Acute otitis media is an inflammation (irritation and swelling with presence of extra immune cells) and/or infection of the middle ear. Acute otitis media refers to a short and severe episode. (Persistent or recurrent middle ear infection is called chronic otitis media .)

Alternative Names

Acute ear infection; acute suppurative otitis; Acute otitis media; Infection - inner ear; Middle ear infection - acute

Causes, incidence, and risk factors

Acute otitis media (acute middle ear infection) is most common in children. It occurs when there is bacterial or viral infection of the fluid of the middle ear, causing the production of pus or excess fluid. This may be accompanied by bleeding in the middle ear. Inflammation of the ear (sterile or serous otitis ) may occur when there is a collection of fluid in the ear that is not infected. This may be caused by overproduction of fluid by the structures in the middle ear or by blockage of the drainage system (the eustachian tube). Pressure from fluids associated with ear infection may cause the eardrum to rupture. A ruptured eardrum can also result in ear infection by allowing bacteria or viruses direct entry to the middle ear. Ear infections are often associated with respiratory infections or with blocked sinuses or eustachian tubes caused by allergies or enlarged adenoids . Risk factors include the following:

Signs and tests

An ear inspection may show dullness, redness, or air bubbles or fluid behind the eardrum. The eardrum may bulge out or retract inward, or it may show openings (perforation). An examination and culture of fluid may show blood, pus, and bacteria.

Treatment

The goal of treatment is cure of the infection. Nasal sprays, nose drops, oral decongestants or, occasionally, oral antihistamines may be used to promote drainage of fluid through the eustachian tube. Ear drops may be prescribed to relieve pain. Over-the-counter antipyretic and analgesic medications (such as acetaminophen - oral) may be used to reduce fever and discomfort. Aspirin should not be given to children during a viral upper respiratory infection because this has been linked with Reye's syndrome . Antibiotics may be prescribed if infection is present and the infection appears bacterial rather than viral. Oral corticosteroids may occasionally be prescribed to reduce inflammation. Applying warmth to the ears (using warm cloths or warm water bottles, for example) may relieve pain. Keep the ears clean and dry to reduce the risk of reinfection. Myringotomy (surgical cutting of the eardrum) may occasionally be needed to relieve pressure and allow drainage. This may or may not also involve placement of drainage tubes in the ear. Surgery to remove the adenoids may prevent them from blocking the eustachian tubes.

Expectations (prognosis)

Otitis media is curable with treatment but may recur. It is not life threatening but may be quite painful.

Complications

Calling your health care provider

Call your health care provider if you or your child have symptoms that suggest acute otitis media. Also, call if the symptoms worsen, or if new symptoms appear, especially these:

Prevention

Always hold infants in a sitting position during feeding. For children and adults who have a history of frequent ear infections , nasal sprays, preventive antibiotics, or decongestants may be recommended during respiratory infections. (Note: Nasal sprays should only be given for short periods of time. Prolonged use can cause dependence on the nasal spray, or can cause the congestion to get worse instead of better.)