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Ear Infections (Otitis Media)

Ear infections are the most common cause of medical visits worldwide. There are multiple types of “ear infection” representing the different anatomical parts of the ear. These include the outer ear, middle ear, and inner ear

What Are the Causes of Ear Infections

What Are the Causes of Ear Infections

Inflammation of the middle ear, usually caused by bacteria, may be the result of viral infection which has caused a fluid buildup behind the eardrum, which may or may not become purulent (containing pus.). Anyone may develop an ear infection, but children suffer from them more than adults. The global incidence of ear infection is 10%, half of which occur in children less than 5 years of age. Five out of six children will have at least one ear infection by their third birthday.

The typical signs and symptoms of otitis media (OM) are fever, ear pain, ear drainage, hearing loss, dizziness, malaise, loss of appetite, and sleeping difficulties. Parents may report the previous symptoms as well as their child pulling on their ears and unexplained irritability.

What types of Infections Are Found in the Ear?

What types of Infections Are Found in the Ear?

The most common bacterial causes of infection are: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes and Staphylococcus aureus. These infections may result in suppurative complications such as mastoiditis, meningitis, and intracranial abscess in severe cases.

So why are children most commonly affected? The Eustachian tubes are smaller and more level in children than they are in adults. This makes it difficult for fluid to drain out of the ear. If the eustachian tubes are swollen or blocked with mucus or enlarged adenoids, fluid may not be able to drain. Complicating matters, the immune system of a child is less developed than an adult’s resulting in increased susceptibility to infection.

The adenoids, which are part of the immune system, respond to bacteria passing through the nose and mouth. The adenoids can trap the bacteria causing a chronic infection that can then pass into the eustachian tubes and extend to the middle ear.

Some children have greater ethnic risks of ear infections than others. For example, Native American and Hispanic children have more infections than do children in other ethnic groups. Children in households with smoking family members are at increased risk of middle ear infections. Even in cases where family members smoke outside these children often continue to have infections from exposure of residual smoke. Children in daycare also have an additional risk of increased ear infection. This is presumably due to increased upper respiratory infections from exposure to large numbers of sick kids. As much as possible, limit your child’s exposure to other children when your child or your child’s playmates are sick.

Never put your baby down for a nap, or for the night, with a bottle. This behavior has been shown to increase both ear infections and dental cavities. So what can be done? Wash hands frequently. Washing hands prevents the spread of germs and can help keep your child from catching a cold or the flu.

Initially, observation may be utilized to allow the immune system to handle the infection and reduce the risk of creating antibiotic resistant bacterial strains. Your doctor may prescribe antibiotics against one of the above strains of bacteria. If your doctor prescribes an antibiotic, it’s important to make sure your child takes all of it as prescribed. Even though your child may seem better in a few days, the infection still may not have completely cleared from the ear. Stopping the medicine too soon could allow the infection to return.

Bacteria can form a "biofilm" on the middle ear lining that helps them resist both the body's defenses and antibacterial treatments. A biofilm is bacterial colony attached to a surface. The elaborate matrix created by the bacteria protects them from the body's defense system. Bacteria deep within the biofilm can also enter a metabolic state that renders antibiotics ineffective.

Vaccinating your child against the flu will prevent many unforeseen consequences. When a child is sick, not at home resting to get better, they can contract additional illnesses and sometimes serious complications. They also can disrupt the entire family by passing their illness along to others in the house. For a more detailed explanation of the benefits of a flu vaccine, please read the easy to understand, dedicated web page on the matter at the Centers for Disease Control (CDC)

Flu strains are constantly changing. Every year the flu alters itself enough to be different each flu season. To get a jump start on the latest flu, the medical immunology professionals will take samples from another part of the world, at the end of their flu season, and preparing a vaccination for the populations just starting their flu season. 

A vaccination will greatly reduce the potential of your child contracting the latest flu variant and reduce the number of sick days he or she will use . Make sure your child gets the influenza, or flu, vaccine every year. It is recommended by the Centers for Disease Control you vaccinate your child with the 13-valent pneumococcal conjugate vaccine (PCV13). The PCV13 protects against more types of infection-causing bacteria than the previous vaccine, the PCV7. The Centers for Disease Control and Prevention (CDC) recommends that children under age 2 be vaccinated, starting at 2 months of age. Studies have shown that vaccinated children get far fewer ear infections than children who aren’t vaccinated. The vaccine is strongly recommended for children in daycare.

Once antibiotic and preventative measures fail, placement of PET’s (pressure equalization tubes) permits middle ear ventilation through the ear canal using the tubes as a means to keep the eardrum open. Until the eustachian tube begins to function normally, it is necessary to provide air to the middle ear for normal middle ear pressure and function. In most cases, PET’s last approximately one year and 2/3’s of young children will not require a second set of PET’s. As the children age, the eustachian tube takes a more angled turn to the nasopharynx and the immune system matures enabling it to handle invading bacteria and viruses more efficiently. Occasionally additional tubes or adenoid removal may be necessary to help improve middle ear function to avoid complications and hearing loss. These are discussions that patients and family need to have with their pediatrician, family medicine physician and otolaryngologist (ENT) so that the most appropriate treatment is selected for each individual.


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