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Otitis Media (Acute)

By Richard T. Miyamoto, MD, MS, Indiana University School of Medicine

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 to make the diagnosis.

  • Certain routine childhood vaccinations can reduce the risk of acute otitis media.

  • Severe infections and those that do not go away on their own are treated with antibiotics.

Acute otitis media results from infection by viruses or bacteria, often as a complication of the common cold or of allergies. Although acute otitis media can occur at any age, it is most common between the ages of 3 months and 3 years. Acute otitis media often occurs during this age range because structures in the middle ear, such as the eustachian tube, are immature and not functioning properly. Symptoms and treatment are similar in adults and older children (for acute otitis media in younger children, see Acute Middle Ear Infection in Children ).

Rarely, bacterial otitis media spreads to nearby structures such as the mastoid bone behind the ear (see Mastoiditis), or the inner ear. Spread into the brain is extremely rare, but some people develop meningitis, or a collection of pus ( abscess) in or around the brain.

Symptoms

The infected ear is painful (see Earache), with a red, bulging eardrum. Many people have hearing loss. Infants may simply be cranky or have difficulty sleeping. Fever, nausea, vomiting, and diarrhea often occur in young children. The bulging eardrum sometimes ruptures, causing pus to drain from the ear.

If the infection spreads, people may have a severe headache, confusion, or impaired brain function.

Diagnosis

  • A doctor's evaluation

Doctors use an otoscope to examine the ear canal and eardrum. This examination shows pus is present in the middle ear behind the eardrum.

Prevention

The risk of acute otitis media can be reduced by routine childhood vaccinations against pneumococci (with pneumococcal conjugate vaccine), Haemophilus influenzae type B (HiB), and influenza (flu). Infants should not sleep with a bottle because this makes it easy for liquid to run through the eustachian tube into the middle ear. Secondhand smoke may increase the risk, so people should not smoke in the house or around children.

Treatment

  • Pain relievers

  • Antibiotics if needed

Most people with acute otitis media get better without treatment. However, because it is hard to predict whose symptoms will not lessen, some doctors treat all people with antibiotics, such as amoxicillin. Other doctors give antibiotics only if the illness is severe or if symptoms do not lessen after 72 hours. Pain relief is important. Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can relieve pain. Adults may be given decongestant nasal sprays containing phenylephrine or decongestants taken by mouth such as pseudoephedrine. Antihistamines are useful for people who have allergies but not for those with colds. Decongestants and antihistamines are not helpful for children and may cause bothersome side effects.

If a person has severe or persistent pain and fever, and the eardrum is bulging, a doctor may perform a myringotomy, in which an opening is made through the eardrum to allow fluid to drain from the middle ear. The opening, which does not affect hearing, usually heals without treatment. People who have repeated bouts of otitis media may need to have drainage tubes (tympanostomy tubes) placed in their eardrums (see Figure: Myringotomy: Treating Recurring Ear Infections).

Myringotomy: Treating Recurring Ear Infections

During a myringotomy, doctors make a small opening in the eardrum to allow fluid to drain from the middle ear. Then they place a tiny, hollow plastic or metal tube (tympanostomy tube, or ventilating tube) in the eardrum through the opening. These tubes balance the pressure in the environment with that in the middle ear. Doctors recommend ventilating tubes for some children who have had recurring ear infections ( acute otitis media) or recurring or persistent collections of fluid in their middle ears (chronic secretory otitis media).

Placement of ventilating tubes is a common surgical procedure that is done in a hospital or doctor’s office. General anesthesia or sedation is usually required. After the procedure, children usually go home within a few hours. Antibiotic ear drops are sometimes given after the procedure for about a week. The tubes usually come out on their own after about 6 to 12 months, but some types stay in longer. Tubes that do not come out on their own are removed by the doctor, sometimes under general anesthesia or sedation. If the opening does not close on its own, it may need to be closed surgically.

Children with ventilating tubes may wash their hair and go swimming, but some doctors recommend children do not submerge their head in deep water without using earplugs.

Drainage of fluid from the ears indicates an infection, and the doctor should be notified.

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