A middle ear infection affects the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. There are two types of middle ear infection, acute otitis media (AOM) and otitis media with effusion (OME). AOM comes on quickly with swelling and redness in the ear, fever, ear pain, and temporary hearing impairment because of inflammation and the buildup of fluids in the middle ear. OME occurs after an initial infection has gone away, sometimes mucous and fluid will continue to build up in the middle ear. This can cause the feeling of the ear being "full" and affect your ability to hear clearly.
It is estimated that middle ear infections occur in 80 percent of children by the time they reach age 3.
Persistent fluids in the middle ear, long-term infections or frequent infections —can result in hearing problems and other serious complications.
Your doctor or medical provider can usually diagnose an ear infection or another condition based on the symptoms you describe and a physical exam. The doctor will likely use a lighted instrument (an otoscope) to look at the ears, throat and nasal passage. He or she will also likely listen to your child breathe with a stethoscope.
An instrument called a pneumatic otoscope enables the doctor to look in the ear and judge whether there is fluid behind the eardrum. With the pneumatic otoscope, the doctor gently puffs air against the eardrum. Normally, this puff of air would cause the eardrum to move. If the middle ear is filled with fluid there will be little to no movement of the eardrum.
If diagnosis is uncertain, if the condition hasn't responded to previous treatments, or if there are other persistent or serious problems your doctor may perform other diagnostic tests
Tympanometry. This test measures the movement of the eardrum and provides an indirect measure of pressure within the middle ear.
Acoustic reflectometry. This test measures how much sound emitted from a device is reflected back from the eardrum — an indirect measure of fluids in the middle ear. Normally, the eardrum absorbs most of the sound. However, the more pressure there is from fluid in the middle ear, the more sound the eardrum will reflect.
Tympanocentesis. Rarely, a doctor may use a tiny tube that pierces the eardrum to drain fluid from the middle ear — a procedure called tympanocentesis. Tests to determine the infectious agent in the fluid may be beneficial if an infection hasn't responded well to previous treatments.
Other tests. If your child has had persistent ear infections or persistent fluid buildup in the middle ear, your doctor may refer you to a hearing specialist (audiologist), speech therapist or developmental therapist for tests of hearing, speech skills, language comprehension or developmental abilities.
Symptoms of ear infections usually improve within the first couple of days, and most infections clear up on their own within one to two weeks without any treatment. Depending on the severity of the infection, your doctor may suggest treating the pain and waiting to see if symptoms go away. Ibuprofen or another fever and pain reducer is a common treatment to deal with the pain. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach as one option for:
Children 6 to 23 months with mild inner ear pain in one ear for less than 48 hours and a temperature less than 102.2 F (39 C)
Children 24 months and older with mild inner ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C)
There are a number of ways to treat middle ear infections.
Symptoms lasting more than three days usually mean that antibiotics are necessary. However, if a virus is causing the infection, antibiotics won't cure it.Talk to your doctor about the benefits of antibiotics weighed against the potential side effects and concern about overuse of antibiotics creating strains of resistant disease.
If your child has recurrent otitis media or otitis media with effusion, your doctor may recommend a procedure to drain fluid from the middle ear. Otitis media is defined as three episodes of infection in six months or four episodes of infection in a year with at least one occurring in the past six months. Otitis media with effusion is persistent fluid buildup in the ear after an infection has cleared up or in the absence of any infection.
During an outpatient surgical procedure called a myringotomy, a surgeon creates a tiny hole in the eardrum that enables fluids to be suctioned out of the middle ear. A tiny tube (tympanostomy tube) is placed in the opening to help ventilate the middle ear and prevent the accumulation of more fluids. Some tubes are intended to stay in place for six months to a year and then fall out on their own. Other tubes are designed to stay in longer and may need to be surgically removed.
The eardrum usually closes up again after the tube falls out or is removed.
Chronic infection that results in perforation of the eardrum — chronic suppurative otitis media — is difficult to treat. It's often treated with antibiotics administered as drops. You'll receive instructions on how to suction fluids out through the ear canal before administering drops.