Although middle ear infections are among the most common causes for children to visit a doctor , they can happen to anyone, at any age. The middle ear is the air-filled space behind the ear drum that contains tiny bones that vibrate when touched by sound waves. The vibrations are turned into signals which are sent to the brain which in turn interprets them as sounds.

What Causes Ear Infections

Middle ear infections are caused by viruses and bacteria. In many cases, the problem begins with a cold or another form of respiratory infection. The bacteria or viruses travel to the middle ear via the eustachian tubes (one in each ear) that connects the middle ear to the back of the throat. The bacteria/virus can cause the eustachian tubes to become swollen and blocked. This affects the balance of air pressure in the ear and causes hearing problems. It also may restrict the normal flow of fluids from the middle ear, so that instead of draining away naturally, the fluid comes out of the ear. The fluid that is trapped in the ear can become infected and result in ear pain. Because the eustachian tubes in children are shorter and have less of a draining slope than in adults, the severity of the of the infection is often much greater.

Symptoms Of Ear Infection

The onset of a middle ear infection is typically very rapid and often appears with no warning signs of any kind. The symptoms for children and adults can differ, although overlapping is common. The symptoms include:

For Children:

• Ear pain that is more severe when lying down.
• Pulling the ear.
• Crying more than normal.
• Difficulty in sleeping.
• Irritability or moodiness
• Difficulty in hearing or responding to sounds
• Fluid draining from the ear.
• Loss of balance
• Loss of appetite.
• Headaches.
• Fever of over 38 degrees C.

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For Adults:

• Ear pain.
• Haring problems.
• Fluid draining from the ear.

Diagnosis Of Middle Ear Infections

The symptoms described by the patient are often enough for a doctor to form a diagnosis. An otoscope ( a lighted instrument may be used to look at the ear, nasal passages and throat. A visual examination is often enough to confirm the diagnosis. In case there is some doubt, the following tests may also be used:

• Pneumatic otoscope: This type of otoscope enables the doctor to gently blow air against the eardrum. If the eardrum does not vibrate as it should, it could mean the middle ear is full of fluid.
• Tympanometry: This instrument seals off the ear canal and adjusts the air pressure, causing the ear drum to move. By measuring the amount of movement, the amount of pressure and fluid in the middle ear can be evaluated.
• Acoustic reflectometry: This test measures the amount of sound that bounces back from the eardrum. A healthy eardrum will absorb much of the sound but if there is fluid buildup in the middle ear, the tight eardrum will reflect more sound than it should.
• Tympanocentesis: This test uses a tiny use to enter the eardrum and drain away the fluid from the middle ear. The fluid is then tested for signs of an infection.

The diagnosis will normally reveal one of these conditions:

• Acute otitis media: This is the most common condition and refers to the signs of fluid in the middle ear which is the sign of an infection.
• Otitis media with effusion:  This means that there is fluid in the middle ear, but no sign of an infection.
• Chronic suppurative otitis media: This means that a long-term ear infection has been found which has caused the tearing of the ear drum which is why fluid or pus is draining out of the ear.

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Ear Infection Treatment

The treatment of middle ear infections will be determined by the age of the patient and the severity of the infection. Whether the infection keeps returning and how long fluid remains in the ear will also affect the treatment protocol.

• In many cases, the symptoms of a middle ear infection improve in a few days and the infection may disappear on its own in 1 or 2 weeks without any treatment. The doctor may decide to observe the patient for a few days to see if the condition resolves itself naturally. This is called the wait-and-see approach.
• If bacteria are the cause of the infection or if the symptoms do not fade away naturally, antibiotics may be prescribed. If the infection is severe, antibiotics may be started immediately upon diagnosis.
• Pain relieving medication, either over-the-counter or prescription, may be advised if the pain is severe.
• In cases of chronic frequently recurring infections, if antibiotics are ineffective, or in cases where the fluid remains in the ear after the infection has gone, ear tubes (tympanostomy tubes) may be used. This is normally an outpatient procedure performed by an ENT specialist. A tiny incision is made in the eardrum and a tube is inserted to allow air to enter the middle ear and fluid to drain out. The tube is left in place for some months and if it does not naturally fall out on its own, the doctor will remove it.

Middle ear infections can be upsetting and uncomfortable for both children and adults. While the problem will often resolve itself in a few days, it is important to consult a doctor so that the exact nature of the condition is known. The doctor will advise on whether medication should start immediately or if the wait-and-see approach should be the first course of action. Chronic middle ear infections can lead to hearing loss. In children that could in turn result in developmental issues.

Whether it is a child or an adult, ear ailments should never be taken lightly or ignored. Examination and diagnosis at a hospital with a specialized ENT department will determine the nature of the ear problem and the best course of treatment.

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