Wednesday, 15 August 2018
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Ear Infections (Risk Factors, Causes, Symptoms, Diagnosis, Treatment and Complications)

Ear Infections (Risk Factors, Causes, Symptoms, Diagnosis, Treatment and Complications)


There are many types of Ear Infections that adults can develop – Middle Ear Infections and Outer Ear Infections. Middle ear infections (Otitis Media) are less common in adults than children but it is also severe in adults. Know more about why is Otitis Media more common in children.

On the other hand, adults are more likely to develop outer ear infections (Otitis externa).


Risk Factors of Ear Infections


  1. Age: Children between the ages of 6 months and 2 years are more susceptible to middle ear infections because of the size, shape and position of their eustachian tubes and because of their poorly developed immune systems. Discussed before.
  2. Group child care: Children who are cared for in group settings are more prone to get colds and ear infections than children who stay home because they’re more likely to get more infections, such as the common cold.
  3. Infant feeding: Babies who drink from a bottle, especially while lying down, are more susceptible to have ear infections than babies who are breast-fed.
  4. Seasonal factors: Ear infections are most common during the winter when colds and flu are prevalent, as ear infections most often develop on top of cold or flu. People with seasonal allergies may have a greater risk of ear infections during seasonal high pollen counts.
  5. Poor air quality: Repeated exposure to tobacco smoke or high levels of air pollution can increase the risk of ear infection.


What are the Causes of Ear Infection


Middle Ear Infections Causes:


Middle ear infections (Acute Otitis Media) is most often a bacterial or viral infection that affects the middle ear, the air-filled space, found behind the eardrum that contains the tiny vibrating bones of the ear. Middle ear infections most often occur on top of cold, flu or allergy. And the infection itself is caused by bacterium or virus.


Why is Common Cold Most Often Followed by Middle Ear Infection ?


  • Common Cold causes congestion and swelling of the nasal passages, throat and eustachian tubes_narrow tubes that run from each middle ear to high in the back of the throat, behind the nasal passages, responsible for drainage of the normal secretions from the middle ear.
  • So swelling, inflammation and mucus in the eustachian tubes from an upper respiratory infection such as Common Cold can block them, causing the accumulation of fluids & secretions in the middle ear. A bacterial or viral infection of this stagnant fluid is usually what develops the symptoms of an Ear Infection.


Causes of Secretory Middle Ear Infection (Otitis Media with Effusion):


  • Otitis Media with effusion occurs most often in children under the age of 2, but can occur at any age.
  • Occurs due to inflammation and fluid buildup (effusion) in the middle ear, but there is no acute infection.
  • Adenoids is the most common cause of otitis media with effusion, as adenoids are near the opening of the eustachian tubes, so any inflammation or enlargement of the adenoids can block the tubes, thereby contributing to middle ear infection. this is more likely to play a role in ear infections in children because children have relatively larger adenoids.


Causes of External Ear Infection (Otits Externa):


  • Otitis Externa is also referred to as ” swimmer’s ear” as repeated exposure to water make the external ear more prone to infection.
  • It commonly develops during the summer months when children swim frequently and their ears remain warm and moist.
  • Otitis Externa is slightly more common in females than males.
  • Swimming is the biggest risk factor for otitis externa, especially swimming in polluted water (highly infected by bacteria)
  • people with certain chronic conditions such as eczema, asthma & allergic rhinitis are also at greater risk of developing the condition.


What are the Symptoms of Ear Infection ?


Symptoms of Middle Ear Infection:


  1. Mild to severe ear pain
  2. Difficulty sleeping
  3. Acting more irritable than usual
  4. Difficulty hearing or responding to sounds
  5. Loss of balance
  6. Fever of 38 C or higher
  7. Drainage of fluid from the ear
  8. Headache
  9. Drainage of fluid from the ear _due to rupture of the ear drum as the accumulation of fluids in your middle ear can cause pressure on your eardrum resulting in its rupture. It is seen especially with Otitis Media with Effusion.
  10. Symptoms of ruptured ear drum whivh include ringing in the ear (tinnitus), spinning sensation (vertigo), nausea or vomiting which can result from vertigo
  11. Diminished hearing
  12. popping or fullness in the ear ( symptom of otits media with effusion). Know more about middle ear infection symptoms


Symptoms of External Ear Infection:


  1. swelling
  2. redness
  3. heat
  4. pain in the ear
  5. discharge of pus
  6. itching
  7. Increased fluid drainage
  8. muffled or reduced hearing (temporary hearing loss)
  9. Severe pain in the face, head, or neck means that the infection has severely advanced. Symptoms accompanied by a fever or swollen lymph nodes may also indicate severe infection


How Doctors Diagnosis Ear Infections ?


  • Diagnose of an ear infection or another condition is based on the symptoms you describe and an exam. your doctor will likely use a lighted instrument (called otoscope) to look at your ears, throat and nasal passage. If your child is infected, The doctor will also listen to your child breathe with a stethoscope.
  • The methods of diagnosis include:


Pneumatic Otoscope:


The only specialized tool that a doctor needs to make a diagnosis of an ear infection. This instrument makes the doctor able to look in the ear and judge whether there is fluid behind the eardrum or not. With the pneumatic otoscope, the doctor gently puffs air against your eardrum. Normally, this puff of air can cause the eardrum to move. If your middle ear is filled with fluid, your doctor will observe little to no movement of the eardrum.


Additional Tests:


Other diagnostic tests may be done if there is any doubt about a diagnosis, if the condition hasn’t responded to treatments, or if there are other persistent or serious problems. They include:

  • Tympanometry: his test measures the movement of the eardrum. The device adjusts air pressure in the canal, thereby causing the eardrum to move. The device measures how well the eardrum moves and gives an indirect measure of the pressure within the middle ear.
  • Acoustic Reflectometry: It is considered an indirect measure of fluids in the middle ear.This test can measure how much sound emitted from a device is reflected back from your eardrum — Normally, the eardrum absorbs most of the sound. However, the more pressure in the middle ear due to exccesive fluid , the more sound the eardrum will reflect.
  • Tympanocentesis ( Rarely used): A tiny tube that pierces the eardrum to drain fluid from the middle ear —this is called tympanocentesis. This fluid can be used to determine the infectious agent if the infection hasn’t responded well to treatments.



Other tests:


If your child has had persistent ear infection in the middle ear, your doctor may refer you to a specialist (audiologist), speech therapist or developmental therapist for testing of hearing, speech skills or developmental abilities.


What is the Treatment of an Ear Infection ?


  1. Treatment of Middle Ear Infection:


A. A wait-and-see approach

As symptoms of ear infections most often improve within the first two  days, and most infections sober 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 as an option for:

  • Children of the age between 6 to 23 months with mild inner ear pain in one ear for less than 48 hours and a temperature less than 39 C.
  • Children of 24 months and older with mild inner ear pain in one ear or both of them for less than 48 hours and a temperature less than 39 C.


Some evidence suggests that treatment with antibiotics may be of a great  benefit for certain children with ear infections. So talk to your doctor about the benefits of antibiotics weighed against the adverse effects.


B. Managing pain


Till resolving of the infection, you will need to lessen pain from an ear infection. so the doctor will advise you to take pain relievers which may include the following:


  • A warm compress: Placing a warm, moist towel over the affected ear may lessen pain.
  • Pain medication: the use of over-the-counter acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) can help relieve pain. It is important to use the drugs as directed on the label. Children recovering from chickenpox or flu-like symptoms should never take aspirin because aspirin has been associated with Reye’s syndrome.


C. Antibiotic therapy


Antibiotic treatment is recommended for an ear infection in the following situations (after initial observation waiting time less than 48 hours):


  • Children 6 months and older with moderate to severe ear pain.
  • Children 6 to 23 months with mild inner ear pain in one or both ears.
  • Children 24 months and older with mild inner ear pain in one or both ears for 48 hours and a temperature less than 39 C.


Children younger than 6 months of age with acute otitis media should be treated with antibiotics without the initial observational waiting time.

Even after symptoms have improved, you must take the full course of the antibiotic as prescribed. To avoid recurring infection and resistance of bacteria to antibiotic medications. Talk to your doctor about what to do if you accidentally skip a dose.


2. Treatment of External Ear Infection


  • Outer ear infections may also resolve on their own without treatment.
  • the most common treatment for an outer ear infection that has not resolved on its own is antibiotics ear drops.
  • There are many different types of ear drops that may be used to treat external ear infection, but they all are prescribed for a week to be used several times daily.
  • If the outer ear infection is fungal infection, your doctor will prescribe antifungal ear drops.


What are the Complications of Ear Infections ?


The complications of middle ear infections (Otitis Media) are rare, but very young children are still at great risk due to their low immunity.


1. Mastoiditis:


Develop if an infection spreads out of the middle ear into the area of bone under the ear (the mastoids).Symptoms of mastoiditis can include:


  • Fever
  • Swelling behind the ear
  • Redness and tenderness or pain behind the ear
  • A creamy discharge from the ear
  • Headache
  • Mastoiditis is usually treated in hospital with antibiotics given intravenously. In some cases, surgery is necessary to drain the ear and remove the infected mastoid bone.


2. Cholesteatom:


An abnormal collection of skin cells inside the ear that may develop as a result of persistent middle ear infections.


If not treated, it can eventually damage the delicate structures deep inside the ear, such as the tiny bones which are essential for hearing.Symptoms include:


  • Hearing loss
  • Weakness in half your face
  • Dizziness
  • Tinnitus – hearing sounds from inside your body rather than from an outside source


In most cases, surgery is required.


3. Labyrinthitis:


Occur in some cases, as a result of spread of middle ear infection into the inner ear which can affect the delicate structure deep inside the ear (the labyrinth). Symptoms of labyrinthitis include:


  • Dizziness
  • Vertigo (the feeling that you, or the environment around you, is moving)
  • Feeling imbalanced
  • Hear loss


This symptoms usually pass within a few weeks, although medication to relieve the symptoms and treat the underlying infection may be prescribed.


4. Problems with speech and language development

5. Facial paralysis (very rare)


6. Meningitis:


Very rare, but when develop it is a serious complication of a middle ear infection . meningitis occur as a result of spread of the infection to the protective outer layer of the brain and spinal cord (the meninges).Symptoms can include:


  • Severe headache
  • Being sick
  • A high temperature (fever)
  • Stiff neck
  • Sensitivity to light
  • Rapid breathing


Meningitis caused by a bacterial infection is usually treated in hospital with antibiotics given intravenously.


7. Brain Abscess:


Another very rare and serious complication of a middle ear infection . Brain abscess is a pus-filled swelling that develops inside the brain.Symptoms can include:


  • Severe headache
  • Changes in mental state, such as confusion
  • Paralysis on one side of the body
  • A high temperature
  • Seizures



How to Prevent Ear Infections ?


  1. Prevent common colds: which is the commonest predisposing factor of ear infection by teaching your children to wash their hands frequently and to avoid sharing eating and drinking utensils. Also teach your children to cough or sneeze into their arm crook. Try to limit the time your child spends in group child care. Try to keep your child home from child care or school if your child feels ill.
  2. Avoid secondhand smoke: Make sure that your home is free of any smokes. outside home, as possible, try to stay in smoke-free environments.
  3. Breast-feed your baby: breast-feeding of your baby for at least six months is very important . as breast milk contains antibodies that may offer protection from ear infections.
  4. If you bottle-feed, hold your baby in an upright position: Avoid putting a bottle in your baby’s mouth while he or she is lying down.
  5. Talk to the doctor about vaccinations: Ask your doctor about what vaccinations are suitable for your child.


For examples: Seasonal flu shots, pneumococcal and other bacterial vaccines can help prevent ear infections.

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