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  • Middle Ear Infection

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

    Definition

    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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    Copyright © Nucleus Medical Media, Inc.

    Causes

    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

    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

    Diagnosis

    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

    Treatment

    Treatments include:

    Medication

    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

    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 .

    Prevention

    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.

    RESOURCES

    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/

    CANADIAN RESOURCES

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

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

    References

    Acute otitis media. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 2008. Accessed July 28, 2008.

    Behrmann R, Kliegman R, Jenson HB. Nelson Textbook of Pediatrics . 16th ed. Philadelphia, PA: WB Saunders; 2000.

    Griffith HW. Griffith's 5-Minute Clinical Consult . Baltimore, MD: Williams & Wilkins; 1999.

    Hurst DS, Amin K, Seveus L, Venge P. Evidence of mast cell activity in the middle ears of children with otitis media with effusion. Laryngoscope . 1999;109:471-477.

    Otitis media (ear infection). National Institute on Deafness and Other Communication Disorders website. Available at: http://www.nidcd.nih.gov/ . Published July 2003. Accessed July 29, 2008.

    Phillips BL. Otitis media, milk allergy, and folk medicine. Pediatrics .1972;50:346.

    Side Effects. Antibiotics. Side Effects website. Available at: http://side-effects.org/antibiotics . Accessed November 30, 2010.

    10/12/2006 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Spiro DM, Tay KY, Arnold DH, Dziura JD, Baker MD, Shapiro ED. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA . 2006;296:1235-1241.

    9/23/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Coleman C, Moore M. Decongestants and antihistamines for acute otitis media in children. Cochrane Database of Systematic Reviews. 2008(3). CD001727. DOI: 10.1002/14651858.CD001727.pub4.

    6/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C. Topical analgesia for acute otitis media. Cochrane Database Syst Rev. 2009;(2):CD005657.

    7/21/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Pavia M, Bianco A, Nobile CG, Marinelli P, Angelillo IF. Efficacy of pneumococcal vaccination in children younger than 24 months: a meta-analysis. Pediatrics. 2009;123:e1103-1110.

    11/30/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Coker TR, Chan LS, Newberry SJ, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA. 2010;304(19):2161-2169.

    12/16/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Azarpazhooh A, Limeback H, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev. 2011;11:CD007095.

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