Ear infections, which are also known as otitis media are common problems that bring patients into the medical clinic. They affect children more than adults. In fact, about 50% of infants have at least one ear infection by their first birthday. Otitis media often causes fever, ear pain, irritability, temporary hearing loss, and sometimes loss of appetite.
Ear infection: called otitis (otitis = ear, media = middle) by medical providers is an infection of the middle section of the ear. Patients often develop after an upper respiratory infection or common cold first. A viral URI can cause swelling in the nose, throat and Eustachian tube (tube that connects the middle ear to the throat and helps equalize the pressure when you go up on an airplane of over a mountain pass). When this happens, fluid may build up in the middle ear and bacteria or viruses can then infect that fluid and cause the ear infection. Increasing pressure can cause the eardrum to bulge (which we can see when we look in your ears) which leads to pain, ringing and sometimes difficulty hearing.
Symptoms (not everyone has these):
1) Fever (usually temperature greater than 100.4 degrees F)
2) Pulling on the ear (children)
3) Fussiness or irritability
4) Decreased activity
5) Lack of appetite
6) Vomiting or diarrhea
How do we know if there is an ear infection? We can see the ear drum on examination using the otoscope. The eardrum, when infection is present looks red, and often has a bulged look to it from the pressure of the infection in the middle ear. If there is no infection present, there is usually no redness. There can be pressure, however even if no infection is present if the Eustachian tube is swollen (this is called Eustachian tube dysfunction and can also be painful).
Treatment: The treatment of ear infections can be different depending on which geographic region you are seen. In Europe, they might monitor the patient for 72 hours without the use of antibiotics. Often the symptoms will improve on their own with the use of anti-inflammatory medications such as ibuprofen or aleve along with rest, and sometimes ear drops for pain (if the patient is 2 years or older). In Europe, they treat without antibiotics first because ear infections are caused by a virus about 40-50% of the time and antibiotics will not cure a viral infection.
In the United States, however there is a consensus that antibiotics are the initial therapy of choice for ear infections. There is, however an increasing trend to monitor the patient and only treat with antibiotics if the patient is not improving within 72 hours. Other reasons observation may be recommend are:
1) It is not clear whether the patient has an ear infection based on exam
2) The patient is older than 2 years old
3) The ear pain and fever are mild
4) The patient is otherwise healthy
There is also an emergency of bacteria that are becoming resistant to the normal antibiotic dosage that we have used in the past, and therefore higher dosages have been recommended over the last few years. We usually recommend an ear drops to help with the pain as well as an anti-inflammatory medication such as ibuprofen.
The choice of antibiotic is usually amoxicillin for 10 days, except in patients who are allergic, who were treated with antibiotics in the previous 30 days. Azithromycin or erythromycin can be used if the patient is allergic to amoxicillin, however resistance of the bacteria is common (approximately 25-35%).
A single shot of ceftriaxone (50mg/kg) IM (max 1 gram/day) has been effective for treatment of ear infections in children who fail amoxicillin but there is controversy over how many doses to administer. A single dose has been approved for treatment of ear infections in the US.
If ear tubes are present, we can consider topical ear drops such as ofloxacin or ciprofloxacin but oral is preferred in most patients. Swimming should not be allowed if there is a tear in the ear drum, or if there is any drainage from the ear canal.
Surgical treatment for recurrent ear infections can also be an option. A small opening in the ear drum called a myringotomy may be made and a tube to maintain the opening
Follow-up: If you are not feeling better within 48 hours of treatment, your symptoms get worse, you develop stiff neck, severe headache, confusion, swelling around the ear, dizziness, vomiting, or unusual sleepiness, please call your health care provider for advice.
Complications of ear infections: Possibly complications include rupture of the ear drum, hearing loss or mastoiditis (infection of the mastoid bone of the skull located just behind the outside ear)
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO