What is Middle Ear Infection? What Treatments are Applied?

The middle ear connects to the nasopharynx via the Eustachian tube. The Eustachian tube is responsible for maintaining constant pressure in the middle ear. This ensures that the ear is not affected by pressure changes.

The most common of the middle ear conditions is middle ear infection (otitis media).

Other common conditions include Eustachian tube disorders, otosclerosis (hardening of the middle ear bones), barotrauma, mastoiditis, cholesteatoma, and eardrum ruptures.

What is a middle ear infection?

Ear infections are among the most common ailments in children. While there are many types of ear infections, the most common type is called Otitis Media, which means inflammation and infection of the middle ear.

A middle ear infection is an inflammation/infection of the middle ear. This inflammation usually starts with infections causing the common cold, sore throat, and other respiratory problems. The infection may be viral or bacterial, acute or chronic.

What kind of microorganisms cause middle ear infection?

Bacteria and viruses can cause middle ear infection. Bacteria such as Pneumococcus, Haemophilus influenza, Pseudomonas, and Moraxella are responsible for approximately 85% of acute middle ear infection cases. Viruses account for the remaining 15%.

Why are children more prone to middle ear infection?

Middle ear infection is a very common infection in children. Since the Eustachian tubes are shorter and more horizontal in children than in adults, it is easier for microbes to travel into the middle ear. Another reason why middle ear infection is more common in children is that the lymph gland, called the adenoids, located in the upper back region of the throat and producing lymphocytes that fight infections, is larger than in adults. Enlarged adenoids can prevent the Eustachian tube from opening. Middle ear infection is generally not seen in adults. If an adult has this type of inflammation, other causes are sought.

What is the relationship between bottle feeding and middle ear infection in children?

Bottle feeding children increases the risk of developing a middle ear infection. If the baby drinks milk from a bottle in a lying position, the milk can flow into the ear, creating an infection. The breastfeeding position is more suitable than the bottle-feeding position.

Middle ear infection can be prevented by feeding the baby in a breastfeeding position and not allowing them to go to bed with a bottle, instead of giving the baby the bottle and allowing them to lie on their back and drink milk. In a child who falls asleep while bottle feeding, tooth decay may also occur alongside middle ear infection.

What should be noted in children with middle ear infection?

Middle ear infection is not contagious. A child with a middle ear infection can travel by plane, but if the Eustachian tube is not functioning well, pressure can cause ear pain. Therefore, it is advised not to engage in activities like flying or swimming until the inflammation subsides.

What is acute middle ear infection? What are the symptoms of the condition?

Acute middle ear infection generally starts quickly but is short-lived. Acute middle ear infection is associated with fluid buildup occurring along with the symptoms of an ear infection, an eardrum that is swollen and accompanied by pain, or a perforated eardrum causing inflammatory discharge. Fever may also be present among the symptoms.

Acute middle ear infection can cause restlessness, sleepiness, and feeding difficulties in young children. Older children may complain of ear pain and fullness. Fever can be seen in children of all age groups. These symptoms are usually associated with upper respiratory tract infection symptoms such as a runny nose, congestion, or cough.

The accumulation of pus inside the middle ear causes pain and reduces the vibration of the eardrum. Thus, temporary hearing loss occurs. Severe ear infections can cause the eardrum to rupture, with the fluid in the middle ear beginning to drain into the ear canal. The hole caused by the eardrum rupture can heal with treatment.

What is the frequency of acute middle ear infection?

According to research, the rate of children who have had a middle ear infection at least once by the age of three is 75% among all children. Middle ear infections are more common in boys than in girls.

Is acute middle ear infection contagious?

Ear infections are not contagious, but middle ear infection develops following a cold or another viral infection in many children, and these infections are contagious.

What are the risk factors for acute middle ear infection?

Upper respiratory tract infections can predispose to acute middle ear infection. Children being in places like childcare centers or schools increases the risk of encountering infections more frequently.

Exposure to irritants like cigarette smoke can also cause acute middle ear infection. Children with cleft palate or Down Syndrome are more prone to ear infections. Certain problems with the Eustachian tubes (blockage, structural defect, inflammation, etc.) will increase the risk of acute middle ear infection.

Children who have a middle ear infection before they are six months old tend to have more middle ear infections in the future.

How is acute middle ear infection diagnosed?

There are three criteria for diagnosing acute middle ear infection:

• Acute onset of inflammation
• Middle ear effusion (fluid accumulation)
• Middle ear inflammation

Recurrent acute middle ear infection is defined as three episodes within six months or four episodes within a year. A specific, definitive test method for acute middle ear infection has not yet been developed. Some tests may be required to diagnose chronic middle ear infections.

How is acute middle ear infection treated?

The treatment of acute middle ear infection varies depending on the child’s age and the symptoms of the inflammation. Treatment usually involves 10 days of antibiotic use in the initial stage. Despite antibiotic treatment, fluid remains in the ears of 40% of children with middle ear infection, which can cause temporary hearing loss that may last from three to six months after treatment. This fluid disappears spontaneously in the vast majority of children. Injections may also be given to children who cannot take medication orally, but three days of antibiotic use is more effective than a single injection.

In children with recurrent inflammation, the use of ear tubes that allow the fluid to exit the middle ear may be recommended. Additionally, if the child has eardrum swelling and intense pain, an operation on the eardrum may be considered. The eardrum usually heals within one week.

What is chronic middle ear infection? What are the causes of the condition?

Normally, the Eustachian tube allows fluid to flow throughout the tube, preventing accumulation. Chronic middle ear infection develops over time and often begins with chronic middle ear effusion (fluid) that does not resolve. Bacteria contaminate the fluid that remains for a long time.

Chronic middle ear infection can develop when fluid (effusion) remains behind the eardrum for up to three months after an acute infection.

The bacteria in chronic middle ear infection are often different from those found in acute middle ear infection. Therefore, something that disrupts the functioning of the Eustachian tube can cause chronic middle ear infection.

Chronic middle ear infection can cause ongoing damage to the middle ear and eardrum. The condition usually begins painlessly and without fever. Pressure or throbbing in the ear may be felt for months.

What is the effect of chronic middle ear infection on the eardrum?

The eardrum (tympanic membrane) has three delicate layers that help it be thin yet strong. Chronic middle ear infection causes changes that will weaken the eardrum and often leads to a hole in the eardrum. Eventually, the eardrum loses its strength and begins to collapse into the middle ear cavity.

When the eardrum collapses, it attaches to middle ear structures such as the ossicles (middle ear bones) or the interior wall of the middle ear. This condition impairs sound transmission through the middle ear, and hearing may decrease.

How is chronic middle ear infection diagnosed and treated?

Some tests may be required to diagnose chronic middle ear infections. For this purpose, hearing tests are performed, and the degree of hearing loss is determined.

Pressure measurement is taken in cases where the pressure in the middle ear is increased. Computed tomography (CT) may be used to determine the severity of the disease and the need for surgery.

How is chronic middle ear infection treated?

Initially, the infection can be resolved with antibiotics. If there is a perforation in the eardrum, topical antibiotic drops may also be recommended. If there is scarring (scar) on the eardrum or ossicles, this cannot be resolved with antibiotics alone. In this case, a surgical procedure is performed to repair the eardrum, remove infected tissue and scarring in the middle ear and mastoid bone. **Mastoidectomy** or **tympanoplasty** may be necessary.

The primary goal of chronic middle ear surgery is to remove all infected tissue to prevent the infection from recurring. The secondary goal in surgery is to reconstruct the middle ear cavity with an intact eardrum. Hearing can be restored after these procedures.

It may seem strange that hearing is the last goal, but if the first two goals are not achieved, hearing will be damaged again in a new infection if the infection is not treated, and everything done for hearing will be in vain.

What is serous middle ear infection?

Middle ear infection that occurs without infection is called serous middle ear infection (Otitis Media with Effusion). Enlarged adenoids, sinus diseases, acute middle ear infections, allergies, and rarely tumors can cause serous middle ear infection.

When the Eustachian tube is unable to perform its function, ear ventilation cannot be accomplished. As a result, fluid accumulates in the middle ear. This condition can lead to reduced hearing and a feeling of fullness in the ear.

Serous middle ear infection is initially treated with antibiotics. However, if no improvement is seen, surgical treatments such as the insertion of a ventilation tube into the eardrum are applied. If thinning is observed in the eardrum, surgical intervention is performed directly, without starting antibiotics. If the problem is due to the adenoids, the removal of the adenoids will also be beneficial in addition to the treatment.

What is the role of ear tube surgery in the treatment of middle ear infection?

In chronic middle ear infection, if the fluid inside the ear is very sticky, it cannot be drained. If fluid remains in the middle ear, if left untreated, the inflammation caused by the fluid can erode the ear bone and cause hearing loss, and furthermore, if the inflammation spreads to the brain, it can create a risk of meningitis. Ear tube surgery may be necessary in addition to drug treatment to prevent such situations.

With the tube inserted, airflow is provided to the middle ear. In advanced chronic middle ear infections, a mastoidectomy or tympanoplasty operation, performed under general anesthesia by making an incision behind the ear to drain infected fluid and tissues and close the hole in the eardrum, may be required. Delaying the surgery leads to increased hearing loss and difficulty in daily life. Surgery is not necessary for conditions with little discharge and very little hearing loss.

Ear tubes are placed in the eardrum to provide air passage to the middle ear. These tubes are also called tympanostomy tubes, myringotomy tubes, ventilation tubes, or pressure equalization tubes. They are made of plastic, metal, or Teflon and are coated with a special material to prevent infection. There are two types of ear tubes: short-term and long-term. Short-term tubes stay in the ear for 6–12 months and are normally expelled by the body. Long-term tubes are larger and shaped to prevent movement. These types of tubes usually need to be removed by an ENT specialist, but in rare cases, they may be expelled by the body.