Otitis media is another name for a middle ear infection. It means an infection behind your eardrum. This kind of ear infection can happen after any condition that keeps fluid from draining from the middle ear. These conditions include allergies, a cold, a sore throat, or a respiratory infection. Middle ear infections are common in children, but they can also happen in adults. An ear infection in an adult may mean a more serious problem than in a child. So you may need additional tests. If you have an ear infection, you should see your healthcare provider for treatment. If they happen repeatedly, you should see an otolaryngologist (ear, nose, and throat specialist) or an otologist (ear subspecialist). What are the types of middle ear infections?Infections can affect the middle ear in several ways. They are:
Who is more likely to get a middle ear infection?You are more likely to get an ear infection if you:
What causes a middle ear infection?The middle ear connects to the throat by a canal called the eustachian tube. This tube helps even out the pressure between the outer ear and the inner ear. A cold or allergy can irritate the tube or cause the area around it to swell. This can keep fluid from draining from the middle ear. The fluid builds up behind the eardrum. Bacteria and viruses can grow in this fluid. The bacteria and viruses cause the middle ear infection. What are the symptoms of a middle ear infection?Common symptoms of a middle ear infection in adults are:
You may also have a fever. Rarely, your balance can be affected. These symptoms may be the same as for other conditions. It’s important to talk with your health care provider if you think you have a middle ear infection. If you have a high fever, severe pain behind your ear, or paralysis in your face, see your provider as soon as you can. How is a middle ear infection diagnosed?Your health care provider will take a medical history and do a physical exam. He or she will look at the outer ear and eardrum with an otoscope or an otomicroscope. These are lighted tools that let your provider see inside the ear. A pneumatic otoscope blows a puff of air into the ear to check how well your eardrum moves. If your eardrum doesn’t move well, it may mean you have fluid behind it. Your provider may also do a test called tympanometry. This test tells how well the middle ear is working. It can find any changes in pressure in the middle ear. Your provider may test your hearing with an audiogram (hearing test) or tuning fork. How is a middle ear infection treated?A middle ear infection may be treated with:
Your health care provider may also have you try autoinsufflation. This helps adjust the air pressure in your ear. For this, you pinch your nose and gently exhale. This forces air back through the eustachian tube. The exact treatment for your ear infection will depend on the type of infection you have. In general, if your symptoms don’t get better in 48 to 72 hours, contact your health care provider. Middle ear infections can cause long-term problems if not treated. They can lead to:
Occasionally, you may need CT scan or MRI to check for rare causes such as a cholesteatoma or tumors. If you have a middle ear infection that doesn’t get better, you should see an ear, nose, and throat specialist (otolaryngologist) or a specialized otologist. Ear tubesSometimes fluid stays in the middle ear even after you take antibiotics and the infection goes away. In this case, your health care provider may suggest that a small tube (also called a tympanostomy tube) be placed in your ear. The tube is put at the opening of the eardrum. The tube keeps fluid from building up and relieves pressure in the middle ear. It can also help you hear better. This procedure is sometimes called a myringotomy. It is done more commonly in children but is also performed in adults. In adults, it is a routine procedure that takes under 5 minutes in the office. The tubes usually fall out on their own after 6 months to a year. Ear tubes can be placed by an otolaryngologist or a specialized otologist.
 Researchers looking into whether a shorter course of antibiotics would treat young children's ear infections as well as a longer course found that not only was the shorter treatment less effective but it didn't reduce antibiotic resistance or side effects. The study, published Wednesday in the New England Journal of Medicine, comes as physicians and researchers are looking for ways to curb the unnecessary use of antibiotics, including the possibility of using them for a shorter time against some common infections. The goal is to prevent bacteria from developing resistance to antibiotics. While that strategy didn't pan out in this particular study, shorter antibiotic courses are still being used and studied in other contexts. The study included 520 children between 6 and 23 months old who were diagnosed with an acute middle ear infection, a very common childhood illness. Half of the children were randomly assigned to receive 10 days of the antibiotic amoxicillin-clavulanate, while the other half received five days of the drug plus another five days of a placebo. If the children experienced another ear infection during the period they were in the study, they received the same treatment. Parents, researchers and clinicians didn't know which treatment a child was getting. The kids were tracked for the severity of their symptoms and had regular office visits to check their health, plus additional visits if they were ill. The researchers also checked to see if their throats had been colonized by bacteria that were resistant to the antibiotic. The researchers found that initial treatment failed in 34 percent of the children treated with the five days of antibiotics, compared with 16 percent of children who had the longer treatment. Symptoms were also worse in the group that received the shorter treatment regimen. And there was no difference between the groups in the rate of colonization with antibiotic-resistant bacteria. The results were a surprise, says Dr. Alejandro Hoberman, chief of the division of general academic pediatrics at Children's Hospital of Pittsburgh and an author of the study. "I also expected that if you used an antibiotic for a shorter period of time, there would be fewer adverse events," he says. But that didn't happen; rates of diarrhea and diaper rash, both of which are side effects of antibiotics, were similar in both groups. The authors said the findings can't be generalized to children who are older than 2 years, or to adults. A 2010 Cochrane Review of research found that using antibiotics for less than seven days increased the likelihood of treatment failure. But Hoberman says many of the previous trials had some flaws, including less strict diagnostic criteria. This study was designed to address those gaps. "This study really shows the importance of doing clinical trials," says Dr. Helen Boucher, an infectious disease specialist at Tufts Medical Center and a member of the board of the Infectious Diseases Society of America. There's a push to see if the optimal dose of antibiotics could be shortened in some contexts, but that has to be studied with specific combinations of infections, antibiotics and patient populations, she says. "The whole notion of really figuring out the optimal duration of therapy is one we've been advocating heavily for." For example, a study of a shorter course of antibiotics against urinary tract infections in children is ongoing. And based on the existing research, the IDSA and the American Thoracic Society recommended earlier this year that most patients who develop pneumonia in the hospital receive a short course of antibiotics. Another prong of the strategy is to limit the use of antibiotics to bacterial infections, says Dr. Pranita Tamma, a pediatrician and director of the pediatric antimicrobial stewardship program at the Johns Hopkins University School of Medicine. Parents often come to the doctor when their kids have upper respiratory infections, but most of those are colds caused by a virus and can't be helped by antibiotics. A 2014 study found that displaying posters in exam stating the clinicians' commitment to avoiding unnecessary antibiotic prescriptions for upper respiratory infections lowered the rate of inappropriate prescriptions. "Antibiotics can be lifesaving when used properly," says Tamma. "But every day that an antibiotic is used, whether it's indicated or not, can put you at additional risk." Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter: @katherinehobson |
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