A Look Inside the Ear
Middle ear infections (otitis media) may occur in older children and adults (see Otitis Media (Acute) Otitis Media (Acute) Acute otitis media is a bacterial or viral infection of the middle ear. Acute otitis media often occurs in people with a cold or allergies. The infected ear is painful. Doctors examine the eardrum... read more ) but are extremely common among children between the ages of 3 months and 3 years. These infections often accompany 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 . Young children are particularly susceptible to middle ear infections for several reasons:
Differences from adults in the size and length of their eustachian tubes
Increased susceptibility to infection in general
Increased exposure to infection
Use of a pacifier
A main risk factor is
Exposure to cigarette smoke in the household
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.
The eustachian tube connects the middle ear Middle Ear The ear, which is the organ of hearing and balance, consists of the outer, middle, and inner ear. The outer, middle, and inner ear function together to convert sound waves into nerve impulses... read more with the nasal passages Nose and Sinuses The nose is the organ of smell and a main passageway for air into and out of the lungs. The nose warms, moistens, and cleans air before it enters the lungs. The bones of the face around the... read more and helps balance air pressure in the middle ear with that in the environment. In older children and adults, the tube is relatively vertical, wide, and rigid, and secretions that pass into it from the nasal passages drain easily. In infants and younger children, the eustachian tube is more horizontal, narrower, less rigid, and shorter. Thus, the tube is thought to be more likely to become blocked by secretions and to collapse, trapping the secretions in or close to the middle ear and blocking air from reaching the middle ear. Also, the secretions may contain viruses or bacteria, which multiply and cause infection. Or viruses and bacteria can move back up the short eustachian tube of infants, causing middle ear infections.
The Eustachian Tube: Keeping Air Pressure Equal
The eustachian tube helps maintain equal air pressure on both sides of the eardrum by allowing outside air to enter the middle ear. If the eustachian tube is blocked, air cannot reach the middle ear, so the pressure there decreases. When air pressure is lower in the middle ear than in the ear canal, the eardrum bulges inward. The pressure difference can cause pain and can bruise or rupture the eardrum.
At about the age of 6 months, infants become generally more susceptible to infection because they lose protection from their mother’s antibodies, which they received through the placenta before birth. Breastfeeding Breastfeeding Breast milk is the ideal food for newborns. Although babies may be fed breast milk or formula, the World Health Organization (WHO) and American Academy of Pediatrics (AAP) recommend exclusive... read more seems to partially protect children from infections, including ear infections, because breast milk contains the mother’s antibodies.
Also at about this age, children interact more with other children and may acquire viral infections after touching other children and objects and then putting their fingers in their mouth and nose. These infections may in turn lead to middle ear infections. Attendance at child care centers increases the risk of exposure to the common cold and hence to middle ear infections.
Using a pacifier may impair the function of the eustachian tube and thus interferes with air reaching the middle ear.
All children have pain in the affected ear (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 ). Infants with middle ear infection may simply be cranky or have difficulty sleeping. Young children often have fever Fever in Infants and Children Normal body temperature varies from person to person and throughout the day (it is typically highest in the afternoon). Normal body temperature is higher in preschool-aged children and highest... read more , nausea Vomiting in Infants and Children Vomiting is the uncomfortable, involuntary, forceful throwing up of food. In infants, vomiting must be distinguished from spitting up. Infants often spit up small amounts while being fed or... read more , vomiting Vomiting in Infants and Children Vomiting is the uncomfortable, involuntary, forceful throwing up of food. In infants, vomiting must be distinguished from spitting up. Infants often spit up small amounts while being fed or... read more , and diarrhea Diarrhea in Children Diarrhea is a very common problem in children (see also Diarrhea in adults). Diarrhea is frequent, loose, or watery bowel movements (BMs) that differ from a child’s normal pattern. Sometimes... read more .
Diagnosis of Middle Ear Infections in Children
A doctor's examination
To detect a middle ear infection, doctors look in the ear with an otoscope and examine the eardrum for bulging and redness.
Treatment of Middle Ear Infections in Children
Acute middle ear infections Acute Middle Ear Infection in Children Acute middle ear infection is a bacterial or viral infection of the middle ear, usually accompanying a cold. Bacteria and viruses can infect the middle ear. Children with ear infections may... read more and 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 (an accumulation of fluid behind the eardrum) usually go away without antibiotics. However, antibiotics are sometimes given to treat acute middle ear infections. Secretory otitis media that does not go away may need to be treated with a surgical procedure.
Chronic middle ear infections Chronic Middle Ear Infection in Children 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 can come back frequently or last for a long time. Ear drops, antibiotics, and sometimes a surgical procedure are needed to treat these infections.