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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Ear Infection, Middle

What is it?

Otitis media is an infection of the middle ear, the cavity between the eardrum and the delicate structures of the inner ear. Typically, it occurs when viruses causing an upper respiratory tract infection (such as a cold) or bacteria migrate along the eustachian tube, the passageway between the nasal passages and the middle ear. Infection often causes the tube to become blocked, producing a vacuumlike effect and preventing the mucus, pus, and other fluids produced during an infection from draining out of the middle ear. This causes pain as these fluids exert pressure on the eardrum, possibly rupturing it. Otitis media is very common in children (because the eustachian tube is smaller), and it tends to recur, especially in winter. With prompt treatment, the chances of full recovery are excellent. Persistent forms of the disorder, chronic otitis media, produce milder symptoms. Left untreated, however, chronic otitis media may eventually cause severe structural damage in the ear and skull, resulting in irreversible hearing loss or facial nerve weakness.

What Causes It?

  • A viral or bacterial infection of the upper respiratory tract is the most common underlying cause.
  • Nasal allergies or childhood adenoids may cause blockage of the eustachian tube.
  • A ruptured eardrum facilitates the entrance of infectious agents into the middle ear.
  • Children with congenital problems of the facial skeleton (such as cleft lip) and those with Down syndrome are at greater risk of middle ear infection.
  • Certain groups of people (such as the Navajo) have a hereditary predisposition to ear infections.
  • Second-hand exposure to cigarette smoke raises the risk of middle ear infection in children.
  • Recurrent bacterial ear infections may result in chronic otitis media.

Prevention

  • Protocols for hand washing with soap and warm water should be established for both children and caretakers in schools and daycare settings.
  • At home, wash bed linens, towels, and heating pads regularly to prevent reinfection from pus residues. Discard cotton balls and swabs after use.

Diagnosis

  • The doctor will examine the ear canal with an otoscope, a small, lighted viewing instrument.
  • A culture of the fluid discharge may be taken.

How to Treat It

  • Antibiotics (to be taken for the full term prescribed) may be needed to treat a bacterial infection.
  • Take aspirin or acetaminophen to ease pain and fever. Children should be given acetaminophen only.
  • Your doctor may recommend decongestants or antihistamines to treat symptoms.
  • A small incision (myringotomy) may be made in the eardrum to allow pus to drain. This incision heals by itself in two to three weeks. A tube may be placed within the myringotomy to aerate the middle ear when fluid repeatedly accumulates.
  • Enlarged adenoids may require surgical removal.
  • Rarely, the mastoid process, a bone just behind the ear, becomes infected and must be surgically removed (mastoidectomy).

When to Call a Doctor

  • Call a doctor if you or your child develops an earache that persists despite treatment, especially if symptoms worsen or are accompanied by swelling around the ear, facial twitches, or severe ear pain that suddenly ceases (indicating eardrum rupture).