Middle Ear Infection

Causes

Bacteria and viruses cause this condition, such as:

• Streptococcus pneumoniae (most common)
• Haemophilus influenzae
• Moraxella (Branhamella) catarrhalis
• Streptococcus pyogenes (less common)

Risk Factors

These factors increase your chance of developing middle ear infection:

• Recent viral infection (eg, cold )
• Recent sinusitis
• Age: babies and toddlers
• Season: winter
• Attendance at day care
• Babies who are formula-fed
• Medical conditions that cause abnormalities of the eustachian tubes, such as:
  • Cleft palate
  • Down syndrome
• History of allergies (environmental allergies, food [milk] allergies )
• Gastroesophageal reflux disease (GERD)
• Babies whose mothers drank alcohol while pregnant
• Exposure to second hand smoke, usually cigarette smoke, but also from cooking and wood-heating

Tell your doctor if you have any of these risk factors.

Symptoms

Symptoms include:

• Ear pain (babies may tug or rub at the ear or face)
• Fever
• Irritability
• Hearing loss (may be only temporary, due to fluid accumulation)
• Decreased appetite, difficulty feeding
• Disturbed sleep
• Drainage from ear
• Difficulty with balance

Diagnosis

The doctor will ask about symptoms and medical history, and perform a physical exam. Most middle ear infections can be diagnosed by looking into the ear with a lighted instrument, called an otoscope.

The doctor will see if there is fluid or pus behind the eardrum. A small tube and bulb may be attached to the otoscope. This is to blow a light puff of air into the ear. The puff helps the doctor see if the eardrum is moving normally.

Other tests may include:

• Tympanocentesis—used to drain fluid or pus from the middle ear using a needle, also used to check for bacteria
• Tympanometry—measures pressure in the middle ear and responsiveness of the eardrum, also used to check for fluid or pus
• Hearing test —may be done if you have had many ear infections

Treatment

Treatments include:

If you are diagnosed with an ear infection, follow your doctor's instructions .

Prevention

To reduce the chance of getting an ear infection:

• Avoid exposure to smoke.
• Breastfeed your baby for at least the first six months.
• Try to avoid giving your baby a pacifier.
• If you bottle-feed, keep your baby's head propped up as much as possible. Don't leave a bottle in the crib with your baby.
• Get tested for allergies.
• Treat related conditions, such as GERD.
• Practice good hand washing .
• Make sure your child's vaccinations are up to date. The pneumococcal vaccine can prevent middle ear infections.
• Consider getting a flu vaccine .
• If your child has a history of ear infections, talk to the doctor about long-term antibiotic use. This is used in some cases.
• Ask your doctor about tympanostomy tubes. These tubes help equalize pressure behind the eardrum.
• Xylitol is a natural sugar that is used as a sweetener in gum, candy, and other types of food. Eating food with xylitol on a regular basis may help to reduce your risk of ear infections.

Revision Information

• Reviewer: Kari Kassir, MD
• Review Date: 09/2012 -
• Update Date: 00/93/2012 -