Ear Infection: Middle Ear

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KEY POINTS

• The middle ear is the space behind the eardrum. It can get infected by bacteria or a virus.
• The symptoms of ear infections often go away in a couple of days without treatment. Your provider may tell you to take decongestant pills or a nasal spray to help relieve pressure and pain in your ear.
• Ask your healthcare provider how to take care of yourself at home and what symptoms or problems you should watch for and what to do if you have them.

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What is a middle ear infection?

The middle ear is the space behind the eardrum. It can get infected by bacteria or a virus. Anyone can get an ear infection, but ear infections are more common in children less than 8 years old. Children are more at risk because the tube that connects the ear to the back of the throat is small and can easily get blocked. There is a tube connected to each ear (called the Eustachian tube) to help drain fluid from the ears.

The medical term for a middle ear infection is otitis media.

What is the cause?

Ear infections usually start with an infection of the nose and throat, such as a with cold or sinus infection that spreads to the ear. Ear infections may start with an allergy such as hay fever. The allergy, like an infection, can cause swelling of the Eustachian tube. The swelling may trap bacteria and fluid in your middle ear, which causes an infection.

Pressure from the buildup of pus or fluid in the ear sometimes causes the eardrum to tear. The eardrum is a thin covering that separates your outer ear from your middle ear. It protects the hearing organs of the middle ear. If the eardrum tears or breaks open, it can cause permanent hearing loss if it doesn’t heal properly.

What are the symptoms?

Symptoms may include:

• Earache
• Trouble hearing
• Feeling of stuffiness or blockage in the ear
• Fever
• Dizziness

If you have fluid or pus draining from your ear, it may be a sign of a ruptured eardrum.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Your healthcare provider may use a light called an otoscope to look into your ear canal and check for fluid. Your provider may check your eardrum with a puff of air blown into the ear.

How is it treated?

The symptoms of ear infections often go away in a couple of days without treatment. Your healthcare provider may wait 1 to 3 days to see if the symptoms go away before prescribing an antibiotic. Taking antibiotics when you don’t need them can cause problems such as an allergic reaction, rash, or upset stomach. It can also cause bacteria to become resistant to antibiotics.

If you have a torn (ruptured) eardrum, your healthcare provider will ask you to have it checked in a couple weeks. A tear usually heals by itself, but occasionally the tear needs to have a patch. This is important to protect the tiny bones in the middle ear that allow us to hear well.

Your provider may tell you to take decongestant pills or a nasal spray to help relieve pressure and pain in your ear. Use decongestants as directed. If you are using a nonprescription nasal-spray decongestant, you should not use it for more than 3 days. After 3 days it may make your symptoms worse. Ask your healthcare provider if it is OK for you to use a nasal spray decongestant longer than this.

If you have allergies, ask your healthcare provider if you should take antihistamines to help control your allergy symptoms. Antihistamines block the effect of histamine and decrease swelling in the nose, sinuses, and Eustachian tubes. Histamine is a chemical your body makes when you have an allergic reaction.

Don’t use any eardrops for an earache if there is drainage from the ear unless the drops are prescribed by your healthcare provider.

For pain take a nonprescription pain reliever such as acetaminophen, ibuprofen, or naproxen. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.

• Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
• Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don't take more than 3000 milligrams (mg) in 24 hours. To make sure you don’t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• If you are taking an antibiotic, take the medicine for as long as your healthcare provider prescribes, even if you feel better. If you stop taking the medicine too soon, you may not kill all of the bacteria and you may get sick again.
• For pain relief, either a cold pack or cold wet cloth or a warm moist washcloth or a covered hot water bottle on the ear for 20 minutes may help.
• If you have fluid leaking from your ear, you can wipe it away with a washcloth and loosely plug the ear with cotton.
• Don’t smoke, and stay away from others who are smoking.
• If you have allergies, try to avoid the things you are allergic to.
• Use a humidifier to put more moisture in the air. This can help to open blocked sinuses and relieve pain. Avoid steam vaporizers because they can cause burns. Be sure to keep the humidifier clean, as recommended in the manufacturer's instructions. It's important to keep bacteria and mold from growing in the water container.
• Use saline nasal sprays or rinses to help wash out congested nasal passages.
• If you have had frequent ear infections, ask your provider if you need a hearing test.

Ask your provider:

• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests. Untreated or repeated ear infections can damage your hearing.

How can I help prevent ear infections?

• If you tend to get ear infections often, ask your healthcare provider if you need to be checked for allergies. Getting treatment for allergies may help prevent ear infections.
• Ask if using decongestants when you have a cold may help prevent you from getting ear infections.