Middle Ear Infection

By. Dr. Charu Palta
Shanghai East International Medical Center

Middle ear infections, also known as otitis media, are among the most common illnesses of early childhood. More than 3 out of 4 kids have had at least one ear infection by the time they reach 3 years of age.  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.

Types of middle ear infection

• A middle ear infection can affect one or both of your child’s ears. The main types of infection are:
• Acute otitis media – this comes on suddenly and is typically over quite quickly. The term acute refers to time, not to how serious a condition is.
• Otitis media with effusion – this is also known as glue ear and occurs when fluid builds up in the middle ear behind the ear drum.
• Recurrent acute otitis media – this is when your child has three or more attacks of infection within six months.

What Causes middle ear infections?

Middle ear infection may be caused by bacteria or by a virus. Children often get ear infections when they have a cold. A small tube, called the eustachian tube, leads from the ear to the throat. The tube can become blocked when you get a cold. When this tube becomes clogged and fails to drain properly, bacteria or other germs may become trapped inside the ear causing an infection. In kids, these tubes are also narrower and less stiff, which makes them more prone to blockage.A number of other factors can contribute to kids getting ear infections, such as exposure to cigarette smoke, bottle-feeding, and day-care attendance.

What are the symptoms?
It’s quite likely that an acute middle ear infection will develop soon after your child gets a cough or runny nose. Children with ear infections may:

• Complain of pain in their ears
• Tug or pull 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

How is an ear infection diagnosed?
A child who might have an ear infection should visit a doctor, who should be able to make a diagnosis by taking a medical history and doing a physical exam. To examine the ear, doctors use an otoscope, a small instrument similar to a flashlight, through which they can see the eardrum. Your doctor will look to see if there is inflammation of the middle ear and check the appearance of the ear drum. The color of a normal tympanic membrane is pearly white; with infection it may look inflamed. Your doctor will also be able to see if there is any pus or discharge.

How is an ear infection treated?
There’s no single best approach for treating all middle ear infections. In deciding how to manage your child’s ear infection, a doctor will consider many factors, including:

• the type and severity of the ear infection
• how often your child has ear infections
• how long this infection has lasted
• your child’s age
• risk factors your child may have
• whether the infection affects your child’s hearing

The fact that most ear infections can clear on their own has led a number of physician associations to recommend a “wait-and-see” approach, which involves giving the child pain relief without antibiotics for a few days.
Another important reason to consider this type of approach is the limitations of antibiotics, which:

• won’t help an infection caused by a virus
• won’t eliminate middle ear fluid
• may cause side effects
• typically do not relieve pain in the first 24 hours and have only a minimal effect after that

However, kids who get a lot of ear infections may be prescribed daily antibiotics by their doctor to help prevent future infections. And younger children or those with more severe illness may require antibiotics right from the start.
Whether or not the choice is made to treat with antibiotics, you can help to reduce the discomfort of an ear infection by using acetaminophen or ibuprofen for pain and fever as needed. Your doctor may also recommend using pain-relieving eardrops as long as the eardrum hasn’t ruptured.

Can ear infections be prevented?
Ear infections are very common. But there are things parents can do to reduce the number of ear infections their children may have. Ear infections are not contagious or spread from one person to another, but the colds that result in ear infections are. Colds are spread when germs are released from the nose or mouth during coughing or sneezing. Anything that can reduce the spread of germs will help reduce ear infections.

Because most ear infections occur in children under the age of three, parents can play an active role in preventing them:

• Have children use disposable tissues when they blow their noses or to cover their mouths when they cough.
• Teach children that tissues should be used only once and then thrown away properly.
• Do not put objects like ear buds inside the ear canal
• After swimming gently dry the ear with a hair dryer
• Do not allow children to share toys that they put in their mouths.
• Wash dirty toys in hot, soapy water before allowing other children to play with them.
• Teach children to always wash their hands after sneezing or coughing into them.
• Do not allow sick children to share food or drinks.
• Regularly wash and disinfect all surface areas and common play areas
• Do not share bathroom cups and other utensils that go in the mouth.

You should also remember:

• Breastfeeding appears to lower an infant’s risk of ear infections.
• Children under age two should not lie flat when they bottle-feed.
• No one should be allowed to smoke around children.
• Children in day care centers tend to have more colds and a higher risk of ear infection.