Middle Ear Infection

Otolaryngologist examining a kid ear in a clinic

What are mid ear infections?

Mid ear infections (acute otitis media) typically start in the Eustachian tubes. A bacterial or a viral infection will develop fluid or mucous which fills the Eustachian tubes and occupies the previously air-filled middle ear. The pressure of the fluid buildup on the ear drum (tympanic membrane) is the cause of the extreme pain that is typical of this condition. These are usually secondary infections of flus and colds, but can be experienced without having had any cold or flu symptoms. Individuals with sinus allergies are also be prone to mid ear infections.

What are the symptoms of mid ear infections?

  • Mild discomfort or pain in one or both ears
  • Persistent feeling of pressure within the ear
  • Excessive whining or fussiness in infants
  • Mucous or fluids draining from the ear
  • Decline or loss of hearing

How many types of middle ear infections are there?

There are two types:

  • Acute Otitis Media (AOM)

Usually caused by fluid or mucous built up by bacteria that colonized the Eustachian tube and then spread to the middle ear. AOM can occur during and may even appear after a cold or flu has passed.

  • Otitis Media with Effusion (OME)

Usually occurs when the patient develops a fluid which is called an effusion. This effusion can become trapped behind the eardrum. This condition can appear in one ear or both ears at the same time. What is unique about OME is that it is not actually caused by an infection. It is commonly referred to as “glue ear” because the effusion is very sticky, especially in chronic and severe cases.

Who is most likely to develop a middle ear infection?

Ear infections are common among all races, age groups and sexes, but mid ear infections are infrequent in adults. By far the most common patient population to suffer from mid ear infections is that of children. The Eustachian tubes in children are commonly short and narrow and may be too soft to remain open to allow air to pass to the middle air. As a result, Eustachian tubes become blocked and an infection can develop. Five out of six children (83%) will have at least one ear infection by the age of three.

What can happen if my child’s infection is not treated by a doctor?

  • Hearing loss
  • Perforation of the eardrum
  • Meningitis
  • Mastoiditis (a rare bone condition)

How are mid ear infections evaluated by your doctor?

If your doctor suspects that you or your child has an ear infection, he or she will use an otoscope to examine the ear. They will be looking for signs of inflammation, swelling and redness on or near the eardrum. A healthy eardrum is usually pinkish gray and transparent.

Your doctor may use a pneumatic otoscope to check the pressure on the eardrum caused by the mucous or fluid that has collected in the inner ear. The device injects a small amount of air onto the eardrum and then measures the rate of movement of the eardrum. If the eardrum does not move readily, it can indicate that fluid caused by an infection is present in the mid-ear area.

For an even more detailed analysis, your doctor may use tympanometry to detect fluid in the middle ear and possible infection, to identify a perforation of the eardrum and to identify Eustachian tube problems.

How do you treat mid ear infections?

Ear infections are treatable with a high level of success. It is rare today for a patient to suffer permanent damage to their hearing after seeking medical treatment. The doctor may suggest watchful waiting if the examination does not warrant immediate medical action.

If the doctor determines that an infection is possible, he or she will propose a treatment to reduce pain that may include:

  • Pain Relief: Acetaminophen or ibuprofen for earaches with a cold or a fever over 102
  • Antibiotics: Prescribed to kill bacteria that may be causing the ear infection. (Antibiotics are not needed for earaches caused by a cold or the flu. Antibiotics are prescribed with care as they may cause nausea, diarrhea, rashes, yeast infections and can interact with other drugs.)
  • Myringotomy (ear tubes) may be used to reduce ear fluid