Ear infection, medically known as Acute Otitis media (AOM) is an infection of the middle ear (the space behind the ear drum). The middle ear is an air-filled space located behind the eardrum and it also houses the tiny or delicate vibrating bones of the ear that aid in hearing. This condition is more common in children than adults. 

Causes of Otitis Media 

Ear infections (Otitis media) are caused by bacteria and viruses. Examples are influenzae and Staphylococcus aureus. The bacteria or virus travel into the middle ear through the eustachian tube and causes it to swell. This swelling can cause the tube to become blocked, which keeps normally produced fluids to build up in the middle ear instead of been drained away. This trapped fluid can become infected by a virus or bacteria which leads to the symptoms of ear infection such as pain. 

Risk factors of Otitis Media 

  1. Age: One of the most common reasons why young children (between 6 months and 2 years of age) visit the hospital is because of ear infection. Prematurity and low birth weight children are more likely to develop ear infection. 
  2. Colds: Constant exposure to colds often increases the chances of getting an ear infection. 
  3. Family history: The likelihood of getting an ear infection may run in the family. 
  4. Chronic illnesses: People with chronic illnesses or altered immunity are more likely to develop ear infections. 
  5. Allergies: Allergic reactions can cause swelling of the nasal passages and upper respiratory tract, which can enlarge the adenoids. This enlarged adenoids can block the eustachian tube, preventing ear fluids from draining which further leads to fluid buildup in the middle ear, causing pressure, pain and possible infection. 
  6. Ethnicity: Native Americans and Australian aborigine children have more ear infections than other ethnic groups. 
  7. Weather: Ear infections are most common during winter and fall. 
  8. Craniofacial abnormalities: Craniofacial abnormalities as a result of congenital malformation can increase an individual’s chance of developing ear infection. 

Symptoms of Otitis Media 

Symptoms of ear infection include: 

  1. Ear pain 
  2. Drainage of fluid from the ear 
  3. Difficulty hearing 
  4. Fever 
  5. Poor sleep 
  6. Headache 
  7. Loss of appetite 
  8. Loss of balance 
  9. Feeling of pressure in the affected ear 

Diagnoses of Otitis Media 

  1. Ear Examination: A physical examination is conducted on the ear. An instrument called otoscope is used to look into the ears, throat and nasal passage. A pneumatic otoscope is also used to diagnose ear infection by puffing air into the eardrum. If the middle ear is filled with fluid, there will be little or no movement of the eardrum when air is puffed into the eardrum. Also, a healthy eardrum will be clear and pinkish gray in color while an infected eardrum may be inflamed, swollen or red. 
  2. Tympanometry: This test uses air pressure to check for fluid in the middle ear. It also measures the movement of the eardrum. 
  3. Acoustic reflectometry: This test measures how much sound is reflected back from the eardrum because the eardrum absorbs most of the sound. If there is more pressure from fluid in the middle ear, the eardrum will reflect more sound. 
  4. Tympanocentesis: A tiny tube that pierces the eardrum is used to drain fluid from the middle ear and fluid are tested for viruses and bacteria.  

Management of Otitis Media 

Treatment of otitis media depends on age, severity of the infection, and the nature of the infection (if the infection is occurring for the first time, or repeating infection). Although, symptoms may improve within few days because most infections clear up on their own within one to two weeks without any treatment. Treatment options include: 

  1. Antibiotics: Antibiotics may be prescribed depending on the age of the child and if the cause of ear infection has been confirmed to be by bacteria.  
  2. Analgesic: Medications for pain relief may be prescribed. Examples are acetaminophen (Tylenol) or ibuprofen (Advil, Motrin IB). Otic anesthetic (e.g., Antipyrine) may also be prescribed to relieve pain if the eardrum doesn’t have a hole or tear in it. 
  3. Fluid Drainage using Ear Tubes: A tiny tube called tympanostomy tube is inserted into a tiny opening made by the surgeon in the eardrum. The tube is used to suction fluids out of the middle ear and also to prevent buildup of more fluids. The opening in the eardrum closes up by itself after the tube falls out or is removed.  

Prevention of Otitis Media 

  1. Remind children to wash their hands and faces regularly especially after playing. 
  2. Encourage children to eat healthy foods like fruit and vegetables.  
  3. Keep the ears as dry as possible.  
  4. Prevent common colds, flu and other illnesses by blowing nose in a tissue, putting the tissue in the bin, and not sharing eating and drinking utensils. 
  5. Turn head from side to side after getting out of water to help water drain from the ears. 
  6. Avoid sticking or putting objects into the ear canal for cleaning or pleasure. The ear is a self-cleansing organ. 
  7. Avoid swimming in polluted water. 
  8. Encourage mothers to practice exclusive breastfeeding. 
  9. Avoid smoking or secondhand smoking. 
  10. Ensure up to date vaccination of your children. 

Complications of Otitis Media 

Repeated or untreated ear infections can lead to complications such as: 

  1. Impaired hearing 
  2. Facial paralysis 
  3. Speech or developmental delays in children 
  4. Tearing of eardrum 
  5. Spread of infection to nearby tissues or bones to cause meningitis, mastoiditis, brain abscesses, etc. 

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