Ear Infections!

Ear Infections

Middle-ear infections (otitis media) are inflammation or infections located in the middle ear space. Ear infections can occur as a result of a cold or upper respiratory infection, or may occur in isolation in the presence of chronic middle ear fluid.

Risks

While children or adults may develop an ear infection, the following are some of the factors that may increase a person’s risk of developing ear infections:

• Being around someone who smokes

• Family history of ear infections

• A weak immune system

• Spending time in a day care setting

• Having a cold or upper respiratory infection

• Being bottle-fed while lying on his or her back

• Chronic fluid within the middle ear

Causes

Middle-ear infections are usually a result of dysfunction of the eustachian tube, a canal that links the middle ear with the throat area. The eustachian tube helps to equalize the pressure between the outer ear and the middle ear.

When this tube is not working properly, it prevents normal pressure equalization, causing a buildup of fluid behind the eardrum. Additionally, it can be a source of bacteria to enter the middle ear. When this fluid cannot drain, it allows for the growth of bacteria and viruses in the ear that can lead to an ear infection. The following are some of the reasons that the eustachian tube may not work properly:

• A cold or allergy, which can lead to swelling and congestion of the lining of the nose, throat and eustachian tube (this swelling prevents the normal drainage of fluids from the ear)

• Smoke exposure

• Young age (the eustachian tube of young children is underdeveloped and does not work as efficiently as adults’)

• A malformation of the eustachian tube

• Enlarged and chronically inflamed adenoids

Types of Middle-Ear Infections

Different types of otitis media include the following:

• Acute otitis media. This middle-ear infection occurs abruptly, causing swelling and redness. Fluid and mucus become trapped inside the ear, causing the child to have a fever and ear pain.

• Otitis media with effusion. Fluid (effusion) and mucus continue to accumulate in the middle ear after an initial infection subsides. The child may experience a feeling of fullness in the ear, and it may affect his or her hearing, or cause no symptoms.

• Chronic otitis media with effusion. Fluid remains in the middle ear for a prolonged period or returns again and again, even though there is no infection. May result in difficulty fighting new infection and may affect a person’s hearing.

Symptoms

The following are the most common symptoms of an ear infection. However, each child may experience symptoms differently.

• Fever, especially in infants and younger children

• Fluid draining from ear canals

• Loss of balance

• Hearing difficulties

• Ear pain

It may be more difficult to detect an ear infection in young children who have not learned to speak yet. Symptoms in children and nonverbal individuals may include:

• Unusual irritability

• Difficulty sleeping or staying asleep

• Tugging or pulling at one or both ears

The symptoms of ear infections may resemble other conditions or medical problems. Always consult your child's health care provider for a diagnosis.

Diagnosing Ear Infections

In addition to a complete medical history and physical examination, your child's health care provider will inspect the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the health care provider to see inside the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.

Tympanometry is a test that can be performed in most health care providers’ offices to help determine how the middle ear is functioning. It does not test hearing, but it helps to detect any changes in pressure in the middle ear. This is a difficult test to perform in younger children because the child needs to remain still and not cry, talk or move.

A hearing test may be performed for children who have frequent ear infections.

Treatment

Specific treatment for ear infections will be determined by your health care provider based on the following:

• Age, overall health and medical history

• Extent of the condition

• Tolerance for specific medications, procedures or therapies

• Expectations for the course of the condition

• Your opinion or preference

Treatment may include:

• Antibiotics by mouth or eardrops

• Medication for pain and fever

• Observation

• A combination of the above

If fluid remains in the ear(s) for longer than three months and the infection continues to reoccur even with the use of antibiotics, your health care provider may suggest that small tubes be placed in the ear(s). This surgical procedure, called myringotomy and tympanostomy tube placement, involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to ventilate the middle ear and prevent fluid from accumulating. The child's hearing is restored after the fluid is drained. The tubes usually fall out on their own after six to 12 months.

Your surgeon may also recommend the removal of the adenoids (lymph tissue located in the space above the soft roof of the mouth, also called the nasopharynx) if they are infected or enlarged. Removal of the adenoids has shown to help some people with chronic ear infections.

Treatment will depend on the type of ear infection. Consult your health care provider regarding treatment options.

Effects of an Ear Infection

In addition to the symptoms of ear infections listed above, untreated ear infections can result in any or all of the following:

• Infection in other parts of the head

• Scarring or perforation of the eardrum

• Permanent hearing loss

• Problems with speech and language development (children)