• Middle Ear Infection

    (Acute Otitis; Ear Infection, Middle; Otitis Media)


    With this condition, the middle ear becomes infected and inflamed. The middle ear is located behind the eardrum.
    The Middle Ear
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    Bacteria and viruses cause this condition, such as:
    • Streptococcus pneumoniae (most common)
    • Haemophilus influenzae
    • Moraxella (Branhamella) catarrhalis
    • Streptococcus pyogenes (less common)

    Risk Factors

    These factors increase your chance of developing middle ear infection:
    Tell your doctor if you have any of these risk factors.


    Symptoms include:
    • Ear pain (babies may tug or rub at the ear or face)
    • Fever
    • Irritability
    • Hearing loss (may be only temporary, due to fluid accumulation)
    • Decreased appetite, difficulty feeding
    • Disturbed sleep
    • Drainage from ear
    • Difficulty with balance


    The doctor will ask about symptoms and medical history, and perform a physical exam. Most middle ear infections can be diagnosed by looking into the ear with a lighted instrument, called an otoscope.
    The doctor will see if there is fluid or pus behind the eardrum. A small tube and bulb may be attached to the otoscope. This is to blow a light puff of air into the ear. The puff helps the doctor see if the eardrum is moving normally.
    Other tests may include:
    • Tympanocentesis—used to drain fluid or pus from the middle ear using a needle, also used to check for bacteria
    • Tympanometry—measures pressure in the middle ear and responsiveness of the eardrum, also used to check for fluid or pus
    • Hearing test —may be done if you have had many ear infections


    Treatments include:


    Antibiotics are commonly used to treat ear infections. Examples include:
    • Amoxicillin (Amoxil, Polymox)
    • Clavulanate (Augmentin)
    • Cephalosporins ( cefprozil , cefdinir , cefpodoxime , ceftriaxone )
    • Sulfa drugs (eg, Septra, Bactrim, Pediazole)
    Since bacteria develop a resistance to antibiotics, doctors may take a "wait and see" approach. In some cases, your doctor may prescribe an antibiotic for your child and ask you to use the medication if the pain or fever lasts for a certain number of days. This approach has been effective.
    While antibiotics may be effective, it is also important to keep in mind these medicines can cause a number of side effects. Nausea, stomach pain, and diarrhea are common. Also, a person may have an allergic reaction to the antibiotic. It is important to discuss the risks and benefits of taking antibiotics with your doctor.
    A virus causes some ear infections. This type will not go away faster with antibiotics. Most middle ear infections (including bacterial ones) tend to improve on their own in 2-3 days.

    Over-the-Counter Pain Relievers

    Pain relievers can help reduce pain, fever, and irritability. These include:
    • Acetaminophen
    • Ibuprofen
    • Aspirin
      • Note : Aspirin is not recommended for children or teens with a current or recent viral infection. This is because of the risk of Reye's syndrome . Ask your doctor which other medicines are safe for your child.
    Decongestants and antihistamines are not recommended to treat an ear infection.

    Ear Drops

    In children, ear drops that have a local anaesthetic (eg, ametocaine, benzocaine , or lidocaine) can help decrease pain, especially when the drops are used with oral pain relievers. If there is a chance that the eardrum has ruptured, do not use ear drops.


    Myringotomy is surgery done to open the eardrum. A tiny cut is made in the eardrum to drain fluid and pus.
    If you are diagnosed with an ear infection, follow your doctor's instructions .
    If you are diagnosed with an ear infection, follow your doctor's instructions .


    To reduce the chance of getting an ear infection:
    • Avoid exposure to smoke.
    • Breastfeed your baby for at least the first six months.
    • Try to avoid giving your baby a pacifier.
    • If you bottle-feed, keep your baby's head propped up as much as possible. Don't leave a bottle in the crib with your baby.
    • Get tested for allergies.
    • Treat related conditions, such as GERD.
    • Practice good hand washing .
    • Make sure your child's vaccinations are up to date. The pneumococcal vaccine can prevent middle ear infections.
    • Consider getting a flu vaccine .
    • If your child has a history of ear infections, talk to the doctor about long-term antibiotic use. This is used in some cases.
    • Ask your doctor about tympanostomy tubes. These tubes help equalize pressure behind the eardrum.
    • Xylitol is a natural sugar that is used as a sweetener in gum, candy, and other types of food. Eating food with xylitol on a regular basis may help to reduce your risk of ear infections.


    American Academy of Otolaryngology, Head and Neck Surgery http://www.entnet.org/

    National Institute on Deafness and Other Communication Disorders http://www.nidcd.nih.gov/


    Caring for Kids http://www.caringforkids.cps.ca/

    Health Canada http://www.hc-sc.gc.ca/


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