Ear infection - acute

Answer 1

Definition

Ear infections are one of the most common reasons parents take their children to the doctor. While there are different types of ear infections, the most common is called otitis media, which means an inflammation and infection of the middle ear. The middle ear is located just behind the eardrum.

The term "acute" refers to a short and painful episode. An ear infection that lasts a long time or comes and goes is called chronic otitis media.

For links to other types of ear infections, see otitis.

Alternative Names

Otitis media - acute; Infection - inner ear; Middle ear infection - acute

Causes, incidence, and risk factors

For each ear, a eustachian tube runs from the middle ear to the back of the throat. This tube drains fluid that is normally made in the middle ear. If the eustachian tube becomes blocked, fluid can build up. When this happens, germs such as bacteria and viruses can multiply and cause an infection.

Ear infections are common in infants and children, in part because the eustachian tubes become easily clogged.

Ear infections may also occur in adults, although they are less common than in children.

Anything that causes the eustachian tubes to become swollen or blocked causes more fluids to build up in the middle ear behind the eardrum. These causes include:

• Allergies
• Colds and sinus infections
• Excess mucus and saliva produced during teething
• Infected or overgrown adenoids
• Tobacco smoke or other irritants

Ear infections are also more likely if a child spends a lot of time drinking from a sippy cup or bottle while lying on his or her back. Contrary to popular opinion, getting water in the ears will not cause an acute ear infection, unless the eardrum has a hole from a previous episode.

Ear infections occur most often in the winter. You cannot catch an ear infection from someone else, but a cold may spread among children and cause some of them to get ear infections.

Risk factors for ear infections include the following:

• Attending daycare (especially those with more than 6 children)
• Changes in altitude or climate
• Cold climate
• Exposure to smoke
• Genetic factors (susceptibility to infection may run in families)
• Not being breastfed
• Pacifier use
• Recent ear infection
• Recent illness of any type (lowers resistance of the body to infection)

Symptoms

In infants, the clearest sign is often irritability and inconsolable crying. Many infants and children develop a fever or have trouble sleeping. Parents often think that tugging on the ear is a symptom of an ear infection, but studies have shown that the same number of children going to the doctor tug on the ear whether or not the ear is infected.

Symptoms in older children or adults include:

• Ear pain or earache
• Fullness in the ear
• Feeling of general illness
• Vomiting
• Diarrhea
• Hearing loss in the affected ear

The child may have symptoms of a cold, or the ear infection may start shortly after having a cold.

All acute ear infections include fluid behind the eardrum. You can use an electronic ear monitor, such as EarCheck, to detect this fluid at home. The device is available at pharmacies, but you still need to see your doctor to confirm any possible ear infection.

Signs and tests

You will be asked if there have been any ear infections in the past, and whether your child (or you, if you are the patient) have had any recent cold or allergy symptoms.

The health care provider will perform a physical exam. This will include an examination of the throat, sinuses, head, neck, lungs, and ears. The health care provider looks inside the ears using an instrument called an otoscope. If infected, there may be areas of dullness or redness, or there may be air bubbles or fluid behind the eardrum. The fluid may be bloody or filled with pus. The health care provider will also check for any signs of perforation (a hole) in the eardrum.

A hearing test may be recommended if there is a history of persistent (chronic and recurrent) ear infections.

Treatment

Some ear infections will safely clear up on their own without antibiotics. Often, treating the pain and allowing the body time to heal itself is all that is needed:

• Apply a warm cloth or warm water bottle to the affected ear.
• Use over-the-counter pain relief drops for ears, or ask the doctor about prescription ear drops to relieve pain.
• Take over-the-counter medications for pain or fever, such as ibuprofen or acetaminophen. Do NOT give aspirin to children.

All children younger than 6 months with a fever or symptoms should see the doctor. Children who are older than 6 months may be watched at home if they do not have:

• A fever higher than 102 F
• More severe pain or other symptoms
• Other medical problems

If there is no improvement or symptoms get worse, schedule an appointment with your health care provider to determine whether antibiotics are needed.

ANTIBIOTICS

A virus or bacteria can cause ear infections. Antibiotics will not help an infection caused by a virus. Many health care providers no longer prescribe antibiotics for every ear infection. However, all children younger than 6 months with an ear infection are treated with antibiotics.

Your health care provider is more likely to prescribe antibiotics if:

• Your child is under age 2
• Has a fever
• Appears sick
• Is not improving over 24 to 48 hours

Make sure you or your child takes the antibiotics every day and finishes all the medicine, rather than stopping when symptoms go away. If the antibiotics do not seem to be working within 48 to 72 hours, contact your doctor. You may need to switch to a different antibiotic.

Amoxicillin is commonly the first choice. Other antibiotics that may be given are azithromycin or clarithromycin, cefdinir, cefuroxime, cefpodoxime, amoxicillin clavulanate (Augmentin), clindamycin, or ceftriaxone.

Side effects of antibiotics include nausea, vomiting, and diarrhea. Although rare, serious allergic reactions may also occur.

Some children who have repeat infections that seem to go away in between may receive a smaller, daily dose of antibiotics to prevent new infections.

SURGERY

If an infection does not go away with the usual medical treatment, or if a child has many ear infections over a short period of time, the doctor may recommend ear tubes.

• In this procedure, a tiny tube is inserted into the eardrum, keeping open a small hole that allows air to get in so fluids can drain more easily. Tympanostomy tube insertion is done under general anesthesia.
• Usually the tubes fall out by themselves. Those that don't fall out may be removed in your doctor's office.

If the adenoids are enlarged, surgical removal of the adenoids may be considered, especially if you continue to have ear infections. Removing tonsils does not seem to help with ear infections.

Expectations (prognosis)

Ear infections can be treated but may occur again in the future. They can be quite painful. If you or your child are prescribed an antibiotic, it is important to finish all your medication as instructed.

Complications

Generally, an ear infection is a simple, nonserious condition without complications. Most children will have minor, temporary hearing loss during and right after an ear infection. This is due to fluid lingering in the ear.

Fluid can remain behind the eardrums even after the infection has cleared.

See also: Otitis media with effusion

Other potential complications from otitis media include:

• Ruptured or perforated eardrum
• Chronic, recurrent ear infections
• Enlarged adenoids or tonsils
• Mastoiditis (an infection of the bones around the skull)
• Meningitis (an infection of the brain)
• Formation of an abscess or a cyst (called cholesteatoma) from chronic, recurrent ear infections
• Speech or language delay in a child who suffers lasting hearing loss from multiple, recurrent ear infections

Calling your health care provider

Call your child's doctor if:

• Pain, fever, or irritability do not improve within 24 to 48 hours
• At the start, the child seems sicker than just an ear infection
• Your child has a high fever or severe pain
• Severe pain suddenly stops hurting -- this may indicate a ruptured eardrum
• Symptoms worsen
• New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles

For a child younger than 6 months, let the doctor know right away if the child has a fever, even if no other symptoms are present.

Prevention

You can reduce your child's risk of ear infections with the following practices:

• Wash hands and toys frequently.
• If possible, choose a daycare that has a class with 6 or fewer children. This can reduce your child's chances of getting a cold or similar infection, and leads to fewer ear infections.
• Avoid pacifiers.
• Breastfeed -- this makes a child much less prone to ear infections. But, if bottle feeding, hold your infant in an upright, seated position.
• Do not expose your child to secondhand smoke.
• Make sure your child's immunizations are up-to-date. The pneumococcal vaccine prevents infections from the bacteria that most commonly causes acute ear infections and many respiratory infections.
• Avoid overusing antibiotics. Overusing antibiotics can lead to antibiotic resistance.

References

American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004;113(5):1451-1465.

Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Rockette HE, Pitcairn DL, et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med. 2007;356:248-261.

Ramakrishnan K, Sparks RA, Berryhill WE. Diagnosis and treatment of otitis media. Am Fam Physician. 2007;76:1650-1656.

Koopman L, Hoes AW, Glasziou PP, Cees L, Appelman L, Burke P, et al. Antibiotic therapy to prevent the development of asymptomatic middle ear effusion in children with acute otitis media: a meta-analysis of individual patient data. Arch Otolaryngol Head Neck Surg. 2008;134:128-132.

Advisory Committee on Immunization Practices (ACIP). Licensure of a 13-Valent Pneumococcal Conjugate Vaccine (PCV13) and Recommendations for Use Among Children. MMWR. 2010 Mar 12;59(09):258-261.

Answer 2

Definition

Ear infections are one of the most common reasons parents take their children to the doctor. While there are different types of ear infections, the most common is called otitis media, which means an inflammation and infection of the middle ear. The middle ear is located just behind the eardrum.

An acute ear infection is a short and painful ear infection. For information on an ear infection that lasts a long time or comes and goes, see: Chronic ear infection.

Alternative Names

Otitis media - acute; Infection - inner ear; Middle ear infection - acute

Causes, incidence, and risk factors

The Eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid normally made in the middle ear. If the Eustachian tube becomes blocked, fluid can build up. This can lead to infection.

Ear infections are common in infants and children, because the Eustachian tubes become easily clogged.

Ear infections may also occur in adults, although they are less common than in children.

Anything that causes the eustachian tubes to become swollen or blocked causes more fluids to build up in the middle ear behind the eardrum. These causes include:

• Allergies
• Colds and sinus infections
• Excess mucus and saliva produced during teething
• Infected or overgrown adenoids
• Tobacco smoke or other irritants

Ear infections are also more likely if a child spends a lot of time drinking from a sippy cup or bottle while lying on his or her back. However, getting water in the ears will not cause an acute ear infection, unless the eardrum has a hole from a previous episode.

Acute ear infections occur most often in the winter. You cannot catch an ear infection from someone else, but a cold may spread among children and cause some of them to get ear infections.

Risk factors for acute ear infections include:

• Attending daycare (especially those with more than 6 children)
• Changes in altitude or climate
• Cold climate
• Exposure to smoke
• Genetic factors (susceptibility to infection may run in families)
• Not being breastfed
• Pacifier use
• Recent ear infection
• Recent illness of any type (lowers resistance of the body to infection)

Symptoms

In infants, the main sign is often irritability and inconsolable crying. Many infants and children with an acute ear infection have a fever or trouble sleeping. Tugging on the ear is not always a sign that the child has an ear infection.

Symptoms of an acute ear infection in older children or adults include:

• Ear pain or earache
• Fullness in the ear
• Feeling of general illness
• Vomiting
• Diarrhea
• Hearing loss in the affected ear

The ear infection may start shortly after having a cold. Sudden drainage of yellow or green fluid from the ear may mean a ruptured eardrum.

All acute ear infections include fluid behind the eardrum. You can use an electronic ear monitor, such as EarCheck, to detect this fluid at home. The device is available at pharmacies, but you still need to see your doctor to confirm any possible ear infection.

Signs and tests

The health care provider will look inside the ears using an instrument called an otoscope. This may show:

• Areas of dullness or redness
• Air bubbles or fluid behind the eardrum
• Bloody fluid or pus inside the middle ear
• A hole (perforation) in the eardrum

A hearing test may be recommended if the person has a history of ear infections.

Treatment

Some ear infections will safely clear up on their own without antibiotics. Often, treating the pain and allowing the body time to heal itself is all that is needed:

• Apply a warm cloth or warm water bottle to the affected ear.
• Use over-the-counter pain relief drops for ears, or ask the doctor about prescription ear drops to relieve pain.
• Take over-the-counter medications for pain or fever, such as ibuprofen or acetaminophen. Do NOT give aspirin to children.

All children younger than 6 months with a fever or symptoms should see the doctor. Children who are older than 6 months may be watched at home if they do not have:

• A fever higher than 102 °F
• More severe pain or other symptoms
• Other medical problems

If there is no improvement or symptoms get worse, schedule an appointment with your health care provider to determine whether antibiotics are needed.

ANTIBIOTICS

A virus or bacteria can cause ear infections. Antibiotics will not help an infection caused by a virus. Many health care providers no longer prescribe antibiotics for every ear infection. However, all children younger than 6 months with an ear infection are treated with antibiotics.

Your health care provider is more likely to prescribe antibiotics if:

• Your child is under age 2
• Has a fever
• Appears sick
• Is not improving over 24 to 48 hours

Make sure you or your child takes the antibiotics every day and finishes all the medicine, rather than stopping when symptoms go away. If the antibiotics do not seem to be working within 48 to 72 hours, contact your doctor. You may need to switch to a different antibiotic.

Amoxicillin is commonly the first choice. Other antibiotics that may be given are azithromycin or clarithromycin, cefdinir, cefuroxime, cefpodoxime, amoxicillin clavulanate (Augmentin), clindamycin, or ceftriaxone.

Side effects of antibiotics include nausea, vomiting, and diarrhea. Although rare, serious allergic reactions may also occur.

Some children who have repeat infections that seem to go away in between may receive a smaller, daily dose of antibiotics to prevent new infections.

SURGERY

If an infection does not go away with the usual medical treatment, or if a child has many ear infections over a short period of time, the doctor may recommend ear tubes.

• In this procedure, a tiny tube is inserted into the eardrum, keeping open a small hole that allows air to get in so fluids can drain more easily. Tympanostomy tube insertion is done under general anesthesia.
• Usually the tubes fall out by themselves. Those that don't fall out may be removed in your doctor's office.

If the adenoids are enlarged, surgical removal of the adenoids may be considered, especially if you continue to have ear infections. Removing tonsils does not seem to help with ear infections.

Expectations (prognosis)

Ear infections can be treated but may occur again in the future. They can be quite painful. If you or your child are prescribed an antibiotic, it is important to finish all your medication as instructed.

Complications

Generally, an ear infection is a minor medical problem that gets better without complications. Most children will have minor, short-term hearing loss during and right after an ear infection. This is due to fluid lingering in the ear.

Rarely, a more serious infection may develop, such as

• Mastoiditis (an infection of the bones around the skull)
• Meningitis (an infection of the brain)

Fluid can remain behind the eardrums even after the infection has cleared for weeks or even months.. See also: Otitis media with effusion

Other potential complications include:

• Ruptured or perforated eardrum
• Chronic, recurrent ear infections
• Enlarged adenoids or tonsils
• Formation of an abscess or a cyst (called cholesteatoma) from chronic, recurrent ear infections
• Speech or language delay in a child who suffers lasting hearing loss from multiple, recurrent ear infections

Calling your health care provider

Call your child's doctor if:

• Pain, fever, or irritability do not improve within 24 to 48 hours
• At the start, the child seems sicker than just an ear infection
• Your child has a high fever or severe pain
• Severe pain suddenly stops hurting -- this may indicate a ruptured eardrum
• Symptoms worsen
• New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles

For a child younger than 6 months, let the doctor know right away if the child has a fever, even if no other symptoms are present.

Prevention

You can reduce your child's risk of ear infections with the following practices:

• Wash hands and toys frequently.
• If possible, choose a daycare that has a class with 6 or fewer children. This can reduce your child's chances of getting a cold or similar infection, and leads to fewer ear infections.
• Avoid pacifiers.
• Breastfeed -- this makes a child much less prone to ear infections. But, if bottle feeding, hold your infant in an upright, seated position.
• Do not expose your child to secondhand smoke.
• Make sure your child's immunizations are up-to-date. The pneumococcal vaccine prevents infections from the bacteria that most commonly causes acute ear infections and many respiratory infections.
• Avoid overusing antibiotics. Overusing antibiotics can lead to antibiotic resistance.

References

Tahtinen PA, Laine MK, Huovinen P, Jalava J, Ruuskanen O, Ruohola A. A placebo-controlled trial of antimicrobial treatment for acute otitis media. N Engl J Med. 2011 Jan 13;364(2):116-26.

Hoberman A, Paradise JL, Rockette HE, Shaikh N, Wald ER, Kearney DH, et al. Treatment of acute otitis media in children under 2 years of age. N Engl J Med. 2011 Jan 13;364(2):105-15.

Coker TR, Chan LS, Newberry SJ, Limbos MA, Suttorp MJ, Shekelle PG, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis mediain children: a systematic review. JAMA. 2010 Nov 17;304(19):2161-9.

Koopman L, Hoes AW, Glasziou PP, Cees L, Appelman L, Burke P, et al. Antibiotic therapy to prevent the development of asymptomatic middle ear effusion in children with acute otitis media: a meta-analysis of individual patient data. Arch Otolaryngol Head Neck Surg. 2008;134:128-132.

Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 years---United States, 2011. MMWR. 2011;60(5).

Reviewed By

Review Date: 05/01/2011

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 3

Is your child irritable, inconsolably crying, feverish, and having trouble sleeping? If so, your child may have an ear infection.

Ear infections are one of the most common reasons parents take their children to the doctor. The most common type is called otitis media, which means an inflammation and infection of the middle ear. The middle ear is located just behind the eardrum.

The Eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid normally made in the middle ear. If the tube gets blocked, fluid can build up, leading to infection. Ear infections are common in infants and children because their tiny. Eustachian tubes become easily clogged. They're often caused by Allergies, colds, and excess mucus and saliva produced during teething.

Infants with an ear infection will often be irritable. You may have a hard time consoling their crying, and your child may have a fever and not sleep very well. Older children may have an ear ache and tell you their ear feels full. Because ear infections have fluid behind the ear drum, you can use an electronic ear monitor to detect this fluid at home.

Children under 6 months old who might have an ear infection need to see a doctor. Your child's doctor will look inside the child's ear using an instrument called an otoscope. The doctor might see areas of redness, air bubbles behind the ear drum, and fluid inside the middle ear.

Often, an ear infection will clear up on its own. For older children, you can place a warm cloth or bottle on their ear and give them over-the-counter ear drops to relieve their pain.

If bacteria caused the ear infection, your child may need to take antibiotics. In fact, all ear infections in children under 6 months old are treated with antibiotics. If the infection does NOT go away, on its own or with treatment, the doctor may recommend ear tube surgery. In this procedure, a tiny tube is inserted into the eardrum to drain the fluid. The tube will usually fall out on its own.

Ear infections are very treatable, but they may come back again. If your child has to take an antibiotic, make sure they take all of the medicine.

Reviewed By

Review Date: 10/25/2011

Alan Greene, MD, Author and Practicing Pediatrician; also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.