Ear Infections

Overview

Ear infections (also known as acute otitis media) are infections of the middle ear, which is the air-filled space behind the eardrum containing the tiny vibrating bones of the ear. They are more common in children than adults. Although ear infections often resolve on their own, they can cause pain, fever, trouble sleeping, and other symptoms. Antibiotics may be prescribed to clear the infection in some cases. Repeated ear infections can lead to hearing problems and other complications.

Understanding the disease

Symptoms

The symptoms of ear infections include tugging or pulling at an ear, trouble sleeping, crying more than usual, fussiness, trouble hearing or responding to sounds, loss of balance, fever of 100 F (38 C) or higher, drainage of fluid from the ear, headache, loss of appetite, ear pain, and drainage of fluid from the ear.

Risk Factors

Risk factors for developing ear infections include:

• Age: Children between 6 months and 2 years old are more susceptible due to their underdeveloped immune systems and the size and shape of their eustachian tubes.
• Group child care: Children in group settings are more likely to get ear infections due to increased exposure to infections like the common cold.
• Infant feeding: Bottle-fed babies, especially those who drink while lying down, are more prone to ear infections compared to breastfed babies.
• Seasonal factors: Ear infections are more common during the fall and winter months, with people having a higher risk if they have seasonal allergies during high pollen counts.
• Poor air quality: Exposure to tobacco smoke or high levels of air pollution increases the risk of ear infections.
• Alaska Native heritage: Ear infections are more prevalent among Alaska Natives.
• Cleft palate: Differences in bone structure and muscles in children with cleft palates may make it difficult for the eustachian tube to drain, increasing the risk of ear infections.
• Speech or developmental delays: Impaired hearing due to ear infections can lead to delays in speech, social, and developmental skills for infants and toddlers.

Development

Ear infections can develop in different ways:

1. Otitis media with effusion (OME): This occurs when there is swelling and fluid buildup in the middle ear without a bacterial or viral infection. It may happen after an ear infection has resolved, or it can be caused by a noninfectious blockage of the eustachian tubes. Chronic otitis media with effusion (COME) happens when fluid remains in the middle ear and continues to return without infection.
2. Chronic suppurative otitis media (CSOM): This is an ear infection that doesn't go away with the usual treatments. It can lead to a hole (perforation) in the eardrum. Ear infections are more likely to occur in children due to their underdeveloped immune systems and the size and shape of their eustachian tubes. Risk factors for ear infections include young age, exposure to tobacco smoke or air pollution, seasonal factors, group child care, and Alaska Native heritage.

Assessment and Diagnosis

Triage

You should see a doctor if ear infection is suspected when:

• Symptoms last for more than a day.
• Symptoms are present in a child less than 6 months of age.
• Ear pain is severe.
• Your infant or toddler is sleepless or irritable after a cold or other upper respiratory infection.
• You observe a discharge of fluid, pus, or bloody fluid from the ear.

Diagnosis

A doctor can diagnose an ear infection or another condition based on the symptoms described and an exam. The doctor will likely use a lighted instrument called an otoscope to look at the ears, throat, and nasal passage. They will also listen to the child's breathing with a stethoscope. If there is fluid behind the eardrum, the doctor may use a pneumatic otoscope to check for movement. Additional tests may be performed if there is doubt about the diagnosis, if the condition hasn't responded to previous treatments, or if there are other long-term or serious problems.

Management and Treatment

Complications

Potential complications of ear infections include impaired hearing, speech or developmental delays in children, spread of infection to nearby tissues such as mastoiditis or meningitis, and tearing of the eardrum that may require surgical repair. Repeated ear infections can lead to more significant hearing loss and ongoing speech or developmental delays.

Prevention

There are some ways to help prevent ear infections:

1. Hand hygiene: Encourage your child to wash their hands frequently and thoroughly, especially after using the restroom, blowing their nose, or coughing/sneezing. Teach them to use tissues and dispose of them properly, and to avoid sharing eating or drinking utensils.
2. Limit exposure to secondhand smoke: Ensure that no one smokes in your home or around your child. When outside, keep your child away from smoke-filled environments.
3. Breastfeeding: If possible, breastfeed your baby for at least six months. Breast milk contains antibodies that may offer protection from ear infections.
4. Vaccinations: Consult with your doctor about appropriate vaccinations for your child, such as seasonal flu shots, pneumococcal, and other bacterial vaccines, which may help prevent ear infections.
5. Reduce exposure to group childcare: If possible, keep your child home from childcare or school when they are ill. Limiting exposure to group childcare settings with multiple children may also help reduce the risk of ear infections.
6. Upright bottle feeding: If bottle-feeding, hold your baby in an upright position to avoid potential ear infection risks associated with propping a bottle in your baby's mouth while they are lying down.
7. Adequate ventilation: Ensure that your child's bedroom has good ventilation to prevent moisture buildup, which can contribute to the development of ear infections. Remember, while these measures can help reduce the risk of ear infections, they may not completely prevent them. It is essential to monitor your child's health and seek medical attention if you notice any signs of an ear infection or if they experience persistent symptoms.

Home Remedies

Home remedies for ear infections may include:

1. Warm compresses: Apply a warm, moist compress to the affected ear to help alleviate pain. You can use a warm towel or cloth, but be careful not to burn the skin.
2. Over-the-counter pain relievers: Ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) can help reduce pain and discomfort associated with ear infections. Always follow the dosage instructions and consult a doctor before giving medication to children.
3. Nasal decongestants and antihistamines: Decongestants can help alleviate pressure in the inner ear, while antihistamines may help with dizziness or vertigo. Consult a doctor before using these medications, especially for children.
4. Sleep upright: Elevate the head of your bed or use pillows to keep the head elevated to help reduce pressure in the inner ear, especially when sleeping.
5. Saline nasal spray: A saline nasal spray can help keep nasal passages moist, which may reduce the risk of ear infections.
6. Avoid smoking: Exposure to secondhand smoke can increase the risk of ear infections. Ensure that you and your children are in smoke-free environments.
7. Encourage good hygiene: Teach children to wash their hands frequently, avoid sharing eating or drinking utensils, cover their mouths when coughing or sneezing, and stay home when ill to prevent the spread of infection.
8. Breastfeeding: Breastfeeding, especially for at least six months, may offer some protection against ear infections as breast milk contains antibodies that can help protect against infections. If symptoms persist or worsen, it is important to consult a doctor. They can provide a proper diagnosis and recommend the best course of treatment, which may include medication or other interventions.

Treatment

Treatment for ear infections Ear infection (middle ear) treatments depend on the severity and duration of the symptoms. In most cases, ear infections resolve on their own within a few days. The following treatments may be recommended:

1. Pain Management: Over-the-counter pain relievers like ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) can help manage pain and discomfort associated with ear infections.
2. Antibiotics: If the infection is severe or persists for an extended period, a doctor may prescribe antibiotics to clear the infection. Antibiotics are typically not recommended for viral infections, as they are generally ineffective against them.
3. Observation: If symptoms are mild and the infection is likely to resolve on its own, a doctor may recommend monitoring the situation and observing the patient's condition.
4. Home Remedies: Applying a warm compress to the affected ear may provide relief from pain and discomfort. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help manage symptoms.
5. Breastfeeding: Breastfeeding can help protect infants from ear infections, as breast milk contains antibodies that may offer some protection. In some cases, surgical repair may be needed for a tear in the eardrum. This usually heals within 72 hours. Please consult a healthcare professional for personalized advice and proper diagnosis.

Preparing for medical consultation

To prepare for an appointment regarding ear infections, consider doing the following:

1. Be aware of any pre-appointment restrictions: Ask your healthcare provider if there's anything you need to do in advance, such as restricting your diet or avoiding certain activities.
2. Write down symptoms: Note any symptoms you're experiencing, including pain, hearing difficulties, dizziness, or discharge from the ear. Include the onset of each symptom and their severity.
3. Record key personal information: Provide information about any recent illnesses, changes in your immune system, or known allergies that could be related to your ear infection.
4. List medications and supplements: Make a list of all the medications, vitamins, or supplements you're currently taking to share with your healthcare provider.
5. Bring previous medical records: Bring any previous scans or X-rays, as well as any other relevant medical records, to the appointment.
6. Prepare questions: Write down any questions you may have for your healthcare provider, such as treatment options, potential side effects, or how to manage symptoms in the meantime. Remember to bring a family member or friend along for support and to help remember the information shared during the appointment.