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What are middle ear infections (otitis media or OM)?
Middle ear infections one of the most common conditions among children. They shouldn’t be ignored. Untreated ear infections can lead to unnecessary pain and permanent hearing loss for your child.
An ear infection occurs in the middle ear and is caused by a bacterial or viral infection. It creates pressure in the small space between the eardrum and the back of the throat called the Eustachian tube.
Smaller Eustachian tubes are more sensitive to pressure, which causes the ear pain. A child’s adenoids (the little bits of tissue that hang above the tonsils at the back of the throat) can block the opening of Eustachian tubes because they are larger in young children.
Eustachian tubes do not work properly when filled with drainage from the nose or mucous from allergies, colds, bacteria, or viruses because the drainage presses on the eardrum, which is what causes the pain.
A chronic ear infection can last for 6 weeks or more, but most go away on their own after 3 days. Children who are routinely exposed to illness from other kids (especially during the winter months), or second-hand smoke are more likely to get ear infections, as does bottle-feeding, because your baby is lying down while eating.
Some ear pain is due to teething in babies, a buildup of earwax, or a foreign object your child may have put in their ears. When the pressure increases, it can cause your child’s eardrum to rupture or pop, leaving a hole in the ear. The initial pop hurts, but actually relieves the pressure and pain.
Symptoms of middle ear infections
Intense pain in your child’s affected ear is usually the first sign of an ear infection. Young children can tell you that their ear hurts, but babies may only cry. Your child may repeatedly pulls on the ear that hurts.
The pain is usually worse at night and when your child is chewing, sucking a bottle, or lying down because that’s when the pressure is at its greatest. Other symptoms include a runny nose, cough, fever, vomiting, or dizziness, and hearing loss.
Chronic, frequent ear infections can cause permanent hearing loss. You might suspect your child has hearing loss if you have to talk louder to your child, your child turns up the volume of the TV or music, is not responding to softer sounds or is suddenly less attentive at school.
What causes middle ear infections?
Ear infections happen in the middle ear. They are caused by a bacterial or viral infection. The infection creates pressure in the small space between the eardrum and the back of the throat.
This area is called the Eustachian tube. These tubes do not work properly when filled with drainage from the nose or mucous from allergies, colds, bacteria, or viruses.
How are middle ear infections diagnosed?
Your doctor will be able to check for an ear infection by using a small scope with a light to look into your child’s ear. The infection is not visible without that tool, called an otoscope. Your doctor will know if the eardrum is infected if it looks red and he or she sees fluid inside the ear, the eardrum ruptured, leaving a hole that is visible to your doctor, or if your child has related symptoms, such as a runny nose, cough, fever, vomiting, and dizziness.
Can middle ear infections be prevented or avoided?
Although an ear infection is not contagious, the bacteria or virus that causes it is often passed from person to person like most germs. It’s important to:
- Vaccinate your child with a pneumococcal conjugate vaccine to protect against several types of pneumococcal bacteria. This type of bacteria is the most common cause of ear infections. Get your child’s vaccinations on time.
- Practice routine hand washing and avoid sharing food and drinks, especially if your child is exposed to large groups of kids in day care or school settings.
- Avoid second-hand smoke.
- Breastfeed your baby exclusively for the first 6 months and continue breastfeeding for at least 1 year. Place your baby at an angle while feeding.
- Common allergy and cold medicines do not protect against ear infections.
Middle Ear infection treatment
Ear infections usually go away in a few days without the use of medicine and don’t require surgery. Doctors are cautious about prescribing antibiotics for ear infections unless they are chronic and frequent.
Research shows that over prescribing antibiotics for ear infections is not effective. Doctors treat the pain and fever of an ear infection with over-the-counter (OTC) pain relievers or eardrops, and wait a few days to see if your child’s infection disappears on its own.
They’ll ask you to bring your child in again if there’s no improvement. The doctor may prescribe an antibiotic at that point if it is a bacterial infection.
If your child has chronic and frequent ear infections, signs of hearing loss, or speech delays because of that hearing loss, your doctor might refer you to an ear, nose, and throat (ENT) specialist for ear tube surgery. An ENT surgically inserts tubes inside your child’s middle ear.
The tubes relieve the pressure and allow the fluid to drain. Some children naturally have small Eustachian tubes, so this helps correct that problem. As your child’s ears grow and develop, the tubes fall out automatically and the ear infections are no longer a problem.
Sometimes, the tubes fall out too soon and have to be replaced. For some children, they never fall out and eventually have to be surgically removed. The surgery is quick and does not require overnight hospitalization.
Your doctor may recommend ear tube surgery in certain instances, such as frequent ear infections, or if your child has Down syndrome, cleft palate or a weakened immune system.
Never stick anything in your child’s ear to relieve the pain of an ear infection, to remove the tubes or remove a foreign object. See your child’s doctor to have it removed.
Living with middle ear infections
Young children are more likely to get ear infections than are older children or adults. They are one of the most common illnesses among children. If your child suffers from several ear infections each year, you’ll want to look out for symptoms every time he or she has a stuffy nose or congestion.
Many times, an ear infection will clear up on its own within a week or two. If you can manage your child’s pain at home, the American Academy of Family Physicians recommends a wait-and-see approach for 48 hours before seeing a doctor and asking for an antibiotic. This is unless your child has pain in both ears, is less than 2 years old, and has a fever higher than 102.2°F.
Questions to ask your doctor
- How can I keep my child comfortable at night with the pain of an ear infection?
- Is there drainage with an ear infection?
- What is the difference between an ear infection and swimmer’s ear?
- Is my child a candidate for ear tubes?
- What are the risks of surgically inserting tubes inside my child’s middle ear? What are the risks of not?
- Should my child get regular hearing tests if he or she has had ear infections?
Surgery for middle ear infections
Why Surgery?
Many kids get middle ear infections (otitis media, or OM), usually between the ages of 6 months and 2 years.
Some kids are particularly susceptible because of environmental and lifestyle factors (like attendance at a group childcare, secondhand tobacco smoke exposure, and taking a bottle to bed).
Although these infections are relatively easy to treat, a child who has multiple ear infections that do not get better easily or has evidence of hearing loss or speech delay may be a candidate for ear tube surgery.
During this surgery, small tubes are placed in the eardrums to ventilate the area behind the eardrum and keep the pressure equalized to atmospheric pressure in the middle ear.
About Otitis Media
The middle ear is an air-filled cavity located behind the eardrum. When sound enters the ear, it makes the eardrum vibrate, which in turn makes tiny bones in the middle ear vibrate. This transmits sound signals to the inner ear, where nerves relay the signals to the brain.
A small passage leading from the middle ear to the back of the nose — called the eustachian tube — equalizes the air pressure between the middle ear and the outside world. (When your ears pop while yawning or swallowing, the eustachian tubes are adjusting the air pressure in the middle ears.)
Infection
Bacteria or viruses can enter the middle ear through the eustachian tube and cause an infection — this often occurs when a child has had a cold or other respiratory infection. When the middle ear becomes infected, it may fill with fluid or pus, particularly if the infection is bacterial.
Pressure from this buildup pushes on the eardrum and causes pain, and because the eardrum cannot vibrate, the child may experience a temporary decrease in hearing.
With treatment, a bacterial infection can be quickly cleared up. In most kids the fluid will resolve over time and hearing will be restored. Some research suggests that long periods of hearing loss in young children can lead to delays in speech development and learning.
Symptoms and Diagnosis
Symptoms of otitis media include:
- pulling or rubbing the ears because of ear pain
- fever
- fussiness or irritability
- fluid leaking from the ear
- changes in appetite or sleeping patterns
- trouble hearing
Call your doctor if you think your child has an ear infection. He or she will perform a physical examination and look at your child’s eardrums. If the doctor suspects a bacterial infection (often based on the presence of pus behind the eardrum), he or she may elect to wait and see if the immune system will clear the infection without the use of antibiotics.
If symptoms persist (fever and pain) for more than 48 hours, then antibiotics may be prescribed. This is important to know since unnecessary use of antibiotics can lead to resistant bacteria.
In some instances, the doctor will insert a needle through the eardrum to remove a sample of the pus from the middle ear for a laboratory culture. Called a tympanocentesis, this procedure can help the doctor decide which antibiotic to use.
Treatment
Although ear tube surgery is a relatively common procedure, surgery is not the first choice of treatment for otitis media. Antibiotics are often used to treat bacterial ear infections but many ear infections are viral and cannot be treated with antibiotics. These infections need to get better on their own, and only time can help them heal.
But if your child has frequent ear infections that don’t clear up easily or a hearing loss or speech delay, the doctor may suggest surgery to drain fluid from the middle ear and insert a ventilation tube.
Because most kids have had infections in both ears, surgery is often done in both; this is called a bilateral myringotomy, or BMT. A tiny tube, called a pressure equalization (PE) or tympanostomy tube, is inserted into the eardrum to ventilate and equalize pressure in the middle ear. This will help to prevent future infections and the accumulation of fluid, and will help normalize hearing.
The presence of the tiny hole in the eardrum from the tube doesn’t impair hearing (in fact, kids with a speech or language delay from hearing loss often will see a normalization of their hearing). Depending on the type used, the tube remains in place for about 6 months to 18 months or more.
Tympanostomy Tube Surgery
If your child is old enough to understand what surgery is, talk about what happens during ear tube surgery:
- Because your child will receive general anesthesia, the surgery will be performed in a hospital so that an anesthesiologist can monitor your child. The procedure takes about 10 to 15 minutes.
- The surgeon will make a small hole in the eardrum and remove fluid from the middle ear using suction. Because the surgeon can reach the eardrum through the ear canal, there is no visible incision or stitches.
- The surgeon will finish by inserting a small metal or plastic tube into the hole in the eardrum.
Afterward, your child will wake up in the recovery area. In most cases, the total time spent in the hospital is a few hours. Very young children or those with significant medical problems may stay longer.
After Surgery
A tympanostomy tube helps prevent recurring ear infections by allowing air into the middle ear. Other substances, including water, may sometimes enter through the tube, but this is rarely a problem. Your surgeon might recommend earplugs for regular bathing or swimming.
In most cases, surgery to remove a tympanostomy tube isn’t necessary. The tube usually falls out on its own, pushed out as the eardrum heals. A tube generally stays in the ear anywhere from 6 months to 18 months, depending on the type of tube used.
If the tube remains in the eardrum beyond 2 to 3 years, however, it probably will be removed surgically to prevent a perforation in the eardrum or accumulation of debris around the tube.
Although effective in reducing chronic ear infections, ear tubes are not always a permanent cure for otitis media. Up to 25% of kids who need ear tubes before the age of 2 may need them again.
Care After Ear Surgery for middle ear infections
These instructions give you information about caring for yourself after your procedure. Your doctor may also give you more specific instructions. Call your doctor if you have any problems or questions after your procedure.
Follow these instructions at home:
- Do not move your head quickly or suddenly.
- Keep your ear dry. Do not let water get in your ear or on the bandage (dressing) that covers your ear. Follow your doctor’s instructions about how to bathe.
- There are many different ways to close and cover a cut (incision), including stitches (sutures), skin glue, and adhesive strips. Follow your doctor’s instructions about:
- Incision care.
- Dressing changes and removal.
- Incision closure removal.
- Take medicines only as told by your doctor.
- Try not to cough or sneeze. If you do cough or sneeze, open your mouth. This keeps the pressure the same on both sides of your eardrum.
- Avoid blowing your nose as told by your doctor. If you do blow your nose, do it gently. Blow your nose on one side or nostril at a time.
- Return to your normal activities as told by your doctor.
- Avoid activity that takes a lot of effort, including heavy lifting, as told by your doctor.
Contact a doctor if:
- You have redness, puffiness (swelling), or pain at the site of your incision.
- You have fluid, blood, or yellowish-white fluid (pus) coming from your incision.
- You have a fever.
- You feel sick to your stomach (nauseous).
Get help right away if:
- You feel more pressure in your ear.
- Your ear pain is much worse.
- You throw up (vomit).
