Middle Ear Infection (Otitis Media)

Otitis media, or middle ear infection, is an infection with fluid behind the eardrum, redness, swelling and pain in the middle ear.

The most important sign is pain in the ear. The next are redness and swelling. Hearing loss can develop, and the eardrum can burst. When it bursts, the infected fluid runs out of the ear.

The condition can also run quietly, with no sign at all. It can last months or even years in a patient who develops no complication.

One child in four has at least one middle ear infection before the age of ten. The risk is highest between 6 and 24 months. After the age of five it falls.

In most cases the illness is expected to settle by itself, though that does not always happen. As it advances it causes pain in the ear, and that pain sometimes becomes unbearable. Babies under 24 months need antibiotics.

What it feels like

Ear pain is the commonest sign. Severe pain is frequent in the acute stage, and it can be strong enough to wake the patient. Fever and reduced hearing usually come with it.

In a bacterial infection the eardrum swells and stretches, which makes the pain worse. When a lot of fluid collects, the drum can burst and blood-stained fluid can run from the ear. The stretching then stops, so the pain disappears. At that stage discharge from the ear is the clearest sign.

The signs develop quickly and settle within a few days. That form is called acute otitis media.

Ear problems also cause heavy pain in the teeth, and heavy toothache is felt in the ear.

The main signs

• Ear pain
• High fever
• Tiredness
• Dizziness
• Balance problems
• Slightly reduced hearing. When the middle ear fills with fluid, the hearing loss can be a sign of glue ear, which is also called otitis media with effusion.
• A burst eardrum, after which the fluid drains and the pain disappears
• Discharge from the ear, which appears when the eardrum bursts

Signs in a small child

Babies and small children cannot say what is wrong, so watch for these signs:

• Rubbing or pulling at the ears, or putting their hands to the ear
• Restlessness
• Feeding poorly
• A runny nose
• Diarrhoea
• Signs of reduced hearing, such as not reacting to moderately loud sounds, or seeming inattentive

What causes it

Bacteria or viruses cause middle ear infection. It usually appears after a cold or another airway infection. The bacteria or viruses pass into the middle ear through the Eustachian tube, which is the passage that connects the middle ear to the back of the throat. They swell the tube, and the swelling blocks it.

Two small pads called adenoids sit in the tissue high at the back of the nose and take part in the immune system. They lie close to the Eustachian tubes and tend to swell when the immune balance is disturbed. That swelling blocks the tube as well and raises the chance of infection.

Babies who take a bottle lying down get more infections. The risk is also higher at the change of the seasons, along with airway illness. In a child born with a cleft palate the Eustachian tube cannot clean itself, which leads to infection.

Once the tube is blocked, the middle ear can no longer clear itself and fluid collects. What collects becomes a place where viruses and bacteria live, and the infection follows.

Middle ear infection is commoner in children because their Eustachian tube is shorter and less sloped. Infection therefore follows a cold more easily. Some allergies and heavy exposure to cigarette smoke also lead to it.

How the doctor makes the diagnosis

See an ear, nose and throat specialist. The doctor looks for the signs and asks questions about them, then examines the ear, the nose and the throat with an otoscope, which is a lighted instrument. In a patient with otitis media, the collected fluid changes how the eardrum looks.

Treatment

Treatment changes with the age of the patient and with the state of the infection.

If the signs are mild and there is no fever, the infection can be left to settle by itself. If waiting brings no improvement, or the illness advances, medicines are needed. Antibiotics come first, when bacteria cause the infection.

Before prescribing an antibiotic for a baby, the doctor watches for fever. If the baby does not start to recover without one, treatment begins. At any age, take the dose that the doctor sets. A different dose brings side effects.

As the antibiotic eases the infection, the pain lessens. Many patients stop the medicine at this point. Do not stop before the course the doctor prescribed is finished, because worse problems follow later.

If the infection has damaged or burst the eardrum, drops can be prescribed alongside the antibiotic. They help the eardrum repair itself.

The infection causes severe pain and high fever, so painkillers and medicines to bring the fever down can be prescribed. Take these at the prescribed dose as well.

Decongestant medicines that open the nose can be recommended, to reduce swelling in the Eustachian tube and the lining of the upper airway. Vaccines exist against some of the microorganisms that cause the infection, and some patients are advised to have them.

When medicines do not work, the surgeon can perform a myringotomy. This operation is done under general anaesthesia. The surgeon makes a hole in the eardrum and places a tube in it, which drains the fluid that collects and keeps causing infection.