Ear infections are a simplified term for Otitis Media, which is an infection of the middle ear. It involves the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. This condition is more common in children than adults, and can be acute or chronic.
Epidemiology
In Asia, the prevalence of acute otitis media is 10.85%, among which 51% occur in children under the age of five. The incidence rate of chronic suppurative otitis media (chronic inflammation of the middle ear) is 4.76℅, with 22.6% of cases occurring annually in children under five. And 30 in every 10,000 people will experience hearing loss due to ear infections.
Signs & Symptoms of Ear Infections
Children
- Ear pain, especially when lying down
- Tugging or pulling at ear
- Trouble sleeping
- Crying more than usual
- Fussiness
- Trouble hearing or responding to sounds
- Loss of balance
- Fever of 100 F (38 C) or higher
- Drainage of fluid from the ear
- Headache
- Tinnitus
Adults
- Ear pain
- Drainage of fluid from the ear
- Trouble hearing
Risk Factors for Ear Infections
- Age: Children aged between 6 months and 2 years are at a higher risk of ear infections.
- Group child care: Children in daycare homes are more frequently exposed to infections, resulting in an increased chance of developing an ear infection.
- Bottle feeding
- Seasonal factors: Ear infections more commonly occur in the fall and winter.
- Air pollution
- Cleft palate
Diagnosis
The diagnosis is based on your medical history and a clinical examination. The symptoms are analysed and an examination is done using different instruments to look at the ears, throat, and nasal passage.
Pneumatic otoscope
This is the main instrument used to diagnose an ear infection. The examination is done to check:
- Colour: The tympanic membrane, also called the eardrum, is normally translucent and pale grey. However, an opaque yellow or blue discolouration would be consistent with middle-ear effusion (accumulation of fluid).
- Position of the eardrum: A bulging of the eardrum suggests acute otitis media while in cases of middle ear effusion, the eardrum is typically retracted or in the neutral position.
- Mobility: The eardrum should move in response to different air pressures in the ear. Impaired mobility of the eardrum is seen in cases of effusion.
- Perforation in the eardrum.
Other instruments that may be used are:
- Tympanometry test: a small instrument is used to measure air pressure in the ear.
- Acoustic reflectometry: to measure how much sound is reflected from the eardrum — an indirect measure of fluids in the middle ear.
- Tympanocentesis: In rare instances, this procedure is done to drain fluid from the middle ear.
If infections or fluid buildup in the middle ear recur too often, you may also be referred to a hearing specialist (audiologist), speech therapist, or developmental therapist.
Treatment for Ear Infections
A watch-and-wait approach
The 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.
Managing pain
Pain management is very important in symptomatic patients. Over-the-counter oral pain medication such as paracetamol, ibuprofen, etc. may be given. However, do not give aspirin to children and teenagers recovering from chickenpox or flu-like symptoms as aspirin has been linked with Reye’s syndrome.
Alternatively, pain-relieving ear drops may be used as long as the eardrum doesn’t have a hole or tear in it.
Antibiotic therapy
If the ear infection is persistent after an initial observation period, antibiotic treatment may commence. It is important to finish the course of antibiotics that is prescribed, even after feeling better.
Surgical drainage
Tympanocentesis can be done as an early intervention by primary care providers, but more invasive procedures (for example, a myringotomy) would require an ear specialist.
During a myringotomy, a surgeon creates a tiny hole in the eardrum that allows for suction of fluid out of the middle ear. A tiny tube called a tympanostomy tube is placed in the opening to help ventilate the middle ear and prevent the buildup of more fluids. These tubes are of different types. There are tubes intended to stay in place for six months to a year and then fall out on their own, while other tubes are designed to stay in longer and may need to be surgically removed. Finally, the eardrum usually closes up again on its own after the tube falls out or is removed.
Complications of ear infections if left untreated
- Recurrence of infections
- Impaired hearing
- Speech or developmental delays
- Spread of infection resulting in mastoiditis, pus-filled cysts, petrositis, labyrinthitis, and meningitis
- Tearing of the eardrum
- Cholesteatoma (an abnormal, noncancerous skin growth)
- Tympanosclerosis (scarring of the eardrum)
- Facial paralysis
Conclusion
Ear infections are a leading cause of outpatient visits in hospitals. Apart from being uncomfortable, it can result in serious complications if not treated in time. It is also one of the more prominent causes of preventable hearing loss, particularly in developing countries. Hence, early diagnosis and treatment have to be done particularly in the first years of life to prevent permanent hearing impairment.
