Middle Ear Infections (Otitis Media)

A common ear infection, known as “Otitis media” is the inflammation of the space behind the eardrum called the middle ear. This infection may be caused by bacteria or more commonly a virus, or by the presence of fluid in the ears. Redness of the eardrum may indicate an infection, which is known as acute otitis media, and may be treated with antibiotics to kill the bacteria. If there is fluid behind the drum but no redness or infection, that is known as otitis media with effusion, or fluid, and often the fluid will go away on its own.

Pain in the ear is the most common sign for acute otitis media, which may manifest itself as irritability or tugging of one or both ears in young children. Other symptoms may include fever, pressure, a feeling of ear fullness, ringing in the ears, or hearing loss. Otitis Media with Effusion (non-infected) typically does not cause pain or fever, but rather fullness, decreased hearing, and ringing in the ears.

In most instances, our physicians will call for a tympanogram, which measures the pressure of the middle ear by placing a probe in the ear canal to confirm whether fluid is present. A hearing test may also be ordered to evaluate for hearing loss.

The Eustachian tube is a small channel running from the middle ear space to the back of the nose to allow pressure or fluid to drain out of the middle ear and into the back of the nose. “Popping” your ears by blowing gently while closing your nose and mouth may force open this tube to relieve any pressure behind your eardrum. The Eustachian tube is lined with the same type of lining as the inside of your nose, so any condition that causes swelling in the inside of your nose, such as allergy or infection, may also cause swelling, which causes the Eustachian tube to close. If this tube does not open, fluid and pressure may build up behind the eardrum, which causes intermittent ear pain, ear fullness, popping sounds or hearing loss. Persistent fluid may cause otitis media with effusion or if infected may cause acute otitis media. If the Eustachian tube continues to dysfunction, pressure and fluid behind the eardrum may rupture, which allows fluid to leak out of the ear canal.

All children with otitis media or otitis media with effusion experience some degree of hearing loss, which is typically only equivalent to placing your hands over your ears. Misunderstanding speech may become a problem in adults, but in children, such hearing loss could result in delayed speech and language skills. Hearing can be immediately restored by draining the fluid with ear tubes.

There are several factors that increase the risk of otitis media in children and adults. In general, children will experience more ear infections than adults because their Eustachian tube is much smaller and therefore may become more easily dysfunctional (“closes up”).

Exposure: The more a child is exposed to other children, such as in school or day care, the greater his or her risk of exposure to harmful, infection-causing bacteria.

Smoking and Second-hand Smoke: Second-hand smoke has been linked to an increase in otitis media in children of smoking parents.

Enlarged Adenoids: The adenoids are like tonsils that are located behind the nose near the opening of the Eustachian tube. If they become enlarged, they may block the Eustachian tube or harbor infection.

Acute otitis media is typically caused by bacteria such as Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis, and antibiotics are often used to kill these bacteria, the most common being amoxicillin. Amoxicillin has a long record of safety; however there has been an increase in resistance from some bacteria, so amoxicillin is often prescribed in higher doses. Other antibiotics may be prescribed, including azithromycin (Zithromax), clarithromycin (Biaxin), and amoxicillin-clavulanate (Augmentin), or cefdinir (Omincef).

Antibiotic resistance has become a major concern lately. If a patient uses antibiotics for an extended period or takes several antibiotics but continues to have infections, the bacteria may have developed resistance to the prescribed antibiotics. Additionally, all medications have the potential for side effects, especially when taking for extended periods, such as gastrointestinal issues or rashes.

Lastly, antibiotics do not treat the underlying cause of otitis media, so repeated infections may occur.

Just as allergies can cause the lining of the nose to swell and enlarge, the lining of the Eustachian tube may also swell with allergy exposure. This may cause the tube to close and become dysfunctional resulting in pressure sensation, popping, or hearing loss.

Most children with otitis media outgrow the problem between ages 3-5 because their Eustachian tube becomes more functional as they age, allowing fluid and pressure to drain from the middle ear. Additionally, a child’s immune system becomes more effective in fighting infection as he or she ages.

General ENT

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