Middle Ear Infections
In the early stages, middle ear infections can be very painful. Sometimes, associated
problems linger for months and affect hearing. But, despite their potential severity,
middle ear problems respond well to treatment.
What are
middle ear infections?
Middle ear infections occur behind the eardrum (the thin sheet of tissue that
passes sound waves between the outer and middle ear). These infections are usually due to
bacteria or viruses, which are often related to a recent cold or allergy problem. In many
cases, both ears are affected. Middle ear infections are most common in young children,
whose ear anatomy is not yet fully developed. Children under age 5, boys, bottle-fed
infants, and children in daycare run the greatest risk of infection. Although much less
common, middle ear infections can also occur in older children and adults. |
Are these
infections serious?
Middle ear infections can be painful and they tend to disrupt sleep- for you as well as
for your child. But this isn't the full extent of the problem. Middle ear infections can
also limit the eardrum's flexibility, reducing your child's ability to hear. This could
make it harder for your child to learn to talk. Depending on when the hearing problem
starts and how long it lasts, your child's learning ability could be affected. |
What causes Middle Ear Fluid?
Here are some things that may cause middle ear fluid to happen in your child:
- Past ear infection. It is common for children to have middle ear infections.
And some children with middle ear infection later have middle ear fluid.
- Blockage of the Eustachian tube.
- Cold or flu
There is no one cause for middle ear fluid. Often, your child's health care
provider will not know what caused the middle ear fluid.
How can Middle Ear Fluid be prevented?
Recent studies show that children who live with smokers and who spend time in group
child care have more ear infections.
Because some children who have middle ear infections later get middle ear fluid, you
might help prevent middle ear fluid by:
- Keeping your child away from cigarette smoke.
- Trying to keep your child away from playmates who are sick.
Treatment restores health and hearing
Middle ear infections can be treated, but over-the-counter remedies aren't the answer.
Middle ear problems need a doctor's case. Special medications are often used to cure or
prevent infection. In some cases, the doctor may suggest a simple surgical procedure to
control future problems.
Medical Care
The doctor examines your child to diagnose the cause of his or her symptoms. If a
middle ear infection is present, your child's age and the number and severity of
infections all influence treatment decisions. Your child's treatment plan may include
using antibiotics and finding ways to reduce the risk of future infections. |
Surgical Care
If your child has ongoing or frequent middle ear problems, the doctor may recommend
surgery to stop discomfort and correct any hearing loss. The procedure used to treat
middle ear problems is quick and effective. In fact, children can almost always be treated
and released the same day (outpatient surgery). |
Making a diagnosis
If an ear problem seems likely, the doctor will examine your child and view both
eardrums. Tests may be done to check the condition of the middle ear or to measure any
hearing loss. Treatment recommendations will be based on results of the exam and any
tests, as well as your child's health history.
Examining your child
| The physical exam helps the doctor determine the specific
type of ear problem affecting your child. The exam also helps identify any respiratory
illnesses, such as bronchitis, pneumonia, or strep throat. During the exam, the doctor
listens to your child's heart and lungs |
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and looks in the ears, nose, and throat. If your child's tonsils
(masses of tissue near the back of the throat) are greatly enlarged, the doctor may check
the adenoids (pads of tissue in the upper part of the throat) as well. |
Viewing the
eardrum
If the doctor suspects a middle ear problem, pneumatic otoscopy is almost always
performed. Using a special device (otoscope) to look down the ear canal, the doctor views
the eardrum and any fluid behind it. Once in place, the device can also be used to change
the amount of air pressure in the canal, so the doctor can see how flexible the eardrum
is. Reduced eardrum flexibility is often linked with fluid buildup. Pneumatic otoscopy
takes just seconds and rarely causes discomfort. |
If adenoids
are infected
The adenoids are located near the site where the Eustachian tube opens into the throat.
Their job is to help filter inhaled germs before they reach the lungs. If the adenoids
themselves get infected, they may swell. After repeated infections, the adenoids may
remain enlarged, blocking the Eustachian tube opening. In some cases, germs stopped by the
adenoids may enter the Eustachian tube and spread to the middle ear. Adenoid-related ear
problems happen more often in older children and adults. |
Checking
the middle ear
If your child can sit still for several minutes, the eardrum and middle ear may be
tested to learn how well they are working. Tympanometry and acoustic reflex
testing both use a probe to send air and sound through the outer ear. Tympanometry
measures the amount of sound bouncing off the eardrum. The purpose is to evaluate the
eardrum's flexibility and its response to loud sounds.
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Identifying hearing loss
To learn if a young child has trouble hearing, the doctor or a hearing specialist may
talk or play with the youngster. The child's response to changes in the speaker's voice
helps identify hearing loss. Older children and adults may be given an audiometric test.
In some cases, young children with chronic fluid may also be tested. During audiometry,
sound waves are sent into the outer ear or vibrations are passed through the bones behind
the ear. The listener signals every time he or she hears a tone. Test results are used to
identify the types of sounds that can and cannot be heard. |
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Other tests
If the doctor suspects a problem with the structure of your child's ear, a special test
may be done. A computed tomography (CT) scan shows the images of the middle ear
bones or bone surrounding the ear. Magnetic resonance imaging (MRI) is used to
check for soft tissue problems, such as nerve damage or tumors. To identify an inner ear
problem, a sophisticated hearing test may be done to pinpoint any problem with the nerve
pathways that send signals to the brain. These tests take time to perform, but they do not
cause pain. |
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Medical care comes first
Most children have had at least one middle ear infection by the age of 2. Treatment may
depend on whether the problem is acute or chronic, as well as how often it comes back and
how long it lasts. The doctor may prescribe medication and then watch to see how healing
progresses. For many children, taking antibiotics and reducing risk factors are all the
treatment that's needed. |
Watching and waiting
If this is your child's first or second acute infection, the doctor may prescribe
antibiotics and suggest a period of "watchful waiting". During this time, your
child's ears will probably be retested to look for any eardrum or hearing changes. In most
cases, fluid outlasts the acute infection by two or three weeks. If the fluid buildup
becomes chronic, however, the doctor may watch your child for up to several months. Why?
Because even chronic fluid may go away with time - provided that no new infection occurs.
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Reducing risk factors
Some behaviors or surroundings increase your child's risk of ear infection. Reducing
such risk factors can be a benefit at any point in treatment. The tips below may help:
- If your child goes to group daycare, he or she runs a greater risk of getting colds or
flu. Help prevent these illnesses by teaching your child to wash his or her hands often.
- If food allergies are a problem, identify the food that triggers the reaction and help
your child avoid it. In some children, eating or drinking dairy products causes tissues
around the Eustachian tube to swell. This may make a blockage more likely.
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Using antibiotics
Antibiotics may be used as a short- or long-term treatment, depending on whether the
ear problem is acute or chronic. Either way, antibiotics will be effective only in
treating bacterial infections. For an acute middle ear infection, the doctor may prescribe
7 to 14 days of antibiotic treatment. In a case of chronic fluid, the doctor may suggest
using antibiotics to prevent any new infection while waiting for the fluid to go away.
Such antibiotic use may last weeks or months.
Although most children can take antibiotics without problems, side effects can occur.
Some children get stomach upset, including vomiting or diarrhea. Some get rashes, hives,
puffy eyes, or yeast infections. In rare cases, an allergic reaction may cause breathing
problems that require immediate medical care. If your child shows any type of reaction
during antibiotic use, call the doctor. |
Tips on taking antibiotics
To be effective, antibiotics must be taken correctly. Follow these tips for the best
results:
- Ask if your child can be given a prescription that needs to be taken only once or twice
a day. This may make life easier for everyone.
- Find out if doses should be given with meals or spaced equally throughout the day. Also,
ask if your child should stop eating certain foods while on the antibiotic.
- Be sure your child takes the medication as prescribed while attending daycare or school
or while staying in another household. Send a note with instructions to the teacher or
other responsible adult.
- Store the antibiotic correctly. The pharmacist can tell you if it needs to be kept out
of sunlight or placed in the refrigerator.
- Measure liquid doses carefully, so you won't run out of medication too soon.
- Make sure your child takes the entire prescription.
Limiting future problems
Most children outgrow middle ear problems by about age 8. Until then, however, you can
reduce your child's risk of middle ear infection by following these tips:
- Teach your child good habits that help prevent colds, such as washing hands often and
using tissues instead of handkerchiefs.
- Teach your child to drink only from his or her own container.
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- Keep your child away from secondhand smoke.
- Follow the doctor's advice about keeping your child's ears dry.
- Call the doctor if you suspect your child has an ear problem. Don't wait. Delaying
treatment could affect hearing!
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