What Research Is Being Done On Middle Ear Infections
Researchers sponsored by the National Institute on Deafness and Other Communication Disorders are exploring many areas to improve the prevention, diagnosis, and treatment of middle ear infections. For example, finding better ways to predict which children are at higher risk of developing an ear infection could lead to successful prevention tactics.
Another area that needs exploration is why some children have more ear infections than others. For example, Native American and Hispanic children have more infections than do children in other ethnic groups. What kinds of preventive measures could be taken to lower the risks?
Doctors also are beginning to learn more about what happens in the ears of children who have recurring ear infections. They have identified colonies of antibiotic-resistant bacteria, called biofilms, that are present in the middle ears of most children with chronic ear infections. Understanding how to attack and kill these biofilms would be one way to successfully treat chronic ear infections and avoid surgery.
Understanding the impact that ear infections have on a childs speech and language development is another important area of study. Creating more accurate methods to diagnose middle ear infections would help doctors prescribe more targeted treatments. Researchers also are evaluating drugs currently being used to treat ear infections, and developing new, more effective and easier ways to administer medicines.
How Is An Ear Infection Treated
Treatment of ear infections depends on age, severity of the infection, the nature of the infection and if fluid remains in the middle ear for a long period of time.
Your healthcare provider will recommend medications to relieve you or your childs pain and fever. If the ear infection is mild, depending on the age of the child, your healthcare provider may choose to wait a few days to see if the infection goes away on its own before prescribing an antibiotic.
Antibiotics may be prescribed if bacteria are thought to be the cause of the ear infection. Your healthcare provider may want to wait up to three days before prescribing antibiotics to see if a mild infection clears up on its own when the child is older. If your or your childs ear infection is severe, antibiotics might be started right away.
The American Academy of Pediatrics has recommended when to prescribe antibiotics and when to consider waiting before prescribing based on your childs age, severity of their infection, and your childs temperature. Their recommendations are shown in the table below.
American Academy of Pediatrics Treatment Guide for Acute Otitis Media
|in one or both ears
|Mild for < 48 hours and temp < 102.2° F
|Treat with antibiotic OR observe. If observe, start antibiotics if child worsens or doesnt improve within 48 to 72 hours of start of symptoms
Treating A Viral Or Bacterial Sinus Infection
How you treat a sinus infection depends on whether bacteria or a virus is to blame. In the case of a viral infection, your surgeon or doctor is likely to recommend a wait and see approach, since there is no type of medicine that will kill the virus and speed up healing.
While you do have to wait for a virus to clear up on its own, there are some things you can do to make yourself more comfortable in the meantime. Your surgeon might recommend using a saline rinse in your nostrils to help clear away mucus and debris. Pain relievers can also reduce any discomfort youre experiencing due to headaches or facial pain. A pain reliever can also help lower a fever.
Medicine is available to treat a bacterial sinus infection. If your surgeon determines that bacteria is the source of your infection, he might prescribe antibiotics to kill the bacteria and speed up healing. Depending on the type of bacteria thats causing the infection, you might need to take antibiotics for just a few days or for a few weeks.
Theres one thing thats important to understand about antibiotics: They wont help viral infections at all. In fact, they might make things worse. While they wont exacerbate the infection, antibiotics can cause some unpleasant side effects. They can also lead to antibiotic resistance, making future bacterial infections more difficult to treat. Its important only to take antibiotics if your doctor prescribes them.
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The Role Of Eustachian Tubes
The eustachian tubes connect the middle ear to the back of the throat. The ends of these tubes open and close to regulate air pressure in the middle ear, resupply air to this area, and drain normal secretions.
A respiratory infection or allergy can block the eustachian tubes, causing a buildup of fluids in the middle ear. Infection can occur if this fluid becomes infected bacterially.
The eustachian tubes of young children are smaller and more horizontal than in older children and adults. This means that fluid is more likely to collect in the tubes rather than drain away, increasing the risk of an ear infection.
Virtual Appointment With Your Primary Care Doctor
You can also schedule a virtual appointment with the doctor that usually cares for you or your child. Theyll have the best information about your familys health and what treatments may be appropriate. If necessary, your childs primary care doctor can prescribe antibiotics and recommend additional treatments.
Keep in mind that if its only been a couple days since the ear infection started, you may not get a prescription for antibiotics. Your doctor will likely recommend treating the ear infection with OTC pain relievers and scheduling another appointment after a week or so. Its also possible that the doctor may want to see you or your child in person.
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Preparing For An Appointment
You’ll likely begin by seeing your family doctor or your child’s pediatrician. You may be referred to a specialist in ear, nose and throat disorders if the problem has persisted for some time, is not responding to treatment or has occurred frequently.
If your child is old enough to respond, before your appointment talk to the child about questions the doctor may ask and be prepared to answer questions on behalf of your child. Questions for adults will address most of the same issues.
- What signs or symptoms have you noticed?
- When did the symptoms begin?
- Is there ear pain? How would you describe the pain mild, moderate or severe?
- Have you observed possible signs of pain in your infant or toddler, such as ear pulling, difficulty sleeping or unusual irritability?
- Has your child had a fever?
- Has there been any discharge from the ear? Is the discharge clear, cloudy or bloody?
- Have you observed any hearing impairment? Does your child respond to quiet sounds? Does your older child ask “What?” frequently?
- Has your child recently had a cold, flu or other respiratory symptoms?
- Does your child have seasonal allergies?
- Has your child had an ear infection in the past? When?
- Is your child allergic to any medication, such as amoxicillin?
Where Can I Find Additional Information About Ear Infections
The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language.
Use the following keywords to help you search for organizations that can answer questions and provide printed or electronic information on ear infections:
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Symptoms Of Inner Ear Infection
Since the inner ear plays key roles in both hearing and balance, any issues with these senses could be linked to an infection in this area. Infections in other parts of the ear are less likely to affect your hearing or balance, but the other symptoms can be similar.
Possible signs of an inner ear infection or inflammation include:
- Vertigo, a sensation that you or your surroundings are spinning or moving around even when everything is still
- Having trouble balancing or walking normally
- Feeling like the ear is full or blocked
- Tinnitus or ringing in your ears
- Fluid or pus coming from your ear
Inner ear infections can also be linked to other symptoms, depending on the source of the infection. For example, if the infection spread to the inner ear from your airways, you might also have a runny nose. In some cases, these other symptoms might be fading when the problems in your inner ear begin, because the original infection might have been eliminated. You could also have more generalised symptoms of infection, such as a fever.
Middle Ear Infections In Children
Acute Otitis Media
An inflammation in the middle ear is known as “otitis media.” AOM is a middle ear infection caused by bacteria in the middle ear fluid trapped by a Eustachian tube that is not working well. AOM may develop during or after a cold or the flu. With AOM:
- Middle ear infections are extremely common in children younger than 3. But they are infrequent in adults.
- In children, ear infections often recur, particularly if they first develop in early infancy.
- AOM symptoms improve within 48 to 72 hours with or without antibiotic treatment in most children. There does not appear to be any risks of complications for at least the first 2 to 3 days.
- Even after symptoms subside, fluid may persist in the middle ear for weeks to months after AOM onset.
Otitis Media with Effusion
OME occurs when fluid, called an effusion, becomes trapped behind the eardrum in one or both ears. In chronic and severe cases, the fluid is very sticky and is commonly called “glue ear.” With OME:
- Fluid is present. But there is no infection.
- There is usually no pain. Sometimes the only clue that it is present is a feeling of stuffiness in the ears, which can feel like “being under water.”
- Hearing may be temporarily impaired in children. But most children will not have long-term hearing loss.
Chronic Otitis Media
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Viral Upper Respiratory Tract Infection
Viral URI evolves following direct invasion of the mucosa coating the upper airway by viral agents, which undergo frequent changes in antigenicity, posing challenges to the immune defense system. Inoculation by the virus begins when secretions are transferred by touching a hand exposed to the pathogen to the nose or mouth or by directly inhaling respiratory droplets. Most viral URI symptoms result from the inflammatory response of the immune system to the invading pathogens. Local infection in the nasopharynx can easily spread to the adjacent organs, leading to sinusitis, laryngitis, tracheobronchitis, pneumonia, and AOM in particular .
Several respiratory viruses have been extensively studied related to AOM pathogenesis among the more common and important are IAV, RSV, human rhinovirus , and adenovirus.
In addition to the above viruses, parainfluenza viruses and human enteroviruses have been found associated with AOM approximately one-third of URI associated with these viruses developed AOM within 4 weeks of URI onset. Many other types of common URI viruses, including coronaviruses 229E, OC43, and NL63 have also been reported associated with AOM development after URI .
Other Home Remedies For Nausea
Some other home remedies that a person can try to help reduce their nausea include:
- an electrolyte replacement sports drink
Most of the research into these home remedies focuses on their effectiveness in treating nausea related to pregnancy or chemotherapy. However, a person may wish to try for themselves to see if the remedies help with nausea related to inner ear infections.
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Why Do Children Get Many More Ear Infections Than Adults Will My Child Always Get Ear Infections
Children are more likely than adults to get ear infections for these reasons:
- The eustachian tubes in young children are shorter and more horizontal. This shape encourages fluid to gather behind the eardrum.
- The immune system of children, which in the bodys infection-fighting system, is still developing.
- The adenoids in children are relatively larger than they are in adults. The adenoids are the small pads of tissue above the throat and behind the nose and near the eustachian tubes. As they swell to fight infection, they may block the normal ear drainage from the eustachian tube into the throat. This blockage of fluid can lead to a middle ear infection.
Most children stop getting ear infections by age 8.
Signs Of Ear Infection In Babies And Toddlers
Ear infections, particularly middle ear infections, are especially common in babies and toddlers due to the relative narrowness of their Eustachian tube.
Signs and symptoms of an ear infection in babies and toddlers may include:
- High temperature
Ear infections in babies and toddlers will usually clear up on their own, without specific treatment. However, for babies and toddlers experiencing recurrent infections that do not respond well to antibiotics, a doctor may recommend a minor surgical procedure known as a myringotomy.
The procedure involves making a small incision in the eardrum to allow fluids to drain out a small ventilation tube, often called grommets, may also be inserted. This ear tube will typically fall out on its own in around 6 to 18 months.
Although a myringotomy and grommets are generally effective at reducing the number of ear infections experienced by young children, they can still occur. The main sign of an ear infection after tubes have been inserted is the discharge of yellowish fluid from the ear, which will commonly not be accompanied by pain or fever. Antibiotics will typically be prescribed to treat the ear infection.
If you are concerned that your child may have an ear infection, try using the Ada app to find out what the problem may be.
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A Pharmacist Can Help With An Ear Infection
Speak to a pharmacist if you think you have an outer ear infection.
They can recommend acidic eardrops to help stop bacteria or fungus spreading.
- a long-term medical condition such as diabetes or a heart, lung, kidney or neurological disease
- a weakened immune system because of chemotherapy, for example
Concurrent Bacterial Otopathogens And Viruses Present In The Same Child
Concurrent bacterial and viral detection of the three predominant bacteria, NTHi, S. pneumoniae and M. catarrhalis and the three most frequently detected viruses, HRV, WU polyoma virus and RSV, were examined within the upper respiratory tract of children with a history of OM, undergoing VTI for OM. For each child, the otopathogens identified within the MEE, NPS and adenoids were mapped and their concurrent presence in multiple upper respiratory tract locations within the same child are presented in Figure 1. These data show that when any of the 3 predominant bacteria are present within the middle ear, it is highly indicative of the same bacteria being present within the NPS and adenoids concurrently. Interestingly, only the presence of HRV within the MEE may indicate concurrent presence within the nasopharynx and adenoids, with RSV not identified as frequently in other areas of the upper respiratory tract .
Figure 1 Distribution of concurrent bacterial and viral detection of predominant otopathogenic microbes within the middle ear effusate , nasopharyngeal swab and adenoid samples of the same peri-urban/urban children in South-East Queensland who were undergoing ventilation tube insertion for otitis media . Each circle represents the sample locations within each child and their intersections indicate the number of children with the same microbe identified within two or three of the sample locations.
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What Happens If My Child Keeps Getting Ear Infections
To keep a middle ear infection from coming back, it helps to limit some of the factors that might put your child at risk, such as not being around people who smoke and not going to bed with a bottle. In spite of these precautions, some children may continue to have middle ear infections, sometimes as many as five or six a year. Your doctor may want to wait for several months to see if things get better on their own but, if the infections keep coming back and antibiotics arent helping, many doctors will recommend a surgical procedure that places a small ventilation tube in the eardrum to improve air flow and prevent fluid backup in the middle ear. The most commonly used tubes stay in place for six to nine months and require follow-up visits until they fall out.
If placement of the tubes still doesnt prevent infections, a doctor may consider removing the adenoids to prevent infection from spreading to the eustachian tubes.
Check If Its An Ear Infection
The symptoms of an ear infection usually start quickly and include:
- discharge running out of the ear
- a feeling of pressure or fullness inside the ear
- itching and irritation in and around the ear
- scaly skin in and around the ear
Young children and babies with an ear infection may also:
- rub or pull their ear
- not react to some sounds
- be irritable or restless
- be off their food
- keep losing their balance
Most ear infections clear up within 3 days, although sometimes symptoms can last up to a week.
|Inner ear infection
|Can affect both children and adults
|Usually affects children
|Usually affects adults aged 45 to 75
|Caused by viral or bacterial infections
|Caused by viruses like colds and flu
|Caused by something irritating the ear canal, such as eczema, water or wearing earplugs
|Affects parts of the inner ear like the labyrinth and vestibular system, and can lead to labyrinthitis
|Affects the eustachian tube, which connects the middle ear to the back of the nose
|Affects the ear canal
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When To Call Your Doctor
You should talk to your doctor or pediatrician about any ear infections and if you or your child has the following symptoms:
- Fever greater than 101 F
- Severe ear pain and drainage from the ear
- Pus or blood in the outer ear
Also call your pediatrician if your child is sluggish, cant stop crying despite efforts to soothe, shows signs of weakness, has a crooked smile, and/or is not walking straight.