Middle Ear Infection

(Acute Otitis; Ear Infection, Middle; Otitis Media)

by Rosalyn Carson-DeWitt, MD

Definition

With this condition, the middle ear becomes infected and inflamed. The middle ear is located behind the eardrum.

The Middle Ear

© 2009 Nucleus Medical Media, Inc.

Causes

This condition is caused by bacteria and viruses, such as:

• Streptococcus pneumoniae (most common)
• Haemophilus influenzae
• Moraxella (Branhamella) catarrhalis
• Streptococcus pyogenes (less common)

Risk Factors

These factors increase your chance of developing middle ear infection:

• Recent viral infection (eg, cold)
• Recent sinusitis
• Age: babies and toddlers
• Season: winter
• Attendance at day care
• Babies who are forumula-fed
• Medical conditions that cause abnormalities of the eustachian tubes, such as:
  • Cleft palate
  • Down syndrome
• History of allergies (environmental allergies, food [milk] allergies)
• Gastroesophageal reflux disease (GERD)
• Babies whose mothers drank alcohol while pregnant
• Exposure to second hand smoke, usually cigarette smoke, but also from cooking and wood-heating

Tell your doctor if you have any of these risk factors.

Symptoms

Symptoms include:

• Ear pain (babies may tug or rub at the ear or face)
• Fever
• Irritability
• Hearing loss (may be only temporary, due to fluid accumulation)
• Decreased appetite, difficulty feeding
• Disturbed sleep
• Drainage from ear
• Difficulty with balance

Diagnosis

The doctor will ask about symptoms and medical history, and perform a physical exam. Most middle ear infections can be diagnosed by looking into the ear with a lighted instrument, called an otoscope.

The doctor will see if there is fluid or pus behind the eardrum. A small tube and bulb may be attached to the otoscope. This is to blow a light puff of air into the ear. The puff helps the doctor see if the eardrum is moving normally.

Other tests may include:

• Tympanocentesis—used to drain fluid or pus from the middle ear using a needle, also used to check for bacteria
• Tympanometry—measures pressure in the middle ear and responsiveness of the eardrum, also used to check for fluid or pus
• Hearing test —may be done if you have had many ear infections

Treatment

Treatments include:

If you are diagnosed with an ear infection, follow your doctor's instructions.

Prevention

To reduce the chance of getting an ear infection:

• Avoid exposure to smoke.
• Breastfeed your baby for at least the first six months.
• Try to avoid giving your baby a pacifier.
• If you bottlefeed, keep your baby's head propped up as much as possible. Don't leave a bottle in the crib with your baby.
• Get tested for allergies.
• Treat related conditions, such as GERD.
• Practice good hand washing.
• Make sure your child's vaccinations are up to date. The pneumococcal vaccine can prevent middle ear infections.
• Consider getting a flu vaccine.
• If your child has a history of ear infections, talk to the doctor about long-term antibiotic use. This is used in some cases.
• Ask your doctor about tympanostomy tubes. These tubes help equalize pressure behind the eardrum.
• Large adenoids can interfere with the eustachian tubes. Ask your child's doctor about having the adenoids removed.

American Academy of Otolaryngology, Head and Neck Surgery
http://www.entnet.org

National Institute on Deafness and Other Communication Disorders
http://www.nidcd.nih.gov

Caring for Kids
http://www.caringforkids.cps.ca/

Health Canada
http://www.hc-sc.gc.ca/index_e.html

REFERENCES:

Acute otitis media. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 2008. Accessed July 28, 2008.

Behrmann R, Kliegman R, Jenson HB. Nelson Textbook of Pediatrics . 16th ed. Philadelphia, PA: WB Saunders; 2000.

Griffith HW. Griffith's 5-Minute Clinical Consult . Baltimore, MD: Williams & Wilkins; 1999.

Hurst DS, Amin K, Seveus L, Venge P. Evidence of mast cell activity in the middle ears of children with otitis media with effusion. Laryngoscope . 1999;109:471-477.

Otitis media (ear infection). National Institute on Deafness and Other Communication Disorders website. Available at: http://www.nidcd.nih.gov/ . Published July 2003. Accessed July 29, 2008.

Phillips. Otitis media, milk allergy, and folk medicine. Pediatrics .1972;50:346.

10/12/2006 DynaMed's Systematic Literature Surveillance http://www.dynamicmedical.com/what.php : Spiro DM, Tay KY, Arnold DH, Dziura JD, Baker MD, Shapiro ED. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA . 2006;296:1235-1241.

9/23/2008 DynaMed's Systematic Literature Surveillance http://www.dynamicmedical.com/what.php : Coleman C, Moore M. Decongestants and antihistamines for acute otitis media in children. Cochrane Database of Systematic Reviews. 2008(3). CD001727. DOI: 10.1002/14651858.CD001727.pub4.

6/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C. Topical analgesia for acute otitis media. Cochrane Database Syst Rev. 2009;(2):CD005657.

7/21/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Pavia M, Bianco A, Nobile CG, Marinelli P, Angelillo IF. Efficacy of pneumococcal vaccination in children younger than 24 months: a meta-analysis. Pediatrics. 2009;123:e1103-1110.

Last reviewed September 2009 by Elie Edmond Rebeiz, MD, FACS
Last Updated: 11/16/2009