An ear infection (acute otitis media) is most often a bacterial or viral infection that affects the middle ear.

Introduction

An ear infection (acute otitis media) is most often a bacterial or viral infection that affects the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. Children are more likely than adults to get ear infections. Ear infections frequently are painful because of inflammation and buildup of fluids in the middle ear.

There are two different types of otitis media. Either can occur in one or both ears.

Acute otitis media, which is also called an ear infection, is an infection of the middle ear. Fluid in the middle ear may remain even after an infection is gone.

Otitis media with effusion, also called middle ear fluid, is fluid that is not infected. When a child has a cold, a small tube between the ear and the throat can become blocked, causing fluid to build up in the middle ear

Epidemiology of ear infection

80% of all children have ear infections before the age of three, which represents 16M annual episodes in the US alone.  20-30% of children have an average of 6 recurrences before the age of seven.  Ear infections are the most common cause for a sick child visit to the doctor and accounts for half of all pediatric antibiotics.  The World Health Organization attributes 28K annual deaths to complications resulting from ear infections.

What causes an ear infection?

Ear infections are caused by viruses or bacteria that infect the middle ear. In children, the Eustachian tube, which runs from the ear to the back of the throat, is short, and more horizontal than an adults. It becomes blocked more easily, such as during a common cold.

When the tube becomes blocked, fluid does not drain away from the middle ear as it normally does. This may cause an infection which usually arises from germs found in the nose and throat.

Other causes are:

An upper respiratory tract infection

Sudden changes in air pressure (i.e. airline travel)

Using cotton buds to clean the ears (they push ear wax further down the ear canal and may cause a blockage)

Smaller than average Eustachian tubes

Swimming in polluted water (called otitis externa, or swimmer’s ear)

What are the symptoms of ear infection?

In child

The first signs of infection are often similar to those of a cold, with a snuffly, blocked or runny nose and mild fever.

Your child may not want to eat or sleep, and is generally irritable.

Sometimes there is a discharge (pus or blood) coming from the ear.

An older child may complain of an earache, headache or hearing problems. A younger child may simply pull at their ear or be upset. Babies (up to 12 months) can become extremely irritable, shove fingers in their ears and lose their appetite.

Sometimes the symptoms are very mild and the ear infection is only picked up when a doctor looks at your child’s ears.

Poor sleep

Child pulls on ear

In Adults

Earache

Feeling of fullness or pressure

Hearing problems

Dizziness, loss of balance

Nausea, vomiting

Ear drainage

Fever

Risk factors

Ear infections occur most commonly in young children because they have short and narrow eustachian tubes. Infants who are bottle-fed also have a higher incidence of ear infections than their breastfed counterparts. Other factors that increase the risk of developing an ear infection are:

Altitude changes

Exposure to cigarette smoke

Pacifier use

Age

Recent illness or ear infection

Infant feeding. Babies who drink from a bottle, especially while lying down, tend to have more ear infections than do babies who are breast-fed.

Seasonal factors. Ear infections are most common during the fall and winter when colds and flu are prevalent. People with seasonal allergies may have a greater risk of ear infections during seasonal high pollen counts.

Poor air quality. High levels of air pollution can increase the risk of ear infection.

How can Otitis Media affect hearing?

When a child has fluid in the middle ear, the fluid reduces sound traveling through the middle ear. Sound may be muffled or not heard. Children with middle ear fluid will generally have a mild or moderate temporary hearing loss. (It’s as if you plugged your ears with your fingers.) However, some children have no change in their hearing.

Mild Hearing Loss—A child may not hear or may hear very faintly the soft sounds at the beginnings and ends of words, such as the “s” in “sun” and the “t” in “cat,” and words spoken quickly such as “and.”

Moderate Hearing Loss—A child may have trouble hearing most speech sounds, and may have trouble with short, softly spoken words and word endings. It’s important to know that some children with otitis media have no loss of hearing. A hearing loss due to middle ear fluid should go away once the fluid is gone.

Speech or developmental delays. If hearing is temporarily or permanently impaired in infants and toddlers, they may experience delays in speech, social and developmental skills.

Spread of infection. Untreated infections or infections that don’t respond well to treatment can spread to nearby tissues. Infection of the mastoid, the bony protrusion behind the ear, is called mastoiditis. This infection can result in damage to the bone and the formation of pus-filled cysts. Rarely, serious middle ear infections spread to other tissues in the skull, including the brain or the membranes surrounding the brain (meningitis).

Tearing of the eardrum. Most eardrum tears heal within 72 hours. In some cases, surgical repair is needed.

How can I recognize if my child has a hearing loss?

Having difficulty paying attention

Showing a delayed response or no response when spoken to

Saying “huh?” often

Not following directions well

Turning up sound on radios, TV, CDs

Withdrawing from other children

Being over-active or uncooperative

Diagnosing middle ear infection

A middle ear infection (otitis media) can usually be diagnosed using following instruments:

An otoscope

Otoscope is a small handheld device with a magnifying glass and a light source at the end. Using an otoscope, a doctor can examine the ear to look for signs of fluid in the middle ear, which may indicate an infection.

Otoscope

Tympanometry

Tympanometry is a test that measures how the ear drum reacts to changes in air pressure. During a tympanometry test, a probe is placed into your child’s ear. The probe changes the air pressure at regular intervals while transmitting a sound into the ear. A measuring device is attached to the probe to record how the drum moves and how changes in air pressure affect this movement. A healthy ear drum should move easily if there’s a change in air pressure. If your child’s ear drum moves slowly or not at all, it usually suggests there’s fluid behind it.

Tympanometry and its Parts

Audiometry

Audiometry is a hearing test that uses a machine called an audiometer to produce sounds of different volume and frequency. This can help determine if your child has any hearing loss as a result of their condition. During the test, your child listens through headphones and is asked if they can hear the sounds.

Audiometry

Scans

On the very rare occasions where there’s a possibility the infection has spread out of the middle ear and into the surrounding area, a scan of the ear may be carried out. This may be either a:

  1. Computerized tomography (CT) scan
  2. Magnetic resonance imaging (MRI) scan

Treatment and Medications

Most bouts of ear infection will clear on their own without treatment within 2-3 days. The immune system can usually clear germs (bacteria or viruses) that cause ear infections. However, treatments that may be advised include the following:

Painkillers

If the ear infection is causing pain, then give painkillers to children regularly until the pain eases. For example, paracetamol (Calpol®, Disprol®, etc) or ibuprofen. These medicines will also lower a raised temperature which can make a child feel better. If antibiotics are prescribed (see below), you should still give the painkiller as well until the pain eases.

Antibiotics  

Antibiotics are not advised in most cases. This is because the infection usually clears within 2-3 days on its own. Also, it is best not to take antibiotics unless needed, as side-effects such as diarrhea or rash can sometimes be a problem. Antibiotics are more likely to be prescribed if:

The child is under 2 years old (as the risk of complications is greater in babies).

The infection is severe.

The infection is not settling within 2-3 days.

Complications develop.

Neck exercises

Some earaches are caused by pressure in the ear canal. Certain neck exercises can be used to relieve this pressure. Neck rotation exercises are particularly beneficial.

Follow these steps to perform neck rotations exercises:

Sit straight up with both feet flat on the ground.

Slowly rotate your neck and head to the right until your head is parallel with your shoulder.

Rotate your head the other way, until your head is parallel with your left shoulder.

Raise your shoulders high as if you’re trying to cover your ears with your shoulders.

Make the movements slowly, hold them gently stretching more for a count of five, then relax.

Repeat these often throughout waking hours.

Natural remedies

Naturopathic drops

Naturopathic ear drops are made from herbal extracts. They can be found online and in some drug stores. One study found that drops containing herbal extracts in a base of olive oil could be just as, or even more, effective as traditional over-the-counter ear drops.

Tea tree oil

Tea tree oil has powerful antifungal, antiseptic, anti-inflammatory, and antibacterial properties. These can be applied as ear drops to reduce pain and discomfort. If you’re worried about sensitivity, you can mix a few drops of tea tree oil with a small amount of olive oil.

Ginger

Ginger has natural anti-inflammatory properties that can help soothe pain from earaches. Apply ginger juice, or strained oil that was warmed with ginger in it, around the outer ear canal. Do not put it directly into the ear.

Garlic

Garlic has both antibiotic and pain-relieving properties. One study found that eardrops containing garlic, among other ingredients, were just as effective as over-the-counter eardrops. Soak crushed garlic for several minutes in warm olive or sesame oil. Strain the garlic out and apply the oil into the ear canal.

Home care

You can help your child in several ways.

Offer fluids (water), frequently and in small amounts (‘sips’), especially if they have a fever.

Give pain relief medication if your child is in pain, for example paracetamol (such as Panadol or Dymadon), Ibuprofen or a paracetamol-codeine mix (such as Painstop). Carefully check the label for the correct dose and make sure you are not giving your child any other products containing paracetamol (such as some cough medicines and cold and flu preparations).

Raise the head of the bed or cot to help drain fluid in the Eustachian tube (make sure your baby cannot slip under the covers).

Give your child plenty of rest, with quiet activities at home.

Keep children away from childcare or school until they are better.

Do not put cotton buds in the ear even if there is pus or blood. This may damage the eardrum.

Do not fly with your child until your doctor tells you it is all right to do so.

Prevention and control of ear infection

Avoid contact with cigarette smoke.

Breastfeed your baby for the first six to 12 months if you are able to, as it provides more natural immunity to fight infections.

Some research suggests limiting the use of dummies in young children.

Teach an older child to blow their nose ‘softly’, which helps to clear fluid from the Eustachian tube.

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