An infection in the space behind the eardrum is called otitis media - otherwise
known as an ear infection. It can cause significant pain and fever or
be completely asymptomatic. Otitis media accounts for the vast majority
of office visits.
Ear infections occur most commonly in the middle ear. It is important that
the middle ear contain air that is of the same pressure as the outside
ear so that the eardrum can vibrate. To equalize the pressure there is
a valve called the eustacean tube that runs from the middle ear to the
back of the throat near the adenoids. When the pressure is not equal air
travels through the eustacean tube and "pops" the ears.
Because the tissue of the eustacean tube is like that of the nose, anything
that can cause swelling of the nose can cause swelling of the eustacean
tube and close it off so that no air can travel to relieve the pressure.
Children get more infections because their eustacean tubes are smaller
and it takes very little swelling to close them off. Colds, allergies,
tobacco smoke and other irritants increase the swelling and set children
up for infection. Heredity is also a factor, as we tend to have the same
anatomy as our parents.
Most earaches can be treated at home with warm packs, plenty of fluids,
rest and lots of love. For pain, acetaminophen (Tylenol) or ibuprofen
(Advil, Motrin) work well if one follows the recommended dosing on the
bottle. If your child or you are not showing improvement over 3-5 days
or symptoms are worsening including increased pain, fever (temperature
greater than 100.3 by any measurement) or drainage from the ear, a physician
should be consulted.
Your physician may elect to treat the infection with antibiotics. There
are a wide variety of antibiotics available, and your physician will chose
one based on the likely bacteria present, previous experience with you
and within the community, and other factors such as convenience and your
insurance formulary. A decongestant may be prescribed to try to shrink
the swelling of the eustacean tube and decrease the fluid in the middle
ear. Ear drops may be given for pain relief or antibiotic drops if the
eardrum has ruptured. Your physician may elect just to observe the infection
or not use antibiotics if it is viral.