Middle Ear Infection

By Jack S.C. Fong, MD, FAAP

Middle ear infection is one of the most common childhood illnesses.  The middle ear is a small space separated from the external ear canal by an eardrum.  It is necessary for this small space to be ventilated through a tube connecting the middle ear to the nose cavity.  When the patency of this tube is compromised, the middle ear is no longer ventilated, leading to fluid accumulation and infection.

Disruption of proper ventilation of the middle ear may result from the smallness of tubes in a baby and/or swelling of the lining of the nose cavity.  This swelling may reflect an upper respiratory tract infection, an allergic reaction or a response to irritants such as tobacco smoke.  Another potential irritant is the pooling of stale infant formula at the back of the throat.  This clandestine event may take place when a baby sleeps with a bottle.  The supine sleeping position of a baby permits the accumulation of a small residual volume of formula.  There are also genetic, anatomic, environmental and structural factors which account for the common occurrence of middle ear infection in young children.

Nasal congestion with discharge is one of the most common preceding events leading to middle ear infection.  Clinical presentations of middle ear illness can be quite variable. Fluid accumulation in the middle ear may be accompanied with mild hearing deficit and possibly clumsiness and nausea.  The latter symptom results from the disturbance of a sensory organ located next to the middle ear.  Middle ear infection may be accompanied by fever.  An older child will complain about earaches, while young infants may only exhibit irritability.  Proper medical intervention of middle ear infection requires the awareness of caregivers that any symptom can be quite variable and subtle.  Indeed, the illness can be completely asymptomatic and only diagnosed during a routine wellness visit.

Medical intervention of middle ear infection is very important for the maintenance of wellness in a child.  Without treatment, the infection may spread into other parts of the body including sinuses, mastoids and, rarely, the brain.  Inflammatory process within the middle ear may also increase the pressure to rupture an eardrum. This will be accompanied with the drainage of pus into the external ear canal. Chronic infection will lead to scarring of the tympanic membrane and subsequent hearing deficit.  Impairment in hearing is the major cause of speech pathology.

Treatment of middle ear infection includes the use of antibiotics and of strategies to re-establish the ventilation.  The best approach dealing with this common infection is to focus on prevention through environmental control including the avoidance of second-hand smoke, the practice of no formula bottle in a crib and the attention to pollutants, allergens and irritants.  When prevention fails, early intervention is possible through awareness of risk factors including genetics, young age, formula use, exposure to other young children, winter months and “cold” symptoms.

Jack S.C. Fong, MD, FAAP is chairman of the Department of Pediatrics at Danbury Hospital.