Otitis media is an infection of the middle ear, the area just behind the
eardrum. It happens when the eustachian tubes, which drain fluid and bacteria
from the middle ear out to the throat, become blocked. Otitis media is common in
infants and children, because their immune systems are immature and their
eustachian tubes are easily clogged. Ear infections rarely happen in adults,
Signs and Symptoms
Acute otitis media causes pain, fever, and difficulty in hearing. In infants,
the clearest sign of otitis media is often irritability and inconsolable crying.
Infants may not want to drink their bottle or they may pull on their ears
(although this may be due to teething or just being tired).
Other symptoms that may be associated with an ear infection include sore
throat (pharyngitis), neck pain, nasal congestion and discharge (rhinitis),
headache, and ringing (tinnitus), buzzing, or other noise in the ear.
Blockage of the eustachian tubes may be caused by the
Tobacco smoke or other environmental irritants
Infected or overgrown adenoids
Sudden increase in pressure (such as during an airplane take off or
Drinking while lying on the back, such as with a propped bottle
Excess mucus and saliva produced during teething
Otitis media occurs most frequently in the winter. It is not contagious in
itself, but a cold may spread among a group of children and cause some of them
to get ear infections.
Recent illness (such as a cold or sinus infection)
History of allergies (like hay fever, also called allergic rhinitis,
Attending day care, especially with more than 6 children at the center
Exposure to second hand smoke
Crowded or unsanitary living conditions
Family members who are prone to ear infections
The doctor will ask questions about whether you (or your child) have had ear
infections in the past and will want you to describe the current symptoms,
including whether you have had any symptoms of a cold or allergies recently.
Your health care provider will examine your throat, sinuses, head, neck, and
lungs. Using an instrument called an otoscope he or she will look inside your
ears. If infected, there may be areas of dullness or redness or there may be air
bubbles or fluid behind the eardrum. The fluid may be bloody or purulent (filled
with pus). The physician will also check for any sign of perforation (hole or
holes) in the eardrum.
A hearing test may be recommended if your child has had persistent (that is
chronic and recurrent) ear infections. It is difficult to test hearing if your
child is under two years old.
You can reduce your child's risk of ear infection by the following
Don't expose your child to second hand smoke.
Reduce your child's exposure to respiratory infections. For example,
attending a day care with six or fewer children can lessen your child's chances
of getting a cold or similar infection; this, in turn, leads to fewer ear
infections. Similarly, frequent hand and toy washing is also helpful.
Always hold your infant in an upright, seated position during bottle
feeding. This prevents pooling of fluid and its associated risk of becoming
Breastfeeding can make a child less prone to ear infections.
Avoid the use of pacifiers.
Pneumococcal vaccine prevents infections from the organism that most
commonly causes acute ear infections and many respiratory infections.
Giving lots of affection and helping your child learn to relax may
help prevent colds and, therefore, ear infections.
The goals for treating ear infections include curing the infection, relieving
pain and other symptoms, and preventing recurrent ear infections. If a bacterial
infection is present, antibiotics are necessary (see section entitled
With that said, antibiotics tend to be overused for the treatment of ear
infections. Many studies suggest that uncomplicated ear infections in children
over two years old can resolve within one week without antibiotics. In general,
antibiotics are overused in the Western culture, leading to the growth and
development of organisms that are resistant to these drugs. Finally, many ear
infections are caused by a virus, not a bacterium; antibiotics are intended to
treat bacterial infections.
Antibiotics should generally be used in children under two years old. Those
older than two should be assessed individually and antibiotics given
Luckily, there are many alternative ways to treat the symptoms of ear
infections and to prevent persistent and recurrent ear infections. For example,
herbal ear drops and
homeopathic remedies can be helpful for
treating or preventing ear infections.
Applying warm compresses (for example, using a warm clot or hot water bottle
filled with warm water) may help relieve pain.
Antibiotics are prescribed to treat a bacterial infection. It is
essential that the instructions for taking the drug (that is, how much, how
often, and for how long) be followed carefully. The entire course of the
antibiotic must be completed in order to avoid a relapse. The antibiotic most
often prescribed for acute otitis media is amoxicillin, unless your child is
allergic to penicillin in which case, there are several others from which your
doctor will choose. If your doctor suspects a resistant organism (see earlier
explanation), a different antibiotic will be selected.
For chronic otitis media (that is, recurrent and persistent ear infections)
or if your child has a perforated eardrum or develops infection after
tympanostomy tubes have been placed (see
Surgery and Other Procedures), antibiotic
ear drops may be prescribed instead of oral antibiotics and continued for a long
period of time (like a few months).
Nasal sprays, nose drops, oral decongestants, or, occasionally, oral
antihistamines may be used to promote drainage of fluid through the eustachian
Ear drops may be prescribed to relieve pain.
Over the counter oral medications for pain and/or fever may be used,
like ibuprofen or acetaminophen. Aspirin should not be used in children.
Rarely, oral corticosteroids may be prescribed to reduce inflammation.
Surgery and Other Procedures
If there is fluid in the middle ear and the condition persists, even with
antibiotic treatment, a healthcare provider may recommend myringotomy (surgical
opening of the eardrum) to relieve pressure and allow drainage of the fluid.
This may or may not involve the insertion of typanostomy tubes (often referred
to as ear tubes). In this procedure, a tiny tube is inserted into the eardrum,
keeping open a small hole through which fluids can drain to the outside.
Tympanostomy tube insertion is done under general anesthesia. Usually the tubes
fall out by themselves or are removed in your provider's office.
If your adenoids and tonsils are enlarged, surgical removal may be
considered, especially if you have chronic, recurrent ear infections. Similarly,
surgical repair of a ruptured eardrum may be necessary to prevent recurrent ear
Nutrition and Dietary Supplements
Foods rich in antioxidants and other important chemicals that help boost
immune function are important to include in your child's daily diet. Such foods
include fresh, darly colored fruits and vegetables. Eating plenty of omega-3
fatty acids (a group of essential fatty acids that tend to reduce inflammation)
may be important as well. Sources of omega-3 include fish, walnuts, and
flaxseeds. Children should not have these foods prior to ages 2 to 3 years old.
Because supplements (like those described below) may have side effects or
interact with medications, they should be taken only under the supervision of a
knowledgeable healthcare provider.
Lactobacillus- a probiotic or
"friendly"/healthy bacteria, may reduce the incidence of respiratory infections,
like colds and sinusitis, and their associated complications such as ear
infections. More research in this area would be helpful.
Xylitol - a sugar alcohol produced naturally
in birch, strawberries, and raspberries has properties that fight pneumococcus,
a bacteria that commonly causes ear and upper respiratory infections. Some
studies are reporting that children who chew gum (if they are old enough) or
take a syrup containing xylitol experience fewer ear infections than children
who do not take xylitol. More research is needed on this
The use of herbs is a time-honored approach to strengthen the body and treat
disease. Herbs, however, contain active substances that can trigger side effects
and interact with other herbs, supplements, or medications. For these reasons,
herbs should be taken with care and only under the supervision of a practitioner
knowledgeable in the field of herbal medicine.
Calendula, St. John's wort, Mullein flower, Garlic
Herbal specialists will often prescribe herbal ear drops containing one or
all of these ingredients for ear pain or infection. In a study conducted in
Israel, 103 children with ear infections were given herbal ear drops or drops
containing pain-relieving medications. The herbal ear drops contained a variety
of herbal extracts including calendula, St. John's wort, mullein flower, and
garlic. The researchers found that the combination of herbs in the ear drops was
as effective as the medication ear drops in reducing the childrens' ear
The Native American medicinal plant known as coneflower (Echinacea
angustifolia/Echinacea pallida/Echinacea purpurea) is one of the most
popular herbs in America today. Used primarily to reduce the symptoms and
duration of the common cold and flu and to alleviate the symptoms associated
with them, such as sore throat (pharyngitis), cough, and fever, many herbalists
also recommend echinacea to help boost the activity of the immune system and to
help the body fight infections. For this reason, professional herbalists may
recommend echinacea to treat ear infections.
Parts of the eucalyptus plant have the ability to fight infection, reduce
inflammation, and lower fever. For this reason, eucalyptus is often found in
remedies used to treat the common cold. Similarly, some herbalists prescribe a
tincture made from eucalyptus leaves for chronic ear infections. It is important
to note that children under 6 years old should not take eucalyptus leaves or oil
by mouth and children under 2 should not apply the oil to the face or nose.
Therefore, use of eucalyptus ear drops should be reserved for children older
than 2 years and oral eucalyptus for children older than 6 years.
Some preliminary animal studies suggest that capsaicin, an active ingredient
found in cayenne, may help prevent the development of ear infections for those
at risk. Much more research is needed before knowing if this same benefit
applies to people. Also, capsaicin has been used in homeopathic doses to treat
In test tube laboratory studies, tea tree oil demonstrates ability to fight
many of the organisms that cause ear infections. Whether this will translate
into helpful treatment for otitis media in people is unknown at this time,
however. Like capsaicin, much more research is needed, particularly since one
early animal study raises the possibility that tea tree oil may cause hearing
damage in guinea pigs.
Chiropractors report and preliminary evidence suggests that spinal
manipulation treatments may benefit some children with otitis media. In one
study involving 315 children with otitis media, a total of five spinal
manipulations significantly improved symptoms after 11
Although not many studies have examined the effectiveness of specific
homeopathic therapies in general, there have been several studies evaluating the
use of homeopathy for ear infections. Some of the homeopathic remedies included
in such studies or that a professional homeopath might consider for the
treatment of ear infections are listed below. Before prescribing a remedy,
homeopaths take into account a person's constitutional type. A constitutional
type is defined as a person's physical, emotional, and psychological makeup. An
experienced homeopath assesses all of these factors when determining the most
appropriate treatment for each individual.
Aconitum -- for throbbing ear pain that comes on suddenly after
exposure to cold or wind; and in children with high fever and whose ears have a
bright red coloring
Belladonna -- for sudden onset of infection with piercing pain
that often spreads to the neck, flushed face including reddened ears, agitation
(even impaired consciousness and nightmares), wide-eyed stare, high fever, and
swollen glands; this remedy is most appropriate for children who feel relief
when sitting upright and from warm compresses to the ear; this remedy should not
be used in children whose symptoms have persisted for more than 3 days
Chamomilla -- for intense ear pain and extreme irritability and
anger (including screaming); this remedy is most appropriate for children who
are difficult to comfort unless being rocked or carried by a person who is
walking back and forth
Hepar Sulphuricum -- for sharp pains and a smelly,
yellowish-green discharge that occur in the middle and late stages of an ear
infection, particularly when the child is extremely moody and clearly angry;
this remedy is most appropriate for individuals whose symptoms are worsened by
cold air and improved by warmth
Lycopedium- for right sided ear pain
that is worse in the late afternoon and early evening; the child will generally
say that his ears feel stuffed up and he may hear a ringing or buzzing sound;
the appropriate individual tends to be insecure and need others around, although
the personality type may act like a bully as a defense mechanism
Mercurius- good for chronic ear
infections; for acute or chronic pain that is worse at night and may extend down
into the throat; relief comes from nose blowing; and the appropriate child may
sweat or drool a lot and have bad breath
Pulsatilla -- for infection following exposure to cold or damp
weather; the ear is often red and may have a yellowish/greenish discharge; ear
pain worsens when sleeping in a warm bed and is relieved somewhat by cool
compresses; this remedy is most appropriate for children who tend to be gentle,
weepy, and mildly whiny and are easily soothed by affection
Silica- for chronic or late stage
infection when the child feels chilly, weak and tired; sweating may also be
Warnings and Precautions
For a child under two, let the doctor know right away if he or she is
experiencing a fever, even if no other symptoms are present. Also, if high fever
or severe pain is present in a child, of any age, the doctor should be seen
right away as well.
Let your health care provider know if your child's symptoms (namely, pain,
fever, or irritability) do not improve within 24 to 48 hours.
If severe pain suddenly stops hurting, this may indicate a ruptured eardrum.
It is possible that swimming will exacerbate an ear infection, particularly
the pain from changes in pressure if swimming under water. If a ruptured eardrum
is present, swimming is out of the question and even without a rupture, diving
and swimming underwater should be avoided with an ear infection. If your child
has ear tubes, use earplugs or cotton balls coated with petroleum jelly when
swimming to prevent infection.
Prognosis and Complications
Generally, an ear infection is a simple, non-serious condition without
complications. Most children will have minor, temporary hearing loss during and
right after an ear infection. This is due to fluid lingering in the ear.
Permanent hearing loss is extremely rare, but the risk increases if the child
has a lot of ear infections. Other potential complications from otitis media
Ruptured or perforated eardrum
Chronic, recurrent ear infections
Enlarged adenoids or tonsils
Mastoiditis (an infection of the bones around the skull)
Meningitis (an infection of the brain)
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; again, this is very unusual
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Review Date: June 2003
Reviewed By: Participants in the review process include: Gary Guebert, DC, DACBR,
(Chiropractic section October 2001) Login Chiropractic College, Maryland
Heights, MO; Jacqueline A. Hart, MD, Department of Internal Medicine,
Newton-Wellesley Hospital, Boston, Ma and Senior Medical Editor A.D.A.M., Inc.;
Paul Rogers, MD, Facility Medical Director, Bright Oaks Pediatrics, Bel Air MD;
Joseph Trainor, DC, (Chiropractic section October 2001) Integrative
Therapeutics, Inc., Natick, MA; David Winston, Herbalist, Herbalist and
Alchemist, Inc., Washington, NJ; Leonard Wisneski, MD, FACP, George Washington
University, Rockville, MD.
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