Middle Ear Infection (Otitis)

A middle ear infection, also called otitis, occurs when the area behind the eardrum becomes inflamed as a result of a bacteria or virus. The condition is most common in children. According to the Lucile Packard Children’s Hospital at Stanford, middle ear infections occur in 80 percent of children by the time they reach age 3 (LPCH).

Most middle ear infections occur during the winter and early spring. Often, middle ear infections go away without any need for medication. However, if pain persists or if you have a fever, you should seek medical treatment.

There are two types of middle ear infections: acute otitis media (AOM) and otitis media with effusion (OME).

Acute Otitis Media

This type of ear infection comes on quickly and is accompanied by swelling and redness in the ear. Fever, ear pain, and hearing impairment often occur as a result of fluid and/or mucous that is trapped in the middle ear.

Otitis Media with Effusion

After an initial infection has gone away, sometimes mucus and fluid will continue to build up in the middle ear. This can cause the feeling of the ear being “full” and affect your ability to hear clearly.

There are a variety of symptoms associated with middle ear infections. Some of the most common are:

• ear pain
• irritability
• difficulty sleeping
• tugging or pulling at the ears
• fever
• yellow, clear, or bloody discharge from the ears
• loss of balance
• problems hearing
• nausea and vomiting
• diarrhea
• decreased appetite
• congestion

There are a number of reasons why children get middle ear infections. They often stem from a prior infection of the respiratory tract that spreads to the ears. When the tube that connects the middle ear to the pharynx (Eustachian tube) is blocked, fluid will collect behind the eardrum. Bacteria will often grow in the fluid, causing pain and infection.

Your pediatrician will first want to make sure they have your child’s medical history. Next, they will do a physical examination. During the exam, your doctor will look at the outer ear and eardrum using a lighted instrument called an otoscope to check for signs of redness, swelling, pus, and fluid.

Your doctor might also conduct a test called tympanometry to determine whether the middle ear is operating properly. For this test, a device is put inside your ear canal, changing the pressure and making the eardrum vibrate. These changes are measured and recorded on a graph, which is interpreted by your doctor.

There are a number of approaches to treating middle ear infections. Treatment will be based on your child’s age, health, and medical history. Doctors will also take into consideration the following:

• the severity of the infection
• the ability of your child to tolerate antibiotics
• opinion or preference of the parents

Depending on the severity of the infection, your doctor may tell you that the best option is to treat the pain and wait to see if symptoms go away. Ibuprofen or another fever and pain reducer is a common treatment to deal with the pain.

Symptoms lasting more than three days usually mean that antibiotics are necessary. However, if a virus is causing the infection, then antibiotics will not cure it.

Complications resulting from ear infections are rare, but they can occur. Some complications associated with middle ear infections are:

• infection that spreads to the bones of the ear
• infection that spreads to the fluid around the brain and spinal cord
• permanent hearing loss
• ruptured eardrums

There are ways to lower your child’s risk of getting ear infections.

• Wash your hands and your child’s hands frequently.
• Keep foreign and unclean items out of your toddler or baby’s mouth.
• Avoid smoky environments or areas where people frequently smoke.
• Breastfeed instead of bottle-feeding your infant.
• Keep your child’s immunizations up-to-date.
• Wean your child from the pacifier by age of 12 months.