An ear infection is a common problem in infants. As many as 5 out of 6 infants will experience at least one bout of ear-infection before their third birthday. It’s important to recognize the symptoms so that timely action can be taken. Ear infections may not be a serious condition but puts the child in great discomfort and pain. The condition goes away on its own in most cases, while for the rest, it is easily treatable.
Anatomy of the ear
The ear can be divided into 3 parts – the outer-ear, middle-ear and inner-ear.
- The outer-ear is the visible portion containing the ear-flap and the ear-canal or external auditory-canal. The build-up of wax typically happens in this ear-canal.
- The middle-ear consists of the ear-drum called tympanum, and three delicate bones or ossicles – called malleus, incus and stapes. These bones transmit the vibrations from the tympanum to the inner-ear. The middle-ear is where ear infections occur either in infants, children or adults.
- The inner-ear contains a snail-shaped labyrinth. The sound vibrations from the ossicles are converted into electrical signals inside the labyrinth. A nerve called the auditory nerve carries these electrical signals to the brain.
- Other members: The Eustachian tube connects the middle-ear to the upper-throat. It helps regulate air-pressure in the middle-ear. Adenoids are soft pouches of tissue found in the upper throat behind the nose. These tissues help fight infections caused by bacteria that have entered the mouth.
Ear Infection in infants
Middle-ear Infection, also called Otitis Media (OM) is a common childhood ailment, affecting infants as young as 3 months to children aged 8 years. Most cases however are between 3 months to 3 years. Further, a quarter of the children affected (25%) will have a repeat infection before the age of 8 years. Adults can also develop this condition although it is much rarer compared to children.
Causes of OM
Otitis Media is caused by viruses or bacteria. Bacteria or viruses present in the nose and throat travel to the middle-ear through the Eustachian tube. Further, the Eustachian tubes (one in each ear) swell up. Fluids that are normally produced in the body as a result of the infection would ideally drain out through the Eustachian tube into the throat and nose. But now, the swollen tubes block this movement. As a result, the fluids accumulate in the middle-ear and may even come out of the outer-ear. The problem is compounded by the fact that, unlike adults where the Eustachian tubes are long and sloping, thereby helping fluids to drain quickly, in children, these tubes are shorter and flatter. As a result, when there is an infection, fluids don’t drain out easily and start accumulating in the middle-ear.
Types
OM is of three types:
- Acute otitis media: This is a bout of infection that occurs suddenly after a cold or any respiratory infection. The bacteria or viruses cause fluid to get trapped behind the eardrum, causing pain, swelling or bulging of the eardrum. The condition goes away quickly on its own. However, in some infants, it recurs repeatedly and stays longer each time (chronic).
- Otitis media with effusion: This condition follows a bout of the above-acute otitis media. The symptoms of acute otitis media are no longer seen nor is there any active infection. However, the fluid remains trapped, causing temporary and mild hearing-loss. Further, the infection may recur. This condition can also happen if there is a block in the Eustachian tube due to reasons other than ear-infection.
- Chronic suppurative otitis media: In this, the ear-infection does not go away even with treatment, and gradually, a hole or tear is formed in the eardrum.
Risk Factors for OM
- Age: Children in the age-group of 3 months to 3 years are at greater risk than older children and adults.
- Family history: If the parents or close blood-relations had ear infections in childhood, such a child is at higher risk.
- Respiratory infections: Cold, pneumonia and any respiratory infection increases the risk hugely.
- Allergies: These can cause swelling of the nasal passages and upper respiratory tract. In turn, this enlarges the adenoids. Enlarged adenoids then block the Eustachian tube. As a result, there is a fluid buildup in the middle-ear, causing pain, pressure and most likely infection.
- Chronic illnesses: Adults with immune deficiency and chronic respiratory diseases such as cystic fibrosis and asthma are at risk.
- Race: White Caucasian and Hispanic children are at more risk than others.
Symptoms of OM / How will a parent know?
- Ear pain: Infants that can speak will mention the pain in the ears. Younger infants that cannot speak tug at their ears or rub their ears, cry more than usual, be unable to fall asleep, and be fussy or irritable.
- Low or poor appetite: Changes in pressure in the middle-ear caused by OM makes chewing and swallowing of food more painful, hence the child loses desire to feed – either bottle-feed, mother’s milk or solid food.
- Irritability: The constant pain in the ear makes the child more irritable.
- Poor sleep: When lying down, or in a horizontal position, the pressure and hence pain in the ear may worsen, causing sleep issues.
- Fever: OM can cause temperatures ranging from 100° F (38 C) up to 104° F, in as many as half the cases.
- Discharge from the ear: A yellow, brown, or white fluid may discharge from the ear and this is a sign that the eardrum is ruptured.
- Poor hearing: Bones in the middle-ear and the nerves that send electrical signals to the brain work in tandem. Any fluid behind the eardrums slows down the working of the inner-ear bones and hence the transmission of these electrical signals.
Complications from untreated OM
- Loss of hearing: Repeated infections can cause more and more fluid to build-up in the ear causing muffling or distortion of sound and eventually hearing loss.
- Delayed speech and language development: Speech and hearing are closely related in growing children. A hindrance to one can hinder the other. Muffled hearing for short or long periods can significantly hinder speech-development.
- Tear in the eardrum: The constant pressure in the ear due to fluid build-up can cause the eardrum to rupture one day.
- Infection starts spreading: Untreated OM can damage the mastoid bone behind the ear, and spread to membranes surrounding the brain and spinal cord, thereby causing meningitis.
Diagnosis
- Ear examination: An ENT specialist will use a special instrument called an otoscope to look at the eardrum. A healthy eardrum will be pinkish-gray in color and translucent. In the case of OM, it will be reddish-colored, swollen or inflamed.
- Using a pneumatic otoscope: This instrument will blow a small amount of air on to the eardrum after which its movement is observed. If there is no fluid in the middle-ear, the eardrum will move easily.
- Tympanometry: In this, a special probe pushes air at slight pressure into the ear. The movement of the eardrum is then recorded on a graph. Patterns in the graph will tell if there is wax in the ears, a tear in the eardrum or fluid in the middle-ear.
- Using stethoscope: The doctor will listen to the person’s breathing which can indicate any infection in the throat or nasal passage (upper respiratory infections). This can hint at the possibility of OM.
Treatment
- Wait and watch: If the infection appears mild (symptoms are not severe), the doctors may advise monitoring for a few days.
- Antibiotics: If bacteria is the cause of infection, antibiotics will be started right-away or after a few days depending on the extent of infection. The anti-biotic may be given as ear-drops (in case of a tear in the eardrum) or oral medicine. The full course of medication must be followed strictly, if not the infection can recur.
- Pain-killers: Over-the-counter drugs such as Ibuprofen and Acetaminophen may be prescribed by the doctor in the form of ear-drops or oral medicine. This will relieve the pain while the antibiotics fight the infection.
- Ear tubes: Called tympanostomy tubes, these are recommended when the child has had recurring bouts of OM, or hearing loss due to OM, or anti-biotics were not effective in earlier episodes. A tiny tear is made in the ear-drum and these tiny tubes are inserted there. These bring air into the middle-ear and drain the fluid out. The tubes remain in the ear for 6-12 months.
Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals
NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.
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