Ear Infection (Otitis Media): Causes, Symptoms, and Diagnosis

What is ear infection (otitis media)?

Ear infection, medically known as otitis media, is an inflammation or infection of middle ear, the air-filled space behind the eardrum. It commonly occurs when bacteria or viruses enter this area, often following a cold, sore throat, or respiratory infection, leading to fluid and mucus buildup, causing swelling, redness, and pain.

There are different types of otitis media, including:

• Acute otitis media: Sudden onset infection with symptoms like ear pain and fever
• Otitis media with effusion: Fluid accumulation without active infection
• Chronic otitis media with effusion: Long-term fluid in the middle ear without signs of acute infection

Acute otitis media is the most common type, especially in children. Diagnosis typically involves a clinical examination, including looking for a bulging eardrum with an otoscope. Ear infection treatment depends on severity and may include pain relievers and sometimes antibiotics.

How common are ear infections?

Ear infections are very common, particularly in children under three years old. Acute otitis media is one of the most frequent paediatric diagnoses worldwide. It's estimated that 80% of children experience at least one episode of ear infections or otitis media by age three, making it a significant health concern in early childhood.

Why are children more likely to get ear infections than adults?

Children are more prone to ear infections because their eustachian tubes, which connect the middle ear to the throat, are shorter, more horizontal, and functionally immature compared to adults. This anatomy makes fluid drainage less efficient and allows easier entry of bacteria and viruses into the middle ear, leading to ear infections.

Symptoms of an ear infection (Otitis Media)

Common ear infection symptoms include:

• Ear pain (otalgia)
• Feeling of fullness or pressure in the ear
• Hearing loss
• Fluid drainage if the eardrum ruptures
• Fever and irritability, especially in children
• Difficulty sleeping

Some people with ear infections may also experience:

• Ringing or buzzing in the ear (tinnitus)
• Balance issues due to the ear's role in equilibrium

Ear infection symptoms usually develop quickly, within 1-2 days of infection onset. The severity varies with age and infection type but typically includes discomfort and signs of inflammation in the middle ear. Prompt medical attention is important to prevent ear infection complications.

Symptoms of an Ear Infection in Infants and Young Children

In infants and young children, ear infection symptoms can be harder to detect as they cannot verbalise their discomfort. Watch for these signs:

• Persistent crying and irritability
• Tugging or pulling at the affected ear, indicating ear pain
• Difficulty sleeping
• Feeding difficulties or refusal to eat (swallowing can worsen ear pain)
• High fever, often with vomiting or diarrhea
• Reduced response to sounds or temporary hearing loss
• Balance problems
• Fluid drainage from the ear if the eardrum ruptures

For example, a child who was sleeping well but suddenly wakes up crying and tugging at their ear may have developed an ear infection. Similarly, an infant who usually feeds eagerly but now refuses the bottle or turns away while nursing may be experiencing ear pain. Early ear infection detection is crucial to prevent complications and promote healing. If you suspect an ear infection in your child, consult a paediatrician promptly.

Causes of ear infection (otitis media)

The main ear infection or otitis media causes are bacterial or viral related infections of the middle ear, often following upper respiratory infections like colds or sore throats. Common bacterial culprits include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Viral infections can predispose one to subsequent bacterial infections.

Risk factors for ear infections

Several factors increase the risk of developing ear infections, including:

• Children between 3 months and 3 years are most susceptible due to immature eustachian tubes.
• Exposure to cigarette smoke
• Attending daycare or school
• Winter season when respiratory infections are common
• Allergies or frequent colds
• Anatomical abnormalities of the eustachian tube or palate
• Bottle-feeding infants while lying down
• Family history and genetic predisposition
• Immunodeficiency or chronic health conditions

For instance, a toddler who attends daycare, has frequent colds, and is exposed to secondhand smoke would be at higher risk for recurrent ear infections. Understanding these factors helps guide prevention strategies.

Some tips to reduce ear infection risk:

• Avoid smoking around children
• Hold infants upright during feeding
• Manage allergies
• Practice good hygiene to prevent spread of germs
• Stay up to date on vaccinations

Discuss your child's specific risk factors with their paediatrician for personalised advice.

What are the complications of ear infections?

If left untreated or in cases of recurrent infections, ear infections or otitis media can lead to complications such as:

• Persistent fluid in the middle ear (otitis media with effusion), which can cause hearing loss and speech delays in children if chronic
• Eardrum perforation or scarring from repeated infections
• Mastoiditis: Infection spread to the mastoid bone behind the ear
• Cholesteatoma: Cyst-like growth in the middle ear from chronic inflammation
• Meningitis: Infection spread to the membranes surrounding the brain and spinal cord
• Facial nerve paralysis
• Labyrinthitis: Inflammation of the inner ear leading to vertigo and balance problems

In rare cases, untreated ear pain causes brain abscesses or blood clot. Prompt diagnosis and appropriate ear infection treatment are essential to avoid these serious complications. For example, if a child has persistent hearing loss or speech delay despite treatment, they may have developed otitis media with effusion and require longer-term management. Consult an ENT specialist if ear infection complications are suspected.

When to seek medical attention

Consult a doctor if you or your child experiences ear pain or fullness, fluid drainage from the ear, hearing loss, fever above 101°F (38.3°C), symptoms that last more than 1-2 days or worsen over time, recurrent ear infections, high fever, neck stiffness, confusion, or facial weakness, which may indicate rare complications.

For infants under 3 months, seek immediate medical care for any fever or if they are very irritable or lethargic. Your doctor will examine the ears, assess symptoms, and recommend appropriate ear infection treatment. Remember, ear pain causes can occur due to other reasons, so an accurate diagnosis is key.

How is an ear infection diagnosed?

If you suspect an ear infection, your doctor will start by taking a detailed medical history and performing a physical examination. They will use an otoscope, a lighted instrument, to look inside your ear canal and examine the eardrum (tympanic membrane) for signs of infection, such as redness, swelling, or fluid buildup.

Your doctor may also perform a tympanometry test, which measures the movement of the eardrum in response to changes in air pressure. This test can help determine if there is fluid in the middle ear, a common sign of otitis media or ear infections.

Are there additional tests my child may need?

In most cases, a physical examination and tympanometry are sufficient to diagnose an ear infection. However, if complications are suspected or the infection doesn't respond to initial treatment, your child may need additional tests:

• Imaging studies: CT scans or MRI scans may be ordered to rule out complications such as mastoiditis (infection of the mastoid bone) or intracranial infections.
• Blood tests: These tests can help identify any underlying conditions that may be contributing to recurrent ear infections.

Your doctor will determine if further testing is necessary based on your child's specific symptoms and medical history.

How is an ear infection treated?

Ear infection treatment depends on various factors, including the patient’s age, the severity and duration of symptoms, and whether the cause is bacterial or viral. Treatment approaches can vary but generally fall into medical interventions and supportive care methods.

• Antibiotics: If the infection is bacterial, your doctor may prescribe antibiotics such as amoxicillin. These are often given for middle ear infections (otitis media), especially in children under two or in cases with persistent symptoms. It is crucial to complete the full course of antibiotics, even if symptoms begin to improve, to ensure the infection is fully resolved and to prevent antibiotic resistance.
• Pain Management: Over-the-counter medications like acetaminophen (paracetamol) or ibuprofen are commonly used to relieve ear pain causes and reduce fever. These medications do not treat the infection itself but help improve comfort while the body recovers.
• Watchful Waiting: For mild ear infections, especially those suspected to be viral, healthcare providers may suggest a “watchful waiting” approach. This involves monitoring the symptoms for 48 to 72 hours before initiating antibiotics, especially if the child is otherwise healthy and symptoms are mild, as many ear infections resolve on their own without medication.
• Ear Tubes: Children who experience frequent ear infections or have long-lasting fluid in the middle ear may benefit from ear tube surgery. Small tubes are inserted into the eardrum to improve air circulation, prevent fluid buildup, and reduce the frequency of infections.

In addition to medical treatments, several home remedies may offer symptom relief:

• Warm Compress: Applying a warm cloth to the affected ear can help soothe discomfort.
• Upright Resting Position: Keeping the head elevated can encourage drainage and reduce pressure in the middle ear.
• Keep Ears Dry: Avoid getting water in the affected ear during showers or swimming, as moisture can worsen the condition or slow healing.

Always consult a healthcare professional for proper diagnosis and treatment for ear infections. Following the recommended treatment plan is essential to ensure complete recovery and avoid complications such as hearing loss or recurrent infections.

Complications of untreated ear infections

While most ear infections resolve without complications, untreated or chronic infections can lead to serious issues. Persistent fluid buildup and inflammation in the middle ear can cause temporary or, in rare cases, permanent hearing impairment. A severe infection can cause the eardrum to rupture, resulting in pain, hearing loss, and discharge from the ear.

Chronic otitis media can also lead to the growth of a cyst-like structure called a cholesteatoma, which can damage the delicate bones of the middle ear and cause hearing loss. In rare instances, an untreated ear infection can spread to nearby tissues, leading to serious complications such as mastoiditis, meningitis, or brain abscess. Prompt diagnosis and appropriate treatment are essential to minimise the risk of these complications.

When to see a doctor

It's important to seek medical attention if you or your child experience symptoms of an ear infection, especially if they include severe ear pain, fever above 102°F (39°C), discharge or blood oozing from the ear, persistent symptoms that last more than 2-3 days, and hearing loss or muffled hearing.

For infants and young children who cannot verbally express their discomfort, watch for signs such as tugging or pulling at the ear, irritability or excessive crying, difficulty sleeping, loss of appetite, and fever. If you notice any of these signs, schedule an appointment with your healthcare provider for an evaluation.

Conclusion

Ear infections are a common condition that can cause significant discomfort and impact daily life. By understanding the causes, symptoms, and diagnostic process, to seek timely treatment and prevent complications appropriate treatment and prevent complications. If you suspect an ear infection, don't hesitate to consult your healthcare provider for personalised guidance and care. Metropolis Healthcare's expert diagnostic services and at-home sample collection can help you get the answers you need to prioritise your ear health.

FAQs

Can an ear infection go away on its own?

Some ear infections, particularly those caused by viruses, can resolve without treatment. However, it's important to monitor symptoms closely and seek medical advice if they persist or worsen.

When can my child return to normal daily activities?

Once your child's symptoms have improved and they have completed the prescribed course of antibiotics (if applicable), they can usually resume normal activities.

Do I need to cover my child's ears if they go outside with an ear infection?

Unless specifically advised by your doctor, there is no need to cover the ears when going outdoors. However, it's important to protect the ears from water exposure during swimming or bathing.

Can my child go swimming with an ear infection?

It's generally recommended to avoid swimming until the infection has cleared and any eardrum perforation has healed to prevent further complications.

Can I travel by air or be in high altitudes if I have an ear infection?

Changes in air pressure during air travel or at high altitudes can sometimes exacerbate ear pain and discomfort. Consult your doctor for guidance, especially if your symptoms are severe.