Definition

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

This condition is caused by bacteria and viruses, 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:

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)

Other medications sometimes used include:

  • Cephalosporins (cefprozil, cefdinir, cefpodoxime, ceftriaxone)
  • Sulfa drugs (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. *

Some ear infections are caused by a virus. 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
  • Note: Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving a child aspirin.

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

Ear Drops

Ear drops may help decrease pain. 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 bottlefeed, 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 handwashing .
  • Make sure your child has been vaccinated. The pneumococcal vaccine can reduce the risk of 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.
  • Large adenoids can interfere with the eustachian tubes. Ask your child's doctor about having the adenoids removed .