Middle Ear Infection

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Introduction

What is a middle ear infection?

A middle ear infection, also called otitis media, is a common, often painful, type of ear infection that occurs behind the eardrum. Middle ear infections are caused by bacteria or viruses. A middle ear infection can interfere with the normal process of hearing and result in ear pain, hearing impairment, and other symptoms. People of all ages can get a middle ear infection, but it is more common in infants and young children up until the age of three.

Your ear is divided into three sections: the outer ear (includes the ear and ear canal), the middle ear (includes the eardrum and three tiny bones called ossicles), and the inner ear. Hearing occurs when sound waves travel through the outer ear and into the middle ear, where they cause vibration of the eardrum and ossicles. These vibrations are then transmitted through the inner ear, converted into electrical impulses, and translated by the brain as sound.

The Eustachian tubes are responsible for equalizing air pressure in the middle ear and allowing mucus to drain from the middle ear to the throat. Sometimes, however, the tube can become blocked by congestion, which causes fluid from the middle ear to build up. Bacteria or viruses can enter the middle ear through the Eustachian tubes, leading to an ear infection.

There are two types of middle ear infections:

  • Acute otitis media usually follows a viral upper respiratory tract infection, such as a cold or flu.

  • Chronic otitis media is an ongoing middle ear infection that can occur after acute otitis media or because of a poorly healed ruptured eardrum.

Treatment for a middle ear infection varies depending on the specific type of infection. Treatment may include oral medications, ear drops, or surgical procedures in severe cases.
Complications of a middle ear infection can be serious in some cases and result in permanent hearing loss, brain abscess, meningitis, and other problems.

Seek prompt medical care if you, or your child, have symptoms of a middle ear infection, such as ear pain and drainage, or if a middle ear infection is not getting better. Seek immediate medical care (call 911) if you or your child, someone you are with, develops seizures, lethargy, or a change in alertness.

Symptoms

What are the symptoms of a middle ear infection?

Symptoms of a middle ear infection can vary and differ depending on the specific type of infection. Young children are unable to clearly communicate symptoms. They may resort to crying and ear tugging.

Common symptoms of a middle ear infection include:

  • A feeling of fullness in the ear

  • Chills

  • Drainage of pus and blood from the ear canal followed by relief from pain, which indicates that the eardrum has ruptured

  • Ear pain

  • Fever

  • Hearing loss

  • Irritability, fussiness, poor feeding, and poor sleeping in infants and young children

  • Tugging or rubbing at the ear in infants and young children

Serious symptoms that might indicate a life-threatening condition

In some cases, a middle ear infection can result in serious, even life-threatening, complications, such as meningitis or a brain abscess. Seek immediate medical care (call 911) if you, or someone you are with, have any of these symptoms:

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness

  • Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions

  • Neck stiffness

  • Purple-reddish rash of tiny spots

  • Seizures

  • Stiff neck

Causes

What causes a middle ear infection?

Normally, fluid in the middle ear drains through the Eustachian tube to the throat. When the Eustachian tube becomes blocked or swollen, the fluid builds up in the middle ear. Bacteria and viruses grow and multiply easily when fluid in the middle ear does not drain normally. Conditions that cause swelling or blockage of the Eustachian tube include:

What are the risk factors for developing a middle ear infection?

Middle ear infections can occur in any age group or population, although they most commonly occur in infants and young children. A number of factors increase the risk of developing a middle ear infection including:

  • Exposure to other children (child daycare setting)

  • Family history of middle ear infections

  • Living in a cold climate

  • Not being breastfed as an infant

  • Perforated eardrum

  • Recent illnesses, especially an upper respiratory infection or sinusitis

  • Smoking and secondhand smoke

  • Traveling to a different climate or altitude

  • Use of an oral pacifier

Reducing your risk of a middle ear infection

In some cases, bacterial ear infections in infants and toddlers may be prevented by vaccinating them with the pneumococcal vaccine, as recommended by your health care provider.

You may also be able to lower your risk of developing other types of middle ear infections by protecting yourself and your child from colds, flu, and upper respiratory infections. Ways to reduce the risk of middle ear infections include:

  • Avoiding contact with a person who has an upper respiratory infection

  • Avoiding touching your eyes, nose, ears and mouth, which can transmit an infectious virus from the hands into the body

  • Breastfeeding infants

  • Covering your mouth and nose with your elbow (not your hand) or a tissue when sneezing or coughing

  • Eating a well-balanced diet that includes a sufficient amount of fruits and vegetables

  • Getting enough rest

  • Not smoking, and avoiding secondhand smoke

  • Using appropriate antibacterial cleaners to clean hands and surfaces

  • Washing hands frequently during and after contact with a person who is sick

  • Washing hands frequently with soap and water for at least 15 seconds

Treatments

How is a middle ear infection treated?

Treatment generally involves an individualized, multifaceted plan that addresses the infection, minimizes ear pain, and reduces the possibility of complications, such as hearing loss. There is great controversy surrounding the use of antibiotics in young children since outcomes are not better than supportive treatments. Many worry about overprescribing of antibiotics, which can lead to the development of antibiotic-resistant organisms.

Treatment of a middle ear infection may include:

  • Acetaminophen (Tylenol) for fever and ear pain

  • Antibiotic medications for ear infections caused by bacteria. Antibiotics may be given as oral pills or in ear-drop form.

  • Antibiotics are ineffective against viruses and are not prescribed for middle ear infections caused by a virus.

  • Corticosteroids to reduce ear inflammation and pain

  • Drinking extra fluids

  • Follow-up medical care, as recommended, during and after a middle ear infection to reevaluate the ear and assess the risk of developing complications, such as hearing loss and chronic otitis media

  • Getting extra rest and sleep

  • Surgery in some cases to insert tubes in the ears to drain excess ear fluid, remove infected tissue, or repair a damaged eardrum. Tonsillectomy may be recommended for recurrent otitis media caused by Eustachian tube obstruction due to swollen tonsils.

If you or your child has a middle ear infection, do not use aspirin or products that contain aspirin because of the risk of developing a rare but life-threatening condition called Reye syndrome. Reye syndrome has been linked to taking aspirin during a viral illness, such as a viral middle ear infection or flu.

What are the possible complications of a middle ear infection?

Complications of a middle ear infection can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of a middle ear infection include:

  • Bell’s palsy (swollen or inflamed nerve that controls facial muscles)

  • Brain abscess

  • Chronic otitis media (ongoing middle ear infection)

  • Enlarged adenoids (enlarged lymphoid tissue in the back of the nose)

  • Loss of hearing, even deafness

  • Meningitis (infection or inflammation of the sac around the brain and spinal cord)

  • Ruptured eardrum

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 10
  1. Ear infections in children. National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/hearing/earinfections
  2. Middle ear infections. KidsHealth, a service of Nemours. http://kidshealth.org/parent/infections/ear/otitis_media.html
  3. Ear infections. FamilyDoctor.org. http://familydoctor.org/online/famdocen/home/common/ear/330.printerview.html
  4. Torpy, JM, Lynm, C, Glass, RM. Acute otitis media. JAMA Patient Page. JAMA. 2010;304(19):2194. http://jama.ama-assn.org/content/304/19/2194.full.pdf+html
  5. Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL (Eds), Textbook of Pediatric Infectious Diseases, 6th ed. Philadelphia: Saunders, 2009.
  6. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
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