Causes and Symptoms of Ear Infections

Overview

An ear infection, which is most often called acute otitis media is a condition where there is a sudden infection of the middle ear (the space behind the eardrum). Ear infections are mostly seen in children compared to adults. In majority of the cases, ear infections often clear up on their own. They do not require any treatment.

Causes of Ear Infection:

An ear infection is caused due to a bacterium or virus infection which includes Streptococcus pneumonia or Hemophilus influenza. These ear infections are often a result of other illness which includes cold, cough, allergic reactions, flu-like symptoms, etc. resulting in causing congestion and swelling of the throat, nasal passage, and Eustachian tube blockage. The other causes which can result in causing ear infections are listed below:

• Otitis media with effusion- during this condition, there is an accumulation of fluid or swelling in the middle ear without any bacterial or viral infection. it occurs due to persistent accumulation of fluid in the middle ear after an ear infection has recovered. Otitis media with effusion can also occur due to dysfunction or non-infectious blockage in the eustachian tube.
• Chronic otitis media with effusion- chronic otitis media with effusion occurs when the fluid remains in the middle ear and continues to reoccur without any viral or bacterial infection.
• Chronic suppurative otitis media- a condition during which the ear infection does not go away with the usual treatment. It can even lead to a hole in the eardrum.
• Eustachian tube blockage can be caused due to allergies, excess mucus production or accumulation, sinus infection, changes in air pressure, cold, smoking, etc. 
• Malformation of the Eustachian tube.

Risk factors associated with an Ear Infection

The risk factors that are associated with an ear infection are listed below:

• Age: the incidence of an ear infection is higher in children between 6 months to 2 years age group compared to adults, due to the shape and size of their eustachian tubes and due to their poor immune systems.
• Infants who are on bottle feeding- infants who are on bottle feed and drinks milk in a lying position have a higher risk of developing an ear infection compared to infants who are breastfeeding
• Group child care- kids who are in group child care or who go to babysitting places are exposed to more infections such as colds and coughs compared to children who stay at home
• Cleft palate- children who are diagnosed with cleft palate have difficulty in draining fluids from the eustachian tube
• Poor air quality- people who are exposed to air pollution or smoking have a higher risk of getting recurrent ear infections
• Seasonal factors- ear infections can be caused due to seasonal allergies
• Alaska native heritage- ear infection is more common in Alaskan natives
• People who have a weak immune system
• Family history of ear infection.

Symptoms of Ear Infection

The symptoms associated with ear infection differs from one individual to another. Some of the symptoms associated with ear infections are:

• Ear pain
• Fever, especially in children
• Hearing difficulties
• Loss of balance
• Unusual irritability
• Difficulty to sleep
• Fluid drainage from the ear
• Tugging or pulling off one ear in children
• Headache

Diagnosis of Ear Infection

The diagnosis of ear infection can be done by advising the patient to undergo a couple of tests. They include:

• Physical examination- during the physical examination, the doctor will record the history of the patient completely. The doctor will record their family history, history of ear infections, and recurrent cold or flu attacks in the past. The doctor will examine the ear with the help of instruments. They include:
• Pneumatic otoscope- pneumatic otoscope is a specialized tool that is often used to diagnose an ear infection. During the examination, the doctor gently puffs air against the eardrum with the help of an otoscope. In normal cases, the air which is puffed will cause the eardrum to move. While in ear infections the doctor will notice little or no movement of the eardrum.
• Tympanometry- during this test, the doctor will check the movement of the eardrum.
• Acoustic reflectometry- during this test, the doctor will assess how much sound is reflected from the eardrum (an indirect measure of fluids in the middle ear 
• Hearing test- the doctor might suggest a hearing test for patients who have chronic ear infections.
• Fluid sample- the doctor will take a sample of fluid from the middle ear and send it to the laboratory in order to determine whether certain types of resistant bacteria are present.
• Blood test- it is done to check the immune function of the patient.
• CT scan- CT scan of the head is advised in cases where the doctor suspects the infection has spread beyond the middle ear.
• Tympanocentesis- this is a procedure that is advised by the doctor very rarely. During this procedure, the doctor pierces the eardrum in order to drain fluid from the eardrum. The fluid is later sent for laboratory tests.

Treatment for Ear Infection

The treatment strategies for ear infections vary from person to person. The treatment options include:

• Wait and watch approach- in most cases, an ear infection does not require any treatment. They often clear up on their own within one to two weeks without any treatment.
• Antibiotic therapy- antibiotic treatment is usually recommended when the patient complains of persistent ear infection. Antibiotics are prescribed for bacterial infection. Viral infections do not respond to antibiotics.
• Management of pain- ear infection patients usually complain of ear pain. For such patients, the doctor recommends over-the-counter drugs, which include acetaminophen, and ibuprofen. These drugs can also be used to treat fever. Aspirin is usually avoided in children, due to the threat of Reye’s syndrome (a condition that can cause swelling of the brain and liver).
• Anesthetic drops
• Surgery- surgery is recommended for patients who do not respond to conservative management. Ear tubes are placed in conditions when there is a recurrent accumulation of fluid in the middle ear. An ear tube called a tympanostomy tube is placed in the opening to help ventilate the middle ear and prevent the accumulation of fluid in the middle ear. Myringotomy is another surgical option the surgeon would prefer to treat ear infections. during the myringotomy procedure, the surgeon creates a tiny hole in the eardrum that enables the surgeon to drain fluid from the middle ear.

Complications of Ear Infection

The complications that are associated with ear infections are listed below:

• Spread of infection to other parts of the body- Untreated ear infections will result causing the spreading of infections to the nearby tissues. The infection can spread to the mastoid (mastoiditis). This infection will further result in causing damage to the bone and the formation of pus-filled cysts.
• Tearing of eardrum
• Impaired hearing
• Speech or developmental delay
• Meningitis.

Prevention of Ear Infection

Ear infections can be prevented by following a few measures strictly. They are listed below:

• If you are bottle feeding the baby, hold the baby in an upright position
• Breastfeed the baby
• Avoid smoking
• Prevent common cold and other illnesses
• Vaccinate the child against the flu
• Avoid second-hand smoking
• Washing hands regularly
• Dry the ears thoroughly after swimming
• Control allergies

FAQ

Q) Can ear infections be contagious?

No, ear infections cannot be contagious.

Q) What is an inner ear infection?

An inner ear infection is often a condition where there is inflammation or irritation of the parts of the ears responsible for hearing and balancing. An inner ear infection is often caused due to recurrent cold or flu or if a middle ear infection spreads to the inner ear.

Q) What are the types of inner ear infections?

There are two types of inner ear infections. They include:

• Labyrinthitis
• Vestibular neuritis

References

1. "Ear infection (middle ear)" Mayo Clinic
2.  "Ear Infections Causes, Symptoms, and Treatment" Healthline
3. " Ear Infection (Otitis Media)" Hopkins medicine
4. "Ear Infection"  Centers for Disease Control and Prevention
5. "Ear Infections: Diagnosis and Treatment" Webmd