Ear Infection,....

Ear Infection - Acute

• • Alternative Names
  • Causes
  • Symptoms
  • Exams and Tests
  • Treatment
  • Outlook (Prognosis)
  • Possible Complications
  • When to Contact a Medical Professional
  • Prevention
  • References
• In-Depth Report
• News & Features
• Reporter's File
• Expert Q & A
• Questions for Your Doctor
• Clinical Trials
• 5 Things to Know

Related Topics

• Ear Infection - Chronic
• Otitis
• Allergies
• Enlarged Adenoids
• Ruptured Eardrum
• Mastoiditis
• Meningitis

Ear infections are one of the most common reasons parents take their children to the doctor. While there are different types of ear infections, the most common is called otitis media, which means an inflammation and infection of the middle ear. The middle ear is located just behind the eardrum.
An acute ear infection is a short and painful ear infection. For information on an ear infection that lasts a long time or comes and goes, see: Chronic ear infection.

Times Essentials

Recent findings and perspectives on medical research.

Reporter's File

Ear Infections Too Often Misdiagnosed, Then Overtreated

Too many doctors, and parents, rely on antibiotics for ear infections, despite a woeful lack of evidence for their benefits.

Alternative Names

Otitis media - acute; Infection - inner ear; Middle ear infection - acute

Causes »

The Eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid normally made in the middle ear. If the Eustachian tube becomes blocked, fluid can build up. This can lead to infection.
Ear infections are common in infants and children, because the Eustachian tubes become easily clogged.
Ear infections may also occur in adults, although they are less common than in children.
Anything that causes the eustachian tubes to become swollen or blocked causes more fluids to build up in the middle ear behind the eardrum. These causes include:

• Allergies
• Colds and sinus infections
• Excess mucus and saliva produced during teething
• Infected or overgrown adenoids
• Tobacco smoke or other irritants

Ear infections are also more likely if a child spends a lot of time drinking from a sippy cup or bottle while lying on his or her back. However, getting water in the ears will not cause an acute ear infection, unless the eardrum has a hole from a previous episode.
Acute ear infections occur most often in the winter. You cannot catch an ear infection from someone else, but a cold may spread among children and cause some of them to get ear infections.
Risk factors for acute ear infections include:

• Attending daycare (especially those with more than 6 children)
• Changes in altitude or climate
• Cold climate
• Exposure to smoke
• Genetic factors (susceptibility to infection may run in families)
• Not being breastfed
• Pacifier use
• Recent ear infection
• Recent illness of any type (lowers resistance of the body to infection)

Symptoms »

In infants, the main sign is often irritability and inconsolable crying. Many infants and children with an acute ear infection have a fever or trouble sleeping. Tugging on the ear is not always a sign that the child has an ear infection.
Symptoms of an acute ear infection in older children or adults include:

• Ear pain or earache
• Fullness in the ear
• Feeling of general illness
• Vomiting
• Diarrhea
• Hearing loss in the affected ear

The ear infection may start shortly after having a cold. Sudden drainage of yellow or green fluid from the ear may mean a ruptured eardrum.
All acute ear infections include fluid behind the eardrum. You can use an electronic ear monitor, such as EarCheck, to detect this fluid at home. The device is available at pharmacies, but you still need to see your doctor to confirm any possible ear infection.
In-Depth Symptoms »

Exams and Tests »

The health care provider will look inside the ears using an instrument called an otoscope. This may show:

• Areas of dullness or redness
• Air bubbles or fluid behind the eardrum
• Bloody fluid or pus inside the middle ear
• A hole (perforation) in the eardrum

A hearing test may be recommended if the person has a history of ear infections.
In-Depth Diagnosis »

Treatment »

Some ear infections will safely clear up on their own without antibiotics. Often, treating the pain and allowing the body time to heal itself is all that is needed:

• Apply a warm cloth or warm water bottle to the affected ear.
• Use over-the-counter pain relief drops for ears, or ask the doctor about prescription ear drops to relieve pain.
• Take over-the-counter medications for pain or fever, such as ibuprofen or acetaminophen. Do NOT give aspirin to children.

All children younger than 6 months with a fever or symptoms should see the doctor. Children who are older than 6 months may be watched at home if they do not have:

• A fever higher than 102 °F
• More severe pain or other symptoms
• Other medical problems

If there is no improvement or symptoms get worse, schedule an appointment with your health care provider to determine whether antibiotics are needed.
ANTIBIOTICS
A virus or bacteria can cause ear infections. Antibiotics will not help an infection caused by a virus. Many health care providers no longer prescribe antibiotics for every ear infection. However, all children younger than 6 months with an ear infection are treated with antibiotics.
Your health care provider is more likely to prescribe antibiotics if:

• Your child is under age 2
• Has a fever
• Appears sick
• Is not improving over 24 to 48 hours

Make sure you or your child takes the antibiotics every day and finishes all the medicine, rather than stopping when symptoms go away. If the antibiotics do not seem to be working within 48 to 72 hours, contact your doctor. You may need to switch to a different antibiotic.
Amoxicillin is commonly the first choice. Other antibiotics that may be given are azithromycin or clarithromycin, cefdinir, cefuroxime, cefpodoxime, amoxicillin clavulanate (Augmentin), clindamycin, or ceftriaxone.
Side effects of antibiotics include nausea, vomiting, and diarrhea. Although rare, serious allergic reactions may also occur.
Some children who have repeat infections that seem to go away in between may receive a smaller, daily dose of antibiotics to prevent new infections.
SURGERY
If an infection does not go away with the usual medical treatment, or if a child has many ear infections over a short period of time, the doctor may recommend ear tubes.

• In this procedure, a tiny tube is inserted into the eardrum, keeping open a small hole that allows air to get in so fluids can drain more easily. Tympanostomy tube insertion is done under general anesthesia.
• Usually the tubes fall out by themselves. Those that don't fall out may be removed in your doctor's office.

If the adenoids are enlarged, surgical removal of the adenoids may be considered, especially if you continue to have ear infections. Removing tonsils does not seem to help with ear infections.
In-Depth Treatment »

Outlook (Prognosis)

Ear infections can be treated but may occur again in the future. They can be quite painful. If you or your child are prescribed an antibiotic, it is important to finish all your medication as instructed.

Possible Complications

Generally, an ear infection is a minor medical problem that gets better without complications. Most children will have minor, short-term hearing loss during and right after an ear infection. This is due to fluid lingering in the ear.
Rarely, a more serious infection may develop, such as

• Mastoiditis (an infection of the bones around the skull)
• Meningitis (an infection of the brain)

Fluid can remain behind the eardrums even after the infection has cleared for weeks or even months.. See also: Otitis media with effusion
Other potential complications include:

• Ruptured or perforated eardrum
• Chronic, recurrent ear infections
• Enlarged adenoids or tonsils
• Formation of an abscess or a cyst (called cholesteatoma) from chronic, recurrent ear infections
• Speech or language delay in a child who suffers lasting hearing loss from multiple, recurrent ear infections

When to Contact a Medical Professional

Call your child's doctor if:

• Pain, fever, or irritability do not improve within 24 to 48 hours
• At the start, the child seems sicker than just an ear infection
• Your child has a high fever or severe pain
• Severe pain suddenly stops hurting -- this may indicate a ruptured eardrum
• Symptoms worsen
• New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles

For a child younger than 6 months, let the doctor know right away if the child has a fever, even if no other symptoms are present.

Prevention »

You can reduce your child's risk of ear infections with the following practices:

• Wash hands and toys frequently.
• If possible, choose a daycare that has a class with 6 or fewer children. This can reduce your child's chances of getting a cold or similar infection, and leads to fewer ear infections.
• Avoid pacifiers.
• Breastfeed -- this makes a child much less prone to ear infections. But, if bottle feeding, hold your infant in an upright, seated position.
• Do not expose your child to secondhand smoke.
• Make sure your child's immunizations are up-to-date. The pneumococcal vaccine prevents infections from the bacteria that most commonly causes acute ear infections and many respiratory infections.
• Avoid overusing antibiotics. Overusing antibiotics can lead to antibiotic resistance.

Cauliflower Ear

• What is cauliflower ear?
• What causes cauliflower ear?
• What are the symptoms of cauliflower ear?
• What is the treatment for cauliflower ear?
• What is the prognosis for cauliflower ear?
• How can cauliflower ear be prevented?
• Patient Comments: Cauliflower Ear - Cause

Ear Anatomy

The anatomy of the ear can be a little confusing, especially since the ear is responsible not only for hearing, but also for balance.
There are three components to the ear: the outer ear, the middle ear and the inner ear. All three are involved in hearing but only the inner ear is responsible for balance.
The outer ear is composed of the pinna, or ear lobe, and the external auditory canal. Both structures funnel sound waves towards the ear drum or tympanic membrane allowing it to vibrate. The pinna is also responsible for protecting the ear drum from damage. Modified sweat glands in the ear canal form ear wax.
The middle ear is an air filled space located in the temporal bone of the skull. Air pressure is equalized in this space via the Eustachian tube which drains into the nasopharynx or the back of the throat and nose. There are three small bones, or ossicles, that are located adjacent to the tympanic membrane. The malleus, incus, and stapes are attached like a chain to the tympanic membrane and convert sound waves that vibrate the membrane into mechanical vibrations of the three bones. The stapes fills the oval window which is the connection to the inner ear.

What is cauliflower ear?

Cauliflower ear (boxer's ear, wrestler's ear) is an acquired deformity of the outer ear. It is usually due to blunt trauma to the ear. When the cartilage of the ear is injured by trauma or inflammation, the blood supply from the skin is disrupted. It often forms a large pocket of blood, called a hematoma. As the injury to the ear heals it can shrivel up and fold in on itself and appear pale, giving it a cauliflower-like appearance, hence the term cauliflower ear. Wrestlers, boxers, and martial artists in particular are susceptible to this type of injury.

What causes cauliflower ear?

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The ear is vulnerable to blunt trauma. When the ear is struck and a blood clot develops under the skin, or the skin is sheared from the cartilage, the connection of the skin to the cartilage is disrupted, causing cauliflower ear.
The cartilage of the ear has no other blood supply except that supplied by the overlying skin. When the skin is pulled from the cartilage, and/or separated from the cartilage by blood (as with accumulated blood from injury or inflammation) or infection, the cartilage is deprived of important nutrients. Ultimately, the cartilage dies and the risk of infection is increased.
Untreated, the ear cartilage begins to contract on itself forming a shriveled up outer ear, known as the cauliflower ear deformity. Once there is cartilage death and scarring (fibrosis), the resulting deformity is generally permanent. The ear may also appear pale, due to loss of blood supply. In some cases, cosmetic procedures may improve the appearance of the ear.
Cartilage damage may also result from piercing the upper ear in the cartilage. Piercing can lead to a type of ear cartilage infection called auricular perichondritis, which can result in cauliflower ear. An even more rare cause of cauliflower ear is from the inflammation of cartilage in relapsing polychondritis.

 

 

What are the symptoms of cauliflower ear?

Because cauliflower ear is usually due to trauma, the symptoms depend on the severity of the trauma to the ear. Symptoms of cauliflower ear include pain, swelling, bruising, and deformity of the curvature of the ear. If the trauma to the ear leads to loss of hearing, ringing in the ear (tinnitus), headaches, blurred vision, or facial swelling, the damage from the trauma could be severe and medical attention should be sought immediately.

What is the treatment for cauliflower?

The goals of treatment are to drain blood from the hematoma, treat any infection, and reduce inflammation in order to re-establish the connection of the skin to the underlying cartilage. Treatment usually requires draining accumulated blood (the hematoma) through an incision in the ear and applying a compressive dressing to sandwich the two sides of the skin against the cartilage. Antibiotics are given to prevent infection.
Patients may be referred to an ear, nose, and throat doctor (otolaryngologist) or plastic surgeon to treat this deformity and assure proper healing.

What is the prognosis for cauliflower ear?

When treated aggressively and promptly, cauliflower ear deformity is unlikely. Any delay in diagnosis leads to more difficulty in managing the problem, increased chances for insufficient blood supply to the ear cartilage, and escalated risk of deformity.

How can cauliflower ear be prevented?

Protective headgear and helmets worn during sporting activities can help prevent this condition. Helmets can also protect from serious head injury.
See a doctor (preferably an otolaryngologist or plastic surgeon) for definitive care as soon as possible after the injury.