Health and Fitness » infection involving the middle ear

The common name for otitis media, this is an infection involving the middle ear (that cavity between the eardrum and the inner ear). A middle ear infection can produce pus or fluid and cause hearing loss. While an ear infection is painful, it is not terribly serious; it is easily treated and there are not usually any long-term complications.

Ear infections are most common in children because of the shortness of their eustachian tubes (the passage that connects the back of the nose to the middle ear), which makes it easier for bacteria to enter from the back of the throat. Almost all children have had at least one infection by the time they are six years old. They are most susceptible to ear infections during the first two years of life.

Some children (especially babies with ear infections within two months of birth) have recurrent ear infections. They seem to run in families and are characterized by persistent fluid in the middle ear and short-term hearing loss. These conditions may require long-term antibiotics or surgery.

Cause
During a cold, the eustachian tube can swell and become blocked, allowing fluid to accumulate in the middle ear. The fluid produced by the inflammation cannot drain off through the tube and instead collects in the middle ear, where it can allow bacteria and viruses drawn in from the back of the throat to breed.

The usual cause of a middle ear infection is bacteria that are normally present in a child’s throat, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

Risk factors for the developing of an ear infection include being male, bottle-fed, Native American or Hispanic, and younger than two. Other risk factors include living in crowded conditions, going to day care, having allergies, and inhaling household cigarette smoke.

Symptoms
Acute middle ear infection causes sudden, severe earache, deafness, ringing of the ear (tinnitus), sense of fullness in the ear, and fever. Occasionally, the eardrum can burst, which causes a discharge of pus and relief of pain. Parents may notice a baby or young child suffering cold with thick discharge, irritability, pulling or tugging at the ear, crying in the middle of the night, shaking his head, and exhibiting poor appetite. There may be fluid draining from the ear, although this is not always the case. A low fever is common. The worst symptom is ear pain.

Chronic middle ear infection is usually caused by repeated attacks of acute otitis media, with pus seeping from a perforation in the eardrum together with some degree of deafness. Complications include otitis externa (inflammation of the outer ear), damage to the bones in the middle ear, or a matted ball of skin debris which can erode the bone and cause further damage (called a “cholesteatoma”). Rarely, infection can spread inward from an infected ear and cause a brain abscess.

Diagnosis
Middle ear infection can be detected by examining the ear with an instrument called an otoscope. A sample of discharge may be taken to identify the organism responsible for the infection, but it is not often done.

Treatment
Acute middle ear infection usually clears up completely with antibiotic drugs, although sometimes there may be continual production of a sticky fluid in the middle ear known as “persistent middle ear infection.” A doctor may also remove pus and skin debris and prescribe antibiotic ear drops. Ephedrine nose drops can help establish draining of the ear in children.

Since the mid-1980s, some strains of bacteria have developed resistance to amoxicillin and other antibiotics. Some children may not improve after 10 days of antibiotics and may need three or four more weeks of drug treatment.

Acetaminophen may be given to relieve pain or to reduce fevers above 101°F. A warm towel or hot water bottle over the sore ear, or an ice pack wrapped in a towel, may ease pain. The child should lie with the infected ear down to help drain the fluid.

Complications
Rarely, a middle ear infection can lead to bacterial MENINGITIS and MASTOIDITIS (a serious infection of the air cells behind the middle ear). Warning signs of mastoiditis include: high fever, severe ear pain, pus-like drainage, and redness, swelling, and tenderness behind the ear.

Prevention
Breast-feeding prevents ear infections during the first six months. Bottle-fed babies should not drink with the bottle propped or while lying on the back. Adults should not smoke around an infant, since the smoke irritates the lining of the nose and throat. Early treatment prevents most problems.