Middle Ear Infections

Middle ear infections (otitis media) lie behind the eardrum and are typically caused by viruses or bacteria related colds or allergies. One or both ears may be involved. Acute middle ear infections Chronic middle ear infections Examination and treatment Reducing risk for middle ear infections

Acute middle ear infections

The eustachian tube connects your middle ear with the back of your throat. Normally, the eustachian tube drains fluid from the ear into the throat and also equalizes the air pressure on each side of the eardrum when you swallow. When you have a cold, however, bacteria can enter the tube, irritating it and causing it to swell. This swelling blocks the drainage from the ear and causes a buildup of pressure from both fluid and air that are trapped in the middle ear. If infection from the eustachian tube spreads to the fluid in the middle ear, pressure will increase behind the eardrum and cause pain. It is also possible for the eardrum to rupture.

In young children and infants, the eustachian tube is shorter and straighter than in adults. This causes more frequent infections because it is easier for the germs and bacteria to reach the inner ear.

Chronic middle ear infections

If the fluid isn't drained either through a rupture of the eardrum or relief of swelling of the eustachian tube, the infection can be become "chronic" meaning that it is an ongoing condition. The fluid that is trapped in the middle ear will become thicker, which reduces its volume and relieves the pressure. Rather than being forced outward, the eardrum will now be pulled inward due to the change in pressure. This stiffens the eardrum and affects hearing.

Allergies and enlarged adenoids may also contribute to chronic ear infections. Adenoids are glands at the back of the throat that help the body build resistance to incoming infections. In young children (typically under the age of five), the adenoids can swell from repeated infections, blocking the eustachian tube and preventing fluid from draining from the middle ear. It is also possible for some of the germs the adenoids trap to enter the eustachian tube and spread to the middle ear.

For chronic ear infections that do not improve or respond to anti-biotics, Dr. Alexander may recommend a procedure called Myringotomy, also referred to as "putting tubes in the ears."

Examination and treatment

Dr. Alexander will look at the eardrums with an otoscope to determine if infection is present. A normal eardrum will appear shiny and pink or gray when viewed through an otoscope, while an infected eardrum may appear red and fluid may be visible behind it. The otoscope also allows him to vary the air pressure in the ear canal to see how flexible the eardrum is. The amount of flexibility in the eardrum helps determine whether there is fluid buildup behind it or not.

While the infections are painful, antibiotic treatment may or may not be necessary.

Studies now show that in older children and adults, ear infections don't usually cause serious damage. If the infection doesn't get better on its own in the first couple of days, treatment with antibiotics can begin without harm to the ear. Children under the age of 2 years, however, may still need medication to avoid complications.

Chronic ear infections in children can also lead to delayed speech due to the fact that the child hasn't been able to hear very well. If Dr. Alexander suspects problems with hearing, an audiometric test may be done to test hearing.

Reducing risk for middle ear infections

• Increase handwashing to prevent spreading germs
  
  
• If nasal allergies are a problem, remove as many of the allergens as possible and limit exposure to tobacco smoke
  
  
• Watch out for food allergies. In some children, dairy products cause the eustachian tube to swell, increasing the likelihood of fluid buildup in the middle ear.