Middle-ear infection – symptoms, course and treatment

What middle-ear infection is

An acute middle-ear infection (Latin: otitis media acuta, OMA) is a viral or bacterial illness that causes painful and frequently suppurative inflammation of the middle-ear mucosa. It commonly originates as a viral infection of the upper respiratory tract, which enters the middle ear via the Eustachian tube or haematogenously, followed by a bacterial infection.

A middle-ear infection has a sudden, severe onset and is very painful, particularly in the initial stage. With proper and timely treatment, however, it is usually cured quickly and without complications. A middle-ear infection is not contagious; only the original infection that caused it is contagious, explains MUDr. Veronika Horáková, general practitioner for adults and physician specialising in occupational medical services at EUC PLS.

Middle-ear infection in children and adults

Otitis occurs with great prevalence in babies, i.e. infants and toddlers. The frequency of occurrence decreases as children age. Up to 75% of the population has had a middle-ear infection at least once. In small children, the infection is often bilateral. The younger the patient, the more likely it is that he or she will have recurring middle-ear infections.

Middle-ear infections generally occur more frequently in winter and in children who attend collective facilities (e.g. schools) or who live in sub-standard hygienic conditions. Though it is typically an illness of young people, it can also affect adults, e.g. in the case of insufficient rest when one has an infection of the paranasal sinuses, changes in air pressure or an illness of the teeth, tonsils or larynx.

Middle-ear infection and symptoms

The following symptoms may occur with an acute middle-ear infection:

• ear pain – a typical symptom only in the case of approx. 50% of children with a middle-ear infection.
• sudden loss of hearing together with a respiratory tract infection (difficult to detect in very young children).
• diarrhoea – attendant symptom in infants.
• sudden discharge from the ear – this may appear even after relatively mild symptoms.
• restlessness and sleep disruption, loud screaming.
• sensitivity to touch.
• headache and abdominal pain.
• loss of appetite and vomiting.
• high temperature or even fever.

An acute middle-ear infection can be inferred on the basis of pain, redness, warming and swelling of the surrounding skin and mucosa. If the ear canal becomes swollen, fluids and mucus cannot drain out and thus accumulate in the middle ear. If the pressure in the ear is too great, a rupture can form in the eardrum, through which the inflammatory fluid leaks out. The rupture in the eardrum usually heals without any problems. A middle-ear infection rarely occurs without rhinitis.

A chronic middle-ear infection usually occurs without a high temperature or fever, is not as painful and presents rather as burning or itching in the ear. The patient may have a blocked ear or feel buzzing or pressure in the ear. A chronic middle-ear infection can also cause hearing impairment in adults and children.

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Course and duration of a middle-ear infection

The clinical course of a middle-ear infection can be divided into the following periods:

• First period – Inflammation develops and escalates to spontaneous perforation. It often begins with stabbing pain and the feeling of a blocked ear in the case of acute rhinopharyngitis. The patient’s temperature rises, accompanied by a loss of appetite, constipation and vomiting. Pain in the ear and the surrounding area is the main symptom and disappears with the drainage of pus upon spontaneous perforation (tearing). In less severe cases, fever is mild; in more severe case, the patient’s temperature can rise above 39°C.
• Second period – This period begins with perforation with a reversal of the subsiding acute symptoms. The discharge from the ear is mucopurulent and odourless. The patient’s general condition improves as his/her pain subsides, temperature decreases, appetite returns and sleep returns to normal. Hearing impairment persists but does not worsen; after roughly one week, the discharge from the ear subsides and hearing is restored.
• Third period – symptoms disappear entirely, the local inflammatory changes recede and the discharge gradually disappears. The perforation closes and other changes to the eardrum disappear. In the case of an uncomplicated course of the illness, the inflammation heals within roughly three weeks; hearing may be restored later.

Diagnosis and treatment of a middle-ear infection

An acute middle-ear infection is usually accompanied by the problems that are typical of the illness. The doctor makes a diagnosis by means of otoscopy, i.e. examination of the eardrum with an otoscope. A diagnosis can often only be confirmed by performing an examination with special instruments (e.g. a tympanometer).

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The aim of treatment is to alleviate the symptoms of the infection, accelerate the absorption of the middle-ear secretion, treat conductive hearing loss and minimise complications and the consequences thereof, as well as the possibility of recurrence of the illness. Treatment always depends on the age of the patient and the severity of the illness. Unpleasant symptoms can be temporarily alleviated with cold compresses.

In the case of the non-purulent variant, nasal drops are administered. Pain and fever can be reduced by administering analgesics, antipyretics or a combination of both (ibuprofen, paracetamol). If it is a purulent bacterial infection, antibiotics or antibiotic ear drops are usually administered. If the pus in the ear is putting pressure on the eardrum, it is necessary to eliminate the inflammation by puncturing the eardrum and suctioning the pus out (paracentesis). This procedure greatly alleviates the pain.

The transition of an acute middle-ear infection to a chronic infection can be prevented only by properly completing treatment of the acute infection and fully taking all medications. Another important part of treatment is keeping the ear canal clean, correctly blowing one’s nose (from one nostril) and taking care of the nasal sinuses (rinses with a neti pot and a saline solution; nasal drops are better than spray and should be administered when lying down).

Home remedies and old wives’ tales for a middle-ear infection

When it comes to a middle-ear infection, it is not recommended that you rely on self-treatment, natural remedies or old wives’ tales involving, for example, putting garlic in the ear. Even if an acute middle-ear infection is only suspected, it is always necessary to seek the assistance of a doctor, who will make a professional diagnosis and suggest appropriate treatment. This is especially true in the case of young children.

Complications of a middle-ear infection

A child reacts to the locus of infection in his/her whole body. Therefore, it is necessary to consider the possibility of an illness of the ear in the case of any indistinct febrile illness in a newborn or infant who cries at night, is restless, vomits or loses weight.

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Very serious complications may arise if a middle-ear infection is left untreated – e.g. rupturing of the ear drum due to the accumulation of pus (which can even cause hearing loss) or inflammation of the bones behind the ear, which can result in meningitis. Because the facial nerve is in close proximity to the middle ear, temporary facial paralysis may also occur.

When to go to the emergency room with an infection

Otitis should not be underestimated. Especially in the case of small children, it is always necessary to seek medical attention and to undergo the ordered examinations. This is the only possible way to detect complications the may be developing.

Doctors also urge patients to always finish taking prescribed antibiotics, even if symptoms are quickly subsiding. If there is a sudden explosion of pain with a sharply rising temperature at night, we recommend that the patient go to the emergency room without delay.

Forms of prevention

In the case of a child, sensible ear protection and hardening of the child are also important measures (in addition to correct positioning during breastfeeding, for example). Also in adults, increasing the body’s resistance, gradual hardening and prevention of colds and other infections are appropriate preventive measures.

Care for the nasal sinuses is also important, especially in the early stage of an acute upper respiratory tract infection.

Currently, it is possible to protect children against pneumococcal infections by means of vaccination from the age of two months. The doctor’s approach to the patient in the treatment of a middle-ear infection must be very individual. Only effective cooperation between the paediatrician, general practitioner, ENT and microbiologist will bring success in terms of reducing the risk of an acute infection becoming chronic.

You can also contact the experts at EUC clinics.

Experts at EUC clinics

Zdroje: medicinapropraxi.cz, nzip.cz, wikiskripta.eu

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autor:

MUDr. Veronika Horáková