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    Middle Ear Infections - Acute Otitis Media

    Overview
    Causes
    Risk Factors
    Symptoms
    Diagnosis
    Treatment
    Prevention
    Where to Seek Treatment
    Singapore General Hospital
    Contributed by Dept of Otolaryngology
    Singapore General Hospital

    Overview

    The middle ear is the space behind the eardrum and is responsible for transmission of sound from the outer to the inner ear. Infection of the middle ear can be acute or chronic.

    Acute Otitis Media refers to fluid in the middle ear with signs and symptoms of infection such as pain, fever, bulging eardrum and hearing loss.


    Causes

    The middle ear is connected to the back of the nose via a small canal called the eustachian tube. Bacteria can make their way into the middle ear via this canal where they are usually flushed out through the eustachian tube. Both bacteria and virus can infect the middle ear.

    A blockage in the canal (usually due to a cold/flu), or when it does not function properly, can lead to germs getting trapped in the middle ear, causing an ear infection.

    Children are predisposed to suffer from acute otitis media because of the anatomy and function of their ears and eustachian tube.


    Risk Factors

    Children are prone to ear infections because their eustachian canal is smaller and more horizontal. They tend to get more ear infections between 6-24 months. They are also more prone to upper respiratory tract infections such as colds and flus.

    An ear infection, in itself, is not contagious but the upper respiratory viruses that cause the infection can spread amongst children. Therefore, children in day care are more prone to ear infections. Children who use pacifiers are also at risk.

    Other risks factors include immature immune systems and factors that can cause the eustachian canal to be blocked are allergies, acid reflux, or environmental irritants like tobacco smoke.


    Symptoms

    • Young children tend to tug their ears if they have an ear infection because of the pain and accumulation of fluid in the ear.
    • They may also cry, scream or are generally more irritable.
    • Older children will be able to complain of pain and hearing loss.
    • They will also tend to have fever.

    Diagnosis

    The diagnosis is often evident from history and physical examination. A swab of the pus may be obtained.


    Treatment

    Diagnosis-ear-examMost middle ear infections will resolve on their own, without antibiotics. A healthy, older child may be treated with pain killers and close followup.

    Antibiotics can be given if the symptoms are severe, persist, or worsen. Antibiotics may also be given to children who are young or at risk for complications to help resolve the infection, reduce pain and prevent complications. Once antibiotics are given, the fever and pain should improve or resolve within 48 to 72 hours.

    Painless fluid in the middle ear may last for a few weeks or months after an acute infection. It may be necessary to drain the fluid if it fails to drain by itself.

    Symptomatic relief of upper respiratory infection symptoms (running nose, blocked nose) with antihistamines or nasal decongestants may be given.

    Complications

    Complications such as acute mastoiditis, meningitis and brain abscess arising from middle ear infection are now rare because of antibiotics usage.


    Prevention

    It is impossible to prevent middle ear infection totally. However, some useful measures include:

    a. Discourage the use of pacifi ers as this predisposes the child to middle ear infection. Also avoid letting the child drink while lying fl at on his back.

    b. Wash hands and clean toys frequently as the viruses that cause upper respiratory tract infections (fl u/cold) can be transmitted by contact.

    c. Avoid being in a small room with other sick children or adults as respiratory tract infections can also be spread through the air.

    d. Breastfeeding is very useful in reducing the number of ear infections. A child should be nursed throughout the first year. Even a few weeks of breastfeeding can result in fewer ear infections.

    e. Vaccinate your child with the pneumococcal and flu vaccines as they help in the prevention of ear infections.

    f. Treat your child for allergies and avoid exposure to cigarette smoke. g. Ensure that the child gets sufficient sleep and good nutrition.

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