Living with
Middle Ear Infection (Otitis Media)

What is middle ear infection (otitis media)?

An ear infection commonly affects the middle ear and is medically known as otitis media.
This occurs when there is build-up of fluid behind the eardrum where the important bones of hearing are located.

Most ear infections clear up on their own. However, sometimes analgesia, for the management of pain, and antibiotics are needed for the treatment of ear infections.

Ear infections are very common in children. Chronic ear infections or having multiple ear infections can cause cumulative damage that can lead to hearing problems and other serious complications.

How do you know you have a middle ear infection?

Symptoms of an ear infection come on suddenly.

Common signs and symptoms in children include:

• Ear pain (otalgia); this may be worse when lying down
• Tugging or pulling at the ear
• Trouble getting to sleep or staying asleep and fussiness
• Crying more than usual
• Difficulty hearing and responding to sounds, or difficulty with balance
• Fever
• Fluid coming from the ear
• Headache
• Loss of appetite or trouble feeding.

Common signs and symptoms in adults include:

• Ear pain (otalgia)
• Fluid coming from the ear – indicating the ear drum has burst
• Fever
• Trouble hearing or dizziness with difficulty balancing
• Loss of appetite and nausea.

When to see your doctor:

It is important to get an accurate diagnosis and prompt treatment if your child has an ear infection. Contact a healthcare adviser if you or your child have symptoms of an ear infection, especially if symptoms are severe and long-lasting – but do not wait until this is the case, rather, seek healthcare advice immediately.

What causes middle ear infection?

Typically, bacteria or viruses are responsible for conditions such as a cold and the flu, sinusitis and other infections, along with allergies and cigarette smoke, that can cause inflammation, fluid build-up and swelling in the Eustachian tubes that run from the middle ear to the nasal passages and back of the throat.

Alternatively, the adenoids in children may become swollen and enlarged blocking the Eustachian tube (the adenoids are tissues near your tonsils that are responsible for some immune functions, and they can become easily infected and inflamed).

When the Eustachian tube is blocked, secretions cannot drain from the middle ear. In children, the eustachian tubes are more difficult to drain as they are narrower and more horizontal. The built-up fluid can also become easily infected.

Risk factors for ear infections include:

• Age: Children between the ages of six months and two years are more susceptible to ear infections. Children cared for in close-contact, group settings, like day-cares or nursery schools, are also more likely to get common infections, such as a common cold and the flu that can cause ear infections.
• Infant bottle/formula-feeding: Babies who are not breastfed and who drink from formula from a bottle, especially when they are fed while they are lying down, tend to have more ear infections than breast-fed babies.
• Seasonal factors: Ear infections are most common during the colder, winter months when colds and the flu circulate. Seasonal allergies may also cause affected people to get more ear infections.
• Smoking and pollution: People who are smokers or who are exposed to second-hand tobacco smoke and high levels of air pollution tend to have an increased risk of developing ear infections.

How can you prevent middle ear infections?

• Prevent common colds and the flu and treat allergies: Wash your hands frequently and teach your children to wash their hands properly. Also practice good cough hygiene. Find out how to manage allergies here.
• Avoid second-hand smoke: Make sure that no one smokes in your home smokes and avoid second-hand smoke when you are out.
• Breast-feeding: If possible, breast-feed your baby for at least six months. Breast milk contains antibodies that may offer protection through immunity against common infections. If you bottle-feed, hold your baby in an upright position when feeding them.
• Talk to your doctor about vaccinations: Make sure your child is properly vaccinated. Annual flu vaccines and the pneumococcal vaccine, among others, may help prevent ear infections.
  Talk to your doctor about what vaccines may help you avoid common infections.

What treatment is available for a middle ear infection?

Most ear infections clear up on their own; however, analgesia or pain management may be needed in the form of paracetamol or non-steroidal anti-inflammatories (NSAIDs) like ibuprofen.

Consult your healthcare provider or pharmacist about using these medications, especially for children and teenagers.

Topical analgesic ear-drops can be used to relieve pain as well, as long the ear drum is not ruptured.

However, if symptoms are severe, last for more than one day or occur in very young children, consult your healthcare provider immediately as antibiotic treatment may be needed.

What are the complications that can occur because of middle ear infection?

Most ear infections don’t cause long-term complications. However, recurrent and multiple ear infections can cause complications such as:

• Rupture of the eardrum: While most eardrum tears heal within 72 hours, sometimes surgical repair is needed.
• Hearing loss: Mild hearing problems with ear infection, that goes away once the infection resolves, is common and need not cause extreme concern. Recurrent ear, or persistent fluid build-up in the middle ear, can cause significant, permanent hearing loss if there is damage to the eardrum or middle ear hearing structures.
• Speech or developmental delays in children: This usually results from hearing difficulties caused by ear infections in very young children.
• Mastoiditis and other spread of infection: Untreated infections can spread to nearby tissues, such as the mastoid (the bony protrusion behind the ear) which is called mastoiditis. This can result in damage to the mastoid bone and cause cysts or abscesses in the bone and other tissues.
  Rarely, middle ear infections can spread to other tissues in the head or skull, causing serious conditions like meningitis (the inflammation of the membranes around the brain).