Middle Ear Infection

If you’re suffering from ear pain and muffled hearing, you may have a middle ear infection (otitis media). This type of ear infection affects 45–80% of all children before school age; however, it can also impact adults and may be chronic. Although the majority of research has been done on the pediatric population, the incidence of acute otitis media in older children and adults is estimated as follows:

  • Aged 15 to 24 years: 3.1–3.5%
  • Aged 25 to 85 years: 1.5–2.3%

As the name implies, this type of infection affects the air-filled cavity of the ear located behind your eardrum (tympanic membrane). Three small bones (ossicles) inside the middle ear transmit sound vibrations from the eardrum to your inner ear. Otitis media is considered a middle ear infection, while otitis externa impacts the outer ear. 

Types of middle ear infections

Middle ear infections can be acute or chronic. In acute cases, the infection develops suddenly, resulting in redness and swelling caused by fluid and pus buildup trapped under your eardrum. Middle ear infections that don’t clear up or repeatedly recur over several months to years are considered chronic. Although eardrum perforation and hearing loss may occur, chronic otitis media isn’t typically painful.

Otitis media with effusion is often categorized as the third type of ear infection. Both acute and chronic middle ear infections can lead to effusion—fluid and mucus that accumulates in the middle ear after the infection has cleared up. This can result in a feeling of fullness and diminished hearing. 

Causes of middle ear infection

The most common underlying cause of middle ear infections is Eustachian tube dysfunction, including obstruction. The Eustachian tube links the back of your nose to the middle ear. Eustachian tube dysfunction may occur when the mucosal tube lining swells up, or the tube doesn’t open or close properly. This can prevent fluid from draining from your middle ear, thereby allowing bacteria and viruses to grow in the fluid, which results in an infection. Risk factors include:

  • Smoking or secondhand exposure
  • Seasonal or year-round allergy symptoms
  • Colds or other upper respiratory infections

Disease-related risk factors

Individuals with congenital or acquired immunologic deficiencies are at higher risk of otitis media that continues into adulthood. Obstruction or dysfunction in adults can be caused by specific malignancies, a diminished immune system, or previous radiation to tumors in the general ear area. Studies indicate 15–50% of people develop serious otitis media solely from this type of radiation. However, many of these cases are caused by obstruction of the Eustachian tube from the tumor or surgery to remove it.

Symptoms of middle ear infection

In adults, the following symptoms are common signs of a middle ear infection:

  • Unilateral ear pain (on one side)
  • Drainage of fluid from the impacted ear
  • Fever
  • Balance issues
  • Transient conductive hearing loss
  • Pain that can range from mild to severe

A sudden relief of pain, possibly with pus discharge from the ear canal, may be a sign that your eardrum ruptured. If you develop a high fever, severe pain behind an ear, bloody fluid in your ear, or facial paralysis, it’s important to consult a doctor as soon as possible. 

Middle ear infection treatment

In uncomplicated acute otitis media in adults, antibiotic therapy is the primary treatment. For mild to moderate infections, antibiotics are typically taken orally twice daily for 5–7 days. Severe infections may require more intensive initial treatment, such as middle ear fluid cultures, blood cultures, and intravenous antibiotics. Additional treatments include:

  • Pain medication
  • Decongestants, antihistamines, or nasal steroids
  • Pressure Equalization (PE) tube (for chronic otitis media with effusion)

The primary risk of untreated otitis media in adults is permanent hearing loss. If your symptoms don’t improve in 48 to 72 hours, contact your healthcare provider. If your hearing loss persists, schedule an appointment with a licensed hearing care professional as soon as possible.

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