Treat a Middle Ear Infection

Middle ear infections are fairly common in childhood. One of every 10 children will experience otitis media, the medical term for middle ear infection, every year. This is 10 times the number of adults who will suffer from a middle ear infection.[1] Otitis media (OM) is the second leading cause of doctor’s visits and and the most frequent reason for antibiotic prescription in children.[2]

Steps

Finding the Infection

  1. Determine if the infection is located in the middle ear. The middle ear is an air filled, mucous-lined cavity between the outside of the body and the inner ear. Draining the middle ear is the Eustachian tube which also normalizes pressure between the outside and the inside of the body. Between the middle ear and the outer ear is the tympanic membrane.[3]
    • Middle ear infections, also called acute otitis media, occur when the Eustachian tube becomes blocked from swelling, inflammation, fluid from a viral upper respiratory infection, or irritation related to allergies, excess mucous and saliva during teething, infected or enlarged adenoids and tobacco smoke.[4]
  2. Evaluate for risk factors that increase the potential for a middle ear infection. Specific risk factors include being between the age of 18 months and six years, attending daycare, and tobacco smoke in the home. Children who use a pacifier and who are fed directly from a bottle and not breastfed are also at higher risk, because the action can change the flow of fluid in the Eustachian tube.[1]
    • People are more susceptible in the fall and winter months, if you have underlying medical conditions such as allergies, and if your family has a history of infections. Many ear infections occur during or right after a viral upper respiratory infection.
  3. Watch out for a change in behavior. Infection in the middle ear will increase the pressure, which causes the pain. This can cause the child to be more irritable and to cry more. When lying down, chewing, or sucking, that pressure increases, which also increases the pain.[5] Children may tug or pull at their ears in an attempt to relieve the pressure and pain. Tugging on his ears does not always mean that your child has an ear infection.
    • The infection can also cause difficulty hearing or trouble responding to sounds. When the middle ear fills with bacteria and fluid in an infection, it reduces the transmission of sound waves and affects hearing.
  4. Look for symptoms. There are numerous symptoms of these infections besides ear pain. You may have a fever over 100 degrees Fahrenheit, a headache, a loss of appetite, clumsiness, and trouble with balance. Infection in the middle ear will cause the body temperature to rise as the immune system fights the infection. Headache and loss of appetite may be commonly associated with fever.[6] Ear infections can also cause vomiting or diarrhea.[7]
    • There may also be fluid drainage from the ear. If the pressure in the middle ear builds up high enough and the Eustachian tube is not open enough to allow drainage, the tympanic membrane may rupture. After it ruptures, thick fluid will drain from the ear and the person will no longer experience pain from the pressure.[5] See your doctor if you think your child may have ruptured their tympanic membrane.

Treating an Middle Ear Infection

  1. Wait and see. The American Academy of Family Physicians recommend that physicians take a “wait and see” approach to the treatment of otitis media in many cases. Most infections will resolve spontaneously within two weeks with the pain significantly reduced within three to four days.[8]
    • Watch children aged 6 months to 23 months who have a temperature less than {{safesubst:#invoke:convert|convert}}, have only mild ear pain in one ear, and who have symptoms less than 48 hours.
    • Watch children 24 months or older who have mild pain in one or both ears with a temperature of less than 102.2 degrees Fahrenheit and symptoms less than 48 hours.
    • Children with the following medical conditions are not candidates for a “wait and see” approach[5]: children with cleft palate, children with Down’s Syndrome, children with underlying immune system disorders, children under six months old, and children with a history of recurrent middle ear infections.
  2. Consider treatment with antibiotics. In some circumstances, the physician will recommend antibiotics at the first visit for treatment of an ear infection, especially for infants under six months, children with moderate to severe pain, children with a temp of 102.2 Fahrenheit or higher, or children from six months to 23 months with bilateral ear infections. Secondary effects from a middle ear infection in a child or an adult can result in an infection in another part of the head and even the brain, permanent hearing loss, or paralysis of a nerve in the face.[9]
    • Although the antibiotics will address the growth of bacteria in the middle ear, it takes a couple of days for reduction in pressure and the pain to get better.[8]
    • Watch for side effects from antibiotics.[4] Some children can experience nausea, vomiting, and diarrhea from the use of antibiotics.
  3. Relieve the pain and discomfort. Whether or not antibiotics are prescribed, the child or adult will continue to experience pain and pressure until the infection begins to clear. Relieve that pain using the following strategies:
    • Administer Tylenol or ibuprofen to help relieve the pain and reduce the fever. Consult with your physician about which over-the-counter medication is preferred and how much to give your child.[5] Do not give aspirin to children as it has been linked to Reye’s Syndrome.[10]
  4. Apply a warm cloth or warm water bottle. You can use a warm cloth or warm water bottle over the affected ear to help the pain. Ensure that the heat will not burn the skin. If moist heat is used, the warm cloth should be in a water tight plastic bag.[4]
    • Applying warm, moist heat over the external ear can increase the risk of a swimmer’s ear infection.
  5. Ask about pain-relieving ear drops. If there is extreme pain, ask your doctor for ear drops that can help. These can be used only if the eardrum or tympanic membrane has not ruptured. If it has, the medication or drops can get inside the middle ear and cause damage.[11]
    • Many of the drops that were used in the past have been taken off of the market and are no longer available. Ask your doctor if drops can or should be used for your child.
  6. Talk with your doctor about using garlic oil or olive oil. Garlic has antimicrobial effects and can help fight the infection naturally. Slightly warmed olive oil can soothe the tympanic membrane and reduce pain and inflammation.
    • Nothing should be used in the external ear if the person has tubes placed in the eardrum or if you suspect the eardrum has ruptured. Oils, medications (unless prescribed specifically for a ruptured eardrum), or pain ear drops should not enter the middle ear.
    • Never use oil that is too warm because it can burn the ear. The oil should be tested against the inner wrist.
  7. Restrict the activities. Limit the activities of the affected person based on how she feels. A middle ear infection is not life-threatening and doesn’t require that you restrict all activities. If she feels up to going out, then it’s fine to go out. The same is true for adults.
    • If the child is not cranky and appears up to the activity planned, there is no reason not to continue with the plans.

Preventing Middle Ear Infections

  1. Investigate myringotomy tubes or ear tubes. These are surgically placed tubes in the ears of children with chronic otitis media. They are used to relieve the pressure, allow drainage, and allow reduced fluid build up in the middle ear to reduce the number of ear infections.[12]
    • Although the placement of the tubes is minor surgery, the procedure carries surgical risks that are related to the use of anesthesia, including harm to the vocal cords, trauma to the teeth or tongue, temporary mental confusion, heart attack, lung infection, and rarely, death.[13] The risks of anesthesia are low in healthy children and adults, but higher in people who have other underlying medical conditions.
  2. Feed your baby in an upright position. Never put your child to bed with a bottle. Lying down and drinking from a bottle increases the risk that fluid will reflux up the Eustachian tube and create an environment for bacterial growth and a middle ear infection.[14] The lower the baby’s head during feeding, the greater risk there is for formula to reflux into the eustachian tubes and increase the risk of infection.
  3. Reduce the exposure to tobacco smoke. Cigarettes and other smoking tobacco products increase the inflammatory response in the Eustachian tubes and therefore the risk of a middle ear infection. Limit your child's contact with people who smoke. If you have the infection, do not smoke and avoid enclosed spaces with those who do. [14]
  4. Limit the exposure to others who are ill. Having a viral upper respiratory infection increases the risk of developing otitis media due to fluid from the viral infection blocking the eustachian tube. By limiting exposure to other sick children, you reduce the risk that you or your child will experience a middle ear infection.[14]
    • Don't send your child to school or daycare if he has a fever.
  5. Make sure your child is up to date on his or her vaccinations, including a yearly flu shot. Ear infections are common after infection with the flu. Some of the most common bacteria that cause ear infections can be reduced by vaccination, such as Streptococcus pneumoniae and Haemophilus influenza.[15]

Tips

  • Pain from middle ear infections are greatest in the first 24 hours and are usually reduced within 3 days. Antibiotics do not have an effect on pain and pressure for at least 48 hours. Whether your physician recommends a “wait and see” approach or not, use comfort methods to reduce the pain and pressure.
  • Never put anything in the external ear if you suspect the eardrum has ruptured.

Warnings

  • Do not use antihistamines or cold preparations to treat congestion. This type of medication works to dry out body secretions. This concentrates the levels of bacteria in the middle ear and does not help to reduce the pressure, pain, or infection.[2]
  • See your doctor if your child gets worse, does not get better within 3 days after starting antibiotics or if your child develops a rash, hives, swelling of the throat, lips, or tongue, or has trouble breathing after starting the antibiotics.[16]

Related Articles

Sources and Citations

  1. ↑ 1.0 1.1 http://www.myvmc.com/diseases/otitis-media-middle-ear-infection/
  2. ↑ 2.0 2.1 http://www.medscape.org/viewarticle/730698
  3. ↑ http://www.nebraskamed.com/health-library/3d-medical-atlas/291/anatomy-of-the-ear
  4. ↑ 4.0 4.1 4.2 http://www.nlm.nih.gov/medlineplus/ency/article/000638.htm
  5. ↑ 5.0 5.1 5.2 5.3 http://kidshealth.org/parent/infections/ear/otitis_media.html
  6. ↑ http://www.mayoclinic.org/diseases-conditions/ear-infections/basics/symptoms/con-20014260
  7. ↑ https://www.nlm.nih.gov/medlineplus/ency/article/000638.htm
  8. ↑ 8.0 8.1 http://www.mayoclinic.org/diseases-conditions/ear-infections/basics/treatment/con-20014260
  9. ↑ http://www.urmc.rochester.edu/Encyclopedia/content.aspx?ContentTypeID=134&ContentID=250
  10. ↑ http://www.aafp.org/afp/2009/1215/p1472.html
  11. ↑ http://kidshealth.org/parent/infections/ear/otitis_media.html#
  12. ↑ http://www.entnet.org/content/ear-tubes
  13. ↑ http://www.nlm.nih.gov/medlineplus/ency/article/007410.htm
  14. ↑ 14.0 14.1 14.2 http://www.nidcd.nih.gov/health/hearing/pages/earinfections.aspx#10
  15. ↑ http://www.entnet.org/content/ear-infection-and-vaccines
  16. ↑ http://www.mayoclinic.org/diseases-conditions/drug-allergy/basics/symptoms/con-20033346
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