Ear Infection – Acute Otitis Media

February 3, 2017

Ear infections happen when the middle ear becomes inflamed. The middle ear is the small space behind the eardrum. Ear infections are also called acute otitis media. They can happen in one or both ears.

There are three main parts of the ear: outer, middle, and inner –

  • The outer ear is the opening outside of the body.
  • The middle ear houses delicate bones that aid in hearing.
  • The inner ear holds organs that control hearing and balance.

The Eustachian tube regulates air pressure within the middle ear, connecting it to the back of the nose and throat.

Acute otitis media occurs when a cold, allergy, or upper respiratory infection, and the presence of bacteria or viruses lead to the accumulation of pus and mucus behind the eardrum, blocking the Eustachian tube. This causes earache and swelling.

Acute otitis media with effusion is caused by germs or viruses that grow. As they grow, they cause pus to form behind the eardrum. This infection is usually very painful. Acute otitis media without effusion is a very early infection before the middle ear fluid has formed. The eardrum is usually red and painful.

It is a very common infection. Every year in America about 1 in 10 children (particularly children younger than 4 years old) will have a middle ear infection, compared with about 1 in 100 adults. By age three years, 50 – 85% of children will have had acute otitis media. The incidence peaks between age 6 – 12 months, and recurrent acute otitis media is common, affecting 10 – 20% of children by age one year.


Acute otitis media (middle ear infection) is usually due to a combination of factors that increase susceptibility to bacterial and viral infections in the middle ear. The primary setting for middle ear infections is in a child’s Eustachian tube, which runs from the middle ear to the nose and upper throat. The Eustachian tube is shorter and narrower in children than adults, and therefore more vulnerable to blockage. It is also more horizontal in younger children and therefore does not drain as well.

Infections – Many bacteria and viruses normally thrive in the passages of the nose and throat. Most are not harmful. However, certain types of bacteria are the primary causes of acute otitis media (AOM). They are detected in about 60% of cases. The bacteria most commonly causing ear infections are – Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis etc.

Viruses play an important role in many ear infections, and can set the scene for a bacterial infection. Rhinovirus is a common virus that causes a cold and plays a leading role in the development of ear infections. It is not the direct infecting organism, however. If a cold does occur, the virus can cause the membranes along the walls of the inner passages to swell and obstruct the airways. If this inflammation blocks the narrow Eustachian tube, the middle ear may not drain properly.

Medical or Physical Conditions that Affect the Middle Ear – Any medical or physical condition that reduces the ear’s defense system can increase the risk for ear infections. Children with shorter than normal and relatively horizontal Eustachian tubes are at particular risk for initial and recurrent infections. Inborn structural abnormalities, such as cleft palate, increase risk. Genetic conditions, such as Kartagener’s syndrome in which the cilia (hair-like structures) in the ear are immobile and cause fluid build up, also increase the risk.

Genetic Factors – Several studies suggest that multiple genetic factors may make a child more susceptible to acute otitis media. Abnormalities in genes that affect the defense systems (cilia and mucus production) and the anatomy of the skull and passages would also increase the risk for ear infections.

Risk Factors

Risk factors for acute otitis media include –

  • Age – children between 6 – 36 months are most likely to get ear infections
  • Attending daycare
  • Recent illness, such as a cold or sinus infection
  • History of allergies, like hay fever, also called allergic rhinitis, or sinusitis
  • Exposure to secondhand smoke
  • Having family members who are prone to ear infections; studies show a clear genetic component for both acute and recurrent otitis media
  • Using a pacifier
  • Having a history of gastroesophageal reflux disease (GERD)

Children who are most at risk of a middle ear infection include –

  • Those born with a cleft palate
  • Those with a weakened immune system due to another illness or medicines they may be taking
  • Aboriginal children living in over-crowded conditions.


Ear infections can be painful. Trapped fluid puts pressure on the eardrum, causing it to bulge. Other symptoms include –

  • Ear pain – This symptom is obvious in older children and adults, but for children who cannot yet speak, you should watch for other signs, like irritability or a great deal of crying.
  • Loss of appetite – This may be most noticeable in young children, especially during bottle feedings. Pressure in the middle ear changes as the child swallows, causing more pain and less desire to eat.
  • Irritability – Any kind of continuing pain may cause irritability in children and adults. Poor sleep: Pain may be worse when the child is lying down, as fluid is shifting.
  • Fever – Ear infections can cause temperatures up to 104° F.
  • Drainage from the ear – Yellow, brown, or white fluid that is not earwax may seep from the ear. This may mean that the eardrum has ruptured (broken).
  • Difficulty hearing – Bones of the middle ear connect to the nerves that send electrical signals (as sound) to the brain. Fluid behind the eardrums slows down movement of these electrical signals through the inner ear bones.


  • Impaired hearing – Mild hearing loss that comes and goes is fairly common with an ear infection, but it usually returns to what it was before the infection after the infection clears. Persistent infection or persistent fluids in the middle ear may result in more significant hearing loss. If there is some permanent damage to the eardrum or other middle ear structures, permanent hearing loss may occur.
  • Speech or developmental delays – If hearing is temporarily or permanently impaired in infants and toddlers, they may experience delays in speech, social and developmental skills.
  • Spread of infection – Untreated infections or infections that don’t respond well to treatment can spread to nearby tissues. Infection of the mastoid, the bony protrusion behind the ear, is called mastoiditis. This infection can result in damage to the bone and the formation of pus-filled cysts. Rarely, serious middle ear infections spread to other tissues in the skull, including the brain.
  • Tearing of the eardrum – Most eardrum tears heal within 72 hours. In some cases, surgical repair is needed.


Antibiotics – Antibiotics, prescribed by your doctor, may be needed to kill the bacteria that are causing the ear infection. Do not forget to take or give it in regular doses until the bottle is empty, even if the pain and fever are gone. Finishing the medicine will keep the ear infection from flaring up again.

Antibiotics may cause nausea, diarrhea, rashes, or yeast infections, and may also interact with other medications. Rarely, allergic reactions can occur.

Ear drops – If the child has recurring ear infections, a perforated eardrum, or develops infection after ear tubes have been placed (see Surgery and Other Procedures), the doctor may prescribe antibiotic ear drops instead of oral antibiotics, to be used over a period of time, such as a few months.

Ibuprofen, acetaminophen – Ask the doctor about using over-the-counter oral medications for pain or fever, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). Children under 19 should not take aspirin, due to the risk of developing a rare but serious illness called Reye’s syndrome.

Surgical Treatments – If the ear infection keeps coming back or lasts for a long time, the doctor may suggest surgery.

Alternative Treatment

Probiotics – So-called “good” bacteria or probiotics help prevent infections in the intestines, and there is preliminary evidence that they might help prevent colds, too

Xylitol – A sugar alcohol produced naturally in birch, strawberries, and raspberries, it may help fight a type of bacteria that’s associated with ear infections. Studies suggest that, patients who chewed sugarless gum sweetened with xylitol reduced their risk of developing an ear infection by more than a third.

Herbal ear drops (Calendula officinalis, Hypericum perfoliatum, Verbascum thapsus, Allium sativum) – A few studies suggest that ear drops containing calendula, mullein, St. John’s wort, and garlic were as effective at relieving pain as prescription ear drops.

Belladonna, as a homeopathic medicine — In one study, children who took a homeopathic preparation of belladonna had fewer ear infections, and the ones they got didn’t last as long as children who took antibiotics.

Echinacea (Echinacea purpurea) – Although it has not been studied for ear infections, some doctors may suggest echinacea to help prevent recurring ear infections.

Bee propolis – Studies provide the efficacy of a propolis and zinc suspension in preventing AOM.

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