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Ear pain and middle ear infection

The most common diagnoses in children going to doctor office is middle ear infection. Approximately one third of all children before 3 years old have middle ear infection. It is also the most common cause of hearing loss in children. 

What is middle ear infection?
It is infection of middle ear cavity. Can be seen in one ear or two ears together.
Mostly seen in children but sometimes in adults also. More common in winter and at the beginnig of spring. 

Is it important?
Yes, since as a cause of hearing loss effects the learning and speaking capacitiy of the children. Can cause serious pain and rarely spreads to the neighboring tissues and organs.
However with necessary treatment and good follow up it is not important and mostly heals without any sequela. What is important is to recognise and treat early. 

How does middle ear work?
Middle ear is a small air filled space seperated from the external ear canal by a very thin ear drum (membrane). It is composed of membrane and three tiny ossicles attach to each other as a bridge. Sound waves hit the ear drum and vibrates these ossicles in which this vibration is trasmitted and augmented by these ossicles. Vibration goes to inner ear fluid where at the end change into nerve stimulation. 

In a healthy middle ear the air pressure is equal to the outer air pressure so that ear drum vibrates freely without any tension. Air comes from the Eustachian tube while swallowing and yawning. This happens more than a thousand times a day. 

What causes middle ear infection?
Mostly microbes enter to the middle ear through the Eustachian tube from the upper respiratory infections. 

During the infection middle ear is filled with pus, sometimes ear drum is perforated and pus come out. Acute infections mostly resolve but fluid in the middle ear can stay months. This causes temporary hearig loss and these children are prone to new ear infections more than othet children. 

What are the complaints of middle ear infections?
The commonest symptom is pain. Pressure, obstruction feelings are observed. Children who cannot talk pull their ears and cry suddenly without any reason. Fever is mostly associated with these symptoms. 

Fluid in the middle ear causes hearing loss. With appropriate treatment this fluid resolves and hearing becomes normal. If complications occur, hearing may decrease permanently. 

What should be expected from ear, nose, throat examination?
Ear, nose, throat specialist evaluates the color and position of ear drum, drainage if present with all upper respiratory system. 

Tests can be asked if needed. Odiogram test the hearing level. Tympanogram for understanding the compliance of the middle ear. These tests can help to arrange the treatment.
You can help the doctor to keep your chilld quiet if possible. Please do not say words like “if you do not take your drugs doctor will use syringe”. Children mostly do not afraid of examination if explained properly. Good follow up is also very important fot treatment of middle ear infections, please obey to follow ups on time. 

Importance of drugs: Doctor can prescribe more than one drug and that may continue 10-14 days. Please be sure that your child is taking these drugs properly.
Please inform your doctor for any kind of sypmtom that you think it is not normal. 

What other kind of treatments can be needed?
Most ear infections heal with appropriate treatment. In some other conditions doctor can try other treatment options. Ear drum can be perforated by the doctor and pus come out. This decreases the pain immediately and also helps to get better quicker. This perforation is closed in one or two days spontaneously. If the middle ear fluid persist more than necessary (depends on the doctor’s observations) and causes severe hearing loss then ventilation tubes can be inserted to the tympanic membrane. 

If adenoid and tonsils accompany to the middle ear infections then doctor can offer operation of adenoid and tonsils with tubes as well. 

Allergies should be treated. 

Do not forget... Middle ear infection is not a serious disease if treated properly. You should admit your doctor’s advices.

My persistent symptoms 31 May, 2013 - 12:14

I am writing to you from St. John's, Newfoundland (Canada). I have a sinus problem started in Nov 2008 upon working for more than a month in a gas plant. I did not have sinus problems prior to this date.

At that time, I may have been exposed to airborne asbestos and other irritants. In the place where I lived at that time, the Winter is so harsh. Temperature during Winter is normally at least 25 Cecilius below zero.

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