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

The Middle Ear

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Causes

Bacteria and viruses (most common) cause this condition. Common bacteria include:

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

Middle ear infections are more common in the winter. These factors increase your chance of developing middle ear infection:

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:

  • 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
  • Tympanocentesis—used to drain fluid or pus from the middle ear using a needle, also used to check for bacteria
Treatment
Medication

Antibiotics

  • oral antibiotics are commonly used to treat ear infections. Examples include:
    • Amoxicillin
    • Amoxacillin/clavulanate
    • Cephalosporins ( cefprozil , cefdinir , cefpodoxime , ceftriaxone )
    • Sulfa drugs
  • Antibiotic-glucocorticoid ear drops may be used if ear drums rupture or you have ear tubes
  • Some doctors may take a "wait and see" approach. In some cases, your doctor may prescribe an antibiotic for your child and ask you to use the medication if the pain or fever lasts for a certain number of days. This approach has been effective.
  • While antibiotics may be effective, it is also important to keep in mind these medicines can cause a number of side effects including.
    • Nausea, stomach pain, and diarrhea are common.
    • Allergic reaction to the antibiotic.
    • Development of antibiotic resistence if used when not needed
  • It is important to discuss the risks and benefits of taking antibiotics with your doctor.
  • A virus causes a lot ear infections. This type will not go away faster with antibiotics. Most middle ear infections (including bacterial ones) tend to improve on their own in 2-3 days.

Pain relievers can help reduce pain, fever, and irritability. These include:

  • Acetaminophen
  • Ibuprofen
  • Aspirin
    • Note: Aspirin is not recommended for children or teens with a current or recent viral infection. This is because of the risk of Reye's syndrome. Ask your doctor which other medicines are safe for your child.
  • In children, ear drops that have a local anaesthetic (eg, ametocaine, benzocaine , or lidocaine) can help decrease pain, especially when the drops are used with oral pain relievers. If there is a chance that the eardrum has ruptured, do not use ear drops.

Decongestants and antihistamines are not recommended to treat an ear infection.

Myringotomy

Myringotomy is surgery done to open the eardrum. A tiny cut is made in the eardrum to drain fluid and pus.

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 bottle-feed, 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 if you or your child have chronic nasal congestion. Keep allergy symptoms well controlled.
  • Treat related conditions, such as GERD.
  • Practice good hand washing.
  • Make sure your child's vaccinations are up to date.
  • Consider getting a flu vaccine. Pneumococcal vaccine may prevent some ear infections caused by Pneumococcus, but the overall effect on ear infections is not known.
  • If your child has a history of ear infections, talk to the doctor about long-term antibiotic use.
  • Ask your doctor about tympanostomy tubes. These tubes help equalize pressure behind the eardrum and prevent fluid build-up and infection.