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Ear anatomy
Ear anatomy


Middle ear infection (otitis media)
Middle ear infection (otitis media)


Eustachian tube
Eustachian tube


Mastoiditis - side view of head
Mastoiditis - side view of head


Mastoiditis - redness and swelling behind ear
Mastoiditis - redness and swelling behind ear


Ear tube insertion  - series
Ear tube insertion - series


Definition:

Ear infections are one of the most common reasons parents take their children to the doctor. While there are different types of ear infections, the most common is called otitis media, which means an inflammation and infection of the middle ear. The middle ear is located just behind the eardrum.

The term "acute" refers to a short and painful episode. An ear infection that lasts a long time or comes and goes is called chronic otitis media .

For links to other types of ear infections, see otitis.



Alternative Names:

Otitis media - acute; Infection - inner ear; Middle ear infection - acute



Causes, incidence, and risk factors:

For each ear, a eustachian tube runs from the middle ear to the back of the throat. This tube drains fluid that is normally made in the middle ear. If the eustachian tube becomes blocked, fluid can build up. When this happens, germs such as bacteria and viruses can multiply and cause an infection.

Ear infections are common in infants and children, in part because the eustachian tubes become easily clogged. Anything that causes the eustachian tubes to become swollen or blocked causes more fluids to build up in the middle ear behind the eardrum. These causes include:

  • Colds and sinus infections
  • Allergies
  • Tobacco smoke or other irritants
  • Infected or overgrown adenoids
  • Excess mucus and saliva produced during teething

Ear infections are also more likely if a child spends a lot of time drinking from a sippy cup or bottle while lying on his or her back. Contrary to popular opinion, getting water in the ears will not cause an acute ear infection, unless the eardrum has a hole from a previous episode.

Ear infections occur most often in the winter. You cannot catch an ear infection from someone else, but a cold may spread among children and cause some of them to get ear infections.

Risk factors for ear infections include the following:

  • Not being breastfed
  • Recent ear infection
  • Recent illness of any type (lowers resistance of the body to infection)
  • Day care (especially with more than 6 children)
  • Pacifier use
  • Genetic factors (susceptibility to infection may run in families)
  • Changes in altitude or climate
  • Cold climate

Adults can also have ear infections, although they are less common than in children.



Symptoms:

In infants, the clearest sign is often irritability and inconsolable crying. Many infants and children develop a fever or have trouble sleeping. Parents often think that tugging on the ear is a symptom of an ear infection, but studies have shown that the same number of children going to the doctor tug on the ear whether or not the ear is infected.

Symptoms in older children or adults include:

The child may have symptoms of a cold, or the ear infection may start shortly after having a cold.

All acute ear infections include fluid behind the eardrum. You can use an electronic ear monitor, such as EarCheck, to detect this fluid at home. The device is available at pharmacies, but you still need to see your doctor to confirm any possible ear infection.



Signs and tests:

The doctor will ask questions about whether your child (or you) have had ear infections in the past and will want you to describe the current symptoms, including whether your child has had any symptoms of a cold or allergies recently. Your doctor will examine your child's throat, sinuses, head, neck, and lungs.

Using an instrument called an otoscope, the doctor will look inside your child's ears. If infected, there may be areas of dullness or redness or there may be air bubbles or fluid behind the eardrum. The fluid may be bloody or purulent (filled with pus). The physician will also check for any sign of perforation (hole or holes) in the eardrum.

A hearing test may be recommended if your child has had persistent (chronic and recurrent) ear infections.



Treatment:

Some ear infections will safely clear up on their own without antibiotics. Often, treating the pain and allowing the body time to heal itself is all that is needed:

  • Apply a warm cloth or warm water bottle.
  • Use over-the-counter pain relief drops for ears.
  • Take over-the-counter medications for pain or fever, like ibuprofen or acetaminophen. Do NOT give aspirin to children.
  • Ask the doctor about ear drops to relieve pain.

All children younger than 6 months with a fever or symptoms should see the doctor. Children who are older than 6 months may be watched at home if they do not have:

  • A fever higher than 102 °F
  • More severe pain or other symptoms
  • Other medical problems

If there is no improvement or symptoms get worse, schedule an appointment with your health care provider to determine whether antibiotics are needed.

ANTIBIOTICS

A virus or bacteria can cause ear infections. Antibiotics will not not help an infection caused by a virus. Many doctors no longer prescribe antibiotics for every ear infection.

Your doctor is more likely to prescribe antibiotics if your child is under age 2, has a fever, is acting sick (beyond just the ear), or is not improving over 24 to 48 hours. All children younger than 6 months with an ear infection are treated with antibiotics.

Make sure you or your child takes the antibiotics every day and finishes all the medicine, rather than stopping when symptoms go away. If the antibiotics do not seem to be working within 48 to 72 hours, contact your doctor. You may need to switch to a different antibiotic.

Amoxicillin is commonly the first choice. Other antibiotics that may be given are azithromycin or clarithromycin, cefdinir, cefuroxime, cefpodoxime, amoxicillin clavulanate (Augmentin), clindamycin, or ceftriaxone.

Side effects of antibiotics include nausea, vomiting, and diarrhea. Although rare, serious allergic reactions may also occur.

Some children who have repeat infections that seem to go away in between may receive a smaller, daily dose of antibiotics to prevent new infections.

SURGERY

If an infection does not go away with the usual medical treatment, or if a child has many ear infections over a short period of time, the doctor may recommend ear tubes .

  • In this procedure, a tiny tube is inserted into the eardrum, keeping open a small hole that allows air to get in so fluids can drain more easily down the eustachian tube. Tympanostomy tube insertion is done under general anesthesia .
  • Usually the tubes fall out by themselves. Those that don't fall out may be removed in your doctor's office.

If the adenoids are enlarged, surgical removal of the adenoids may be considered, especially if you continue to have ear infections. Removing tonsils does not seem to help with ear infections.



Support Groups:



Expectations (prognosis):

Ear infections are curable with treatment but may recur. They are not life threatening but may be quite painful.



Complications:

Generally, an ear infection is a simple, nonserious condition without complications. Most children will have minor, temporary hearing loss during and right after an ear infection. This is due to fluid lingering in the ear.

Fluid can remain behind the eardrums even after the infection has cleared.

See also: Otitis media with effusion

Other potential complications from otitis media include:



Calling your health care provider:

Call your child's doctor if:

  • Pain, fever, or irritability do not improve within 24 to 48 hours
  • At the start, the child seems sicker than just an ear infection
  • Your child has a high fever or severe pain
  • Severe pain suddenly stops hurting -- this may indicate a ruptured eardrum
  • Symptoms worsen
  • New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles

For a child younger than 6 months, let the doctor know right away if the child has a fever, even if no other symptoms are present.



Prevention:

You can reduce your child's risk of ear infections with the following practices:

  • Wash hands and toys frequently. Also, day care with 6 or fewer children can lessen your child's chances of getting a cold or similar infection. This leads to fewer ear infections.
  • Avoid pacifiers, especially at day care.
  • Breastfeed -- this makes a child much less prone to ear infections. But, if bottle feeding, hold your infant in an upright, seated position.
  • Don't expose your child to secondhand smoke.
  • The pneumococcal vaccine prevents infections from the organism that most commonly causes acute ear infections and many respiratory infections.
  • Some evidence suggests that xylitol, a natural sweetener, may reduce ear infections.
  • Avoid overusing antibiotics.


References:

American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004;113(5):1451-1465.

Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Rockette HE, Pitcairn DL, et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med. 2007;356:248-261.

Ramakrishnan K, Sparks RA, Berryhill WE. Diagnosis and treatment of otitis media. Am Fam Physician. 2007;76:1650-1656.

Koopman L, Hoes AW, Glasziou PP, Cees L, Appelman L, Burke P, et al. Antibiotic therapy to prevent the development of asymptomatic middle ear effusion in children with acute otitis media: a meta-analysis of individual patient data. Arch Otolaryngol Head Neck Surg. 2008;134:128-132.




Review Date: 6/2/2009
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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