Health Concerns

What kind of disease is a middle ear infection?

Young children are very susceptible to ear infections. This page will provide you with everything you need to know about Middle Ear Infections.

Middle ear infection is the inflammation of the middle ear, located behind the eardrum. If a middle ear infection is not treated properly, it may develop into a chronic middle ear infection or middle ear infection with effusion. In some cases it may even lead to a recurrent middle ear infection. In severe cases, your doctor will need to pierce the eardrum as part of the treatment.

Approximately 70% of all children in Japan will suffer at least one middle ear infection before the age of three!

What are the symptoms of a middle ear infection?

Common symptoms of a middle ear infection include ear pain, trouble hearing, fever and discharge from the ear. Discharge is pus that is caused by the inflammation and accumulates in the middle ear, then bursts through the eardrum to seep out of the ear.

What are the causes of a middle ear infection?

A runny nose is filled with bacteria and viruses! The most common cause of middle ear infection is a runny nose! Lots of bacteria including a bacterium called pneumococcus live in a runny nose. Once they transfer into the ear, they can cause a middle ear infection.

Is a middle ear infection a recurrent disease?

Without proper treatment, a middle ear infection will occur repeatedly. More than five episodes of acute middle ear infection in a year is considered a recurrent middle ear infection. In some cases, a child will experience recurring acute middle ear infections. If left untreated, it may develop into a middle ear infection with effusion.

 →Please refer to“Why are young children susceptible to middle ear infections?” for more details

A recurrent middle ear infection is tough not only on the child, but on the parent! Multiple visits to a doctor’s office can become troublesome and costly, and taking care of a sick child at home is tough.

Possible causes of recurrent middle ear infections in young children:
1.    Immature immune systems
2.    Infected with antibiotic-resistance bacteria (bacteria resistant to certain types of antibiotics)
3.    Environment (nurseries, proximity to cigarette smoke, etc.)
Very young children (less than 12 months old) with immature immune systems are particularly susceptible to a recurrent middle ear infection.

What types of middle ear infections are there?

Middle ear infections can manifest in different ways. Some appear with fever or without fever, with pus, some infections recur. Below are some of the most common types of middle ear infections.

Acute Middle Ear Infection

Degree of Risk
Symptoms	Symptoms can include severe ear pain, fever, and discharge from the ear.
Causes	Both bacteria and viruses can cause an infection in the middle ear.
Treatment Period	Once a course of antibiotics is started, it can take up to 10 days to resolve the infection.
Cautions	Identifying a middle ear infection in infants can be difficult, as children not old enough to talk can’t describe their symptoms. Signs to look out for include: a fever of unknown origin, frequently touching or pulls on the ear, has trouble falling asleep, or if tapping the back of the head behind the ear causes pain or makes your child cry. Left untreated, there is a chance that it will lead to a recurrent middle ear infection, a middle ear infection with effusion, or a chronic middle ear infection. You need to pay a careful attention from the beginning. In some cases, discharge from the ear may reduce pain and fever and relieve the condition, however leaving the infection until this level may cause the infection to be chronic. Seeking early treatment is highly recommended!

Middle Ear Infection With Effusion

Degree of Risk
Symptoms	A middle ear infection with effusion is when fluid builds up in the middle ear. It causes hearing problems but does not usually cause pain or fever.
Causes	Most cases are caused by an extended initial episode of acute middle ear infection.
Treatment Period	A full recovery will likely take at least one month, and could take up to few years if the infection is protracted.
Cautions	Identifying a middle ear infection in infants can be difficult, as children not old enough to talk can’t describe their symptoms. Signs to look out for include: a fever of unknown origin, frequently touching or pulls on the ear, has trouble falling asleep, or if tapping the back of the head behind the ear causes pain or makes your child cry. Left untreated, there is a chance that it will lead to a recurrent middle ear infection, a middle ear infection with effusion, or a chronic middle ear infection. You need to pay a careful attention from the beginning. In some cases, discharge from the ear may reduce pain and fever and relieve the condition, however leaving the infection until this level may cause the infection to be chronic. Seeking early treatment is highly recommended!

A chronic middle ear infection is more severe.

Chronic Middle Ear Infection (Chronic Otitis Media)

Degree of Risk
Symptoms	Symptoms include discharge from the ear, hearing problems, ringing in the ear and dizziness as a result of a perforated eardrum.
Causes	In some cases, if antibiotics are ineffective, an acute middle ear infection can become chronic.
Treatment Period	Human ears have a natural cleaning function to push out bacteria. If an inflammation occurs in the middle ear, the body tries to heal the inflammation by bursting the eardrum and pushing the pus out through it.
Cautions	Once the pus has been pushed out and drained from the ear, the inflammation subsides and the hole in the eardrum closes up naturally. However, if an acute middle ear infection is not treated properly or if the infection recurs, the hole may cease to close naturally. This is a state of chronic middle ear infection.

For an acute middle ear infection, which is the most common, it is essential to aspirate your child’s runny nose. It is also important to take the full course of antibiotics, even after symptoms subside.

Why young children are susceptible to middle ear infection?

The ears and nose are connected by the Eustachian tube (auditory tube.) Compared to adults, children’s Eustachian tubes are short and flat, which means mucus can more easily flow into the tube from a runny nose.

Group children’s activities are an ideal place to contract an infection.

Children often catch colds from friends while participating in group activities at kindergartens or playgroups. These colds can develop into middle ear infections.

Children cannot blow their own noses well.

Children under the age of 5 often cannot blow their own noses very well. The resulting buildup of mucus can lead to middle ear infections.

How can I treat a middle ear infection?

Unfortunately, a middle ear infection doesn’t often resolve itself without treatment. If you believe your child has a middle ear infection, please consult an ENT doctor or pediatrician immediately. Once a doctor has diagnosed your child as having a middle ear infection, then, what kinds of treatment options are available?

Treatment at Hospital

Antibiotic treatments
Since a middle ear infection is, in most cases, a bacterial inflammation, antibiotics are the most common treatment. Antibiotics can relieve the symptoms in 3 to 4 days and clear up the infection within approximately 10 days. If the infection persists beyond 10 days, your child may have been infected with antibiotic-resistance bacteria. Please consult with a doctor immediately.

Treatment using a nebulizer
Another common treatment is to use a nebulizer to spray medicinal solution through the nose to the inner nasal passages and throat. * Firstly, aspirate your child’s nose using a nasal aspirator, to reduce further infection. * Use a nebulizer to spray medicinal solution directly to the mucus membranes in the nose. This can help open the nasal passages to ease breathing. * Nasal aspiration is a treatment used at hospitals, but it is also important to aspirate your child’s blocked or runny nose at home in order to prevent future infections.

If the infection persists, your child may require surgery
Depending on the condition of the middle ear infection, treatment may involve piercing the eardrum to drain the pus. It may sound drastic, but the hole of eardrum will heal itself within a couple of days. However, any surgery can be traumatic for your child, not to mention expensive, so prevention is always best. If you suspect your child has a middle ear infection, please consult a doctor immediately.

Treatment at Home

Treatment using a nasal aspirator
If your child gets a middle ear infection, the basic treatment is medication. However, nasal care at home is indispensable as a part of treatment. Lately, doctors recommend aspirating your child’s nose at home using commercially available nasal aspirators. As young infants have trouble blowing their noses effectively, a nasal aspirator can help remove bacteria from your child’s nose. This is very effective for preventing, or promoting early healing of, a middle ear infection. There are a variety of commercially available nasal aspirators in the market. While manually-operated mouth suction or bulb aspirators are a low cost option, electronic aspirators avoid all contact with mucus that is removed from your child’s nose, preventing any risk of the parent contracting the infection. There are also some electronic aspirators available on the market that have the same strength of suction as professional models used by ENT doctors. Functionality has been improved for home use, so nasal care at home is now easier than ever. Since variety of types of nasal aspirators are available and purchased through online retailers, select the one that fits in the best with your child!

Be patient and continue with treatment!
Self-diagnosing a cured middle ear infection and ceasing treatment without consulting your doctor can be dangerous. Incomplete treatment may cause the infection to recur. It is important to continue with treatment until your doctor has determined that the infection is resolved.

How can I prevent a middle ear infection?

A middle ear infection can be painful and traumatic for your child, so prevention is the best method.

1. Aspirate your child's runny nose often at home.
The most common cause of middle ear infection is a runny nose. A child’s runny nose is filled with many bacteria and viruses. Careful aspiration is important, particularly for children who face recurrent middle ear infections. Frequent aspiration using a home nasal aspirator is recommended.

2. Give your child the vaccination.
Pneumococcus is one of the pathogens that can cause a middle ear infection. Getting the pediatric pneumococcal vaccination may prevent a middle ear infection.
* Both the US and Europe acknowledge the preventative efficacy of the pediatric pneumococcal vaccine for middle ear infections. The vaccine reduces likelihood of middle ear infection by 7% in the US and 6% in Finland.

3. Bottle-feed the baby in a position similar to that of breast-feeding.
In some cases the position of bottle-feeding can cause a middle ear infection. When a baby is lying flat while bottle-feeding, milk can flow into the middle ear through the Eustachian tube and cause an infection. This can be prevented by angling your baby upward as much as possible to a position similar to that of breastfeeding. Burping your child after feedings can also help!

4. Avoid tobacco smoke.
Tobacco smoke contains cyanide fume. Cyanide fume inhalation can cause a middle ear infection. Children with smoking parents have higher rates of middle ear infections. Please keep your child away from tobacco smoke!

5. Avoid prolonged use of pacifiers.
Children who use a pacifier longer for than 12 months have a higher chance of developing a middle ear infection. Sucking a pacifier can generate negative pressure in the spaces in baby’s throat and nose, and this affects the middle ear. Stop using a pacifier if the infection recurs many times or is protracted.

6. Make sure your child eats a varied diet that includes lots of vitamins and Omega 3.
Pay attention to what your child eats. Vegetables, fruit and seafood improve the immune system. Vegetables and fruits contain a wide range of nutrients that can help fight infection, and seafood contains Omega 3, which boosts the immune system. Wild salmon in particular contains a high level of Omega 3, and is safe for children to eat.

7. Eliminate environmental allergens.
Dust and environmental allergens can exacerbate nasal congestion, which causes swelling and clogs the Eustachian tube. Try to keep your child’s bedroom free from dust by cleaning it regularly.

Be on the lookout for anything in your child’s environment that might stimulate mucus production. Eliminating environmental allergens will help prevent infection.

Is it safe to bathe a child with a middle ear infection?

If your child doesn’t have fever or pain, it is fine to bathe them from the neck down. Try to keep water away from the ears, so avoid washing your child’s hair. If you’re worried water might have flowed into the ears, consult your pediatrician

Is it safe to bathe a child with a middle ear infection?

If your child doesn’t have fever or pain, it is fine to bathe them from the neck down. Try to keep water away from the ears, so avoid washing your child’s hair. If you’re worried water might have flowed into the ears, consult your pediatrician

Are some children more susceptible to middle ear infection than others?

Yes. There are some hereditary conditions that may be passed to your children, making them more susceptible to middle ear infections. These are listed below.

Inner Ear Functions
Poor ventilatory or pressure-relief functions: Do you frequently have trouble equalizing pressure in your eardrums when at altitude, or when flying? If the pressure-relief functions of your ears are weak, you may have passed this on to your child.

Lymphoid Tissues
Weak lymphoid tissues such as tonsils or adenoid: Do your colds regularly cause swelling in your tonsils, or develop into tonsillitis?

Allergies
You have allergic rhinitis: Are you sensitive to pollen and dust to the point where it makes you sneeze constantly?

I can’t get rid of my child’s middle ear infection.

If the infection persists even after a course of antibiotics, your child may be infected with antibiotic-resistant bacteria. If the incorrect antibiotics were prescribed, there is a chance that antibiotic-resistant bacteria may continue to grow. Please be sure to consult your doctor.

What if my child gets a middle ear infection in the middle of the night?

If an acute earache occurs late at night and you think it could be a middle ear infection, it is best to visit the emergency room. If this is not possible, there are a couple of things you can do to relieve the symptoms and reduce pain.

First Aid Tips:
→ Cool the ear with a cold compress. Make sure to wrap around and cover the ear to cool.
→ Dispense children’s aspirin.

These methods may help relieve the pain to help your child sleep, but be sure to visit an ENT doctor in the morning.