. Hearing loss and spread of the infection to other sites (brain, facial nerves and mastoid bone) can occur.

  • Conditions such as a Common Cold (caused by a virus), sinuses, throat infections, allergies to tree pollen, mold spores, and mites can irritate the eustachian (E) tube and weaken its normal defenses.
  • Once the defenses of the eustachian tube are compromised, it is prone to invasion by bacteria, which then climb up to the air-filled middle ear chamber and cause an infection.  This results in fluid build up, earaches, and other symptoms.
  • Bacteria responsible for Otitis Media are:
    1. Pneumococcus (30-35%)
    2. Haemophilus influenza (20-25%)
    3. Moraxella catarrhalis (10-15%)
    4. Group A Streptococcus and Staphylococcus species (1-3%)
    5. Up to 30% of cases of OM occur without any bacterial infection.

  • Medical history and a physical examination is the first step.
  • There may be facial pain (over the sinuses), nasal (nose) congestion, sore, red throat if allergies exist, or a sinus infection may be present.
  • There may be enlarged lymph glands (pea size nodes) in the neck
  • The mastoid bone may hurt if doctor presses on it.
  • The doctor will use a special light (otoscope) to look into the ear canal, where he will see the ear drum bulging out (fluid behind it), moving poorly, or have a tear and the middle ear where fluid is leaking into the external canal.
  • The fluid that may have leaked out can be collected by a sterile cotton swab, and sent to the laboratory so they can identify the cause and type of the bacterium (takes 24-48 hours).
  • Hearing can be tested by a specialist called an audiologist.
  • In difficult cases, tympanometry may be used to support a diagnosis.  Tympanometry uses air to examine the ability of the eardrum to move.  Abnormal results may indicate a collection of pus andfluid behind the eardrum, in the middle ear.

  • Males more than females
  • Ear injury or previous ear surgery
  • Structural abnormalities of the ear or an abnormal E-tube present at birth
  • Previous history of OM
  • Family history of OM, especially in a sibling
  • Second-hand tobacco smoke
  • Day care
  • Allergies
  • Sinus infections
  • Throat infections
  • Formula feeding

  • Usually treated on an outpatient basis except for infants under 2 years of age with high fever.
  • If not too sick, use Auralgan drops (eases the pain) and Tylenol (pain and fever) by mouth, and observe closely for the first 2-3 days.
  • If symptoms persist for more than 48-72 hours, or the patient is sick, consider antibiotics.
  • Antibiotics such as Amoxicillin are given by mouth for up to 10 days (or until the bacterium is identified).
  • If there are 3 or more OM's in 6 months, or 4 or more in one year, then antibiotics may be needed for up to 6 months.
  • In cases where there is persistent fluid (Effusion) in the middle ear without bacteria (consider Allergy), antibiotics do not help, and Antihistamines (Claritin) or decongestants such as entex can be tried.
  • In allergic OM, where medications do not help, one may consider consulting with an allergy doctor.
  • In cases where middle ear effusion is present for more than 4 months in both ears, or more than 6 months in one ear, or, if hearing is affected (greater than 25 decibel loss), surgery may need to be done.
  • Recurrent bacterial OM (more than 2-3) while on antibiotics may also benefit from surgery.
  • An ENT (ears, nose, throat) doctor will perform all necessary surgeries.
  • Surgeries include drainage of the middle ear fluid via a tiny tube (tympanostomy tube).
  • The tube may be placed for days, weeks, months, or in some cases, permanently.
  • A good diet that is full of vegetables, fruits, fish, and low in animal products (beef, pork, etc.) and fats may help to prevent future infections.
  • Try breast-feeding your baby
  • Stop smoking, especially around your children and animals.
  • Children with PE tubes (see below) can also be treated with antibiotic eardrops, at times.

  • If untreated, the pressure in the ear becomes so high that the eardrum often bursts, and the fluid in the middle ear drains out through the hole created.  These holes usually close on their own without further complications.
  • Multiple ear infections, and infections that do not completely resolve, can result in damage to the middle ear and impair hearing.  This also affects speech development, because children have difficulty hearing how others talk.
  • In rare cases, an untreated infection can spread to the bones of the skull, sinuses, or the brain.

  • Contact your pediatrician and have your child see him/her as soon as possible.

  • A new vaccine called "Prevnar" helps prevent some recurrent ear infections, but it does not prevent all ear infections.
  • In children with a history of multiple ear infections, other therapies may be indicated.
    1. Some children may respond to long-term (6 months) use of low-dose of antibiotics to decrease likelihood of future infections.
    2. Others may benefit from a consultation with an Ear, Nose, and Throat specialist (ENT, or otolaryngologist).  These surgeons may place tubes in the eardrums to prevent future infections.

      • The tubes are called "pressure equalization tubes," or "PE Tubes."
      • These prevent the buildup of Fluid in the middle ear that allows an infection to develop.
      • PE tubes can remain in the eardrum for several years, although most fall out in 6 to 12 months.  The hole in which the tube is placed should close by itself without any problems, alter the tube falls out

  • Jaw or tooth pain can radiate to the ear
  • TMJ is the joint next to the ear that helps us with chewing
  • Arthritis and other diseases can affect it and cause pain near the ear.

more about Middle Ear Infection

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