Ear infection

• Article
• 2021-02-28

What is an ear infection?

An ear infection is inflammation of the middle ear, usually caused by bacteria, that occurs when fluid builds up behind the eardrum. Anyone can get an ear infection, but children get them more often than adults. Five out of six children will have at least one ear infection on their third birthday. In fact, ear infections are the most common reason why parents take their child to a doctor. The scientific name for an ear infection is otitis media (OM).

What are the symptoms of an ear infection?

There are three main types of ear infections. Each has a different combination of symptoms.

• Acute otitis media (AOM) is the most common ear infection. Parts of the middle ear are infected and swollen, and fluid is trapped behind the eardrum. This causes pain in the ear - commonly referred to as an earache. Your child may also have a fever.
• Otitis media with effusion (OME) sometimes occurs after an ear infection has run its course and fluid remains behind the eardrum. A child with OME may not have any symptoms, but a doctor can see the fluid behind the eardrum with a special instrument.
• Chronic otitis media with effusion (COME) occurs when fluid remains in the middle ear for a long time or returns over and over even though there is no infection. COME makes it more difficult for children to fight new infections and can also affect their hearing.

How do I know if my child has an ear infection?

Most ear infections happen to children before they have learned how to speak. If your child isn't old enough to say, "My ear hurts," here are a few things to look for:

• Tugging or pulling on the ear (s)
• Fuss and cry
• Difficulty sleeping
• Fever (especially in infants and younger children)
• Fluid drains from the ear
• Clumsiness or balance problems
• Problems hearing or responding to soft sounds

What causes an ear infection?

An ear infection is usually caused by bacteria and often starts after a child has a sore throat, cold, or other upper respiratory infection. If the infection of the upper respiratory tract is bacterial, the same bacteria can spread to the middle ear; If the infection of the upper respiratory tract is caused by a virus, such as a cold, bacteria can be drawn to the microbe-friendly environment and enter the middle ear as a secondary infection. The infection causes fluid to accumulate behind the eardrum.

The middle ear - where ear infections occur - is located between the eardrum and the inner ear. In the middle ear are three small bones, the hammer, anvil and stirrup, which transmit sound vibrations from the eardrum to the inner ear. The bones of the middle ear are surrounded by air.

The inner ear contains the labyrinth, which helps us to maintain our balance. The cochlea, part of the labyrinth, is a snail-shaped organ that converts sound vibrations from the middle ear into electrical signals. The auditory nerve carries these signals from the cochlea to the brain.

Other nearby parts of the ear can also be involved in ear infections. The Eustachian tube is a small passageway that connects the upper part of the throat to the middle ear. Its job is to supply fresh air to the middle ear, to drain fluid and to keep the air pressure between the nose and ear at a constant level.

Adenoids are small pads of tissue located behind the back of the nose, above the throat, and near the Eustachian tube. Adenoids usually consist of cells of the immune system. They fight infections by trapping bacteria that enter through the mouth.

Why are children more likely to have ear infections than adults?

There are variousreasons why children are more likely to have ear infections than adults.

Eustachian tubes are smaller and more flat in children than in adults. This makes it difficult for fluid to drain from the ear, even under normal conditions. If the eustachian tubes are swollen or blocked with mucus due to a cold or other respiratory illness, fluid may not be able to drain.

A child's immune system is not as effective as that of an adult because it is still developing. This makes it more difficult for children to fight infections.

As part of the immune system, the adenoids respond to bacteria passing through the nose and mouth. Sometimes bacteria get trapped in the adenoids, causing a chronic infection that can then be passed to the eustachian tube and middle ear.

How does a doctor diagnose middle ear infection?

The first thing a doctor will do is ask you about your child's health. Has your child recently had a cold or a sore throat? Does he have trouble sleeping? Is she pulling her ears? If an ear infection seems likely, the easiest way for a doctor is to use a lighted instrument called an otoscope to look at the eardrum. A red, protruding eardrum indicates an infection.

A doctor can also use a pneumatic otoscope, which blows a stream of air into the ear canal to check for fluid behind the eardrum. A normal eardrum moves back and forth more easily than an eardrum with fluid behind it.

Tympanometry, which uses sound tones and air pressure, is a diagnostic test that a doctor can use if the diagnosis is still not clear. A tympanometer is a small, soft plug that contains a small microphone and speaker, as well as a device that varies the air pressure in the ear. It measures how flexible the eardrum is at different pressures.

How is acute middle ear infection treated?

Many doctors will prescribe an antibiotic, such as amoxicillin, to be taken for seven to 10 days. Your doctor may also recommend over-the-counter pain relievers, such as acetaminophen or ibuprofen, or ear drops, to help with fever and pain. (Because aspirin is considered a major preventable risk factor for Reye's syndrome, a child with a fever or other flu-like symptoms should not receive aspirin unless directed to do so by your doctor.)

If your doctor cannot make a definitive diagnosis of OM and your child does not have a severe earache or fever, your doctor may ask you to wait a day or two to see if the earache goes away. The American Academy of Pediatrics issued guidelines (link is external) in 2013 that encourage physicians to observe and closely monitor these children with ear infections that cannot be definitively diagnosed, especially those between the ages of 6 months and 2 years. If there is no improvement within 48 to 72 hours of the onset of symptoms, guidelines recommend that doctors start antibiotic therapy. Sometimes an earache isn't caused by an infection, and some ear infections can get better without antibiotics. Handling antibiotics with care and rightly helps prevent the development of bacteria that become resistant to antibiotics.

If your doctor prescribes an antibiotic, it is important to make sure that your child takes it exactly as prescribed and for the full time. Although your child may look better in a few days, the infection has still not completely cleared from the ear. If you stop taking the medicine too soon, the infection may come back. It's also important to come back for your child's follow-up visit so the doctor can check to see if the infection has cleared up.

How long will it take for my child to get better?

Your child should start to feel better within a few days of visiting the doctor. If it has been several days and your child still seems sick, contact your doctor. Your child may need a different antibiotic. Once the infection has cleared, there may still be fluid

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