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Otitis media (meaning middle ear inflammation) is a middle ear infection caused by viruses or bacteria that can cause pain, a sense of fullness in the ear, and muffled hearing.
The middle ear is located behind the eardrum and is connected to the back of the throat by a small tube called the Eustachian tube. Normally, the middle ear is an air-filled space, but in otitis media the space fills up with fluid. Many cases of otitis media are linked to colds, allergies, or other upper respiratory infections that block fluid drainage through the Eustachian tube, causing infection.
Middle ear infections are very common in children. In many cases, middle ear infections can resolve on their own without antibiotic treatment. Depending on your child's age and medical history and the severity of the illness, antibiotics may be prescribed. Some children have chronic (repeated) ear infections. These children may be good candidates for a minor surgical procedure to have pressure equalizing tubes (PE tubes) inserted into their eardrums to decrease the recurrent infections.
There are other causes of ear discomfort as well:
Infections of the nose or throat may spread through the Eustachian tube, which connects the back of the nose and throat to the middle ear.
If the Eustachian tube becomes blocked and bacteria or viruses are present, fluid can collect behind the eardrum. This fluid creates pressure and can cause an earache, swelling, and redness of the eardrum. The inflammation also affects the ability of the eardrum to vibrate properly and can interfere with hearing. Enlarged adenoids may also interfere with Eustachian tube function.
Young children are more likely to get ear infections than older children and adults. This is because the Eustachian tubes of children are small and can become blocked more easily. Some children are particularly prone to middle ear infections, even without a cold or another trigger.
Exposure to smoking, allergies or immune system deficiencies, and colds and flu can trigger middle ear infections.
There are several things that you can do to help protect your child against ear infections:
If your child has frequent infections, he or she may be a candidate for placement of small pressure equalizing (PE) tubes in the eardrums to drain and ventilate the middle ear, or removal of the adenoids. We can discuss the options that are right for your child.
It can be frustrating to see your child experience repeated ear infections. You'll be glad to know that most children who have chronic ear infections simply outgrow them over time.
Children with middle ear infections sometimes have different symptoms, depending on their ages. Look for the following signs:
Young children who have hearing loss sometimes have difficulty with their speech and learning as a result. Fortunately, when the fluid drains, hearing is almost always restored to normal, but it can take several months. Symptoms can include:
Fluid behind the eardrum can cause temporary hearing loss. Fortunately, when the fluid drains, hearing is almost always restored to normal, but it can take several months. Signs of ear infection include:
If you suspect an ear infection, contact my office to determine whether or not you need a telephone appointment or an exam.
If an office appointment is needed, we will examine the ear using an otoscope, a small instrument that allows for visualization of the eardrum. Using a small rubber tube to gently blow air into the ear can be a quick test to see if there is fluid behind the eardrum.
Treatment of middle ear infections includes relief of pain and fever, along with observation (watchful waiting) or antibiotics. A combination of all of these treatments may also be recommended.
We will decide together whether to treat the infection with antibiotics, depending upon the severity of symptoms, risk factors, medical history, and age. Be aware that once the infection clears up, temporary hearing loss may continue for weeks. This is normal and is not a cause for concern.
This is the most important part of caring for the infection.
Antibiotics are not always needed to treat ear infections. In fact, 70 to 80 percent of ear infections go away with no treatment at all. In many cases, children who are over 2 years old who do not seem ill can often be safely observed for 48 to 72 hours without antibiotics.
If antibiotics are prescribed, symptoms should be much better within a few days. Amoxicillin is the most common antibiotic used for the treatment of ear infections. Sometimes, we might recommend an alternative antibiotic (for example, if you or your child has recently been on amoxicillin, or if there is a penicillin allergy).
In some cases, we might recommend decongestants or antihistamines. Decongestants may relieve nasal congestion. If you or your child suffers from allergies, we might recommend antihistamines or other allergy medications.
If infections are recurrent, chronic, or complicated, we might consider referring you to an ear, nose, and throat specialist for a minor surgical procedure called myringotomy. This procedure is used to relieve pressure caused by the excessive buildup of fluid by creating a small incision or hole in the eardrum. Fluid that has accumulated behind the eardrum from the infection drains out through the incision. A small plastic or metal tube called a pressure equalizing (PE) tube is then inserted through the incision and left in place. The tube provides a ventilation hole in the eardrum, which allows the ear to heal.
Hearing usually improves immediately after the tube is inserted. Since fluid can no longer accumulate in the middle ear, new ear infections are less likely to occur.
Surgery is done in the medical office or outpatient surgery clinic. For older children and adults, a local anesthetic to numb the area is used. Surgery for very young children is usually done under general anesthesia which is administered through a mask.
Recovery is usually quick; your child will go home on the same day. There is rarely pain after surgery, but any discomfort can be treated with acetaminophen. Generally, you can expect a full recovery by the next day.
After the surgery, your child should not be able to feel the PE tube at all, since it's so small. It is common to have drainage or bloody drainage for a few days after the surgery. Most PE tubes will slowly migrate from the eardrum to the ear canal, and then fall out of the ear on their own any time in the next several months. This is normal and not a cause for concern.
The risks of surgery include drainage from the ear (indicating ear infection) and eardrum perforation (hole in the eardrum persisting after the PE tube falls out).
Complications from anesthesia are not common but can be very serious. You can discuss any questions with the anesthesia provider.
If your child is a candidate for pressure equalizing tubes (PE tubes) in the ears, we recommend watching the video called Preparing for Your Procedure (Emmi) for myringotomy (see Related Health Tools).
It is important to prevent water from entering the ears after PE tubes are inserted. Water carries germs that may cause the ear to become infected again.
Bathing and swimming require some precautions:
When to call us
If an infection does occur while a tube is still in place, you will notice pus or a small amount of blood draining from the ear. Please call us if you notice these signs.
If you are concerned about your child’s symptoms and suspect he or she has an ear infection, please contact our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.
Depending on your child’s symptoms and medical history and your preferences, the advice nurse may recommend one of several treatment options:
We will discuss your child’s symptoms and medical history, along with any concerns or questions you may have. We can help you manage your child’s ear pain and understand what may be causing it.
If an office visit is needed, I will examine your child’s ears for signs of infection, using an otoscope, a small instrument that allows me to see the eardrum. I may also use a small rubber tube to gently blow air into the ear, as a quick test to see if there is fluid behind the eardrum.
Together we will create a treatment plan that is right for you and your child.
You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting care for your child easier.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your child’s care to stay current on your child’s health status and to collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your child’s condition, care is safer and more effective.
We will work together to monitor and assess how your child’s medications are working and make adjustments as needed.
Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically, in advance.If refills are needed in the future, you can:
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, such as X-rays, we will schedule an appointment with the Radiology Department.
When the results are ready, I will contact you with the results by letter, secure e-mail message, or phone. In addition, you can view most of your child’s laboratory results online, along with any comments that I have attached to explain them.
My specialty colleagues are readily available to assist me if I need additional advice about your child’s condition. In some cases, I may contact them during your visit, so we can discuss your child’s care together. If we decide your child needs a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.
My goal is to provide high-quality care and to offer you choices that make your child’s health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available to help you manage your child’s care at any time that is most convenient for you. From my home page you can:
You can begin to manage your child’s care online by requesting access through our Act for a Family Member feature. Once you have added your child to your account, you can:
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.