Acute Ear Infections
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.
An acute ear infection is a short and painful ear infection. For information on an ear infection that lasts a long time or comes and goes, see Chronic Ear Infections below.
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The Eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid normally made in the middle ear. If the Eustachian tube becomes blocked, fluid can build up. This can lead to infection.
Ear infections are common in infants and children, because the Eustachian tubes become easily clogged.
Ear infections may also occur in adults, although they are less common than in children.
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
- Excess mucus and saliva produced during teething
- Infected or overgrown adenoids
- Tobacco smoke or other irritants
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. However, getting water in the ears will not cause an acute ear infection, unless the eardrum has a hole from a previous episode.
Acute 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 acute ear infections include:
- Attending daycare (especially those with more than 6 children)
- Changes in altitude or climate
- Cold climate
- Exposure to smoke
- Genetic factors (susceptibility to infection may run in families)
- Not being breastfed
- Pacifier use
- Recent ear infection
- Recent illness of any type (lowers resistance of the body to infection)
In infants, the main sign is often irritability and inconsolable crying. Many infants and children with an acute ear infection have a fever or trouble sleeping. Tugging on the ear is not always a sign that the child has an ear infection.
Symptoms of an acute ear infection in older children or adults include:
- Ear pain or earache
- Fullness in the ear
- Feeling of general illness
- Hearing loss in the affected ear
The ear infection may start shortly after having a cold. Sudden drainage of yellow or green fluid from the ear may mean a ruptured eardrum.
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.
Exams and Tests
The health care provider will look inside the ears using an instrument called an otoscope. This may show:
- Areas of dullness or redness
- Air bubbles or fluid behind the eardrum
- Bloody fluid or pus inside the middle ear
- A hole (perforation) in the eardrum
A hearing test may be recommended if the person has a history of ear infections.
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. But, if there is no improvement or symptoms get worse, schedule an appointment with your health care provider to determine whether antibiotics are needed.
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. 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.
Ear infections can be treated but may occur again in the future. They can be quite painful. If you or your child are prescribed an antibiotic, it is important to finish all your medication as instructed.
Chronic Ear Infections
Chronic ear infection is fluid, swelling, or an infection behind the eardrum that does not go away or keeps coming back, and causes long-term or permanent damage to the ear.
Causes, incidence, and risk factors:
The eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid normally made in the middle ear. If the eustachian tube becomes blocked, fluid can build up. When this happens, infection can occur.
A chronic ear infection occurs when fluid or an infection behind the eardrum does not go away. A chronic ear infection may be caused by:
- An acute ear infection that does not clear completely
- Repeated ear infections
“Suppurative chronic otitis” is a phrase doctors use to describe an eardrum that keeps rupturing, draining, or swelling in the middle ear or mastoid area and does not go away.
Ear infections are more common in children because their Eustachian tubes are shorter, narrower, and more horizontal than in adults. Chronic ear infections are much less common than acute ear infections.
The usual treatment options are antibiotics, steroids and surgical insertion of pressure equalizing tubes in the ears. While studies have shown that antibiotics can be helpful in certain cases, excessive use can lead to bacterial resistance, making infections more difficult to treat. Tubes sometimes do not equalize pressure enough or may need reinsertion over time.
The first step in treating otitis media is a thorough evaluation by a physician. This will include a history and examination of the ear, nose, and throat. Depending on the individual situation, further testing will include a hearing test, tympanometry (a test that measures the pressure in the middle ear) and CT or MRI scan.
Treatment depends upon the stage of the disease. Initially, efforts to control the causes of eustachian tube obstruction, such as allergies or other head and neck infectious problems, may prevent progression of chronic otitis media. Uncomplicated chronic ear fluid is treated with antibiotics, steroids, and/or placement of ventilation tubes. Many children with chronic or recurrent ear infections have ventilation tubes inserted in their eardrums to allow normal air exchange in the middle ear until the eustachian tube matures.
Once the disease has progressed to the point of significant damage to the eardrum or ossicles, more intensive treatment is needed. If active infection is present in the form of ear drainage, antibiotic eardrops are prescribed. Occasionally, these may be supplemented with oral antibiotics.
Once the active infection is controlled, surgery is usually recommended. There are three objectives of surgery for COM:
- Eradication of the disease
- Remodeling of the middle ear and mastoid bone, located just behind the external ear, to prevent recurrence
- Preservation or improvement in hearing
Surgeries to achieve these objectives include tympanoplasty, mastoidectomy, or typanomastoidectomy. The ENT doctor or otologist makes an incision within the ear canal or behind the external ear. Part of the mastoid bone is then drilled away to gain access to the middle ear space. The abnormal tissues are removed. If possible, efforts are made to rebuild the eardrum and the sound-conducting bones. It is sometimes necessary, however, to complete the hearing reconstruction at a later date (a second stage) rather than at the same time as removal of the infected or damaged parts. Patients are usually discharged from the hospital on the same day or one day after surgery.
This information was adapted from Medline Plus.