Health Care and Ear Infections

Ear infections can be a major nuisance and have the potential to develop into hearing loss if not effectively treated. Both children and adults are susceptible. Ear infections are one of the most common reasons parents take their children to the doctor, according to the National Institutes on Health (NIH). While there are different types of ear infections, the most common is called otitis media, which means an inflammation and infection of the middle ear. The middle ear is located just behind the eardrum. The term "acute" refers to a short and painful episode. An ear infection that lasts a long time or comes and goes is called chronic otitis media.

According to eMedTV.com, this inflammation often begins when infections that cause sore throats, colds, or other respiratory or breathing problems spread to the middle ear. These can be viral or bacterial infections. Ear infections in children are often difficult to detect because most children with symptoms do not yet have sufficient speech and language skills to tell someone what is bothering them. Common symptoms of an ear infection in children include:
•Unusual irritability
•Difficulty sleeping
•Tugging or pulling at one or both ears
•Fever
•Fluid draining from the ear
•Loss of balance
•Unresponsiveness to quiet sounds or other signs of hearing difficulty (such as sitting too close to the television or being inattentive).

Ear infections are less common in adults, according to eMedTV. When symptoms do occur in adults, they can include:
•Fever
•Earache
•Ear pain
•Hearing loss
•Feeling of blockage in the ear
•Dizziness.

For each ear, a eustachian tube runs from the middle ear to the back of the throat. This tube drains fluid that is normally made in the middle ear, according to the NIH. If the eustachian tube becomes blocked, fluid can build up. When this happens, germs such as bacteria and viruses can multiply and cause an infection. Ear infections are common in infants and children, in part because the eustachian tubes become easily clogged. Ear infections may also occur in adults, although they are less common than in children. Anything that causes the eustachian tubes to become swollen or blocked causes more fluids to build up in the middle ear behind the eardrum. These causes include:
•Allergies
•Colds and sinus infections
•Excess mucus and saliva produced during teething
•Infected or overgrown adenoids
•Tobacco smoke or other irritants

According to the NIH, ear infections are also more likely if a child spends a lot of time drinking from a sippy cup or bottle while lying on his or her back. Contrary to popular opinion, getting water in the ears will not cause an acute ear infection, unless the eardrum has a hole from a previous episode. Ear infections occur most often in the winter. You cannot catch an ear infection from someone else, but a cold may spread among children and cause some of them to get ear infections. Risk factors for ear infections include the following:
•Attending daycare (especially those with more than 6 children)
•Changes in altitude or climate
•Cold climate
•Exposure to smoke
•Genetic factors (susceptibility to infection may run in families)
•Not being breastfed
•Pacifier use
•Recent ear infection
•Recent illness of any type (lowers resistance of the body to infection)

Your doctor will look into your ear with a special flashlight called an otoscope. With the otoscope, the doctor can see your eardrum, the thin membrane between your outer and middle ear. The doctor may use the otoscope to blow a little puff of air in your ear to see if the air causes your eardrum to move the way a healthy eardrum does. An infected eardrum won't move as it should because the pus presses against it and may make it bulge. An infection also can make the eardrum red. If you have an ear infection, the doctor will make a decision about what to do next. Parents need to watch children over the next day or two to see if they get any bette if there are symptoms of an ear infection. The doctor also might suggest a pain reliever to keep you comfortable.

If bacteria are causing the problem, the doctor might prescribe a medicine called an antibiotic, which usually clears up a bacterial infection, so you'll feel better in a few days. If you are given an antiobiotic, it's very important to keep taking the medicine for as many days as the doctor instructs — even if your ear stops hurting. If you don't take all the medicine, the infection could come back and your ear will start hurting again. Children who have chronic, or frequent, ear infections might need a few other tests. They include an audiogram, which tests your hearing, and a tympanogram, a machine that checks whether your eardrum moves normally.

According to the Mayo Clinic, most ear infections don't cause long-term complications. Frequent or persistent infections and persistent fluid buildup can result in some serious complications:

1.) Impaired hearing: Mild hearing loss that comes and goes is fairly common with an ear infection, but it usually returns to normal after the infection clears. Persistent infection or persistent fluids in the middle ear may result in more significant hearing loss. If there is some permanent damage to the eardrum or other middle ear structures, permanent hearing loss may occur.
2.) Speech or developmental delays: If hearing is temporarily or permanently impaired in infants and toddlers, they may experience delays in speech, social and developmental skills.
3.) Spread of infection: Untreated infections or infections that don't respond well to treatment can spread to nearby tissues. Infection of the mastoid, the bony protrusion behind the ear, is called mastoiditis. This infection can result in damage to the bone and the formation of pus-filled cysts. Rarely, serious middle ear infections spread to other tissues in the skull, including the brain.

Most ear infections don't need treatment with antibiotics. What's best for your child depends on many factors, including your child's age and the severity of symptoms, according to the Mayo Clinic. Symptoms of ear infections usually improve with the first couple of days, and most infections clear up on their own within one to two weeks without any treatment. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach for the first 48 to 72 hours for anyone who is otherwise healthy and who is:
--Six months to 2 years of age with mild symptoms and an uncertain diagnosis.
--More than 2 years old with mild symptoms or an uncertain diagnosis.

Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following:
--A warm compress. Placing a warm, moist washcloth over the affected ear may lessen pain.
--Pain medication. Your doctor may advise the use of over-the-counter acetaminophen (Tylenol, others) or ibuprofen (Motrin, Advil, others) to relieve pain. Use the drugs as directed on the label. Because aspirin has been linked with Reye's syndrome, use caution when giving aspirin to children or teenagers. Although aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.
--Eardrops. Prescription eardrops such as antipyrine-benzocaine (Aurodex) may provide additional pain relief. To administer drops to your child, warm the bottle by placing it in warm water. Put the recommended dose in your child's ear while he or she lies on a flat surface with the infected ear facing up. Benzocaine has been linked to a rare but serious, sometimes deadly, condition that decreases the amount of oxygen that the blood can carry. Don't use benzocaine in children younger than age 2 without supervision from a health care professional, as this age group has been the most affected. If you're an adult, never use more than the recommended dose of benzocaine and consider talking with your doctor.

Your doctor may recommend antibiotic treatment for an ear infection in the following situations:
--Children under 6 months old with a probable diagnosis of ear infection.
--Children 6 months to 2 years old with a certain diagnosis of ear infection.
--Anyone with a probable ear infection and moderate to severe ear pain.
--Anyone with a probable ear infection and a fever over 102.2 F (39 C) or higher.
Even after symptoms have improved, be sure to use all of the antibiotic pills as directed. Failing to do so can result in recurring infection and resistance of bacteria to antibiotic medications. Talk to your doctor or pharmacist about what to do if you accidentally skip a dose.

If your child has otitis media with effusion — persistent fluid buildup in the ear after an infection has cleared up or in the absence of any infection — your doctor may recommend a procedure to drain fluid from the middle ear. During an outpatient surgical procedure called a myringotomy, a surgeon creates a tiny hole in the eardrum that enables him or her to suction fluids out of the middle ear. A tiny tube is placed in the opening to help ventilate the middle ear and prevent the accumulation of more fluids. Some tubes are intended to stay in place for six months to a year and then fall out on their own. Other tubes are designed to stay in longer and may need to be surgically removed. The eardrum closes up again after the tube falls out or is removed.

Ear infections may or may not be serious, depending on the situation. However, they should be addressed if any symptoms worsen or continue. Your family physician can provide treatment and a course of action for any repeat occurrence. Remember, although an ear infection can develop any time and can cause pain and inconvenience, take the time to visit your doctor for care and advice. It's worth the extra cost to make sure that your hearing is saved, and your health does not get worse.

Until next time.