Middle ear infections are a common occurrence in childhood that can cause temporary hearing loss. Also called otitis media, middle ear infections result in inflammation, fluid build-up or a combination of both in the air-filled space behind the eardrum. This build up can reduce the mobility of the eardrum and middle ear bones, leading to decreased hearing ability. If treated properly, the infection will clear and hearing will improve. It's important to learn the symptoms so you know when to seek medical help for your child.
It can be difficult to recognize symptoms for infants and toddlers who cannot verbally express the pain or irritation they might be experiencing. If you're concerned that your young son or daughter could have a middle ear infection, look for these tell-tale signs:
- Constant scratching or pulling at the ears
- Slower to respond to voices and other sounds
- Secretions from the ear
For older children, adolescents and adults, these symptoms are common:
- Constant earache
- Pressure in the ears
- Difficulty understanding speech or engaging in conversation
- Feelings of dizziness or imbalance
- Vomiting or general nausea
If you or your child has any of the symptoms above, call your pediatrician, family doctor or otolaryngologist. It is important to act quickly because a middle ear infection can easily be treated and the pain alleviated. Left untreated, the infection can spread to other tissues in the brain, like the mastoid.
Otitis media may be described as acute or chronic. Acute otitis media usually has a rapid onset and a short duration. Chronic otitis media can affect the middle ear for a much longer period of time, a month or more, and has a much higher risk of recurrence. It is also more likely to cause long-term conductive hearing loss or damage in the middle ear.
Both types of otitis media can be treated with antibiotics, which help destroy the infection. Any fluids in the middle ear space will dissipate gradually over time once the inflammation and swelling are gone and the Eustachian tube can function properly to ventilate the middle ear space.
If you suspect a middle ear infection in your child, act quickly to seek medical treatment.
Until the fluids have cleared, the ear is susceptible to recurrent infections. It is important for the patient to continue to rest and take the entire prescribed course of antibiotics even though the symptoms may have subsided. Older children may report being able to hear better several days after they have resumed normal activities. This is a sign that the fluid build-up has resolved.
For chronic otitis media, an otolaryngologist may recommend a minor surgical procedure to insert pressure-equalization (PE) tubes into the eardrum. This is usually an outpatient procedure in which doctors make a small incision in the eardrum, suck out all the fluids that are present in the middle ear space, then place a small tube in the eardrum. This tube aerates the middle ear space through the ear canal, to allow any trapped fluids to dissipate. Often, the small tube falls out naturally after several months, when the Eustachian tube is functioning again. The eardrum will usually repair itself. This practice is highly effective and therefore commonly used to treat frequent ear infections.
Another common cause of recurrent otitis media is a chronic infection of the adenoids or tonsils. These glands are close to the Eustachian tube, so viral or bacterial invaders can easily spread to the middle ear. When adenoids or tonsils are known to be contributors to middle ear infections, most otolaryngologists recommend surgical removal of those glands via tonsillectomy or adenoidectomy to prevent the spread of infections in the future. Often, surgeons will perform a single outpatient surgery to remove the glands and insert PE tubes. Once the surgical areas have healed and the middle ear space is ventilated, otitis media may cease to be a problem for these children.
Middle ear infections are more common in infants and toddlers than older children and adults due to the positioning of the Eustachian tube that changes rapidly as we develop. The Eustachian tube, which connects the middle ear with the back of the throat, is more horizontally positioned in infants and toddlers than older children.
This anatomical positioning, combined with a less-developed immune system, makes the middle ears of infants and toddlers more vulnerable to any infection that affects the respiratory system. This causes inflammation and swelling, which can effectively disable the Eustachian tube, rendering it incapable of equalizing the pressure in the middle ear space. With no ability to equalize, negative pressure builds up in the tiny middle ear space and normal cellular secretions begin to build up. The negative pressure and fluid can cause pain, pressure, dizziness and reduced hearing ability.
It is not wise to leave a middle ear infection untreated. In some cases, the eardrum will burst from the pressure that builds up in the middle ear. Although it sounds scary, this is a natural response of the body and the eardrum will usually heal itself within three days. However, if the eardrum doesn't burst, the infection can spread dangerously, causing mastoiditis (infection of the mastoid bone of the skull) and infections of other tissues of the brain.
Implications for hearing
All types of middle ear infection can cause some degree of temporary hearing loss. In most cases, the loss is mild and doesn't result in any long-term damage to hearing ability. However, infants and toddlers who suffer from chronic otitis media experience stretches of mild hearing loss during a crucial learning period for speech and language. This is another reason why it is important to seek medical attention quickly. If you suspect your child may have a middle ear infection, contact a physician right away. Hearing ability will improve after the infection is healed and the fluid is resolved.