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Middle Ear Infection

(Acute Otitis; Ear Infection, Middle; Otitis Media)

Definition

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

The Middle Ear

Causes

Bacteria and viruses cause this condition, such as:

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

Risk Factors

These factors increase your chance of developing middle ear infection:

Recent viral infection (eg, cold )
Recent sinusitis
Age: babies and toddlers
Season: winter
Attendance at day care
Babies who are formula-fed
Medical conditions that cause abnormalities of the eustachian tubes, such as:
- Cleft palate
- Down syndrome
History of allergies (environmental allergies, food [milk] allergies )
Gastroesophageal reflux disease (GERD)
Babies whose mothers drank alcohol while pregnant
Exposure to second hand smoke, usually cigarette smoke, but also from cooking and wood-heating

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:

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

Treatment

Treatments include:

Medication

Antibiotics are commonly used to treat ear infections. Examples include:

Amoxicillin (Amoxil, Polymox)
Clavulanate (Augmentin)
Cephalosporins ( cefprozil , cefdinir , cefpodoxime , ceftriaxone )
Sulfa drugs (eg, Septra, Bactrim, Pediazole)

Since bacteria develop a resistance to antibiotics, 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. Nausea, stomach pain, and diarrhea are common. Also, a person may have an allergic reaction to the antibiotic. It is important to discuss the risks and benefits of taking antibiotics with your doctor.

A virus causes some 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.

Over-the-Counter Pain Relievers

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.

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

Ear Drops

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.

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.
Treat related conditions, such as GERD.
Practice good hand washing .
Make sure your child's vaccinations are up to date. The pneumococcal vaccine can prevent middle ear infections.
Consider getting a flu vaccine .
If your child has a history of ear infections, talk to the doctor about long-term antibiotic use. This is used in some cases.
Ask your doctor about tympanostomy tubes. These tubes help equalize pressure behind the eardrum.
Xylitol is a natural sugar that is used as a sweetener in gum, candy, and other types of food. Eating food with xylitol on a regular basis may help to reduce your risk of ear infections.

RESOURCES

American Academy of Otolaryngology, Head and Neck Surgery
http://www.entnet.org/

National Institute on Deafness and Other Communication Disorders
http://www.nidcd.nih.gov/

CANADIAN RESOURCES

Caring for Kids
http://www.caringforkids.cps.ca/

Health Canada
http://www.hc-sc.gc.ca/

References

Acute otitis media. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 2008. Accessed July 28, 2008.

Behrmann R, Kliegman R, Jenson HB. Nelson Textbook of Pediatrics . 16th ed. Philadelphia, PA: WB Saunders; 2000.

Griffith HW. Griffith's 5-Minute Clinical Consult . Baltimore, MD: Williams & Wilkins; 1999.

Hurst DS, Amin K, Seveus L, Venge P. Evidence of mast cell activity in the middle ears of children with otitis media with effusion. Laryngoscope . 1999;109:471-477.

Otitis media (ear infection). National Institute on Deafness and Other Communication Disorders website. Available at: http://www.nidcd.nih.gov/ . Published July 2003. Accessed July 29, 2008.

Phillips BL. Otitis media, milk allergy, and folk medicine. Pediatrics .1972;50:346.

Side Effects. Antibiotics. Side Effects website. Available at: http://side-effects.org/antibiotics . Accessed November 30, 2010.

10/12/2006 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Spiro DM, Tay KY, Arnold DH, Dziura JD, Baker MD, Shapiro ED. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA . 2006;296:1235-1241.

9/23/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Coleman C, Moore M. Decongestants and antihistamines for acute otitis media in children. Cochrane Database of Systematic Reviews. 2008(3). CD001727. DOI: 10.1002/14651858.CD001727.pub4.

6/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C. Topical analgesia for acute otitis media. Cochrane Database Syst Rev. 2009;(2):CD005657.

7/21/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Pavia M, Bianco A, Nobile CG, Marinelli P, Angelillo IF. Efficacy of pneumococcal vaccination in children younger than 24 months: a meta-analysis. Pediatrics. 2009;123:e1103-1110.

11/30/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Coker TR, Chan LS, Newberry SJ, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA. 2010;304(19):2161-2169.

12/16/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Azarpazhooh A, Limeback H, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev. 2011;11:CD007095.

Revision Information

Review Date: 09/2012

Update Date: 00/93/2012

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.