Ear Infections - A Primer

by Mayo Clinic staff

Middle ear infections, also known as otitis media, are among the most common illnesses of early childhood. Three out of four children have had at least one ear infection by age 3, according to the National Institute on Deafness and Other Communication Disorders.

Although ear infections worry parents and make children uncomfortable, most ear infections clear up on their own within a few days. Most children stop having ear infections by age 4 or 5.

Adults rarely get middle ear infections. The treatments for adult ear infections are similar to those for children, although surgery is seldom necessary.

Symptoms
By Mayo Clinic staff

Ear infections in children can be hard to detect, especially if your child is too young to say, "My ear hurts." Knowing what to look for can help. Children with ear infections may:

* Complain of pain in their ears
* Tug or pull at their ears
* Cry more than usual
* Have trouble sleeping
* Fail to respond to sounds
* Be unusually irritable
* Develop a fever of 100 F (38 C) or higher
* Develop a clear fluid that drains from the ears
* Have headaches

Don't stick anything in your child's ears to check for an ear infection.

Adults who have a middle ear infection may have these symptoms:

* Earache
* Fever of 100 F (38 C) or higher
* A feeling of blockage in the ear
* Dizziness
* Temporary hearing loss

When to see a doctor
Ear infections aren't usually an emergency — but they can make you or your child uncomfortable. If the signs and symptoms last longer than a day, call a doctor. In children younger than age 2, watch for sleeplessness and irritability after an upper respiratory infection, such as a cold.

If you see a discharge of blood or pus from the ear, call your family doctor or pediatrician. This could mean your child has a ruptured eardrum. While this might seem like an urgent emergency, the rupture of the eardrum may actually relieve your child's pain, and you can usually safely see the doctor within a day or two for treatment.

If your child has been diagnosed with an ear infection, call the doctor if your child's signs and symptoms don't improve or they get worse after three days.

Causes
By Mayo Clinic staff
CLICK TO ENLARGE
Illustration of middle ear Middle ear

Ear infections usually start with a viral infection, such as a cold. The middle ear lining becomes swollen from the viral infection, and fluid builds up behind the eardrum.

Ear infections can also be associated with blockage or swelling in the narrow passageways that connect the middle ear to the nose (eustachian tubes). When fluid gets trapped in the middle ear when the eustachian tubes become blocked during a cold, it can cause ear pain and infection.

Because children's eustachian tubes are narrower and shorter than those of adults, they are more likely to develop ear infections than do adults.

Another factor in ear infections is swelling of the adenoids. These are tissues located in the upper throat near the eustachian tubes. Adenoids contain cells that normally fight infection. But sometimes the adenoids themselves get infected or enlarged, blocking the eustachian tubes. Infection in the adenoids can also spread to the eustachian tubes.

In addition, children don't have fully developed immune systems. So it's easier for them to develop many illnesses, including colds and ear infections.

Risk factors
By Mayo Clinic staff

Major risk factors for middle ear infections in children include:

* Age. Children between ages 6 and 18 months are the most susceptible to ear infections, although ear infections are common from ages 4 months to 4 years.
* Group child care. Children cared for in group settings are more likely to get colds and ear infections than are children who stay home, because they're exposed to more viruses causing colds, which may then cause or complicate an ear infection.
* Feeding position. Babies who drink from a bottle while lying down tend to have more ear infections than do babies who are held upright during feedings.

Both children and adults are affected by these risk factors:

* Season. Ear infections are most common during the fall and winter. Sometimes, seasonal allergies may also congest your sinuses, making you or your child more likely to develop a middle ear infection.
* Reduced air quality. Children exposed to tobacco smoke or higher levels of air pollution are at higher risk of ear infections.
* Family history. Your child's risk of ear infections increases if another member of the family has had ear infections.
* Race. American Indians and Inuits from Alaska or Canada tend to have more ear infections.

Complications
By Mayo Clinic staff

Many ear infections clear on their own after about three days with no complications. However, long-lasting or recurrent ear infections can lead to:

* Short-term hearing loss. Fluid buildup can temporarily affect hearing. That's because it's harder for the eardrum and the tiny bones in the middle ear to send sound vibrations through fluid.
* Long-term hearing loss. Usually the fluid disappears on its own in a few weeks. But sometimes it remains in the middle ear for months, which can damage the eardrum and bones in the middle ear. Persistent middle ear fluid was once thought to contribute to speech or developmental delays in children, but researchers now say this isn't true.
* Ruptured eardrum. During ear infections, fluid and pus may press against the eardrum. This can be painful. Rarely, the pressure ruptures the eardrum. If this happens, you may see a discharge of pus and blood from the affected ear. This can be alarming. But the rupture actually relieves the pain, and in most cases the eardrum heals on its own. If the eardrum ruptures repeatedly and doesn't heal, surgical repair may be needed.

Untreated ear infections can also lead to a type of sinus infection known as mastoiditis, which affects a space in the bone of the skull that's behind your ear. Rarely, infections can move from the ear to other parts of the head.

Tests and diagnosis
By Mayo Clinic staff

The doctor will examine you or your child and ask some questions about the ear infection. During the exam, the doctor will look for inflammation in the middle ear with a lighted instrument known as an otoscope.

The doctor may also use an instrument called a pneumatic otoscope, which allows him or her to gently puff air on the eardrum. Normally this causes the eardrum to move. Any fluid in the middle ear will prevent that movement.

Sometimes additional, often pain-free tests for ear infections are recommended - especially if you or your child has had fluid in the middle ear for some time:

* Tympanometry. This test measures eardrum movement. A soft plug is inserted into the opening of the ear. The plug includes a device that changes air pressure inside the ear.
* Acoustic reflectometry. During this test, the doctor uses a hand-held instrument to project sounds of varying frequencies into the ear. How the sounds are reflected off the insides of the ear can tell the doctor how much fluid is inside the ear.

Based on the test results, you or your child may be diagnosed with:

* Acute otitis media (AOM). In AOM, parts of the ear are infected and swollen, and fluid and mucus are trapped inside the ear.
* Otitis media with effusion (OME). Effusion refers to fluid. In OME, fluid stays in the ear after the infection has cleared up. The presence of fluid increases the risk of a new infection, and you or your child may need additional treatments to clear the fluid from the ear.

Treatments and drugs
By Mayo Clinic staff

Many cases of ear infection don't need treatment such as antibiotics. What's best for your child depends on many factors, including your child's age, medical history and the type of ear infection.

A wait-and-see approach
Before prescribing antibiotics, most doctors will wait to see if the infection clears up on its own. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach for the first 72 hours for children who:

* Are older than age 6 months
* Are otherwise healthy
* Have mild signs and symptoms or an uncertain diagnosis

Most ear infections clear on their own in just a few days — and antibiotics won't help an infection caused by a virus. In fact, about 80 percent of children with middle ear infections recover without antibiotics. Adults' ear infections also may clear on their own.

Your family doctor or pediatrician may recommend an over-the-counter pain reliever such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to help with the pain from the infection.

If your child doesn't have drainage from the ear or ear tubes, prescription eardrops containing numbing medication may be an option, too. The drops won't cure the infection, but they may relieve pain. Warm the drops slightly by placing the bottle containing the drops in warm water. Then gently lay your child on a flat surface with his or her infected ear facing up. Don't give the drops with your child in your arms or on your lap.

Antibiotic therapy
Treatment with antibiotics is recommended for each of these groups of people:

* Children younger than 6 months old
* Children and adults who have had two or more ear infections in the past 30 days

Some doctors believe people who have otitis media with effusion (OME) should also be given antibiotics. However, it's not universally agreed that antibiotics are necessary or will work to prevent an ear infection for people with OME.

The first choice antibiotic of many doctors is amoxicillin, although other antibiotics are effective if you or your child is allergic to amoxicillin.

If the medication is effective, you or your child should start feeling better in a few days. Be sure to take the antibiotic for the full length of the prescription. Stopping medication too soon could allow the infection to come back.

Remember, antibiotics won't help an infection caused by a virus — and the overuse of antibiotics contributes to strains of the bacteria that resist these medications. Side effects from the medications — such as vomiting, diarrhea and allergic reactions — are possible as well.

Drainage tubes
If fluid in your child's ear is affecting his or her hearing or recurrent ear infections don't respond to antibiotics, your child's doctor may suggest surgery. Surgery is not a common treatment for adults.

The most common surgery for ear infections is a myringotomy and the insertion of tubes in your child's ears. During this procedure, which requires general anesthesia, a surgeon inserts a small drainage tube through your child's eardrum. This helps drain the fluid and equalize the pressure between the middle ear and outer ear.

Your child's hearing should improve immediately. As your child grows, the tubes normally will come out on their own and the drainage holes will heal — often within a year. In the meantime, your child may need to wear special earplugs in the pool and bathtub to keep water out of his or her ears.

Some children continue to have ear infections after surgery. Sometimes this leads to another set of tubes. If the ear infections continue after age 4, the surgeon may recommend removing your child's adenoids.