Acute middle ear infection

Ear infections are some of the most common reasons parents take their children to the doctor. Although these types of ear infections are more common in childhood they are not uncommon in adults. While there are different types of ear infections, the most common is called otitis media, which means an inflammation and infection of the middle ear. The middle ear is located just behind the eardrum.

The term “acute” refers to a short and painful episode that has occured over the course of hours to days. An ear infection that lasts a longer time or comes and goes over a longer period of time is called chronic otitis media.

For each ear, a eustachian tube runs from the middle ear to the back of the nose to a space that is called the nasopharynx. This tube drains fluid that is normally produced by the lining of the middle ear and helps us to equalize the pressure in the ear by yawning or swallowing as we are descending to our destination on a flight home. If the eustachian tube becomes blocked, or doesn’t function as it should, fluid may build up in the middle ear space. When this happens, germs such as bacteria and viruses can multiply and cause an infection. Infections usually result in severe ear pain, clogging, muffled hearing, occasionally a ringing sensation in the affected ear, lack of balance and less commonly a perforation in the ear drum that will culminate a sudden very sharp painful sensation in the ear followed by the onset of yellowish very frequently foul smelling discharge from the ear (pus) that may crust.

Ear infections are common in infants and children, in part because the skull has not matured enough yet. As our skull goes from a more rounded shape to an elongated shape, the angle at which the eustachian tubes changes. We start from having more flattened horizontal eustachian tubes to more angled ones that allow gravity to help in the drainage. This is why childrens’ eustachian tubes become more easily clogged and they develop more middle ear infections.

Ear infections may also occur in adults, although they are less common than in children. Adults who have had middle ear infections in childhood are more likely to suffer from middle ear infections later in life.

Anything that causes the eustachian tubes to become swollen or blocked can lead to a fluid tbuild up in the middle ear behind the eardrum. These causes include:

  • Allergies
  • Colds and sinus infections or post nasal drip
  • Excess mucus and saliva produced during teething
  • Infected or overgrown adenoids – tissue in the back of the nasal cavity or nasopharynx, more common in children
  • Tobacco smoke or other irritants
  • Bottle feeding infants while laying flat can irritate the ends of the eustachian tubes and lead to infection.
  • Certain forms of acid reflux or silent reflux

Ear infections are also more likely if a child spends a lot of time drinking from a sippy cup or bottle while lying on his or her back. Contrary to popular opinion, getting water in the ears will not cause an acute ear infection, unless the eardrum has a hole from a previous episode. Swimmer’s ear is different than a middle ear infection and usually only involves the ear canal or everything leading to but not including the ear canal. The symptoms of swimmer’s ear may sometimes mimic those of a middle ear infection if they present with ear pain, fullness or clogging and discharge. It is important to see an ear nose and throat specialist to help to differentiate between the two. A middle ear infection is not going to respond to ear drops and outer ear infections will equire topical ear drops and sometimes other means to get better.

Middle ear infections occur most often in the winter. This is the time, cold viruses are more common during this time and are easily passed from one person to another. You cannot catch an ear infection from someone else, but a colds spread esaily in daycare facilities among children who commonly pass snotty nose to hand and infect their peers.

Risk factors for ear infections include the following:

  • Attending daycare (especially those with more than 6 children) – if a large number of kids in your daycare have colds, it is sometimes advisable to remove your child from daycare until the end of the cold season.
  • Changes in altitude or climate. Flying with a cold can commonly lead to eustachian tube dysfunction and development of an ear infection.
  • Cold climate
  • Exposure to smoke in the household – especially with young children at home it is important for smokers to keep their habits outdoors.
  • Genetic factors (susceptibility to infection may run in families)
  • Not being breastfed – the passage of important immune factors from mother to babe in the first six months after birth offers some protection from ear infections
  • Pacifier use – early weaning of your child from pacifiers will reduce the occurrence of middle ear infections.
  • Recent ear infection
  • Recent illness of any type (lowers resistance of the body to infection)
  • Feeding the infant in an overly reclined (supine or on the baby’s back) position

In infants, the clearest sign is often irritability and inconsolable crying. Many infants and children develop a fever or have trouble sleeping. Parents often think that tugging on the ear is a symptom of an ear infection, but studies have shown that the same number of children going to the doctor tug on the ear whether or not the ear is infected.

Symptoms in older children or adults include:

  • Ear pain or earache
  • Fullness in the ear
  • Feeling of general illness
  • Vomiting
  • Diarrhea
  • Hearing loss in the affected ear

The child may have symptoms of a cold, or the ear infection may start shortly after having a cold.

All acute ear infections include fluid behind the eardrum. You can use an electronic ear monitor, such as EarCheck, to detect this fluid at home. The device is available at pharmacies or on amazon, but you still need to come see our doctor to confirm any possible ear infection. At Dagan MD NYC we will diagnose and treat middle ear infections and prevent complications.

At Dagan MD, our doctor will first ask if there have been any ear infections in the past, and whether your child (or you, if you are the patient) have had any recent cold or allergy symptoms.

Our doctor will perform a physical exam. This will include an examination of the throat, sinuses, head, neck, lungs, and ears. our doctor looks inside the ears using an instrument called an otoscope or a microscope that helps to magnify the ear. If infected, there may be areas of dullness or redness, or there may be air bubbles or fluid behind the eardrum that may bulge outward. The fluid in the middle ear may be bloody or filled with pus. We will also check for any signs of perforation (a hole) in the eardrum. If any discharge is seen, a special suction device (miniature ear vacuum) will be used gently to remove the discharge to provide relief from the clogging and discomfort. The suction is rarely painful but produces a windlike noise in the ear.

A hearing test may be recommended if there is a history of persistent (chronic and recurrent) ear infections or if hearing loss lasts for more than just a few days.

Some ear infections will safely clear up on their own without any antibiotics. Often, treating the pain and allowing the body time to heal itself is all that is needed:

  • Apply a warm cloth or warm water bottle to the affected ear. This will provide some relief from the pressure and pain inside the ear.
  • Although over-the-counter pain relief drops for ears like Auralgan are more useful in outer ear infections, they may provide some temporary relief. Call our office or schedule an appointment to find out about prescription medications for ear pain.
  • Take over-the-counter medications for pain or fever, such as ibuprofen or acetaminophen. Do NOT give aspirin to children.

All children younger than 6 months with a fever or symptoms should see the doctor. Children who are older than 6 months may be watched at home if they do not have:

  • A fever higher than 102 °F
  • More severe pain or other symptoms
  • Other medical problems

If there is no improvement or symptoms get worse, schedule an appointment with your health care provider to determine whether antibiotics are needed.

A virus or bacteria can cause ear infections. Antibiotics will not help an infection caused by a virus. Many health care providers no longer prescribe antibiotics for every ear infection. However, all children younger than 6 months with an ear infection are treated with antibiotics.

At Dagan MD NYC, our doctors are more likely to prescribe antibiotics if:

  • Your child is under age 2
  • Has a fever
  • Appears sick
  • Is not improving over 24 to 48 hours

Make sure you or your child takes the antibiotics every day and finishes all the medicine, rather than stopping when symptoms go away. This is a recipe for return of the symptoms and turning bacteria more resistant to the antibiotic treatment later. If the antibiotics do not seem to be working within 48 to 72 hours, contact us or make an appointment at Dagan MD to be seen again. You or your child may need to switch to a different or stronger antibiotic.

Amoxicillin or augmentin is commonly the first choice in the treatment of middle ear infections. Other antibiotics that may be given include azithromycin or clarithromycin, cefdinir, cefuroxime, cefpodoxime, amoxicillin clavulanate (Augmentin), clindamycin, or ceftriaxone.

Side effects of antibiotics may include nausea, vomiting, and diarrhea. Although rare, serious allergic reactions may also occur. Always make sure to tell us about preexisting medical conditions, other medications you may be taking and previous side effects or allergic reactions to antibiotics in the past.

Some children who suffer from repeat infections that seem to go away in between may receive a smaller, daily dose of antibiotics to prevent new infections.

What happens ff an infection does not go away with the usual medical treatment?

When there are many ear infections over a short period of time or when middle ear infections result in a non resolving accumulation of fluid inside the middle ear causing hearing loss, we may recommend the insertion of ventilating tubes in the ears.

  • In children, this procedure is performed under a brief general anesthetic in an ambulatory setting. A tiny incision is made in the ear drum through which , a very small tube is passed across the eardrum, intentionally maintaining a small hole  that allows air to get in the middle ear so fluids can drain out more easily. The tube usually remains in the ear for several months before falling out on its own. Occasionally, if middle era infections recur a different kind of tube will be inserted that may remains there even for several years before being taken out. In adults this procedure is usually performed in the office under local anesthetic.
    Usually the tubes fall out by themselves. Those that don’t fall out may be removed in your doctor’s office.
  • If the adenoids are enlarged as well, located very close to the end of the eustachian tube they may cause an obstruction of the clearance of the middle ear. In these cases, surgical removal of the adenoids may be considered, especially in the setting of recurrent ear infections. Removing tonsils does not seem to help with ear infections.

Expectations (prognosis)
Ear infections can be treated but may occur again in the future. They can be quite painful. If you or your child are prescribed an antibiotic, it is important to finish all  medications as instructed. Middle ear infections of childhood do commonly resolve as the child grows and the aeratino of the middle ear develops although in some cases it may persist into adulthood.

Generally, an ear infection is a simple, uncomplicated condition. Most children will have minor, temporary hearing loss during and right after an ear infection. This is due to fluid lingering in the ear. Hearing loss is important to identify early in order to prevent the child from developing learning or developmental delays.

When fluid can remains behind the eardrums even after the infection has cleared, it is called otitis media with effusion. This may cause hearing loss and speech, learning delays and behavioral issues. Identifying chronic otitis media with effusion with hearing tests is very important. The solution is ventilating tubes which restores hearing to normal and may need to be repeated.

Other potential complications from otitis media include:

  • Ruptured or perforated eardrum
  • Chronic, recurrent ear infectionsEnlarged adenoids or tonsils
  • Mastoiditis (an infection of the bones around the skull)
  • Meningitis (an infection of the brain)
  • Formation of an abscess or a cyst (called cholesteatoma) from chronic, recurrent ear infections
  • Speech or language delay in a child who suffers lasting hearing loss from multiple, recurrent ear infections

When to call the doctor?

Call the doctors at Dagan MD NYC if you develop any of the following signs:

  • Pain and fever that do not improve within 24 to 48 hours
  • Severe pain suddenly stops hurting followed by some discharge from the ear — this may indicate a ruptured eardrum
  • New symptoms appear, especially severe headache, dizziness, swelling around the ear or behind the earlobe, or twitching of the face muscles
  • Your symptom worsen
  • At the start, the child seems sicker than just an ear infection
  • Severe pain suddenly stops hurting followed by some discharge from the ear — this may indicate a ruptured eardrum
    Symptoms worsen
  • New symptoms appear, especially severe headache, dizziness, swelling around the ear or behind the earlobe, or twitching of the face muscles

For a child younger than 6 months, let our doctors know right away if the child has a fever, even if no other symptoms are present.

Prevention (mostly advice for children)

You can reduce the risk of ear infections with the following practices:

  • Wash hands, dishes and your children’s toys frequently.
  • If possible, choose a daycare that has a class with 6 or fewer children. This can reduce your child’s chances of getting a cold or similar
  • infection, and leads to fewer ear infections.
  • Avoid pacifiers.
  • Breastfeed — this makes a child much less prone to ear infections. But, if bottle feeding, hold your infant in an upright, seated position.
  • Do not expose your child to secondhand smoke.
  • Make sure your child’s immunizations are up-to-date. The pneumococcal vaccine prevents infections from the bacteria that most commonly causes
  • acute ear infections and many respiratory infections.
  • Avoid overusing antibiotics. Overusing antibiotics can lead to antibiotic resistance.

Inquire with our audiology doctors about swim ear plugs, water protection while swimming if you have tubes we will costumize swim plugs to your ear canal.

At Dagan MD NYC we perform insertion of ventilating tubes, we treat tympanic membrane perforation and repair hearing loss.