Ear infections are one of the most common illnesses in children two years and under. They tend to become less common in childhood, and usually resolve by early adolescence. But they can also be a problem for adults.
Ear infections often occur in combination with a cold or viral upper respiratory illness. Swelling in the sinuses and nasal cavity causes abnormal pressure or ventilation, and fluid can build up behind the eardrum and become infected.
Usually, the fluid goes away by itself after the infection is cleared up.
If fluid in the middle ear remains, and a secondary bacterial infection occurs, it is called acute otitis media. When an acute ear infection resolves and then recurs repeatedly, it is called recurrent acute otitis media.
Signs of ear infections in babies and young children can include:
- Irritability or difficulty feeding
- Tugging on the ears
- Fever without another obvious source of infection
- Restlessness or poor sleep
- Drainage from the ear
Recurrent infections can cause delays in developing language and speech.
Symptoms in adults can include:
- Pressure or pain
- A sense of fullness
- Hearing loss
- Signs of infection such as fever, chills or general malaise
In rare cases, acute otitis media can rupture the eardrum, causing pus to drain out of the ear. It can also injure the facial nerve, causing weakness or paralysis of facial muscles on one side.
Anyone can get an ear infection following a cold or viral illness, but some people are at a higher risk.
Risk factors for children include:
- Craniofacial disorders including cleft lip and cleft palate
- Inherited abnormalities of the skull and face
- Enlarged tonsils and adenoids
- Exposure to colds or viruses in daycare or classroom settings
- Exposure to second-hand smoke
Breast-fed babies are at a lower risk than babies who are not breast-fed.
Risk factors for adults include:
- A history of sinus infections
- A history of allergies
- Enlarged adenoids
- Certain genetic factors
- Conditions causing immune system decline (pregnancy, HIV, chemotherapy, diabetes, etc.)
Acute otitis media is most often treated with antibiotics and pain control.
There is no good evidence that using nasal decongestants or sprays, nasal steroids, or other over-the-counter cold medication decreases the duration or severity of the infection.
When children have four or more ear infections in one year, with multiple courses of antibiotics, they often miss school or daycare and may also have delays in speech and language. This, of course, causes parental distress.
A minor procedure called myringotomy (incision in the ear drum) can be performed and small typmpanostomy tubes can be placed through the eardrum.
The tubes greatly reduce – and often eliminate – recurring ear infections by equalizing pressure in the ear, and preventing fluid from building up.
Hearing improves immediately. The tubes are temporary, and typically fall out within 12 to 24 months. For adults, this procedure can performed in the clinic. For young children, it is performed in the operating room under general anesthesia.
In rare cases, the acute infection resolves, but the fluid in the middle ear remains for longer than three months. This is called chronic otitis media with effusion.
The condition causes a feeling of fullness and pressure in the ear as well as mild hearing loss. In children, it can also lead to speech and language delay. Fortunately, hearing loss is reversible with myringotomy and tube placement.
If left unaddressed, chronic otitis media with effusion can have serious consequences. It can cause severe and irreversible changes to the eardrum and middle ear hearing bones, and can result in permanent hearing loss.
These problems can also cause more severe and dangerous problems such as cholesteatoma.