What Are the Causes, Symptoms, and Treatments of Middle Ear Infection?

Middle ear infection is a common condition, especially in children. About 3 out of 4 children experience at least one episode of middle ear infection by the age of three. However, while it's more common in children, adults can also be affected.

In this article, we will provide a detailed discussion of this condition, including its causes, symptoms, diagnosis, treatment methods, and prevention strategies.

What Is Middle Ear Infection?

A middle ear infection occurs due to a bacterial or viral infection that causes inflammation in the space behind the eardrum, known as the middle ear. This infection can affect one ear or both at the same time. It is more common in children than in adults.

Most middle ear infections occur during the winter or early spring and can often heal without medical intervention. However, medical care should be sought if the pain persists or if the patient has a fever.

What Are the Types of Middle Ear Infection?

There are three types of middle ear infections:

1. Acute Otitis Media (AOM):
   This type occurs suddenly and causes swelling and redness in the middle ear behind and around the eardrum. It is often associated with fever, ear pain, and hearing difficulty due to pus or mucus trapped behind the eardrum.
2. Chronic Otitis Media:
   This occurs due to recurrent infections, where fluid remains in the ear for a prolonged period or repeatedly returns. It is often caused by a perforated or ruptured eardrum, which may lead to ear discharge, hearing loss, or both.
3. Otitis Media with Effusion:
   This is when mucus and fluid continue to accumulate in the middle ear even after the infection has resolved. It may also occur due to colds, allergies, or conditions like cleft palate. This can result in a feeling of ear fullness, blockage, and hearing difficulty.

What Causes Middle Ear Infection?

Middle ear infections are usually caused by dysfunction in the Eustachian tube, which connects the middle ear to the throat. This tube helps equalize pressure between the outer and middle ear. When it doesn’t function properly, fluid fails to drain normally from the middle ear, leading to fluid buildup and increased risk of infection.

Common causes of Eustachian tube dysfunction include:

• Respiratory infections like the common cold or allergies that cause swelling and congestion in the nasal passages, throat, and Eustachian tubes.
• Structural issues or abnormalities in the Eustachian tube.
   

Risk factors for children include:

• Exposure to secondhand smoke.
• Family history of ear infections.
• Weakened immune system.
• Lack of breastfeeding.
• Cold or flu infections.
• Bottle-feeding while lying flat.

What Are the Symptoms of Middle Ear Infection?

Symptoms differ between children and adults:

Symptoms in Children:

• Ear pain, especially when lying down.
• Loss of balance.
• Trouble sleeping.
• Increased crying.
• Hearing difficulty.
• Fever.
• Fluid discharge from the ear.

Symptoms in Adults:

• Ear pain.
• Fluid discharge.
• Hearing difficulty.

How Is Middle Ear Infection Diagnosed?

Diagnosis usually begins with a review of the patient’s medical history and a physical exam. The doctor examines the outer ear and eardrum using an otoscope to check for redness, swelling, pus, or fluid.

Adults can usually describe their symptoms more accurately than children, but complications and treatments are similar across age groups.

A tympanometry test may also be conducted. It involves inserting a device into the ear canal that changes pressure and causes the eardrum to vibrate. The machine records the eardrum's response, helping detect fluid buildup.

What Are the Treatments for Middle Ear Infection?

Treatment depends on various factors, such as:

• Whether the infection is bacterial or viral.
• The severity and duration of the infection.
• The patient’s age and risk factors.
• Impact on hearing.

Treatment for Children:
Most infections in children resolve on their own, so antibiotics are not always immediately prescribed. Doctors usually start with pain relief medications for a few days to see if the condition improves.

If symptoms persist, antibiotics may be prescribed for 10 days. Children aged 6 and above with mild infections may receive a shorter course (5–7 days). If the infected ear is draining, antibiotic ear drops might also be used.

Children with frequent infections, hearing loss, or speech delays may require a minor surgery to insert ear tubes (tympanostomy tubes). These tubes allow fluid to drain from the middle ear and help equalize pressure.

Treatment for Adults:
Treatment for adults is similar. Pain relievers are used first, and antibiotics are prescribed if symptoms last more than 3 days.

At-Home Treatments:

• Warm compresses.
• Rest.
• Gargling with salt water.
• Changing sleep position.
• Over-the-counter pain relievers.

What Are the Risks of Middle Ear Infection?

Most cases resolve without complications, but in rare instances, risks may include:

• Mastoiditis: Infection spreading to the bones behind the ear.
• Meningitis: Infection spreading to the brain and spinal cord lining.
• Permanent hearing loss.
• Ruptured eardrum.

How Can You Prevent Middle Ear Infection?

There are many ways to reduce the risk of middle ear infections, especially in children:

• Encourage frequent handwashing.
• Avoid smoke exposure.
• Keep vaccinations up to date.
• Wean off pacifiers by age 1.
• Breastfeed if possible.

Can a Middle Ear Infection Affect the Brain?

In chronic cases, middle ear infections can cause bone erosion in the ear. If left untreated, the infection can spread to the skull or brain tissues, leading to serious complications.

How Long Do Symptoms Last?

Most middle ear infections resolve on their own within 1 to 2 weeks, and symptoms usually improve within the first 2 days.

Does Middle Ear Infection Cause Headaches and Dizziness?

Yes, headache and dizziness are common symptoms, especially in chronic infections where surrounding tissues are affected. Persistent headache or dizziness should be evaluated by a doctor.

FAQs

How do I know if I have a middle ear infection?
Look for symptoms such as pain, fluid or blood discharge from the ear, and difficulty hearing. These are key signs of middle or inner ear infection.

When is an ear infection dangerous?
It becomes dangerous when chronic, as it can lead to bone damage and spread infection to brain tissues, causing serious complications.