Middle ear infection (otitis media)

Middle ear infection (otitis media) is inflammation located in the middle ear. The middle ear is the space behind the eardrum. Otitis media can occur as a result of a cold, sore throat, or respiratory infection.

What are the different types of a middle ear infections?

Different types of middle ear infection include the following:

• Acute otitis media (AOM) - the middle ear infection may come on quickly. Fluid and mucus become trapped inside the ear, causing the child to have a fever, ear pain and hearing loss.
• Otitis media with effusion (OME) - fluid (effusion) and mucus remain in the middle ear after an initial infection goes away. The child may have a feeling of fullness in the ear and hearing loss.

What are the symptoms of a middle ear infection?

Each child may experience symptoms differently. Some children may be asymptomatic. Symptoms may include:

• Irritability
• Difficulty sleeping or staying asleep
• Tugging or pulling at one or both ears
• Fever
• Fluid draining from ear(s)
• Loss of balance
• Hearing difficulties
• Ear pain
• Nausea and vomiting
• Diarrhea
• Decreased appetite
• Congestion

What are the causes of a middle ear infection?

Middle ear infections are usually a result of a poorly functioning eustachian tube, a canal that links the middle ear with the throat area. When this tube is working properly it:

• Allows air to ventilate into the middle ear
• Allows drainage of fluid out of the middle ear
• Protects the middle ear from bacteria and viruses

When the eustachian tube in not working properly fluid is more likely to build up behind the eardrum. When this fluid cannot drain, it allows for the growth of bacteria and viruses in the ear that can lead to an ear infection. The following are some of the reasons that the eustachian tube may not work properly:

• A cold or allergy which can lead to swelling and congestion of the lining of the nose, throat, and eustachian tube (this swelling prevents the normal flow of fluids).
• A malformation of the eustachian tube

Additional causes of ear infection include incomplete vaccination against the bacteria that cause ear infections. Other risk factors include family history of ear infections, day care attendance, and exposure to tobacco smoke.

How is an ear infection diagnosed?

In addition to a complete medical history and physical examination, your child's provider will inspect the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the provider to see inside the ear. A pneumatic otoscope may also be used; this blows a puff of air into the ear to test eardrum movement.

What are the effects of an ear infection?

In addition to the symptoms listed above, untreated ear infections can result in any or all of the following:

• Infection spreading to nearby areas of the head
• Permanent hearing loss
• Problems with speech and language development

While any child may develop an ear infection, the following are some of the factors that may increase your child's risk of developing ear infections:

• Spending time in a daycare setting
• Being around someone who smokes
• Family history of ear infections
• A poor immune system
• Absence of breastfeeding
• Having a cold
• Bottlefed while lying on the back

When should I contact a doctor?

If your child shows symptoms of an ear infection, you should contact your provider. An ear infection has to be diagnosed by examination, as some of the symptoms of ear infections can be non-specific. If your child has recurrent ear infections, or middle ear infection (otitis media) with effusion that is not going away, they may be a candidate for ear tubes.