Ear infections are caused by either a bacterial or fungal infection of the
outer ear or a viral or bacterial infection of the middle ear. The outer ear
is the visible part of the ear plus the ear canal, a small passage that conducts
sound waves from the outside to the middle ear.
The middle ear is a group of structures that include the eardrum and
three small bones called ossicles that convey sound energy from the ear canal
to the structures of the inner ear. The middle ear is connected to the upper
throat by a passageway called the Eustachian tube, which has two major
functions: to equalize air pressure between themiddle ear and the air outside
the body and to drain fluid or mucus from the middle ear into the throat.
Description
Infection of the outer ear, or otitis externa, is a skin infection caused by
bacteria or fungi that get into the skin of the ear canal through a scratch
or other small break in the skin. The skin lining the ear canal is very thin
and easily damaged. If a person goes swimming, takes a shower, or isexposed to hot, humid weather, bacteria or fungi in the ear canal can
rapidly multiply and cause an inflammation of the skin. Because the skin
of the ear canal is closely attached to the underlying bone, the inflammation
can cause severe pain and swelling that may be sudden. The swelling
of the skin of the canal may lead to temporary hearing loss.
Infection of the middle ear, or otitismedia, is often a complication of the
common cold. It begins when cold viruses (or sometimes bacteria) enter the
Eustachian tube from the upper throat and produce inflammation and swelling
in the tube. Fluid builds up behind the eardrum when the Eustachian
tubes are blocked by swelling; this is called an effusion. The Eustachian tubes
can also be blocked by swollen adenoids, pieces of tissue that are part of the
immune system and lie at the very back of the nasal passages. If the adenoids
become infected, they can swell and block the Eustachian tubes.
Doctors usually distinguish between otitis media with effusion
(OME) and acute otitis media. In OME, the fluid that builds up behind
the eardrum is not itself infected; in acute otitis media, the collection of
fluid itself has become infected by bacteria. The difference is important
because it affects the treatment of the earache.
Demographics
Infection of the outer ear is common. In the United States, it is more
common in the summer months and in the warmer and more humid partsof the country and is more likely to affect adolescents and young adults
than very young children.
Infection of the middle ear, however, is much more common in young
children than in older children or adults. There are two reasons for this.
First, the immune systems of young children are less well developed than
those of older children; second, the Eustachian tubes in young children
enter the upper throat at a lower angle than in older humans. This difference
makes it easier for disease organisms to stay in the tubes and cause inflammation
and swelling rather than being carried downward into the throat.
Infections of the middle ear are very common in children between
six months and three years of age. According to the National Institutes
of Health (NIH), 50 percent of all children in the United States have
at least one episode of otitis media by the time they are a year old, and
80 percent have an episode by three years of age. The costs of treating
these infections and their complications come to $4 billion each year.
Otitis media is more common in the fall and winter months in the
United States. It is somewhat more common in boys than in girls and
is more common in Native Americans than in children of other racial
groups. The reasons for these differences are not known.
Factors that increase a child
’s risk of middle ear infections include: •
in some families, although no specific genes have been linked to
otitis media.
Heredity. Repeated infections of the middle ear are known to run •
Having a cleft palate. •
and other upper respiratory infections that can lead to otitis media.
Day care. Children in day care settings are exposed to common colds •
Exposure to tobacco smoke or air pollution. •
are at greater risk of ear infections than those who are held upright.
Feeding position. Babies who are fed from a bottle while lying down •
Family history of frequent ear infections. •
Use of a pacifier. •
History of allergies. 
Causes and Symptoms
Ear infections are caused by disease organisms causing tissue inflammation
and fluid buildup in the skin of the outer ear or the structures of the
middle ear.The symptoms of otitis externa may include:
•
Sudden onset of pain •
Intense pain when the outer ear is pulled or moved •
Itching •
Swelling of the outer ear or nearby lymph nodes in the neck •
Feeling of fullness in the ear •
Temporary loss of hearing or feeling that sounds are muffled •
Pus draining from the ear •
The symptoms of otitis media may include:
Red or flaky skin on the outside of the ear •
Intense crying in very young children •
Tugging or pulling at the ear •
Fever •
Irritability and headaches •
Trouble sleeping or poor feeding •
Nausea and vomiting (in small infants) •
Hearing loss •
Ringing or buzzing sounds in the ear •
the eardrum has ruptured.)
If the child has otitis media with effusion, there may be a slight
hearing loss or no symptoms at all.
Fluid draining from the ear (This symptom usually indicates that Diagnosis
The diagnosis of an ear infection is based on a combination of the
patient
Otitis externa can usually be diagnosed by simple movement of the outer
ear, which will typically produce intense pain. When the doctor looks
into the ear with an otoscope, the ear canal will look red and swollen, and
there may be pus present. The doctor may take a sample of the pus or
fluid and send it to a laboratory for culture.
In the case of otitis media, the doctor will use a pneumatic otoscope
to examine the child
puff a small amount of air into the middle ear to see whether there is
fluid behind the eardrum. If fluid is present, the eardrum will not move.Another test known as tympanometry may also be done to measure the
movement of the eardrum. In tympanometry, a small plug is inserted
into the outer ear and air is blown into the ear canal to evaluate the
movement of the eardrum.
If there is evidence of hearing loss, the child may be referred to an
audiologist for hearing tests.
Treatment
Treatment of an infection of the outer ear may involve one or more of
the following:
•
remove flaky skin and pus or other fluid.
Cleaning the outer ear with a cotton swab or suction device to •
shut, the doctor may insert a wick that will allow the drops to
penetrate the full length of the ear canal.
Antibiotic ear drops to fight infection. If the ear canal is swollen •
Aspirin or ibuprofen to relieve pain and reduce inflammation. •
tissue swelling.
The patient will be told to avoid swimming or scuba diving until the
infection is cleared and to keep water out of the ears while bathing or
showering.
Treatment of otitis media depends in part on whether the patient
has otitis media with effusion (OME) or a bacterial infection. If the
swelling of the Eustachian tube and the fluid buildup are caused by a
virus, antibiotics will not help. About 80 percent of children with otitis
media do not have a bacterial infection and will recover without
antibiotics.
The American Academy of Pediatrics (AAP) recommends a waitand-
see approach for the first two to three days to see whether the
infection will improve without antibiotics. Parents can give the child
nonaspirin pain relievers to relieve fever, apply warm washcloths to
the outer ear, or use anesthetic ear drops for pain. Antibiotics are
usually prescribed, however, for babies younger than six months; older
children who have had two or more ear infections within a month;
children in severe pain; or children with a fever of 102°F (38.9°C)
or higher.
The doctor may recommend surgical treatment if the child has
recurrent infections of the middle ear or if the infections are not clearedby antibiotics. In this type of surgery, a small drainage tube is inserted
through the eardrum to drain fluid and to equalize the pressure
between the middle ear and outer ear. The tubes usually fall out on
their own as the child grows. If the child
by swollen adenoids, the doctor may recommend surgical removal of
the adenoids.
’s Eustachian tubes are blocked Prognosis
Infections of the outer ear usually clear up completely in about a
week without long-term complications. In some cases, however,
people develop a chronic infection of the outer ear that extends to
inflammation of the surrounding skin. A few people, most often those
with diabetes or a weakened immune system, may develop a severe
infection of the bone and cartilage near the outer ear that can cause
severe pain and spread to the brain. This rare but potentially life-threatening
complication requires treatment with intravenous antibiotics
and sometimes surgery.
Most cases of otitis media improve within two to three days and clear
up completely in a week or two without complications. If fluid remains
behind the eardrum for long periods of time, however, it may eventually
cause hearing loss. Another possible complication of recurrent or
untreated otitis media is the spread of infection into air cells called mastoids
in the bones around the base of the skull, a condition known as
mastoiditis.
Prevention
Infections of the outer ear can be prevented by using ear plugs when
swimming, avoiding swimming in polluted water, drying the ears after
swimming or showering, and avoiding the use of foreign objects to clean
wax out of the ears. It is very easy to damage the skin of the ear canal in
this way.
Infections of the middle ear can be prevented by keeping a child
away from children with colds or upper respiratory infections; by not
exposing the child to tobacco smoke; by feeding the child in an upright
position; and by breastfeeding the child for the first six months of life.
Some doctors also recommend giving the child Prevnar, a vaccine that
protects against pneumonia and appears to reduce the risk of otitis
media as well.The Future
Ear infections are likely to continue being common health problems in
children and adolescents. Researchers are comparing the effectiveness of
tube placement versus removal of the adenoids in treating otitis media.
They are also studying the effectiveness of the pneumonia vaccine in preventing
infections of the middle ear.
SEE ALSO
Cleft lip and palate; Common cold; Smoking For more information
BOOKS
Friedman, Ellen M., and James P. Barassi.
Understanding and Treating Your Child
and Schuster, 2001.
Weisman, Roanne, and John D. Mark.
Colds, and More
My Ear Hurts!: A Complete Guide to’s Ear Infections. New York: SimonYour Sick Child: Fever, Allergies, Ear Infections,. Deerfield Beach, FL: Health Communications, 2006. PERIODICALS
Tarkan, Laurie.
“Ear Infections Too Often Misdiagnosed, Then Overtreated.” New York Times
nytimes.com/ref/health/healthguide/esn-earinfections-ess.html (accessed
July 18, 2008).
, January 22, 2008. Available online at http://health. WEB SITES
American Academy of Family Physicians (AAFP).
Available online at http://familydoctor.org/online/famdocen/home/children/
parents/common/ent/055.html (updated February 2008; accessed July 19,
2008).
American Academy of Otolaryngology
Infections and Earache
HealthInformation/earInfections.cfm (updated January 2008; accessed
July 19, 2008).
KidsHealth.
ill_injure/aches/swimmers_ear.html (updated May 2008; accessed July 19,
2008).National Institute on Deafness and Communication Disorders (NIDCD).
Otitis Media (Ear Infection)
gov/health/hearing/otitism.asp (updated July 2002; accessed July 19,
2008).
National Library of Medicine (NLM).
www.nlm.nih.gov/medlineplus/tutorials/otitismedia/htm/index.htm
(accessed July 19, 2008). This is an online tutorial with voiceover with
options of a self-playing version, a text version, or an interactive version with
questions.WORDS TO KNOW
Effusion: The medical term for an abnormal collection
of fluid in a body cavity.
Eustachian tube: The passageway that connects
the middle ear with the upper throat.
Otitis: The medical term for inflammation of the ear.
Otoscope: An instrument with a light and magnifying
lens that allows a doctor to examine the
eardrum and ear canal.. Available online at http://www.nidcd.nih.Otitis Media. Available online at http://Earaches in Children.—Head and Neck Surgery. Ear. Available online at http://www.entnet.org/Swimmer’s Ear. Available online at http://kidshealth.org/kid/Ear drops containing a steroid medication to reduce itching and’s age, history, and a physical examination in the doctor’s office.’s ear. This specialized otoscope allows the doctor to
Ear Infection
Definition