Acute Middle Ear Infection in Children

An acute middle ear infection is most often caused by the same viruses that cause the common cold Common Cold The common cold is a viral infection of the lining of the nose, sinuses, and throat. Many different viruses cause colds. Usually, colds are spread when a person's hands come in contact with... read more . Acute infection may also be caused by bacteria that sometimes normally reside in the mouth and nose. Bacteria that affect the ears of newborns include Escherichia coli and Staphylococcus aureus. Bacteria that affect older infants and children include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. An infection initially caused by a virus sometimes leads to a bacterial infection. Routine childhood vaccinations have decreased the risk of ear infection.

A main risk factor for acute middle ear infection is

Other risk factors include a strong family history of ear infections, bottle-feeding (instead of breastfeeding), attending a day care center, and living in an area where resources are low or air pollution is high.

Infants with acute middle ear infections have a fever and trouble sleeping. They cry or become irritable for no apparent reason. They may also have a runny nose, cough, vomiting, and diarrhea. The ear is painful (see Earache Earache Earache usually occurs in only one ear. Some people also have ear discharge or, rarely, hearing loss. Ear pain may be due to a disorder within the ear itself or a disorder in a nearby body part... read more ), and hearing may be decreased. Infants and children who cannot communicate verbally may pull at their ears. Older children are usually able to tell parents that their ear hurts or that they cannot hear well.

Commonly, fluid accumulates behind the eardrum and remains after the acute infection has resolved. This disorder is called secretory otitis media Secretory Otitis Media in Children Secretory otitis media occurs when fluid accumulates behind the eardrum and remains there after an acute middle ear infection or blockage of the eustachian tube. A previous ear infection is... read more .

Doctors diagnose acute middle ear infections by using a handheld light called an otoscope to look for bulging and redness of the eardrum and for fluid behind the eardrum. They may need to clean wax from the ear first so they can see more clearly. Doctors may use a rubber bulb and tube attached to the otoscope to squeeze air into the ear to see if the eardrum moves. If the eardrum does not move or moves only slightly, fluid in the middle ear, which is one sign of infection, may be present.

The pneumococcal conjugate vaccine Pneumococcal Vaccine Pneumococcal vaccines help protect against bacterial infections caused by Streptococcus pneumoniae (pneumococci). Pneumococcal infections include ear infections, sinusitis, pneumonia... read more , Haemophilus influenzae type b (Hib) vaccine Haemophilus influenzae Type b Vaccine The Haemophilus influenzae type b (Hib) vaccine helps protect against bacterial infections due to Hib, such as pneumonia and meningitis. These infections may be serious in children. Use... read more , and influenza (flu) virus vaccine Influenza Vaccine The influenza virus vaccine helps protect against influenza. Two types of influenza virus, type A and type B, regularly cause seasonal epidemics of influenza in the United States. There are... read more are routine childhood vaccines that decrease the risk of acute middle ear infections. These vaccines are given to children according to a standard schedule Childhood Vaccination Schedule Most doctors follow the vaccination schedule recommended by the Centers for Disease Control and Prevention (CDC—see the schedule for infants and children and the schedule for older children... read more .

Infants should not sleep with a bottle because drinking from a bottle while going to sleep tends to cause fluid to collect in the eustachian tubes. Fluid in the eustachian tubes traps secretions in the middle ear and prevents air from reaching the middle ear, both of which make infection more likely. Smoking should be eliminated from the household.

Recurring acute otitis media may be prevented by inserting tiny tubes into the eardrum (tympanostomy tubes). These tubes balance the pressure on both sides of the eardrum so fluid is less likely to accumulate (see treatment of chronic middle ear infections Treatment Chronic middle ear infection results from recurring infections that may damage the eardrum or lead to formation of a cholesteatoma, which in turn promotes more infection. Chronic middle ear... read more ).

Acetaminophen or ibuprofen is effective for fever and pain.

Most acute middle ear infections resolve without antibiotics. Thus, many doctors use antibiotics only when children are very young or very ill, do not improve after a brief period of time, when there are signs that the infection is getting worse, or when children have frequent infections. Antibiotics, such as amoxicillin (with or without clavulanate), may be used.

For children, antihistamines (such as brompheniramine or chlorpheniramine) and vasoconstrictors (drugs that constrict blood vessels, also sometimes called decongestants) are not helpful and should not be used.

If the eardrum is bulging and the child has severe or persistent pain, fever, vomiting, or diarrhea, ear specialists may puncture the eardrum (called myringotomy ) to allow the infected fluid to drain. Sometimes ear specialists then also insert tympanostomy tubes. After this procedure, symptoms usually resolve quickly, hearing returns, and the eardrum heals on its own.