Acute middle ear infection is common in children. Its incidence rises during the winter, when respiratory tract infections are common. With prompt treatment, the prognosis is excellent; however, prolonged fluid buildup in the middle ear causes chronic middle ear infection, with possible puncturing of the eardrum, which transmits sound vibrations to the inner ear.

Chronic suppurative middle ear infection may lead to scarring, adhesions, and severe ear damage. Chronic secretory middle ear infection, with its persistent inflammation and pressure, may cause conductive hearing loss.

What causes it?

Ear infections usually start with a viral infection, such as a cold. The middle ear becomes inflamed from the infection, and fluid builds up behind the eardrum.

Ear infections also can be associated with dysfunction or swelling within the eustachian tubes - the narrow passageways that connect the middle ear to the nose. Normally these tubes equalize pressure inside and outside the ear. But a child's eustachian tubes are narrower and shorter than those of an adult. This makes it easier for fluid to get trapped in the middle ear when the eustachian tubes dysfunction or become blocked during a cold.

What are its symptoms?

* The main symptom is pain in the ear.

* Sometimes the ear drum may burst causing a discharge of fluid from the ear. (Incidentally, this releases the pressure behind the ear drum, and therefore the pain usually disappears.)

* Many children are sick when they have a feverish illness, and so may be sick with middle ear infection.

* There may be some decrease in hearing.

* Occasionally people become a little dizzy.

The whole infection usually only lasts a few days, but there may be persisting deafness for up to a few weeks after the infection.

How is it diagnosed?

The diagnosis can usually be made on the basis of the symptoms and by examining the ear with an otoscope.

Possible complications

* Infections may spread to the bone behind the ear, although this is uncommon.

How is it treated?

Treatment of middle ear infection depends on which type of infection is present.

Treating acute suppurative infection

The doctor prescribes an antibiotic - typically, Totacillin or Amoxil. People who are allergic to penicillin derivatives may receive Ceclor or Bactrim.

Usually, an operation called myringotomy is done to treat severe, painful bulging of the eardrum. In this procedure, the doctor cuts into the eardrum and gently suctions fluid or pus from the middle ear to relieve pressure.

Broad-spectrum antibiotics can help prevent acute suppurative middle ear infection in people at high risk for the disorder. In those with recurring middle ear infection, the doctor will use antibiotics with discretion to prevent development of resistant strains of bacteria.

Treating acute secretory infection

The only required treatment may be inflating the eustachian tube by performing Valsalva's maneuver several times a day. To perform this maneuver, the person inhales deeply, holds his or her breath, and strains hard before exhaling.

Otherwise, decongestant therapy may help. The person should continue using decongestants for at least 2 weeks and may even need to use them indefinitely, with periodic evaluation. If decongestant therapy fails, the doctor performs myringotomy and removes middle ear fluid, then inserts a polyethylene tube into the eardrum to equalize pressure immediately. The tube falls out spontaneously after 9 to 12 months. At the same time, any underlying cause is treated. For instance, some people must eliminate allergens or have enlarged adenoids removed.

Painkillers - If the ear infection is causing pain then give painkillers to children regularly until the pain eases. For example, paracetamol (Calpol, Disprol, etc) or ibuprofen. These drugs will also lower a raised temperature which can make a child feel better. If antibiotics are prescribed (see below), you should still give the painkiller as well until the pain eases.

Can anything be done to prevent otitis media?

Specific prevention strategies applicable to all infants and children such as immunization against viral respiratory infections or specifically against the bacteria that cause otitis media are not currently available. Nevertheless, it is known that children who are cared for in group settings, as well as children who live with adults who smoke cigarettes, have more ear infections.