Otitis media symptoms & Treatment-various aspects-
Otitis media, which is commonly referred to as a middle ear infection, can lead to various symptoms.
Ear symptoms
Ear discomfort
Sensation of fullness in the ear
Discharge from the ear
Reduction in hearing of the affected ear
Inflammation, swelling, or opacity of the eardrum
Rupture of the eardrum
General symptoms
Fever, particularly in young children
Feeling of overall unwellness
Fatigue
Nausea
Loose stools
Reduced desire to eat
Sore throat
Other symptoms
Increased irritability
Trouble with sleep
Tugging or pulling at one or both ears
Loss of equilibrium
Coughing
Nasal blockage
Otitis media can result from a cold, influenza, or other respiratory illness. It may also arise from allergies or exposure to cigarette smoke.
Treatment
Otitis media frequently goes away on its own or responds to antibiotics. If not addressed, it might result in additional issues, such as delays in speech and language development, or irreversible hearing impairment.
Symptoms could consist of:
Abnormal irritability.
Trouble sleeping or remaining asleep.
Tugging or pulling at either or both ears.
Fever, particularly in infants and younger children.
Fluid leaking from ear(s).
Loss of equilibrium.
Hearing issues.
Ear discomfort.
Middle Ear Infection
Otitis media refers to an inflammation or infection found in the middle ear. Otitis media can happen as a consequence of a cold, sore throat, or respiratory infection.
Facts about otitis media
Approximately 3 out of 4 children will experience at least one episode of otitis media by the time they reach 3 years old.
Otitis media can also occur in adults, although it is mainly a condition that is seen in children.
Who is at risk for getting ear infections?
While any child can develop an ear infection, the following are some factors that might heighten your child’s likelihood of developing ear infections:
Being in proximity to someone who smokes
A family history of ear infections
A compromised immune system
Time spent in a daycare environment
Not being breastfed
Suffering from a cold
Being bottle-fed while lying on his or her back
What causes ear infections?
Middle ear infections typically arise from a dysfunction of the eustachian tube, a passage that connects the middle ear with the throat area. The eustachian tube assists in balancing the pressure between the outer ear and the middle ear. When this tube is not functioning correctly, it hinders the normal drainage of fluid from the middle ear, resulting in fluid accumulation behind the eardrum. When this fluid is unable to drain, it creates an environment for the proliferation of bacteria and viruses in the ear leading to acute otitis media. Below are some reasons why the eustachian tube may not operate properly:
A cold or allergy can result in swelling and congestion of the tissues in the nose, throat, and eustachian tube (this swelling blocks the normal drainage of fluids from the ear)
A structural issue of the eustachian tube
What are the different types of otitis media?
Various types of otitis media include the following:
Acute otitis media. This middle ear infection develops suddenly, resulting in swelling and redness. Fluid and mucus become trapped in the ear, causing the child to experience fever and ear pain.
Otitis media with effusion. Fluid (effusion) and mucus accumulate in the middle ear after an initial infection has resolved. The child might feel a fullness in the ear which could impact his or her hearing or may present no symptoms.
Chronic otitis media with effusion. Fluid remains in the middle ear for an extended duration or recurs frequently, even in the absence of infection. This may lead to difficulties in combating new infections and could affect the child’s hearing.
Ear Infection Symptoms
The following are the most prevalent symptoms of otitis media. Nonetheless, each child may have a distinct experience with symptoms. Symptoms may consist of:
Unusual irritability
Challenges in sleeping or staying asleep
Tugging or pulling at one or both ears
Fever, particularly in infants and younger children
Fluid leaking from ear(s)
Loss of balance
Hearing impairment
Ear pain
The symptoms of otitis media may be similar to other conditions or medical issues. Always consult your child’s health care provider for a diagnosis.
How is otitis media diagnosed?
In addition to an exhaustive medical history and physical examination, your child’s health care provider will examine the outer ear(s) and eardrum(s) with an otoscope. The otoscope is a lighted device that enables the health care provider to visualize the inside of the ear. A pneumatic otoscope releases a puff of air into the ear to assess eardrum movement.
Tympanometry is a procedure that can be conducted in most health care providers’ offices to assist in evaluating how the middle ear is operating. It does not indicate whether the child can hear or not, but it helps identify any variations in pressure within the middle ear. This test can be challenging to execute in younger children because they must remain still and not cry, speak, or move.
A hearing assessment may be conducted for children who experience frequent ear infections.
Ear Infection Treatment
The specific treatment for otitis media will be established by your child’s health care provider based on the following factors:
Your child’s age, general health, and medical history
Severity of the condition
Your child’s ability to tolerate particular medications, procedures, or therapies
Expectations regarding the progress of the condition
Your views or preferences
Treatment may consist of:
Antibiotic medication orally or via ear drops
Medication (for pain and fever)
Monitoring
A combination of the above
If fluid persists in the ear(s) for over three months, and the infection continues to recur even with antibiotic treatment, your child’s health care provider may recommend placing small tubes in the ear(s). This surgical procedure, known as myringotomy, entails creating a small opening in the eardrum to drain fluid and alleviate pressure from the middle ear. A small tube is inserted into the opening of the eardrum to ventilate the middle ear and prevent fluid from accumulating. The child’s hearing is restored once the fluid is removed. The tubes typically fall out on their own after six to twelve months.
Your child’s surgeon may also advise removing the adenoids (lymphatic tissue situated in the area above the soft palate, referred to as the nasopharynx) if they are infected. The removal of the adenoids has been shown to assist some children with otitis media.
Treatment will vary based on the kind of otitis media. Speak with your child’s health care provider concerning treatment choices.
Long Term Effects of Ear Infections
In addition to the signs of an ear infection mentioned above, untreated ear infections can lead to any or all of the following:
Infection in other areas of the head
Permanent hearing impairment
Issues with speech and language development
Diagnosis and Tests
How is an ear infection identified?
Most healthcare professionals can determine if your child has an ear infection based on symptoms, a physical examination to look for signs of a cold, and an ear examination. For the ear exam, your child’s healthcare professional will inspect your child’s eardrum with a lighted device known as an otoscope. An eardrum that appears inflamed, swollen, or red indicates an ear infection.
Your child’s provider might utilize a pneumatic otoscope to assess for fluid in your child’s middle ear. A pneumatic otoscope sends a puff of air against the eardrum, which should cause movement. If fluid is present in your child’s ear, it will not move easily.
Are there extra tests my child might require?
Your child may require additional tests, including:
Tympanometry: This assessment employs air pressure to detect fluid in your child’s middle ear.
Acoustic reflectometry: This evaluation utilizes sound waves to check for fluid in your child’s middle ear.
Tympanocentesis: This procedure enables your child’s provider to extract fluid from your child’s middle ear and analyze it for viruses and bacteria. Your provider may suggest tympanocentesis if other treatments have not resolved the infection.
Hearing tests: An audiologist may conduct hearing tests to assess if your child experiences hearing loss. Hearing loss is more prevalent in children with persistent or recurrent ear infections or fluid in the middle ear that does not drain.
Management and Treatment
How is an ear infection managed?
Management relies on several factors, including:
Your child’s age.
The extent of the infection.
The type of infection (first incident, ongoing, or recurrent infection).
The duration of fluid presence in the middle ear.
In many cases, ear infections resolve without intervention. Your provider may observe your child’s condition to see if there is improvement before suggesting treatments. Your child might require antibiotics or surgery for infections that persist. Meanwhile, pain relief medications can assist with symptoms such as ear discomfort.
Antibiotics
Your child might need antibiotics if bacteria are responsible for the ear infection. Healthcare providers may wait for up to three days before administering antibiotics to determine if a mild infection resolves independently. If the infection is serious, your child may need to begin antibiotics right away.
The American Academy of Pediatrics offers guidelines on when a child should be given antibiotics and when monitoring is preferable. Factors include your child’s age, the intensity of their infection, and their temperature. The table below summarizes the recommendations.
Pain-relieving medications
Your healthcare provider might suggest over-the-counter (OTC) medications, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), to help alleviate pain and lower fever. They may also prescribe pain-relieving ear drops. Follow your provider’s recommendations regarding which medicines are appropriate for your child.
Never administer aspirin to children. Aspirin has the potential to lead to a severe condition known as Reye’s syndrome.
Ear tubes (tympanostomy tubes)
Your child might require ear tubes if they suffer from frequent ear infections, infections that do not improve with antibiotics, or hearing loss due to fluid accumulation. An ear, nose, and throat (ENT) specialist places the tubes during a tympanostomy. This is a brief (roughly 10-minute) procedure. Your child can return home that same day.
During a tympanostomy, a provider inserts a small metal or plastic tube into a small incision (cut) in your child’s eardrum. The procedure of puncturing (creating a hole in) and draining the eardrum is referred to as a myringotomy. After the tubes are placed, they allow air to enter the middle ear and enable fluid to drain.
The tube typically remains in position for 12 to 18 months. It may detach on its own, or your child may require a surgical procedure for removal. Once the tubes are removed, the hole in your child’s eardrum will heal and close.
Prevention
What can I do to prevent ear infections?
Here are several methods to minimize your or your child’s chances of developing ear infections:
Prevent colds and other respiratory illnesses. Take proactive steps to avoid colds, particularly during your child’s first year. Educate them about proper handwashing and the importance of coughing or sneezing into their elbow. Discourage sharing of food, cups, or utensils. If possible, refrain from enrolling them in large daycare centers until they are older.
Avoid secondhand smoke. Steer clear of exposure to secondhand smoke, and refrain from allowing others to smoke in your child’s vicinity.
Breastfeed (chestfeed) your baby. Whenever feasible, breastfeed your baby during the initial six to twelve months. Antibodies present in breast milk (chest milk) combat viruses and bacteria that can lead to infections.
Bottle-feed your baby in an upright position. If you are bottle-feeding, hold your baby upright so their head is elevated above their stomach. This position can help prevent formula or other fluids from flowing back and accumulating in their eustachian tubes.
Stay up to date on vaccinations. Ensure that your child’s vaccinations are up to date, including annual flu shots for children 6 months and older. Inquire with your child’s pediatrician about vaccines for pneumococcal disease and meningitis.
Outlook / Prognosis
Can an ear infection go away on its own?
Yes, most infections resolve independently. This is the reason your healthcare provider may choose to wait before recommending medications such as antibiotics. In the interim, pain relievers can assist with symptoms, like ear pain.
Depending on your child’s age, symptoms, and temperature, they might require antibiotics to recover. If your child experiences persistent or frequent infections, or if fluid stays in the middle ear and endangers their hearing, ear tubes might be necessary for your child. Adhere to your healthcare provider’s instructions regarding the care of your child.
When can my child go back to regular daily activities?
Children can resume school or daycare once their fever has subsided.
Living With
When should I consult my healthcare provider about an ear infection?
Reach out to your healthcare provider right away if:
Your child develops a rigid neck.
Your child appears lethargic, seems very ill, or continues to cry despite all attempts.
Your child’s walking isn’t stable.
The ear pain you or your child experience is intense.
You or your child have a fever exceeding 104 degrees F (40 degrees C).
Your child exhibits symptoms of facial weakness. (Watch for an uneven smile. )
You notice blood or pus-like fluid leaking from the ear.
Contact your healthcare provider during regular office hours if:
A fever persists or reoccurs more than 48 hours after beginning an antibiotic.
Ear pain does not improve after three days of antibiotic treatment.
Additional Common Questions
Do I need to shield my child’s ears if they go outdoors with an ear infection?
No, it is not necessary to cover their ears for outdoor activities.
Is it permissible for my child to swim with an ear infection?
Swimming is acceptable as long as your child does not have a perforation in their eardrum or discharge from their ear.
Am I allowed to travel by air or be in high altitudes if I have an ear infection?
Air travel or visiting mountain areas is safe, although you might experience temporary discomfort during takeoff and landing when flying. Drinking fluids or chewing gum during descent can alleviate the discomfort. If your young child has an ear infection, allow them to suck on a pacifier to ease discomfort while traveling by air.
A note from Cleveland Clinic
Reach out to your child’s pediatrician if they exhibit signs of an ear infection and their condition does not improve within two to three days. Frequently, ear infections resolve on their own without treatment. Depending on your child’s age and symptoms, antibiotics may be necessary. Your child’s healthcare provider can suggest pain relief options as your child’s body recovers from the illness.
