Middle Ear Infection

What is a Middle Ear Infection?

Also known as acute otitis media, a middle ear infection is an infection that occurs in the space between the eardrum and the inner ear. This area contains delicate bones that transmit sound vibrations from the eardrum to the inner ear.

Middle ear infections are more common in children than in adults. Since a significant portion of these infections resolve on their own, treatment may begin with pain management and monitoring the issue. In some patients, antibiotics may be prescribed to treat the middle ear infection.

Additionally, some individuals are known to be more prone to ear infections. If ear infections frequently recur, they can lead to serious complications, primarily hearing problems.

Middle Ear Infection Diagnosis

The diagnosis of middle ear infection is usually based on the symptoms observed in the patient and a physical examination. During the physical examination, a lighted instrument is used to view the patient’s ear, throat, and nose. This instrument is called an otoscope. Additionally, the patient's breathing will be listened to using a stethoscope.

Pneumatic Otoscope

The instrument called a pneumatic otoscope is usually the only specialized tool a doctor needs to diagnose a middle ear infection. This device allows the doctor to look inside the patient’s ear, helping determine if there is fluid behind the eardrum.

This specialized device gently blows air into the ear. In a healthy ear, the air causes slight movement in the eardrum. However, if there is a middle ear infection, this movement does not occur. If the middle ear is filled with fluid, the eardrum moves very little or not at all.

Additional Tests

If the diagnosis is not certain or if previous treatments have not been effective, additional tests may be performed. These tests include:

Tympanometry

This device ensures the complete sealing of the ear canal and adjusts the air pressure within the canal to allow the eardrum to move. The movement of the eardrum can be measured using this device.

Acoustic Reflectometry

This is a test that measures how much sound is reflected back from the eardrum due to fluids in the middle ear. Under normal conditions, the eardrum absorbs most of the sound. However, if there is excessive fluid pressure in the middle ear, the eardrum reflects sound waves.

Tympanocentesis

This method, which is rarely used, involves specialists using a small tube to pierce the eardrum and drain fluid from the middle ear. The collected fluid is tested for viruses and bacteria. It is particularly useful when an infection does not respond to previous treatments.

Other Tests

If there are more than one ear infection per week or fluid accumulation in the middle ear, the doctor may refer the patient to a hearing specialist, speech therapy, or developmental therapy for tests related to hearing, speech skills, language comprehension, and developmental abilities.

Symptoms of Middle Ear Infection

Symptoms of an ear infection usually begin after a cold, and in adults, the following symptoms may occur:

• Ear pain
• Yellow, brown, or white discharge from the ear
• Loss of appetite
• A feeling of fullness or pressure in the ear
• Sleep problems
• Hearing difficulties in the affected ear

If ear discharge is present, nothing should be inserted into the ear canal. Objects that come into contact with a ruptured eardrum can cause further damage.

Since young children and infants cannot always express their symptoms to others, recognizing the signs in this group is extremely important. If an ear infection occurs in infants and children, the following symptoms may be observed:

• Frequently rubbing or pulling their ears
• Crying more than usual or acting more restless
• Having a fever ranging between 38 to 40 degrees Celsius
• Starting to breathe through the mouth
• Increased snoring
• Refusing to eat

Causes of Middle Ear Infection

Middle ear infections are caused by bacteria or viruses present in the middle ear. The most common causes of ear infections include illnesses that result in the blockage or swelling of the throat, nasal passages, and Eustachian tubes. Examples of such illnesses include the common cold, flu, or allergies.

Additionally, the Eustachian tubes, which extend from both middle ears to the back of the throat behind the nasal passages, are responsible for regulating air pressure in the ear, refreshing the air in the ear, and draining normal secretions from the middle ear.

Blockage of the Eustachian tube due to various reasons can cause fluid buildup. This fluid can become infected, leading to symptoms of an ear infection. In children, Eustachian tubes are narrower and more horizontal, making drainage more difficult. As a result, middle ear infections occur more frequently in children than in adults.

Adenoids, which are considered part of the body’s immune system, are located near the opening of the Eustachian tubes. Therefore, if they become swollen, they can block the Eustachian tube. Swelling of the adenoids is frequently observed in cases of middle ear infections in children.

Risk Factors for Middle Ear Infection

Factors that may increase the risk of developing an ear infection include:

Age

Children between 6 months and 2 years old are more prone to ear infections due to the size and shape of their Eustachian tubes, which hinder efficient drainage. Additionally, their underdeveloped immune systems contribute to the higher occurrence of infections in this age group.

Childcare Centers

Daycare centers, where children with underdeveloped immune systems spend the day together, significantly increase the risk of developing ear infections.

Feeding in Infants

Infants who are bottle-fed while lying down are more likely to develop ear infections.

Seasonal Factors

Although ear infections can occur in any season, they are more common during the fall and winter months. Individuals with seasonal allergies are also at a higher risk of developing ear infections during periods of high pollen counts.

Poor Air Quality

One of the causes of middle ear infections is prolonged exposure to environments with poor air quality. Factors contributing to poor air quality include air pollution and tobacco smoke.

Cleft Palate

Children with a cleft palate are more prone to ear infections due to structural differences in bones and muscles, which make it more difficult for the Eustachian tube to drain properly.

Treatment Methods for Middle Ear Infection

When deciding on the treatment for middle ear infection, the following factors are taken into consideration:

• The patient's age
• The severity of the infection
• The nature of the infection
• Whether fluid will remain in the middle ear for an extended period

Watchful Waiting Approach

Symptoms caused by middle ear infection usually improve within a few days. Most infections heal on their own within 1 to 2 weeks without the need for any treatment. Therefore, the watchful waiting approach is recommended as an option. The necessary conditions for using this approach include:

• Children aged 6 to 23 months with mild middle ear pain in one ear lasting less than 48 hours and a fever below 39°C
• Children aged 24 months and older with mild middle ear pain in one or both ears lasting less than 48 hours and a fever below 39°C

Some evidence suggests that antibiotic treatment may be beneficial for certain children with ear infections. On the other hand, frequent use of antibiotics can lead to bacterial resistance. Therefore, it is recommended to consult a specialist regarding the potential benefits and risks of antibiotic use.

Pain Management

Various treatments are available to reduce pain caused by middle ear infections. These treatments include:

Pain Relievers

Over-the-counter acetaminophen and ibuprofen may be recommended to help relieve pain caused by the infection. It is important to use these medications as directed in the package insert. Additionally, caution should be exercised when giving Aspirin to children or teenagers. Children and adolescents recovering from chickenpox or flu-like symptoms should never use Aspirin, as it is linked to Reye's syndrome.

Anesthetic Drops

These drops can be used to relieve pain if there is no perforation or tear in the eardrum.

Antibiotic Treatment

After the observation period, doctors may recommend antibiotics for the treatment of ear infections if the following conditions develop:

• Children older than 6 months with moderate to severe ear pain in one or both ears lasting at least 48 hours or a high fever of 39°C or above
• Children aged 6 to 23 months with mild middle ear pain in one or both ears lasting less than 48 hours and a fever below 39°C
• Children older than 24 months with mild middle ear pain in one or both ears lasting less than 48 hours and a fever below 39°C

Infants younger than 6 months with confirmed acute middle ear infection are more likely to be treated with antibiotics without an initial observational waiting period.

Even after symptoms improve, it is important to continue taking the antibiotic as prescribed. Not completing the full course of medication can lead to a recurrence of the infection and contribute to bacterial resistance against antibiotics.

Middle Ear Infection Surgery

In certain cases, a surgical procedure may be recommended to drain fluid from the middle ear. Surgery may be advised for patients who experience recurrent, long-term ear infections or persistent fluid buildup in the ear even after the infection has cleared.

Surgical Procedures for Middle Ear Infection

The surgical procedure used to remove fluid buildup in the middle ear due to infection is called a myringotomy. During this procedure, the surgeon makes a small incision in the eardrum to allow fluids to drain from the middle ear.

Following the drainage, a tube is inserted to help ventilate the middle ear. Some tubes stay in place for 4 to 18 months and then fall out on their own.

However, some tubes are designed to remain in the ear for a longer period and may require surgical removal. Once the tube falls out or is removed, the eardrum usually closes on its own.

Complications of Middle Ear Infection Surgery

As with any surgical procedure, myringotomy carries certain risks. Potential complications include:

• Allergic reaction to anesthesia
• Permanent perforation in the eardrum that does not heal
• Chronic drainage
• Hearing problems due to eardrum hardening
• Infection
• Surgical injury to the ear canal
• Excessive bleeding
• Scarring on the eardrum

Benefits of Middle Ear Infection Surgery

Middle ear infection surgery offers several potential benefits, including:

• Reduction in the frequency of ear infections
• Improvement in speech and academic performance in children

Restoration of hearing loss caused by fluid buildup

Improvement in balance

Relief from ear pain and pressure

Life After Middle Ear Infection Surgery

Feeling of ear blockage after middle ear infection surgery is one of the normal side effects. Hearing improvement may take a few days. Additionally, the surgeon provides patients with a detailed list of post-surgery instructions.

Closely following these guidelines is extremely important for a successful recovery. In general, patients should follow these post-surgery recommendations:

• Taking all medications as prescribed
• Using earplugs while bathing or showering
• Regularly changing the gauze
• Avoiding submerging the head in water

After middle ear infection surgeries, patients typically recover completely within approximately four weeks. If ear tubes are placed, they usually fall out within 6 to 12 months. Most people can return to work or school within a few days after surgery.

Types of Middle Ear Infections

The diagnosis of a middle ear infection can be classified in different ways after an examination. While these terms generally refer to ear infections, they have distinct characteristics.

Acute Otitis Media

The diagnosis of an ear infection is commonly referred to as acute otitis media. If a doctor detects signs of fluid in the middle ear along with symptoms of infection, this diagnosis is made. Symptoms of acute otitis media appear suddenly.

Otitis Media with Effusion

If the diagnosis is otitis media with effusion, the doctor has found evidence of fluid in the middle ear, but there are no signs of infection.

Chronic Otitis Media

If this diagnosis is made, it means that a long-term ear infection has caused a perforation in the eardrum. In such cases, pus usually drains from the ear.

How to Prevent Middle Ear Infections?

Following these tips can help reduce the risk of developing a middle ear infection.

Preventing Colds and Other Illnesses

Washing hands frequently and thoroughly, avoiding sharing food and drink utensils, and developing the habit of coughing into the elbow can help reduce the spread of colds and other illnesses.

Additionally, limiting the time children spend in daycare groups can also reduce the risk of infection. Furthermore, if children attending school or daycare become ill, keeping them at home can help prevent the spread of infections.

Avoiding Passive Smoking

It is important to ensure that smoking is not allowed in enclosed spaces or to avoid being in such environments.

Breastfeeding

If possible, breastfeeding the baby for at least six months can provide protection against ear infections.

Keeping Bottle-Fed Babies Upright

When feeding babies with a bottle, it is important to ensure they are in an upright position.

Complications of Ear Infections

Most ear infections do not cause long-term complications. However, recurring ear infections can lead to serious complications, including:

Hearing Loss

One of the most common complications of ear infections is temporary hearing loss. However, this condition usually improves after the infection clears. In cases where infections recur frequently, hearing loss can become severe. If permanent damage occurs to the eardrum or other structures in the middle ear, permanent hearing loss may develop.

Speech or Developmental Delays

If significant hearing loss occurs in children during the speech development phase, delays in speech, as well as social or developmental delays, may be observed.

Spread of Infection

If an infection is not treated or completely eliminated, there is a possibility that it may spread to nearby tissues. One of the most common complications is mastoiditis, which is an infection occurring in the mastoid bone located behind the ear.

This infection can damage the bone and may lead to the formation of pus-filled cysts. In rare cases, severe middle ear infections can spread to other tissues in the skull, including the brain or the membranes surrounding the brain.

Eardrum Perforation

Most eardrum perforations heal within 72 hours. However, some patients may require surgical repair.