Ear Infections

Overview

Ear infections occur when fluid builds up in the middle ear due to blocked Eustachian tubes, occurring often in young children. Symptoms that an individual may experience include ear pain, fever, and difficulty hearing. While most infections clear up on their own, a doctor may recommend antibiotics for treating severe cases of infection. Measures such as breastfeeding, avoiding secondhand smoke, and keeping vaccinations up-to-date can help prevent the infection.

What are Ear Infections?

An ear infection or acute otitis media is an infection of the middle ear, persisting more commonly in young children and adults. This infection is triggered when the eustachian tubes get blocked or swollen, leading to a build-up of mucus in the middle ear.

The infected mucus then causes the symptoms of an ear infection in individuals. While this can clear up on its own, available treatment options help in managing pain and monitoring the severity of the infection. Antibiotics can also help in clearing the infection. However, it can cause serious complications such as hearing loss.

Types of Ear Infections

The following are different types of Ear Infections:

Otitis Externa: This is the inflammation or infection of the ear canal, that is present between the outer ear and eardrum. This fungal or bacterial infection can be caused by exposure to mechanical damage (from overzealous cleaning) o dirty water.

Acute Otitis Media: Also known as the infection of the middle ear, this is the most common ear infection characterised by redness, fluid, swelling and mucus trapped within the middle ear. This infection can cause ear pain and fever.

Otitis Media with Effusion: This is the buildup of fluid and swelling of the middle ear without the presence of any bacteria or virus. This can be triggered if the fluid buildup stays even after the recovery of an ear infection. Blockage or dysfunction of eustachian tubes can also cause this infection.

Chronic Otitis Media with Effusion: In this type of middle ea infection, the fluid remains within the infected area for a long time or frequently persists. This may restrict one’s immune system to fight new infections and may also cause hearing loss.

Serous Otitis Media: Also known as glue ear, this infection type is very common in children between the ages of six months and two years. It develops after a middle ear infection and is known by pus and fluid build-up inside the middle ear.

Infectious Myringitis: This type of ear infection is an eardrum inflammation, that is caused by infectious bacteria or viruses. The infected eardrum can form small blisters, making it painful for an individual.

Acute Mastoiditis: This is the infection of the mastoid, the bone felt immediately behind the ear. Symptoms can include fever, intense ear pain and discharge and swollen skin over the surface of the mastoid.

Symptoms of Ear Infections

Symptoms of an ear infection begin in individuals often after a cold. These may include appetite loss, ear pain, trouble sleeping or hearing in the blocked ear, a feeling of pressure or fullness in the ear, and white, yellow or brown drainage from the ear.

A young child or an infant with an ear infection may exhibit certain signs that an elder must look out for. This includes tugging or rubbing their eyes, having a fever between the range of 100.5 to 104 degrees Fahrenheit, mouth breathing or snoring increasingly, crying more than usual and refusing to eat while feeding.

Causes of Ear Infections

The bacteria or the virus present in the middle ear causes an ear infection. Other medical conditions such as an allergy, upper respiratory infection, cold, or conditions that lead to swelling and congestion of the throat, nasal passages and Eustachian tubes, also contribute to an ear infection. When the eustachian tubes become swollen, they can get blocked, leading to the buildup of fluids in the middle ear. Eventually, this fluid build-up gets infected and exhibits the symptoms of an ear infection.

The eustachian tubes in children are more horizontal and narrow, leading to an increased chance of getting clogged. Additionally, swelling of the adenoids (two tiny tissue pads found high in the back of the nose) may also block the eustachian tubes as it is located close to the tubes’ opening, eventually causing a middle ear infection. This is the common cause of ear infections in children as their adenoids are larger than adults.

Related middle ear conditions that may lead to a middle ear infection include chronic otitis media with effusion, otitis media with effusion and chronic suppurative otitis media. Changes in air pressure, sinus infections, smoking and excess mucus can also cause eustachian tube blockage.

The risk factors for developing an ear infection include being male, having a family history of the same condition, being an infant or a young child (aged between 6 months - 2 years), having chronic respiratory illnesses (asthma or cystic fibrosis) or cold, a child who is Hispanic, Native American or Alaska Native, being in daycare and living in areas that are in greater exposure to secondhand smoke and poor air quality.

An infant who drinks from a bottle while lying down is also at greater risk of an ear infection compared to breastfed babies. Lastly, seasonal factors such as fall or winter (seasons with high pollen count) also raise the risk of getting ear infections.

Diagnosis of Ear Infections

The diagnosis of ear infections primarily involves a physical examination, where a doctor asks the patient about their symptoms or identifies the signs of a cold. A healthcare provider may also conduct an ear exam using an otoscope to view the patient’s eardrum. Ear infection can be indicated by swollen, inflamed or red eardrum.

The expert may also use a pneumatic otoscope to look for fluids in the child’s middle ear. Upon finding something suspicious, the doctor may order tests such as acoustic reflectometry, hearing tests, tympanometry and tympanocentesis. Tests such as blood tests (checks the immune function), fluid samples and computed tomography (CT) scans also help in diagnosing the infection.

Treatment for Ear Infections

Treatment of ear infections depends on various factors, including the severity of the infection, the patient’s age, the duration of fluids in the middle ear and the nature of the infection. The symptoms of a mild ear infection can be alleviated by applying a warm cloth to the infected area, using prescription or over-the-counter (OTC) ear drops, taking OTC medications such as ibuprofen (Advil) or acetaminophen (Tylenol) for pain relief, using OTC decongestants such as pseudoephedrine (Sudafed) and not sleeping on the affected ear.

If the symptoms of a bacterial or chronic ear infection worsen, a healthcare provider may prescribe medicines. For a child, a doctor may ask the parents to wait and see if their symptoms improve within 2 - 3 days, if not they are given prescribed antibiotics (preferably amoxicillin). In some cases, tympanostomy tubes or ear tubes may also be inserted to prevent further ear infections in children. Myringotomy surgery can also be performed to let the fluid drain from the eardrum, resulting in pain relief. In patients who have enlarged adenoids, surgical removal of their adenoids may be ordered by doctors.

Prevention of Ear Infections

While ear infections cannot be prevented, the risk of developing them can be reduced by practising certain healthy measures. These include avoiding crowded places, washing hands frequently, breastfeeding infants instead of bottle-feeding, avoiding exposure to secondhand smoke, refraining from using pacifiers with young children and infants and keeping immunisations (yearly flu vaccines or vaccines for meningitis and pneumococcal disease) up to date. One should also complete the course of antibiotics prescribed by their doctor.

Myths and Facts Related to Ear Infections

Following are the common myths and facts surrounding Ear Infections:

Myth 1: Ear Infections Occur Only in Colder Months
Fact: While ear infections are more common during the colder months, this infection may not occur solely because of the weather. Colds flu, and other respiratory infections can lead to fluid buildup and inflammation in the ears, causing an ear infection.

Myth 2: Ear Infections are Contagious
Fact: The infection itself is not contagious. However, the infection-causing viruses and bacteria can spread from person to person.

Myth 3: Ear Infections Can Only Develop in Children
Fact: While ear infections are more common in children, they can occur in individuals of any age.