EAR INFECTION, MIDDLE (Otitis Media)

General Information

DEFINITION--Infection in the middle ear. This is not contagious from person to person, but the preceding respiratory infection causing it may be infectious.

BODY PARTS INVOLVED--Middle-ear space where nerves and small bones connect to the eardrum on one side and the eustachian tube on the other side.

SEX OR AGE MOST AFFECTED--All ages, but most common in infants and children ages 3 months to 3 years.

SIGNS & SYMPTOMS

• Irritability.
• Earache; feeling of fullness in the ear; hearing loss.
• Fever.
• Discharge or leakage from the ear.
• Diarrhea, vomiting (sometimes).
• Pulling at the ear (small children).

CAUSES

• Viral or bacterial infection that spreads to the middle ear by way of the eustachian tube. These are usually upper-respiratory virus infections in the nose or throat.
• Sinus and eustachian-tube blockage caused by nasal allergies or enlarged adenoids.
• A ruptured eardrum.

RISK INCREASES WITH

• Recent illness, such as a respiratory infection, that has lowered resistance.
• Crowded or unsanitary living conditions.
• Genetic factors. Some American Indians, especially the Navajo, seem more susceptible.
• Cold climate.
• Change in altitude, such as flying or driving up mountains.
• Family history of ear infections.
• Day care.
• Smoking in household.

HOW TO PREVENT

• Bottle- or breast-feed an infant in a sitting position with head up, never lying down.
• Breast-feeding decreases chances of child having ear infections.
• No smoking in the household.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• Fluid from the ear may be cultured.

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Home care after diagnosis.
• Surgery to insert plastic tubes through the eardrum to drain pus or fluid from the middle ear (rare).
• If the eardrum is bulging, a small cut, or myringotomy, (See Glossary) may be made in it to relieve pressure and pain.

POSSIBLE COMPLICATIONS

• May recur.
• Chronic otitis media (pus comes from perforation in eardrum).
• Hearing impairment usually temporary, but sometimes permanent leading to delay of normal language development in children.
• Enlarged adenoids in children from repeated middle-ear infections, causing chronic middle-ear infections.
• Rarely, mastoiditis (infection of the mastoid [bony area just behind the ear]).
• Meningitis (rare).

PROBABLE OUTCOME--Symptoms usually improve in 2 to 3 days.

How To Treat

GENERAL MEASURES--

• Apply heat to the area around the ears to relieve pain.
• Swimming should be avoided until infection clears.

MEDICATION--

• Use ear drops to relieve pain. You may use non-prescription drops or those prescribed for a previous infection. They will not cure the infection.
• Use non-prescription drugs, such as acetaminophen, to reduce pain and fever.
• Your doctor may prescribe antibiotics if the infection appears to be bacterial rather than viral. Finish the medication. The infection may remain active for several days after symptoms disappear.

ACTIVITY--Rest in bed or reduce activity until fever and pain subside.

DIET--No special diet.

Call Your Doctor If

• You or your child have symptoms of a middle-ear infection.
• The following occurs during treatment: Fever. Severe headache. Earache that persists longer than 2 days, despite treatment. Swelling around the ear. Convulsions. Twitching of the face muscles. Dizziness.