|Middle ear infection|
- 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 the flu or a cold. OM can affect people at any age, but it is more common in children under the age of 7.
- 20-40% of the cases of bacterial infections may have fewer or no symptoms.
- In infants, irritability, poor feeding, or loss of appetite may be the only symptoms for the first few months.
- 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
- Conditions such as a Common Cold (caused
by a virus), sinusitis, 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 OM
- Pneumococci (30-35%)
- Haemophilus Influenza (20-25%)
- Moraxella catarrhalis (10-15%)
- Group A streptococci and
Staphylococcus species (1-3%)
- Up to 30% of cases of OM occur without any bacterial infections
- 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 in the eardrum. A tear on the eardrum may
let fluid leak from the middle ear, through the tear, with
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
bacteria (takes 24-48 hours).
- Hearing can be tested by a specialist called an audiologist.
- Males more than females
- Ear trauma or previous ear surgery
- Structural abnormalities of the ear
or an E-tube present at birth
- Previous history of OM
- Family history of OM, especially in
- Second hand tobacco smoke
- Day care
- Sinus infections
- Throat infections
- Usually treated on an outpatient
basis except for infants under 2 years of age with high
- 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
- 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
- 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 a 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 (ear, 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
your physician and see him/her as soon as
- 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
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