Ear Infections

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An ear infection like most other infection is usually caused by a bacterial or viral infection. These infections typically affects the middle ear where it contains the tiny vibrating bones of the ear. Once infected, the ear becomes swollen and results in a buildup of fluids inside the ear.

macro photography of babys ear

Signs and symptoms common in children include:

 Ear pain, especially when lying down

 Tugging or pulling at an ear

 Difficulty sleeping

 Crying more than usual

 Acting more irritable than usual

 Difficulty hearing or responding to sounds

 Loss of balance

 Fever of 100 F (38 C) or higher

 Drainage of fluid from the ear

 Headache

 Loss of appetite

Adults

Common signs and symptoms in adults include:

 Ear pain

 Drainage of fluid from the ear

 Diminished hearing

When to see a doctor?
Signs and symptoms of an ear infection can indicate a number of conditions. It’s important to get an accurate diagnosis and prompt treatment.

 Symptoms last for more than a day

 Ear pain is severe

 Your infant or toddler is sleepless or irritable after a cold or other upper respiratory infection

 You observe a discharge of fluid, pus or bloody discharge from the ear

An adult with ear pain or discharge should also see a doctor as soon as possible.

Risk Factors for ear infections: 

 Age. Children between the ages of 6 months and 2 years are more susceptible to ear infections because of the size and shape of the Eustachian tubes and because of their poorly developed immune systems.

 Group child care. Children cared for in group settings are more likely to get colds and ear infections than are children who stay home because they’re exposed to more infections, such as the common cold.

 Infant feeding. Babies who drink from a bottle, especially while lying down, tend to have more ear infections than do babies who are breast-fed.

 Seasonal factors. Ear infections are most common during the fall and winter when colds and flu are prevalent. People with seasonal allergies may have a greater risk of ear infections during seasonal high pollen counts.

 Poor air quality. Exposure to tobacco smoke or high levels of air pollution can increase the risk of ear infection.

Managing Pain
Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following:

 A warm compress.

 Pain medication.

 Ear drops. Prescribed ear drops.

 Prevent common colds and other illnesses.

 Avoid secondhand smoke.

Talk to a doctor about vaccinations. Ask your doctor about what vaccinations are appropriate for your child. Seasonal flu shots and pneumococcal vaccines may help prevent ear infections.

Dr.Paul Kattupalli’s approach to Treatment of Ear Infections: 

The diagnosis of acute otitis media (AOM) requires bulging of the tympanic membrane or other signs of acute inflammation and middle ear effusion. The importance of accurate diagnosis is crucial to avoidance of unnecessary treatment.

●Start with oral ibuprofen or tylenol to treat ear pain in children with AOM. Topical benzocaine, procaine, or lidocaine preparations (if available) are an alternative for children ≥2 years but should not be used in children with tympanic membrane perforation. He recommends NOT using decongestants and/or antihistamines.

The choice of initial treatment with antibiotics or observation depends upon the age of the child and the laterality and severity of illness.

•He recommend that children with acute otitis media who are <6 months be treated with antibiotics.

•He recommends that children with acute otitis media who are between six months and two years be treated with antibiotics.

•Children ≥2 years who appear toxic, have persistent otalgia for more than 48 hours, have temperature ≥102.2°F (39°C) in the past 48 hours, have bilateral AOM or otorrhea, or have uncertain access to follow-up be immediately treated with an appropriate antibiotic.

For children ≥2 years who are normal hosts (eg, immune competent, without craniofacial abnormalities) and have unilateral acute otitis media with mild symptoms and signs and no otorrhea, initial observation may be appropriate if the caretakers understand the risks and benefits of such an approach.

When antibiotic treatment is warranted, Dr.Paul suggests amoxicillin as the first-line therapy for acute otitis media in most children. The dose is 90 mg/kg per day (we use a maximum of 3 g/day) divided in two doses. He prescribes amoxicillin-clavulanate (Augmentin) as the first-line therapy for children with AOM who have received a beta-lactam antibiotic in the previous 30 days or have concomitant purulent conjunctivitis. The dose is 90 mg/kg per day of amoxicillin and 6.4 mg/kg per day of clavulanate divided in two doses.

Macrolides or clindamycin are an alternative for patients who have had immediate hypersensitivity reactions (eg, anaphylaxis, angioedema, bronchospasm, urticaria) or severe delayed reactions (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis, hemolytic anemia, etc) to penicillin. However, macrolides and clindamycin lack activity against most Haemophilus influenzae isolates and approximately one-third of pneumococcal isolates. Patients with other types of allergic reactions may be treated safely with cefdinir, cefpodoxime, cefuroxime  or intramuscular ceftriaxone.

We generally treat children <2 years, children with tympanic membrane perforation, and children with recurrent AOM for 10 days. We generally treat children ≥2 years without a history of recurrent AOM for five to seven days.

Treatment failure is defined by lack of symptomatic improvement 48 to 72 hours after initiation of antimicrobial therapy. Dr.Paul recommends that patients who fail first-line therapy be treated with Augmentin or cefdinir, cefpodoxime, cefuroxime, and ceftriaxone.

Above are only general guidelines and all treatment plans should be done under the guidance of a physician.

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