Middle Ear Infection In Infants, Toddlers, Children, and Adults

  • Medical Author:
    David Perlstein, MD, MBA, FAAP

    Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

  • Medical Author: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Quick GuideEar Infection Symptoms, Causes, and Treatment

Ear Infection Symptoms, Causes, and Treatment

Are there any home remedies for acute middle ear infection?

Although there are a number of suggested home remedies for the treatment of ear infections, including humidified air, homeopathic treatments, naturopathic ear drops, decongestants, and antihistamines; there are limited studies suggesting the benefits of these measures over accepted and recommended treatments. Both oral and topical analgesics are effective in controlling the pain associated with ear infections, but the use of decongestants or antihistamines has not been demonstrated to improve symptoms or speed the resolution of acute otitis media.

What causes chronic middle ear infection or inflammation?

The Eustachian tube normally prevents the accumulation of fluid by allowing fluid to drain through the tube. Chronic otitis media develops over time, and often starts with a chronic middle ear effusion (fluid) that does not resolve. This persistent fluid will often become contaminated with bacteria, and the bacteria found in chronic otitis media are often different from those found in acute otitis media. Therefore, anything that disturbs the function of the Eustachian tube can lead to chronic otitis media.

In some individuals that are ill from other diseases, if there is pus draining from the ear, there is a danger that otitis media (especially bacterial-caused) may invade the mastoid bone and reach the brain. These individuals need to be seen urgently by a health-care professional. Do not delay treatment by trying home remedies.

What happens to the eardrum in chronic middle ear infection or inflammation?

The eardrum (tympanic membrane) has three delicate layers that help keep the eardrum thin, but strong. A chronic middle ear infection causes changes in the eardrum that weaken it, and often lead to a hole in the eardrum (tympanic membrane perforation). Eventually, the eardrum loses its strength and begins to collapse into the middle ear space.

When the eardrum collapses or retracts from negative pressure in the middle ear, it can attach to the other middle ear structures. It is frequently seen draped around the middle ear bones (ossicles) or the inner wall of the middle ear (promontory). This disrupts the conduction of sound through the middle ear, and may diminish hearing.

What happens to the eardrum if a hole develops in the eardrum?

A hole that forms in the eardrum (tympanic membrane perforation) usually causes a chronic draining ear, or a condition called chronic otitis media with perforation. Often the drainage (otorrhea) will have a foul odor and can be seen draining from the ear. Hearing can improve after the middle ear fluid is released, or it may worsen secondary to the inflammation in the middle ear.

How is chronic middle ear infection or inflammation treated?

Initially, antibiotics may resolve the ear infection. If a tympanic membrane perforation also is present, topical antibiotic drops may be used. If eardrum or ossicle scarring has occurred, that will not be reversed with antibiotics alone. Surgery often is indicated to repair the tympanic membrane (eardrum), remove the infected tissue and scar from the middle ear and the mastoid bone. Long-term prophylactic antibiotics are not recommended.

What are the goals of chronic otitis media surgery?

The goals of surgery are to first remove all of the infected tissue so that it can be "safe" from recurrent infections. The second goal is to recreate a middle ear space with an intact eardrum. Finally, hearing is to be restored. This may seem strange that hearing is the last priority, but if the first two priorities are not met, anything that is done to improve hearing will ultimately fail. If hearing is restored, but the infection returns, the hearing will be lost again. Likewise, if hearing is restored, but the middle ear space is not recreated, the eardrum will re-stick to the middle ear or the ossicles.

What is serious middle ear infection or inflammation?

Serous otitis media is inflammation in the middle ear without infection. Typically, the Eustachian tube is not functioning and cannot ventilate the ear normally. As a result, fluid accumulates in the middle-ear. This can lead to a dullness or fullness within the ear along with diminished hearing.

Which specialties of doctors treat middle ear infections?

The majority of children and adults are diagnosed and treated by either pediatricians, primary health care doctors, emergency or urgent care medical providers, or other health care professionals. ENT specialists may be consulted for some individuals. Rarely, a neurologist or neurosurgeon may be needed if a severe infection that may extend to other organ systems occur.

What limitations are there on a child with middle ear infection or inflammation?

Otitis media is not contagious (although the initial cold that caused it may be). A child with otitis media can travel by airplane but, if the Eustachian tube is not working well, the pressure change as the plane descends may cause the child pain. It is best not to fly (or swim) with a draining ear. You should always consult your physician if you have specific concerns.

Can otitis media (middle ear infection or inflammation) be prevented?

Currently the best way to prevent acute otitis media is to assure a child is vaccinated. Ensuring that your child receives an annual flu vaccine and is up to date with his/her pneumococcal vaccine is the best way to prevent the most common causes of middle ear infections (otitis media). In addition both early and sustained breastfeeding (for at least 6 months) and avoidance of tobacco spoke exposure have been shown to be related to fewer ear infections. Recent studies suggest that Xylitol based gum or lozenges may have a preventive impact on acute otitis media. Unfortunately it cannot be used in young children, and must be used 3-5 times a day during the cold and flu season to be effective.

REFERENCES:

Coleman et al. Cochrane Database Syst Rev 2008 July 16;(3)

Donaldson, J.D., MD. "Acute Otitis Media." Medscape. Updated: May 26, 2016.
<http://emedicine.medscape.com/article/859316-overview>

Lieberthal A et al. Clinical Practice Guideline: The Diagnosis and Management of Acute Otitis Media. Pediatrics. March 2013. 131:3.e964-e999.

Natal, B.L., MD. "Emergent Management of Acute Otitis Media." Medscape. Updated: Aug 31, 2015.
<http://emedicine.medscape.com/article/764006-overview>

Rennie, C.E. "Pneumatic Otoscope Examination." Medscape. Updated: Feb 05, 2016.<http://emedicine.medscape.com/article/1348950-overview>

Medically Reviewed by a Doctor on 3/16/2017

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