Otitis media is an infection of the middle ear, a small bony area covered by the eardrum (tympanic membrane). Sound passes through the eardrum to the middle ear bones and finally onto the inner ear where nerve impulses for hearing are created. The middle ear also is connected to the back of the nose and throat by the Eustachian tube, a narrow tube that helps balance the air pressure inside the middle ear with that outside.
If the Eustachian tube is blocked or does not work well (for example, when someone has a stuffy nose with a cold or allergies), fluid builds up in the middle ear. Sometimes bacteria or viruses grow in this fluid, causing an infection called acute otitis media (AOM). The eardrum becomes red, swollen, and painful; in some cases, the pressure inside the middle ear builds up so much that it causes a hole (perforation) in the eardrum and the infected fluid drains out of the ear canal. This fluid usually goes away, but if it stays in the middle ear even after the infection clears, it is known as otitis media with effusion (OME).
Symptoms of acute otitis media may include:
- Ear pain
- Trouble hearing
- Drainage from the ear
Young children may show ear pain with:
- Difficulty sleeping
- Pulling on the ear
- Poor appetite
- Vomiting or diarrhea
To know if there is AOM, the doctor will:
- Check your child's temperature, since ear infections usually cause fever.
- Look inside your child’s ear with a special light called an otoscope. A normal eardrum is shiny and clear (the small bones in the middle ear may be seen through the eardrum), while an infected eardrum looks red, dull and swollen.
- Try to make the eardrum move by blowing a soft puff of air inside the ear canal with a bulb connected to the otoscope or by using a special device called a tympanometer. When the middle ear is filled with fluid, the eardrum swells and does not move well.
If your child does have AOM, the doctor will:
- Discuss whether or not your child needs an oral (by mouth) antibiotic. Some cases of AOM go away on their own without complication, so your doctor may suggest waiting two to three days without taking any antibiotics. This plan should be considered for:
- Older (more than 2 years old), otherwise healthy children who do not have fever, too much ear pain or a history of many middle ear infections. These older children should have received all of their immunizations, too.
- Younger generally healthy children (ages 6 months to 23 months) with a mild infection in only 1 ear. Similar to older children, they should have received all of their immunizations.
- Decide if your child needs ear drops or not.
- If your child’s ear pain is severe, the doctor may prescribe ear drops that sometimes help to lessen the pain. However, these drops contain an anesthetic (a medicine that takes away pain) that should never be used if your child has a hole in the eardrum.
- If the AOM has caused a hole in the eardrum, the doctor may prescribe different ear drops that help treat the infection and heal the eardrum.
- Recommend ways to ease the pain.
- Discuss the things you should watch for at home.
- Tell you when your child should be seen again. The doctor may want to check your child's ears within a few weeks to make sure that the infection has gone away. This is especially important for:
- Young children who are learning to talk.
- Any child who has had AOM within the past month.
- Those children with a history of many ear infections.
- If the doctor prescribed an antibiotic by mouth, be sure your child takes it exactly as directed.
- Check with your pharmacist to see whether the antibiotic should be taken on an empty stomach or with food.
- Finish all of the antibiotic, even when your child is feeling better after starting the medicine.
- If using ear drops, first warm them by rubbing the bottle in your hands for one to two minutes. Putting cold drops in the ear can cause dizziness.
- Some over-the-counter (OTC) medicines may be helpful: For pain and fever, try acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).
- These over (or behind)-the-counter medicines usually are not helpful:
- Decongestants (for example, pseudoephedrine or Sudafed) and antihistamines (for example, diphenhydramine or Benadryl) typically do not help to clear up an ear infection and can have unwanted side effects.
- Studies have shown that high doses of zinc do not help children get over a cold and therefore, are unlikely to help with ear infections.
Certain over-the-counter medicines should not be used (unless directed by your doctor):
- Herbal remedies (such as Echinacea or elderberry) have not been well studied for treating AOM in children and may have unwanted side effects.
- High doses of vitamin C have not been studied for AOM.
- Never give your child aspirin (or any products that have aspirin in them) because it has been associated with Reye Syndrome, a serious illness that affects the liver and brain.
Other things you and your child can do that may help your child feel better:
- Hold warm (not hot) compresses against the outside of the ear.
- Hold ice packs against the ear (frozen vegetables work well).
- Sleep with the sore ear up or elevate the head, but never put pillows in an infant's crib.
- If there is no liquid or pus draining out of the ear, put a few drops of warm (not hot) olive oil or vegetable oil in the sore ear.
Call the doctor if your child:
- Is getting worse
- Is not drinking and has not gone to the bathroom in six to eight hours
- Seems too sleepy (lethargic) at times when he usually would be awake and active
- Continues to have fever or pain two days after being seen by the doctor
- Gets a rash of any type
Prevent other episodes of otitis media by:
- Not smoking around the child
- Waiting to introduce solid foods until 4-6 months
- Avoiding crowded day care situations
- Never putting your baby to bed with a bottle or cup of milk or juice
- Limiting the use of a pacifier
- Having your child (if old enough) chew gum that contains xylitol
- Teaching your child to wash his or her hands regularly.
Check with your school or day care regarding specific policies about returning after illness. Ear infections are not contagious (spread from person to person). Most often, children with ear infections can go back to school or day care as soon as they have no fever and feel well enough.
If your child needs to take a dose of antibiotic or other medicine during the school day, it can be helpful to ask your pharmacist to put the medicine into two different labeled containers. That way you can send one to school or daycare and leave the other at home. Also be sure to fill out any necessary forms, including a note from your doctor, with specific instructions for giving the medicine.