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Middle ear infection
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- 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.
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- 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:
- Flu, cold, sinus, throat, allergies, and earaches.
- The bone behind the ear (mastoid bone) may hurt if it is pressed.
- Decreased hearing
- Fever may or may not be present.
- If the eardrum is punctured, Fluid may leak out (otorrhea)
- Hearing loss and spread of the infection to other sites (brain, facial nerves and mastoid bone) can occur.
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- 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:
- Pneumococcus
(30-35%)
- Haemophilus influenza
(20-25%)
- Moraxella catarrhalis (10-15%)
- Group A
Streptococcus and Staphylococcus species (1-3%)
- Up to
30% of cases of OM occur without any bacterial
infection.
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- 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 and fluid behind the eardrum,
in the middle ear.
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- 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
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- 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.
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- 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.
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Contact your pediatrician and have your child see him/her as soon as possible.
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- 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.
- Some children may respond to long-term (6 months) use
of low-dose of antibiotics to decrease likelihood of
future infections.
- 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
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- 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.
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