What are ear infections?

Statistics reveal that ear infection is the main cause of health care visits to children for children, with an alarming prevalence which indicates that around 80% of children will experience at least one episode by the age of three (Schilder et al., 2016). This not only underlines the widespread nature of ear infections but also underlines the importance of understanding their implications for children's health.

The impact of ear infections extends beyond the immediate discomfort they cause; They also wear a considerable economic burden. According to the World Health Organisation (WHO), unaddressed hearing loss poses an annual global cost of almost US$ 1 trillion. By 2050, nearly 2.5 billion people are projected to have some degree of hearing loss, and more than 700 million will require hearing rehabilitation. These costs result not only from direct medical expenses, such as doctors' visits and treatments, but also indirect costs, including missed workdays for parents and the potential long-term development consequences for children.

Children with recurring ear infections can face socio-economic implications, such as delays in speech and development. According to studies, children who have undergone a recurring ear infection demonstrate a higher probability of further learning difficulties and socio-emotional problems (Monasta et al., 2012). As such, understanding the prevalence of ear infections is imperative for health care providers, parents and political decision-makers, in order to promote preventive strategies and effective management practices.

This article will discuss the different types of ear infections, as well as the causes, symptoms, diagnosis, and treatment of middle ear infections. It will also highlight some preventative measures you can take to avoid or mitigate the effects of ear infections.

What are the Main Types of Ear Infections?

There are two main types of ear infections.

Otitis Externa: The first is called outer ear infection, also known as otitis externa or swimmer's ear. It affects the ear canal, which goes from the ear opening to the eardrum. An outer ear infection occurs when water enters the ear canal and becomes trapped there by wax build-up. This creates an ideal environment for bacteria to flourish. The body responds to the infection with inflammation, pain, redness, and sometimes a fever.

Otitis Media: The second type is called a middle-ear infection or otitis media. It occurs when either a virus or bacteria cause an infection in the middle ear. The condition is a result of the tubes inside the ears (Eustachian tubes) becoming clogged with mucus and fluid. Middle ear infections can be excruciating and are often accompanied by high fever, hearing difficulty, nausea, and vomiting. The fluid build-up can lead to hearing loss as all that ear fluid prevents sound from getting through. This type of ear infection is much more common, particularly in very young children and infants. When babies and young children pull or slap at their ears, an ear infection is quite possible.

What Causes Middle Ear Infection?

Ear infections (or Acute Otitis Media - AOM) can occur mainly due to the influence of viral infections of the upper respiratory tract or allergies, which are commonly observed in children because of their still developing immune system. The AOM presents itself after these viral diseases due to the inflammation of the Eustachian tubes, which can cause an accumulation of liquid in the middle ear. This fluid then becomes an environment conducive to bacteria, causing an exacerbated infection. Given the complex interaction between environmental factors and physical health, understanding the physiopathology of ear infections remains essential for prevention efforts.

Symptoms of Middle Ear Infection

Ear infections are predominant conditions that can manifest with a variety of symptoms, significantly impacting the quality of life of individuals.

These are some of the most common symptoms of otitis media. Not all of them need to be present for a diagnosis of ear infection (Rosenfeld et al., 2016):

• Ear pain, often throbbing
• Fever
• Irritability, especially in children as they usually do not have the ability to articulate their discomfort
• Pressure or a feeling of fullness in the ear
• Drainage of fluid from the ear
• Hearing difficulty in the affected ear
• Nausea and vomiting

What are the Different Types of Otitis Media?

Acute Otitis Media (AOM)

Acute otitis media comes on rapidly and is defined by swelling and redness in the ear behind and around the eardrum. Ear pain, fever, and partial or complete hearing loss often occur as a result of fluid or mucus caught in the middle ear. Recurrent AOM is repeated episodes of middle ear infections.

Otitis Media with Effusion (OME)

OME is the presence of fluid in the middle ear without any signs or symptoms of acute infection. This can happen when the infection clears up, but mucus and fluid continue to build up in the middle ear. This build-up creates a feeling of fullness in the ear, reducing your ability to hear clearly. OMEs typically resolve on their own. Chronic OME is said to be chronic when middle ear effusion has been present for at least three months.

Why Do Children Get Otitis Media So Often?

One of the reasons infants and young children get otitis media so often is connected to the Eustachian tube, the passage that leads from the pharynx at the back of the throat to the cavity of the middle ear. Because the Eustachian tube is more horizontal in children than it is in adults, it prevents fluid from flowing smoothly. As a result of this, mucus is unable to drain from behind the eardrum. Instead, it stays stuck and causes pain and pressure, often leading to infection. As children get older, the Eustachian tube becomes more vertical and begins to drain better.

Diagnosis and Treatment

Diagnosing Ear Infection:

It is essential to take all ear infections and ear pain seriously. A pediatrician or an ENT (Ears, Nose and Throat) doctor is most qualified to make the diagnosis of otitis media. They have the proper instruments to look inside the ear.

Diagnosis of an ear infection depends on precise and complete clinical evaluation. According to the clinical guidelines described by Rosenfeld et al. (2016), physical examinations play a critical role in establishing the diagnosis. The use of otoscopy, where the doctor will shine a light into the ear canal and magnify the view, is fundamental to evaluate the status of the eardrum/ tympanic membrane, which may seem red, protruding or perforated in the presence of an infection. In addition, tympanometry is a valuable diagnostic tool when the clinician is uncertain. This test measures the movement of the tympanic membrane in response to pressure changes and may indicate if the fluid is present in the middle ear. This diagnostic accuracy is essential for differentiation between Acute Otitis Media (AOM) and other conditions, as ignoring symptoms can lead to mismanagement.

Treating Ear Infection:

When an ear infection occurs, effective treatment strategies focus on the management of symptoms and the judicious use of antibiotics. The American Academy of Family Physician recommends that pain management should be a priority in the treatment of ear infections, recommending over-the-counter meds such as acetaminophen or ibuprofen for children and adults (American Academy of Family Physicians, 2022). In some cases where bacterial infection is suspected and to prevent the eardrum from rupturing, antibiotics can be prescribed, however, their indiscriminate use is discouraged due to growing concerns regarding antibiotic resistance. The American Academy of Pediatrics recommends a careful approach pending for slight cases in which the child is more than six months old and seems to have no serious anguish (American Academy of Pediatrics, 2022).

That being said, while the acute inflammatory phase lasts about two to three days, the entire healing process takes about eight weeks. Medications, when prescribed appropriately, can shorten the duration of the infection.

Recent research emphasises the role of antimicrobial treatments in the effective management of AOM. A systematic review of Tapiainen et al. (2014) points out that antibiotics can significantly resolve symptoms in cases of AOM in a short period of time, usually ranging from 24 to 72 hours. The study indicates that although some cases can resolve spontaneously, the use of antibiotics remains a critical intervention, particularly in patients with moderate to severe symptoms or under two years of age with bilateral infections. It is important to note that the findings also suggest that antibiotic therapy can prevent the recurrence of symptoms, which is a predominant issue in children if no treatment is promptly initiated.

Also, recognising when symptoms may indicate a more serious health problem is crucial for timely intervention. Although mild cases of ear infections may resolve without complications, certain symptoms justify immediate medical attention. This may include severe or growing pain, persistent fever lasting more than two days or fluid drainage that persists beyond 48 hours. In addition, indications of possible complications such as dizziness, balance problems or symptoms suggesting that the infection has spread beyond the ear, require immediate assessment by a healthcare professional.

To summarise, ear infections have a number of symptoms that require careful assessment for precise diagnosis. The use of diagnostic tools, combined with a complete understanding of potential treatment options, enhances patient management. Continuous research emphasises the importance of timely medical intervention, especially in cases where symptoms can mean more serious health concerns. However, understanding of prevention and treatment strategies can significantly reduce the incidence and impact of these infections.

To be on the safe side, visit your ENT if you have ear pain or hearing loss. Be especially alert for signs of middle ear infections in babies and young children, who often pull on their ears when suffering from ear pain and consult your doctor as soon as possible.

As a large percentage of otitis media is viral, antibiotic therapies are not always the appropriate course of treatment. Your doctor can determine whether the likelihood of bacterial or viral infection is higher based on your symptoms. You can try to alleviate the symptoms of middle ear infection with home remedies.

Home Remedies for Otitis Media

There are several things you can do to help relieve your symptoms related to a middle ear infection. Increasing your water intake is one important step you can take to assist your body with clearing the infection. You should drink plenty of water to help flush bacteria and viruses out of the body. Although alternative therapies and home remedies are to ease discomfort, they are not recommended for children.

One popular home remedy you can find online is to use onion poultices that are said to relieve ear pain, however, there is little to no scientific agreement on the effectiveness of onion poultices.

Please remember, you should never delay seeking medical attention if the fever does not subside or if the ear continues to hurt. While home remedies can be quite helpful, they do not replace the need for a doctor’s visit.

How Can I Prevent Ear Infections?

Vaccination:

The preventive measures for ears infections include vaccination, breastfeeding and timely health interventions. According to Schwartz et al. (2017), the Pneumococcal conjugated vaccine (PCV) showed a significant reduction in the incidence of Otitis Media, as it protects from the bacterial strains responsible for many infections of the middle ear. The centers for the control and prevention of diseases (CDC) recommend children to receive the PCV at 2, 4, 6 and 12-15 months of age. In addition, the annual flu vaccine is recommended for children over the age of six months, as it helps to prevent respiratory infections that can lead to otitis media (CDC, 2022).

Breastfeeding:

Incorporating breastfeeding into children's diets for at least the first six months is another protective measure against ear infections. The research indicates that breastfed children have a reduced risk of developing middle ear infections due to the immunological benefits provided by breast milk, which contains antibodies and other substances that reduce the frequency of infections (Gundersen et al., 2020).

Hygiene:

The maintenance of adequate hygiene is fundamental for the health of the ear, in particular as regards the cerumen/ wax production, which plays a protective role in the auditory canal. Rosenfeld et al. (2017) stressed that while the cerumen is essential to trap dust and debris, excessive accumulation can cause a temporary loss of hearing and increase the susceptibility to infections. The guidelines for the management of the cerumen impaction caution against the use of cotton swabs/ Q-tips to clean the ears, since this can further push the wax into the auditory duct. Instead, older children and adults can manage the accumulation of wax with a slight irrigation of the auricular duct with warm water or consult a qualified professional for safe removal. Read more about Ear Wax and its management here.

Diet:

Diet can play a role in preventing recurring infections. Follow these dietary suggestions to help alleviate pain, prevent recurring infections and strengthen the immune system. You may need to make drastic changes in your child's diet for optimal results:

Follow a healthy diet centered around fresh fruits, vegetables, whole grains, and high-quality protein, will make your immune system stronger.

Drink plenty of clean, quality water to thin mucus secretions.

Essential fatty acids, found in cold-water fish, flaxseeds, and flaxseed oil, are useful in reducing the inflammation or the allergies that are often present.

Switch bottle-fed babies to a non-dairy formula, with your doctor's supervision.

Breastfeeding mothers should avoid common allergens, such as cow's milk.

Other Recommendations

Do not bottle-feed while children are lying on their backs. They should be at a thirty-degree angle or more to prevent fluid accumulation in the eustachian tube.

Do not smoke or expose yourself or your child to second-hand smoke. This can reduce the incidence of respiratory infections, thus reducing the risk of ear infections (Melnyk and Fineouut-Overholt, 2022).

Avoid using cotton swabs, as they pack wax into the ear canal.

During an infection, don't allow moisture into your ears.

To decrease pain, apply heat locally. Try a hot-water bottle wrapped in a towel.

Use over-the-counter eardrops with a local anesthetic to prevent infection in your ears.

Complications

Perforations of the eardrum caused by middle ear infections and pressure equalisation tubes (or grommets) inserted to allow fluid build-up to drain, can result in scarring of the eardrum. The formation of scar tissue on the eardrum can lead to hearing difficulty, as the eardrum thickens. If the tiny ear bones in the middle ear, called ossicles, are damaged or deformed as a result of chronic or recurring ear infection and fluid accumulation, this too can cause hearing loss.

The high potential for complications makes a diagnosis by a doctor critical. Never disregard ear pain or hearing loss, and consult an ear, nose and throat specialist immediately.

Read more to learn what to expect when you visit a hearing care professional.

Frequently Asked Questions

How can I prevent the ear infections in my child?

A: The key prevention strategies include the guarantee that the child receives all recommended vaccinations, in particular the pneumococcal vaccine and the annual flu vaccine. In addition, exclusive breastfeeding for the first six months (if possible) can help reduce the risk of ear infections. Keeping the child away from passive smoke and reducing the use of the pacifier after six months can also play a significant role in prevention.

What are the common symptoms of an ear infection?

A: The symptoms may vary, but the common signs of ear infections include ear pain, irritability, difficulty sleeping, fluid drainage from the ear and sometimes fever. If a child has difficulty hearing, this can also indicate an ear infection.

When should I look for medical assistance for an ear infection?

A: Medical assistance should be sought if the child has severe pain, symptoms that worsen or do not improve after two or three days, high fever (greater than 102 ° F) or any fluid drainage that appears purulent. If you notice persistent problems with hearing or balance, promptly consult a healthcare professional.

What treatment options are available for ear infections?

A: The treatment usually provides for the management of symptoms with painkillers such as paracetamol or ibuprofen. In some cases, if a bacterial infection is confirmed, the doctor may prescribe antibiotics. For mild infections, a wait-and-see approach may be recommended before starting antibiotics to evaluate if the body can heal itself of the infection.

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References:

Rosenfeld, R. M., Schwartz, S. R., Cannon, C. R., Roland, P. S., Simon, G. R., Kumar, K. A., ... & Robertson, P. J. (2014). Clinical practice guideline: acute otitis externa. Otolaryngology—Head and Neck Surgery, 150(1_suppl), S1-S24.

Qureishi, A., Lee, Y., Belfield, K., Birchall, J. P., & Daniel, M. (2014). Update on otitis media–prevention and treatment. Infection and drug resistance, 15-24.

Rosenfeld, R. M., Shin, J. J., Schwartz, S. R., Coggins, R., Gagnon, L., Hackell, J. M., ... & Corrigan, M. D. (2016). Clinical practice guideline: otitis media with effusion (update). Otolaryngology–Head and Neck Surgery, 154(1_suppl), S1-S41.

Schwartz, S. R., Magit, A. E., Rosenfeld, R. M., Ballachanda, B. B., Hackell, J. M., Krouse, H. J., ... & Cunningham Jr, E. R. (2017). Clinical practice guideline (update): earwax (cerumen impaction). Otolaryngology–Head and Neck Surgery, 156(1_suppl), S1-S29.

Tapiainen, T., Kujala, T., Renko, M., Koivunen, P., Kontiokari, T., Kristo, A., ... & Uhari, M. (2014). Effect of antimicrobial treatment of acute otitis media on the daily disappearance of middle ear effusion: a placebo-controlled trial. JAMA pediatrics, 168(7), 635-641.

Schilder, A. G., Chonmaitree, T., Cripps, A. W., Rosenfeld, R. M., Casselbrant, M. L., Haggard, M. P., & Venekamp, R. P. (2016). Otitis media. Nature reviews Disease primers, 2(1), 1-18.

Rosenfeld, R. M., Shin, J. J., Schwartz, S. R., Coggins, R., Gagnon, L., Hackell, J. M., ... & Corrigan, M. D. (2016). Clinical practice guideline: otitis media with effusion executive summary (update). Otolaryngology–Head and Neck Surgery, 154(2), 201-214.

Carbone, L., & Austin, J. (2016). Pain and laboratory animals: publication practices for better data reproducibility and better animal welfare. PloS one, 11(5), e0155001.

Ahmad, S. (2022). A review of COVID-19 (Coronavirus Disease-2019) diagnosis, treatments and prevention. Authorea Preprints.

Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.