What is a middle ear infection?
The middle ear is the air-filled space behind the eardrum that houses the hearing bones; it opens into the back of the nose through the Eustachian tube. Infection of this space is called otitis media. It usually develops after an upper respiratory infection, when microbes reach the middle ear through the Eustachian tube.
Why is it so common in children?
In children the Eustachian tube is shorter, more horizontal and less functional than in adults, and enlarged adenoids can block its opening. Middle ear infection is therefore very common, especially between 6 months and 3 years of age. Daycare attendance, exposure to cigarette smoke and bottle-feeding while lying flat increase the risk.
Symptoms
The typical picture of acute otitis media is ear pain, fever and irritability, usually during a cold. Small children cannot describe pain, so ear pulling, crying and sleeplessness are seen instead. The accumulating pus sometimes perforates the drum and drains out — at which point the pain often eases suddenly.
Fluid in the ear (otitis media with effusion)
In some children, fluid builds up silently in the middle ear without pain or fever. Its most important sign is reduced hearing: turning up the television, not responding when called, falling school performance and delayed speech may reveal it. Long-standing fluid can affect hearing and speech development, so it needs to be monitored.
Treatment
Treatment is planned according to age, severity and examination findings. Pain control is fundamental in every patient; antibiotics are used when indicated. In otitis media with effusion, the first approach is usually watchful waiting, since the fluid clears on its own in most children. When fluid persists beyond three months, affects both ears and hearing, or infections keep recurring, ventilation tube placement — with adenoidectomy where needed — comes into consideration.
This article is for general information purposes only; please consult your physician for diagnosis and treatment.