Ear Infection

What is an Ear Infection (Acute Otitis Media)?

An ear infection, or acute otitis media, is a sudden infection of the middle ear—the air-filled space behind the eardrum that houses tiny bones responsible for transmitting sound to the inner ear. Eustachian tubes, which connect the middle ear to the back of the throat, help regulate air pressure and drain fluid. When these tubes are blocked or don’t function well, fluid can accumulate in the middle ear, leading to muffled hearing. Infections caused by bacteria or viruses can inflame this fluid, resulting in discomfort and impaired hearing.

How Common Are Ear Infections?

Ear infections are one of the most frequent childhood illnesses, second only to colds. They are most common in children aged 6 months to 2 years but can occur until about age 8. Adults and older children can also experience ear infections, though they are less frequent.

Why Are Children More Susceptible?

Children are more prone to ear infections because:

• Their Eustachian tubes are smaller and less efficient at draining fluid.
• Their immune systems are still developing.
• They are exposed to more germs through close contact with other children.

Symptoms and Causes of Ear Infections

Ear infections often arise after a cold and may include:

• Ear pain or discomfort.
• Loss of appetite.
• Difficulty sleeping.
• Muffled hearing or trouble hearing in the affected ear.
• A feeling of fullness or pressure in the ear.
• Drainage of yellow, brown, or white fluid from the ear, indicating a possible ruptured eardrum.

For infants and young children who cannot express their discomfort, signs may include:

• Tugging or rubbing at their ears.
• Increased fussiness or crying.
• Fever (100.5–104°F).
• Mouth breathing or snoring, potentially from swollen adenoids.
• Reduced appetite, as swallowing may worsen ear pain.

Ear infections are typically caused by bacteria or viruses that travel to the middle ear after an upper respiratory infection, such as a cold. Blocked or swollen Eustachian tubes trap fluid in the ear, creating an environment where bacteria or viruses thrive.

Are Ear Infections Contagious?

While ear infections themselves are not contagious, the underlying cold or flu virus that may lead to an infection is.

Risk Factors for Ear Infections

• Age: Most common in children aged 6 months to 2 years.
• Family history: A genetic predisposition can increase risk.
• Daycare exposure: Increased contact with contagious illnesses.
• Chronic conditions: Such as asthma or immune deficiencies.
• Environmental factors: Poor air quality or exposure to secondhand smoke.

Potential Complications

Although rare, untreated or repeated ear infections can lead to:

• Hearing loss: Temporary or, in severe cases, permanent.
• Delayed speech development: Caused by impaired hearing during formative years.
• Ruptured eardrum: Often heals naturally, but surgery may be necessary in persistent cases.
• Spread of infection: Severe cases can affect nearby bones or even the brain’s protective layers, leading to conditions like mastoiditis or meningitis.

Diagnosis and Tests

An ear infection is typically diagnosed based on symptoms and a physical examination. A healthcare provider will use an otoscope to inspect the eardrum, looking for signs of inflammation or redness. To check for fluid, they may use a pneumatic otoscope, which releases a puff of air at the eardrum. If fluid is present, the eardrum will not move as expected.

Additional Tests

If necessary, your provider may conduct:

• Tympanometry: Checks for fluid using air pressure.
• Acoustic reflectometry: Uses sound waves to detect fluid.
• Tympanocentesis: Removes fluid for testing.
• Hearing tests: Assess hearing if fluid causes hearing loss.

Management and Treatment

Treatment depends on your child’s age, infection severity, and the duration of symptoms. Many ear infections resolve on their own, and your provider may simply monitor the situation. If the infection persists, antibiotics or even surgery might be needed. Pain relief can be provided with over-the-counter pain medications.

Antibiotics

If the infection is bacterial, antibiotics may be prescribed. Providers often wait a few days to see if the infection improves naturally. In severe cases, antibiotics may be given immediately.

Pain-Relieving Medications

Your healthcare provider may recommend over-the-counter pain relievers like acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) to ease pain and reduce fever. Ear drops may also be prescribed. Always follow the provider’s instructions and avoid giving aspirin to children due to the risk of Reye’s syndrome.

Ear Tubes (Tympanostomy Tubes)

For frequent ear infections or fluid buildup, ear tubes may be recommended. A quick procedure places small tubes in the eardrum to allow fluid drainage and air into the middle ear. These tubes typically stay in for 12 to 18 months and may eventually fall out.

Prevention

To reduce the risk of ear infections, take steps to prevent colds and respiratory illnesses, avoid secondhand smoke, breastfeed, and keep up with vaccinations, including flu shots and pneumococcal disease vaccines.

Outlook / Prognosis

Most ear infections resolve on their own, though antibiotics may be needed if symptoms persist. For recurrent infections or fluid buildup, ear tubes may be necessary.