Otitis media (patient information)

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Otitis media (Ear Infection)

Overview

What are the symptoms?

What are the causes?

Who is at highest risk?

When to seek urgent medical care?

Diagnosis

Treatment options

Where to find medical care for Otitis media?

What to expect (Outlook/Prognosis)?

Possible complications

Prevention

Otitis media On the Web

Ongoing Trials at Clinical Trials.gov

Images of Otitis media

Videos on Otitis media

FDA on Otitis media

CDC on Otitis media

Otitis media in the news

Blogs on Otitis media

Directions to Hospitals Treating Otitis media

Risk calculators and risk factors for Otitis media

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Meagan E. Doherty; Luke Rusowicz-Orazem, B.S.

Overview

Otitis media, commonly known as an ear infection, is an infection or inflammation of the middle ear. This inflammation often begins when infections that cause sore throats, colds, or other respiratory or breathing problems spread to the middle ear. These can be viral or bacterial infections. Seventy-five percent of children experience at least one episode of otitis media by their third birthday. Almost half of these children will have three or more ear infections during their first 3 years. It is estimated that medical costs and lost wages because of otitis media amount to $5 billion a year in the United States. Although otitis media is primarily a disease of infants and young children, it can also affect adults.

What are the symptoms of otitis media?

Otitis media is often difficult to detect because most children affected by this disorder do not yet have sufficient speech and language skills to tell someone what is bothering them. Common signs to look for are:

  • Ear pain
  • Unusual irritability
  • Difficulty sleeping
  • Tugging or pulling at one or both ears
  • Fever
  • Fluid draining from the ear
  • Loss of balance
  • Unresponsiveness to quiet sounds or other signs of hearing difficulty such as sitting too close to the television or being inattentive
  • Clumsiness and poor balance
  • Common cold symptoms

What causes Otitis media?

Anything that causes the eustachian tubes in the middle ear to become swollen or blocked causes more fluids to build up in the middle ear behind the eardrum. These causes include:

Risk factors for ear infections include the following:

  • Attending daycare (especially those with more than 6 children)
  • Changes in altitude or climate
  • Cold climate
  • Exposure to smoke
  • Genetic factors (susceptibility to infection may run in families)
  • Not being breastfed
  • Pacifier use
  • Recent ear infection
  • Recent illness of any type (lowers resistance of the body to infection)

Who is at highest risk?

  • Infants and young children are especially susceptible to ear infections:
    • Immune systems are not fully developed.
    • Smaller and straighter eustachian tubes are more prone to clogging.
    • Larger adenoids interfering with eustachian tube openings.
    • Close proximity with other infants and young children in settings such as schools or daycares, etc.
  • Those with consistent exposure to air pollution, such as secondhand smoke.

Diagnosis

  • The simplest way to detect an active infection in the middle ear is to look in the child's ear with an otoscope, a light instrument that allows the physician to examine the outer ear and the eardrum.
    • Inflammation of the eardrum indicates an infection.
  • There are several ways that a physician checks for middle ear fluid:
    • The use of a special type of otoscope called a pneumatic otoscope allows the physician to blow a puff of air onto the eardrum to test eardrum movement.
      • An eardrum with fluid behind it does not move as well as an eardrum with air behind it.
    • Tympanometry is a test requiring insertion of a small soft plug into the opening of the child's ear canal, providing information indicative of hearing loss from middle ear congestion.

When to seek urgent medical care?

Call your child's doctor if:

  • Pain, fever, or irritability do not improve within 24 to 48 hours
  • At the start, the child seems sicker than just an ear infection
  • Your child has a high fever or severe pain
  • Severe pain suddenly stops hurting -- this may indicate a ruptured eardrum
  • Symptoms worsen
  • New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles

For a child younger than 6 months, let the doctor know right away if the child has a fever, even if no other symptoms are present.

Treatment options

  • Many physicians recommend the use of an antibiotics when there is an active middle ear infection to kill the causative bacteria.
    • Once started, the antibiotic should be taken until it is finished. Most physicians will have the child return for a followup examination to see if the infection has cleared.
    • Several different antibiotics may have to be tried before an ear infection clears due to possibility of the bacteria developing resistance to the antibiotics.
  • If a child is experiencing pain, the physician may also recommend a pain reliever, such as tylenol.
  • Following the physician's instructions is very important. Once started, the antibiotic should be taken until it is finished. Most physicians will have the child return for a followup examination to see if the infection has cleared.
  • A surgical procedure called a myringotomy may be performed in children where middle ear fluid buildup persists for longer than 3 months.
    • While the child is asleep under general anesthesia, the surgeon makes a small opening in the child's eardrum.
    • A small metal or plastic tube is placed into the opening in the eardrum, ventilating the middle ear and helps keep the air pressure in the middle ear equal to the air pressure in the environment.
    • The tube normally stays in the eardrum for 6 to 12 months, after which it usually comes out spontaneously.
    • Some children may need to have the operation again if the otitis media returns after the tubes come out.

Where to find medical care for Otitis media?

Directions to Hospitals Treating Otitis media

Prevention

  • Prevention of otitis media is contingent upon preventing exposure to the cause, including the following:
    • Bacteria and viruses responsible for middle ear infection, such as common cold.
    • Washing hands frequently.
    • Avoiding common cold patients.
    • Limiting child enrollment in daycare.
    • Avoiding pacifiers for infants.
    • Limiting exposure to air pollution, such as secondhand smoke.
    • Breastfeeding infants up to 6 months old to help develop their immune systems.
    • Antibiotic regimens for children that have high risk for otitis media.

What to expect (Outlook/Prognosis)?

  • Otitis media's prognosis is usually good without treatment.
    • Otitis media from infection will usually go away naturally within two weeks.
    • Otitis media from non-infectious causes with fluid buildup will usually go away naturally within 3 months.
  • Complications from otitis media, including meningitis and mastoiditis (infections of the brain and bones around the skull, respectively) can lead to poor prognosis without treatment.
  • Untreated otitis media may lead to permanent hearing impairment due to persistent fluid in the middle ear reducing a child's hearing.
    • Children who have early hearing impairment from frequent ear infections are likely to have speech and language disabilities.

Possible complications

  • Complications include spread of infection outside of the middle ear
  • Other potential complications include the following:
    • Ruptured or perforated eardrum.
    • Chronic, recurrent ear infections.
    • Enlarged adenoids or tonsils.
    • Formation of an abscess or a cyst (called cholesteatoma) from chronic, recurrent ear infections.
    • Speech or language delay in a child who suffers lasting hearing loss from multiple, recurrent ear infections.

Sources

http://www.nlm.nih.gov/medlineplus/earinfections.html Template:WH Template:WS