EAR INFECTIONS

Otitis media can either be acute or chronic depending on the duration of the diseases.

Acute Otitis Media

This is usually of rapid onset and short duration and last for several weeks only. Acute otitis media is typically associated with:

• Fluid accumulation in the middle ear
• Bulging eardrum
• Pain,
• Perforated eardrum
• Drainage of purulent material (pus, also termed suppurative otitis media).
• Fever

Chronic Otitis Media

This is a persistent inflammation of the middle ear, typically for a minimum of 3 months. This may develop after a prolonged period of time with fluid or negative pressure behind the eardrum, and eventually lead to damage to the middle ear and eardrum, and drainage through a hole in the eardrum.

• Starts painlessly
• Without fever
• Ear pressure or popping can be persistent for months
• Subtle loss of hearing

Signs and symptoms common in children include:

• Ear pain, especially when lying down
• Tugging or pulling at an ear
• Difficulty sleeping
• Crying more than usual
• Acting more irritable than usual
• Difficulty hearing or responding to sounds
• Loss of balance
• Fever of 100 F (38 C) or higher
• Drainage of fluid from the ear
• Headache
• Loss of appetite

Common signs and symptoms in adults include:

• Ear pain
• Drainage of fluid from the ear
• Diminished hearing

DIAGNOSIS

Middle ear infections are usually diagnosed using a health history, a physical exam, and an ear exam.

The doctor uses a pneumatic otoscope to look at the eardrum for signs of an ear infection or fluid buildup. For example, the doctor can see if the eardrum moves freely when the pneumatic otoscope pushes air into the ear.

Other tests may include:

• Tympanometry, which measures how the eardrum responds to a change of air pressure inside the ear.
• Hearing tests. These tests are recommended for children who have had fluid in one or both ears (otitis media with effusion) for a total of 3 months. The tests may be done sooner if hearing loss is suspected.
• Tympanocentesis. This test can remove fluid if it has stayed behind the eardrum (chronic otitis media with effusion) or if infection continues even with antibiotics.
• Blood tests, which are done if there are signs of immune problems.

RECOMMENDED MEDICATIONS

A wait-and-see approach

Symptoms of ear infections usually improve within the first couple of days, and most infections clear up on their own within one to two weeks without any treatment. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach as one option for:

• Children 6 to 23 months with mild inner ear pain in one ear for less than 48 hours and a temperature less than 102.2 F (39 C)
• Children 24 months and older with mild inner ear pain in one or both ears for less than 48 hours and a temperature less than102.2 F (39 C)

Some evidence suggests that treatment with antibiotics might be beneficial for certain children with ear infections.

Pain Medications

Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following:

• A warm compress. Placing a warm, moist washcloth over the affected ear may lessen pain.
• Pain medication. Your doctor may advise the use of over-the-counter acetaminophen (Tylenol, others) or ibuprofen (Motrin IB, Advil, others) to relieve pain. Use the drugs as directed on the label. Use caution when giving aspirin to children or teenagers.

Antibiotic therapy

Your doctor may recommend antibiotic treatment for an ear infection in the following situations:

• Children 6 months and older with moderate to severe ear pain in one or both ears for at least 48 hours or a temperature of 102.2 F (39 C) or higher
• Children 6 to 23 months with mild inner ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C)
• Children 24 months and older with mild inner ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C)

Even after symptoms have improved, be sure to use all of the antibiotic as directed. Failing to do so can result in recurring infection and resistance of bacteria to antibiotic medications. If antibiotics are initiated, amoxicillin is usually recommended as the first line treatment. This is usually prescribed for 10 days.