Middle ear infection or Otitis media may result from a respiratory infection or sore throat. Your physician may prescribe ear drops for acute otitis media.

Ear Infection

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Ismail Munir

Overview

The term &ldquo;ear infection&rdquo; is commonly used for acute otitis media<a href="#accordion">[2]</a>. It is also referred to as a middle ear infection. Ear infections commonly occur due to the entrapment of fluid behind the eardrum which leads to pain, inflammation, and bulging of the eardrum. Bacteria and viruses are responsible for causing ear infections.

Ear infections can be very painful. The middle of our ear, behind our eardrum, is filled with air and when it gets filled with fluid, inflammation occurs. This leads to other issues like pain. Ear infections are more prevalent in children, but adults are not immune to them. However, in the case of adults, it tends to go away on its own. In most instances, antibiotics are prescribed to treat ear infections. Ear infections can be acute or can even last for a while i.e., chronic ear infections<a href="#accordion">[9]</a>. Around 75% of children are believed to get an ear infection at least once before turning 3.&nbsp;

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There are three basic categories into which ear infections are divided: 
&nbsp;

<h5>Acute Otitis Media (AOM)</h5>

Being the second most common pediatric diagnosis in the emergency department, it is commonly experienced by children of ages between 6 to 24 months<a href="#accordion">[3]</a>. Common bacteria that are known to cause ear infections are Streptococcus pneumonia, Moraxella catarrhalis, and Haemophilus influenza. In some cases, there may even be a temporary loss of hearing, but it recovers after the infection is treated. AOM is also the most common cause of recurrent ear infections and ruptured eardrums<a href="#accordion">[5]</a>.&nbsp; 
&nbsp;

<h5>Otitis Media With Effusion (OME)</h5>

Otitis media with effusion refers to the collection of non-infected fluid in the space behind the eardrum. It Is also known as secretory or serous otitis media (SOM). The fluid accumulation, in this case, may not be due to a bacterial or viral infection, which is why severe discomfort is not experienced by the patient. There is only a temporary decrease or loss in hearing, but the symptoms are so mild that in many cases it goes undetected<a href="#accordion">[1]</a>. OME is prevalent in children between the age of 6 months and 3 years.&nbsp; 
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<h5>Chronic Otitis Media With Effusion (COME)</h5>

Chronic otitis media refers to the entrapment of fluid in the ear repeatedly. Unlike OME, this does not tend to resolve itself in a matter of 4-6 weeks. In case it does, the infection comes back repeatedly leading to diminished hearing ability. This also has a vital impact on your ear&rsquo;s immune system i.e., its ability to fight off other microbes in case of any infection<a href="#accordion">[13]</a>.

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Signs And Symptoms

Ear infections are easier to diagnose in adults due to clear symptoms of pain and irritation. In children, it can be a difficult process due to their inability to tell you all the symptoms. If your child is suffering any of the symptoms below, immediately consult a physician:

<ul>
	<li>Severe pain in the ear</li>
	<li>Nasal congestion</li>
	<li>Lethargy</li>
	<li>Feeling of fullness in the ear</li>
	<li>Diminished hearing ability</li>
	<li>Loss of appetite</li>
	<li>Loss of balance</li>
	<li>Crying a lot</li>
	<li>Pulling ears</li>
	<li>Trouble sleeping</li>
	<li>Fever</li>
	<li>Fluid drainage from the ear</li>
	<li>Headache 
	&nbsp;</li>
</ul>

Causes

<h5 dir="ltr">Infections</h5>

Primarily, these ear infections are caused by microbes. In most cases, ear infections occur after a cold, flu, or respiratory infection. Inside our ear is the eustachian tube that extends from the middle ear to the back of the throat. This builds the connection of your ear with the throat. The fluid build-up occurs due to the blockage of this tube<a href="#accordion">[9]</a>. These eustachian tubes get easily blocked in children, but this phenomenon also occurs in adults. The blockage and clogging of this tube often lead to inflammation and reduce the impact of sound waves hitting on the eardrum. Hence, the reduced ability to hear.&nbsp; 
&nbsp;

When it comes to the viruses or bacteria that are responsible for ear infections and infecting the fluid that blocks the eustachian tubes, they are either Streptococcus pneumoniae or Haemophilus influenza. Your eustachian tube cani be blocked due to:

<ul>
	<li><a href="https://www.merisehat.pk/disease/cold-flu" target="_blank">Cold</a></li>
	<li>Excess saliva production during teething</li>
	<li><a href="https://www.merisehat.pk/disease/allergies" target="_blank">Allergies</a></li>
	<li>Sinus infection</li>
	<li>Smoking</li>
	<li>Change in air pressure</li>
	<li>Mucus 
	&nbsp;</li>
</ul>

<h5 dir="ltr">Adenoids&nbsp;</h5>

Adenoids are also a common reason for the development of ear infections. Adenoids are small bundles of tissue present behind the nose, high up in the throat<a href="#accordion">[8]</a>. These adenoids are a part of the lymphatic system. In children, enlarged adenoids are a common issue. Many children have enlarged adenoids from birth due to their link with the lymphatic system. Adenoids do tend to get swollen while fighting off an infection. Infection from adenoids can travel to eustachian tubes and lead to its swelling, causing ear infections<a href="#accordion">[4]</a>.

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Diagnosis

There are several ways to diagnose ear infections. The diagnosis method is determined based on the symptoms that are described to your healthcare practitioner. The doctor may check the patient&rsquo;s breathing through a stethoscope since ear infections are common in children, especially during a cough or cold. Other diagnosing practices include: 
&nbsp;

<h5 dir="ltr">Otoscope Ear Exam</h5>

The most common way of diagnosis is through an otoscope. A pneumatic otoscope may be the only tool required to determine the cause of ear discomfort. The otoscope is equipped with a magnifying glass, a light, and a viewing piece. An otoscope requires the physician to hold the ear with one hand and the instrument in another hand. In cases of frequent ear infections or discomfort experienced by a child, the parents are taught to use an otoscope on their own as well<a href="#accordion">[15]</a>.

A healthy eardrum looks pinkish grey in colour whereas an irritated or inflamed eardrum may appear inflamed, or red. Pneumatic otoscope can also aid in checking the fluid present in the middle ear. This is done by blowing air to the eardrum with the help of the otoscope. Ideally, the eardrum should move back and forth due to the empty space in the middle ear, but in case of an infection, this movement will not occur. Thus, indicating the presence of fluid<a href="#accordion">[2]</a>. 
&nbsp;

<h5 dir="ltr">Tympanometry</h5>

Tympanometry is another test employed to determine the functioning of the middle ear. The name is derived from tympanic membrane, commonly known as eardrum. Tympanometry works by employing pressure to the eardrum to see its movement. The results are obtained in the form of a graph called tympanogram. In tympanometry, daPa is the measurement of air pressure. Abnormal tympanometry readings are when the line extends beyond the 0 daPa mark or before the 0 daPa mark<a href="#accordion">[17]</a>.&nbsp; 
&nbsp;

<h5 dir="ltr">Acoustic Reflectometry&nbsp;</h5>

Acoustic reflectometry makes use of acoustic otoscope. It measures the sound reflected from the eardrum. The louder the sound reflected, more severe is the infection<a href="#accordion">[11]</a>. Acoustic reflectometry is relatively easier to perform. Unlike tympanometry, the test can be carried out regardless of the patient crying. However, despite these benefits, acoustic reflectometry is yet to be fully accepted by otolaryngologists from all over the world, because there is still speculation about the standards required to interpret the test<a href="#accordion">[11]</a>.

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Treatment

Treatment of ear infections varies from person to person based on their age, condition, severity, and the type of ear infection. The type of treatment is also affected by the duration for which your ear has been infected and the occurrence of your ear infection i.e. if it happened for the first time or is it a common occurrence.&nbsp;

In many cases, it is recommended to wait it out and for the infection to go away on its own without the need for antibiotics. Several at-home practices can be employed to calm the inflamed area. You can: 
&nbsp;

<ul>
	<li>Apply a warm compress to the affected ear</li>
	<li>Take OTC pain relief ear drops. Consult your pharmacist for the right ear drops for your child</li>
	<li>Do not give aspirin to your children. You can take other child-safe anti-inflammatory medicine like acetaminophen or ibuprofen 
	&nbsp;</li>
</ul>

In case your infection or your child&rsquo;s infection is not getting better or the pain is severe, it is best to consult your physician. The most common treatment used for ear infections that do not heal on their own is through the usage of antimicrobials. &ldquo;Antimicrobial&rdquo; is a broad term that encompasses a broader range of medicines that are not restricted to antibiotics. It also includes antivirals, antifungals, and antiparasitics.&nbsp;

Your physician may prefer to wait for at least three days before resorting to any antimicrobial medicine. The guidelines are set by the American Academy of Pediatrics that suggests the time duration to wait for the ear infection to clear up on its own with respect to the patient&rsquo;s age. Antibiotics are almost always prescribed to younger children, especially those younger than 6 months, after monitoring their condition for 48 hours.&nbsp;

It is important to note that any course of antimicrobials is to be completed fully even if your child gets better in the middle of the treatment. Never stop the treatment mid-way. Your child may experience common side effects of treatments including diarrhea, nausea, and vomiting<a href="#accordion">[9]</a>.&nbsp; 
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<h5 dir="ltr">Myringotomy</h5>

Also referred to as the surgical treatment of an ear infection. This is employed when the infection is not responding to all the other treatments. The process involves the physician creating a small incision in the eardrum, letting the fluid drain. The incision heals within a few days with no signs of scarring<a href="#accordion">[16]</a>. 
&nbsp;

<h5 dir="ltr">Ventilation Tubes</h5>

A vent tube, also known as a myringotomy tube, a pressure equalization (PE) tube, or a tympanostomy tube, is often employed in severe cases for children, under anesthesia. This is a very safe procedure and involves the incision of the eardrum followed by the insertion of the vent tube. These tubes allow for the trapped fluid to drain, and may even be kept installed in the ear for multiple days<a href="#accordion">[10]</a>.

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Due to the common nature of ear infections and how in many cases they go away on their own, the occurrence of complications is not common. However, for people who experience ear infections frequently, they may be prone to more complications. These complications include: 
&nbsp;

<ul>
	<li>Affected Or&nbsp;Loss Of Hearing:&nbsp;While mild ear infections are often characterized by temporary loss of hearing. In cases of severe infections or ongoing infections that occur now and then, the internal structures of the middle ear tend to get affected due to the pressure involved with the fluid clogging. This in turn has an impact on how the vibrations are perceived by the ear bones when they hit the eardrum. Due to compromised internal structures, the vibrations do not travel as freely which leads to hearing impairment.&nbsp; 
	&nbsp;</li>
	<li>Delayed Speech Development:&nbsp;When a child is unable to hear properly, their ability to repeat the words is greatly impacted. This often leads to the child having a hard time learning to speak or learn any language. Bilingual children seem to suffer from it immensely due to the constant switching of languages.&nbsp; 
	&nbsp;</li>
	<li>Spread Of Infection:&nbsp;In cases of bacterial or viral infections impacting the clogging of the middle ear, longer periods of infections tend to damage the structures and surrounding tissues present in the ear<a href="#accordion">[7]</a>. The bone behind the ear, also known as the mastoid bone, is very likely to get infected and cause mastoiditis. Mastoiditis is characterized by the inflammation of the mastoid bone causing a bony protrusion. Mastoiditis can often cause cysts filled with pus.&nbsp; 
	&nbsp;</li>
	<li>Tearing Of The Eardrum:&nbsp;In many cases, children develop a tear in their eardrum which is why discharge of the fluid is a common symptom when it comes to ear infections. In many cases, the tear heals on its own.</li>
</ul>

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Children who use sippy cups or drink milk while laying down are more prone to getting ear infections. This is because the milk may enter the ear and trigger an infection. The same is not usually the issue with water. In adults, the blockage is often triggered due to colds, sinus infections, allergies, etc. The following are the most common risk factors involved in the development of ear infections, in both adults and children: 
&nbsp;

<ul>
	<li>URIs &ndash; Upper Respiratory Tract infections are a common cause of ear infections. Children with underdeveloped immune systems are more at risk of contracting URIs but adults with weakened immune systems may also experience the same issue that may lead to an ear infection.</li>
	<li>Allergic Rhinitis &ndash; Chronic or allergen-specific allergies, hay fever, etc. often cause increased secretions of inflammatory compounds in the body. This also irritates and damages the lining of the ears. This type of risk can be reduced by the administration of antihistamines<a href="#accordion">[6]</a>.</li>
	<li>People with large adenoids and compromised immune systems are more at risk of contracting ear infections.</li>
	<li>Cleft Palate &ndash; Craniofacial disorders often lead to muscle weakness. A cleft palate makes it harder for the ear fluid to drain.</li>
	<li>Malformation Of The Eustachian Tube Or The Horizontal Placement Of The Eustachian Tube also makes it more prone to getting clogged by the fluid and leads to ear infections.&nbsp;</li>
	<li>Smoking Or Exposure To Second-Hand Smoke is also a common cause of ear infections. The smoke tends to block the pathways of the ear, causing it to get blocked.</li>
</ul>

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Ear infections can be easily prevented with a handful of lifestyle changes for adults and how you take care of your baby. A few practices employed right will safe you from the hardships of dealing with a clogged ear. Here are some of the measures you can take to ensure that you or your child are free from ear infections for good:

<ul>
	<li>Breastfeed your child for at least 6 months. Breast milk has key antibodies that help your baby fight off pathogens and build up their immune system.</li>
	<li>Avoid your baby from consuming fluids while lying down flat. Always try to keep your baby in an upright position to avoid any fluid from getting in their ear.</li>
	<li>Prolonged use of pacifiers has been related to increased chances of ear infection. However, pacifiers also play a vital role in avoiding sudden infant death syndrome, which is why it is best to slowly stop your child&rsquo;s use after 6 months of age.</li>
	<li>Get your child the Prevnar 13 vaccine administered along with the annual flu shot. Prevnar 13 aids in preventing ear infections, whereas the flu shot will eradicate the chances of your child getting their ear clogged due to persistent flu.&nbsp;</li>
	<li>Avoid cotton swabs. Let your physician remove&nbsp;the earwax. Cotton swabs can leave residue in the ear that may lead to blockage and irritation of the ear canals.</li>
	<li>Taking a decongestant before boarding a plane, in case you have flu, prevents the chances of developing ear infections due to the change in air pressure.</li>
</ul>

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In a study conducted by the researchers at the University of Illinois, they managed to design a 3-D printed model device that can inactivate Pseudomonas aeruginosa. The bacterium is responsible for causing ear infections. This will eradicate the use of antibiotics, which are ineffective in 30% of the cases, all while avoiding the development of antibiotic resistance in children. The device is a micro plasma jet array that produces plasma consisting of charged particles and certain molecules that have previously played their role in deactivating or denaturing pathogens<a href="#accordion">[14]</a>.

&nbsp;

Key Points

<ul>
	<li>Ear infections are characterized by the blockage or the clogging of the space in the middle ear by fluid. This fluid may or may not be infected.</li>
	<li>There are 3 types of ear infections common in children and adults: acute otitis media (AOM), otitis media with effusion (OME), and chronic otitis media with effusion (COME).</li>
	<li>The diagnosis of ear infections is best done with the help of an otoscope.</li>
	<li>Ear infections can go away on their own, but in severe cases, they are treated with the help of antimicrobials or through surgical measures.</li>
	<li>Children and adults with cough, flu, allergies, and sinus issues are more prone to getting ear infections.</li>
	<li>Ear infections can be prevented by the administration of the right vaccines to your children.</li>
	<li>As an adult, the best way to prevent the infection is to avoid smoking&nbsp;and treat colds and flu before they worsen.</li>
	<li>Latest research has suggested the possibility of a targeted therapy that may reduce or completely replace the usage of antibiotics in the treatment of ear infections, avoiding the development of antibiotic resistance.</li>
</ul>

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