- What Are the Possible Complications of Ear Infections?
- Warning Signs to Watch Out For
- Middle ear infection (otitis media)
- Symptoms of a middle ear infection
- When to seek medical advice
- How middle ear infections are treated
- What causes middle ear infections?
- Can middle ear infections be prevented?
- Further problems
- What Can Cause Chronic Ear Infections?
- Ear infections can lead to meningitis, brain abscess and other neurological complications
- Young mother died from brain abscess after doctor diagnosed her with minor ear infection
- Middle-Ear Infection (Otitis Media)
- What Is It?
What Are the Possible Complications of Ear Infections?
The common ear infection can sometimes lead to hearing problems and, rarely, serious and even life-threatening complications.
Some complications can affect the bones behind the ear or the eardrum.
Ear infections aren’t usually a huge cause for concern. They’re not contagious, and in most cases they clear up on their own or with over-the-counter pain medicine (such as ibuprofen) and a round of antibiotics. (1)
They’re also very common, especially among children. In fact, at least 8 in 10 children will have one or more ear infections by their third birthday. (1)
Complications, though rare, do occur. When they do, they can be serious. (2)
“Complications can happen at any age, but they’re much more common in children under the age of 1,” says Sujana S. Chandrasekhar, MD, a partner at ENT and Allergy Associates in New York City.
“We’re really aggressive when a small baby comes in with an ear infection because their preformed pathways between the brain and the ear — there are a couple that are open,” which makes small children more prone to complications, Dr. Chandrasekhar says. “Young children we treat early and aggressively to prevent complications.”
The following are some complications associated with ear infections:
- Hearing loss, which could result if infections occur frequently or never fully heal. Most of the time, hearing loss is only temporary, and the risk of permanent hearing loss due to ear infections is low, affecting about 2 out of every 10,000 children who suffer from a middle ear infection. (3,4) If hearing loss does occur, however, it can be troublesome, especially for young children who are just learning to speak. “The way they learn, speech and language education is by hearing and overhearing,” Chandrasekhar says. It becomes an even more serious concern if the infection affects both ears instead of just one. (5) Prolonged hearing loss among young children could lead to delays in a child learning to talk and understand adults. (6)
- Mastoiditis, which is an infection of the bones behind the ear. This can begin as a mild infection with the potential to turn into something serious. In most cases, a child is at risk of developing mastoiditis if he or she has repeat ear infections. Symptoms include redness or swelling on the bone behind the ear, swollen ear lobes, and headaches. If treatment options don’t work and the infection continues to spread, other serious complications can occur, including hearing loss, meningitis, and brain abscess. (7)
- Meningitis, which is an infection in the membranes surrounding the brain and spinal cord. (8) Adults and children over age 2 may exhibit flu-like symptoms, including headaches, fever, and nausea, while infants may cry constantly, seem extremely tired, or experience stiffness in their body and neck. Chandrasekhar says if bending your neck forward to touch your chin to your chest really hurts, it could be a sign of meningitis. Meningitis can be life-threatening or can lead to permanent brain damage, so it’s important to see a doctor as soon as you have these signs and symptoms. (9) The usual treatment is hospitalization and antibiotics through an IV for up to 21 days. (4)
- Brain abscess, which occurs when pus gathers in the brain as a result of infection. “We see it more often in countries where access to healthcare is not great. But we actually see it sometimes in the United States, and that’s something that needs to be recognized and treated quickly,” Chandrasekhar says. Symptoms of brain abscess include fever, nausea, vomiting, headache, and variations with consciousness. In order to diagnose, a doctor will likely examine the brain and nervous system to check for increased pressure within the skull. (10) It’s definitely considered an emergency, but chances of survival have been improving over the last half century. The recovery rate has improved from 33 percent to 70 percent. (4)
- Ruptured eardrum If the eardrum ruptures (bursts), which can happen as a result of fluid building up pressure in the middle ear, a small hole results. It usually heals within a couple of weeks. (3) Interestingly, “once the eardrum ruptures, there’s no more pain because there’s no more pressure,” Chandrasekhar says, adding that more than 90 percent of ruptured ear drums heal on their own.
- Facial paralysis (8) “The facial nerve, which is the nerve that animates your face, runs right through the ear, and you can develop a facial paralysis where one side of your face doesn’t move ,” Chandrasekhar says. This has become less common thanks to antibiotic treatments. It used to occur in 1 in 50 cases of middle ear infections but now only occurs in about 1 in every 2,000 cases. Almost everyone who experiences this complication will make a full recovery, though it’s still considered an emergency and patients should see a doctor right away, Chandrasekhar says. (4)
There’s also a risk that repeat ear infections, which occur in about 25 percent of children, may end up damaging the small bones in the middle ear. This can damage hearing, or it may lead to a condition called cholesteatoma, which occurs when tissue grows and blocks the eardrum. Surgery is usually needed to treat this condition. (3,5,11)
Warning Signs to Watch Out For
“The risk of having any of these complications is extremely low,” Chandrasekhar says. And thanks to advances in treatments, complications have become even more rare. (3)
But there are a few signs to be on the lookout for. Pain that continues to get worse, changes in your mental state, or a very high spiking fever (for instance, jumping from 102 back to 98 to 104 to 99) are all indications there’s potentially something serious going on, Chandrasekhar says.
To better your chances of recovery, visit your doctor as soon as you notice any of these symptoms.
When the doctor looks at the eardrum, he or she will see that it is red, often bulging, and be able to make the diagnosis of an ear infection.
For children, the most common trigger of an ear infection is an upper respiratory viral infection, such as a cold or the flu. These disorders can make the Eustachian tube so swollen that air can no longer flow into the middle ear. Allergies — to pollen, dust, animal dander, or food — can produce the same effect as a cold or flu, as can smoke, fumes, and other environmental toxins. Bacteria can cause an ear infection directly, but usually these organisms come on the heels of a viral infection or an allergic reaction, quickly finding their way into the warm, moist environment of the middle ear. Invading bacteria can wreak major havoc, turning inflammation into infection and provoking fevers.
Among the bacteria most often found in infected middle ears are the same varieties responsible for many cases of sinusitis, pneumonia, and other respiratory infections. According to the American Academy of Otolaryngology-Head and Neck Surgery (ear, nose, and throat physicians), the conjugate pneumococcal vaccine is very effective against several strains of the most common bacteria that cause ear infections. This vaccine is routinely given to infants and toddlers to prevent meningitis, pneumonia, and blood infections. Your child’s doctor should advise you on the use of this vaccine, which may help to prevent at least some ear infections.
Ear infections occur in various patterns. A single, isolated case is called an acute ear infection (acute otitis media). If the condition clears up but comes back as many as three times in a 6-month period (or four times in a single year), the person is said to have recurrent ear infections (recurrent acute otitis media). This usually indicates the Eustachian tube isn’t working well. A fluid buildup in the middle ear without infection is termed otitis media with effusion, a condition where fluid stays in the ear because it is not well ventilated, but germs have not started to grow.
In recent years, scientists have identified the characteristics of people most likely to suffer recurrent middle ear infections:
- Individuals with a family history of ear infections
- Babies who are bottle-fed formula (babies who are fed breastmilk have fewer ear infections)
- Children who attend day care centers
- People living in households with tobacco smokers
- People with abnormalities of the palate, such as a cleft palate
- People with poor immune systems or chronic respiratory diseases, such as cystic fibrosis and asthma
Middle ear infection (otitis media)
Otitis media is an infection of the middle ear that causes inflammation (redness and swelling) and a build-up of fluid behind the eardrum.
Anyone can develop a middle ear infection but infants between six and 15 months old are most commonly affected.
It’s estimated that around one in every four children experience at least one middle ear infection by the time they’re 10 years old.
Symptoms of a middle ear infection
In most cases, the symptoms of a middle ear infection (otitis media) develop quickly and resolve in a few days. This is known as acute otitis media. The main symptoms include:
- a high temperature (fever)
- being sick
- a lack of energy
- slight hearing loss – if the middle ear becomes filled with fluid, hearing loss may be a sign of glue ear, also known as otitis media with effusion
In some cases, a hole may develop in the eardrum (perforated eardrum) and pus may run out of the ear. The earache, which is caused by the build-up of fluid stretching the eardrum, then resolves.
Signs in young children
As babies are unable to communicate the source of their discomfort, it can be difficult to tell what’s wrong with them. Signs that a young child might have an ear infection include:
- pulling, tugging or rubbing their ear
- irritability, poor feeding or restlessness at night
- coughing or a runny nose
- unresponsiveness to quiet sounds or other signs of difficulty hearing, such as inattentiveness
- loss of balance
When to seek medical advice
Most cases of otitis media pass within a few days, so there’s usually no need to see your GP.
However, see your GP if you or your child have:
- symptoms showing no sign of improvement after two or three days
- a lot of pain
- a discharge of pus or fluid from the ear – some people develop a persistent and painless ear discharge that lasts for many months, known as chronic suppurative otitis media
- an underlying health condition, such as cystic fibrosis or congenital heart disease, which could make complications more likely
Read more about diagnosing middle ear infections
How middle ear infections are treated
Most ear infections clear up within three to five days and don’t need any specific treatment. If necessary, paracetamol or ibuprofen should be used to relieve pain and a high temperature.
Make sure any painkillers you give to your child are appropriate for their age. Read more about giving your child painkillers.
Antibiotics aren’t routinely used to treat middle ear infections, although they may occasionally be prescribed if symptoms persist or are particularly severe.
Read more about treating middle ear infections
What causes middle ear infections?
Most middle ear infections occur when an infection such as a cold, leads to a build-up of mucus in the middle ear and causes the Eustachian tube (a thin tube that runs from the middle ear to the back of the nose) to become swollen or blocked.
This mean mucus can’t drain away properly, making it easier for an infection to spread into the middle ear.
An enlarged adenoid (soft tissue at the back of the throat) can also block the Eustachian tube. The adenoid can be removed if it causes persistent or frequent ear infections. Read more about removing adenoids.
Younger children are particularly vulnerable to middle ear infections as:
- the Eustachian tube is smaller in children than in adults
- a child’s adenoids are relatively much larger than an adults
Certain conditions can also increase the risk of middle ear infections, including:
- having a cleft palate – a type of birth defect where a child has a split in the roof of their mouth
- having Down’s syndrome – a genetic condition that typically causes some level of learning disability and a characteristic range of physical features
Can middle ear infections be prevented?
It’s not possible to prevent middle ear infections, but there are some things you can do that may reduce your child’s risk of developing the condition. These include:
- make sure your child is up-to-date with their routine vaccinations – particularly the pneumococcal vaccine and the DTaP/IPV/Hib (5-in-1) vaccine
- avoid exposing your child to smoky environments (passive smoking)
- don’t give your child a dummy once they’re older than six to 12 months old
- don’t feed your child while they’re lying flat on their back
- if possible, feed your baby with breast milk rather than formula milk
Avoiding contact with other children who are unwell may also help reduce your child’s chances of catching an infection that could lead to a middle ear infection.
Complications of middle ear infections are fairly rare, but can be serious if they do occur.
Most complications are the result of the infection spreading to another part of the ear or head, including:
- the bones behind the ear (mastoiditis)
- the inner ear (labyrinthitis)
- the protective membranes surrounding the brain and spinal cord (meningitis)
If complications do develop, they often need to be treated immediately with antibiotics in hospital.
Read more about the complications of middle ear infections
What Can Cause Chronic Ear Infections?
There are multiple causes for recurring (chronic) ear infections, or recurring otitis media, ranging from allergies, sinusitis, ear injuries, and bacterial infections from colds or flu.
This medical condition can result in a ruptured eardrum, hearing loss, balance function, or in protracted cases, facial inflammation or paralysis. Getting medical help quickly is necessary to maintain good hearing health—especially for young children, as the ability to hear is necessary for learning language.
Chronic Ear Infection, Defined
Otitis media affects the space behind the eardrum (middle ear) and is diagnosed as ‘chronic’ when an ear infection does not heal or if it is recurring. The acute version tends to come on quickly and is of shorter duration but symptoms may be more severe. The Eustachian tube, which drains fluids away from the middle ear, may become plugged due to a viral or bacterial infection, allowing a buildup of fluid to press against the eardrum. Otitis externa, or swimmer’s ear, affects swimmers when contaminated water enters the ear, allowing the growth of bacteria and infection in the outer ear.
Young children and infants are more likely to develop ear infections due to the Eustachian tubes’ being smaller and more horizontal than those of adults, making it harder for fluid to drain away. Adults are more likely to get infections from swimming, injuries (such a foreign body in the ear), or following upper respiratory illnesses.
Fluid buildup alone (called otitis media with effusion, or O.M.E.) is a separate and distinct condition, and is not helped by the antibiotics commonly used for acute otitis media.
The symptoms may be milder for recurring ear infections compared to more acute forms, may come and go, and affect one or both ears. Common symptoms may include any of the following:
- Low fever
- Pressure in the ear
- Pus-like fluid draining from the affected ear
- Ear pain, usually mild but may be severe in acute cases
- Difficulty hearing
- Difficulty sleeping
In infants, outside of fever, trouble sleeping and eating as well as increased fussing, or pulling on the affected ear are often the only indicators of an ear infection.
Sometimes ear infection symptoms can be treated at home until the patient is able to get an appointment to see the doctor or visit a hospital or urgent care medical center. Warm cloths applied against the ear as well as over-the-counter (OTC) pain relievers can be helpful. Waiting until an annual physical to discuss this is usually not a good idea, even if the symptoms seem mild, as damage can occur regardless of the pain level.
During the examination, the physician may order tests such as fluid cultures looking for bacteria or a CT scan to determine if the infection has spread beyond the middle ear.
Your doctor will usually prescribe antibiotics to clear up any infection and sometimes antibiotic ear drops, particularly if the eardrum has been perforated. According to the American Academy of Pediatrics (AAP), physicians are being encouraged to take a more wait-and-see approach due to over-prescription of many common antibiotics, leaving questionable evidence for use as well as subjecting patients to other side effects such as stomach complaints or allergic reactions.
In severe cases of chronic ear infections, surgery may be indicated. The surgeon inserts small tubes through a tiny hole in the eardrum, connecting the middle ear to the outer ear, enabling fluid to drain out. This procedure, usually performed on both ears, is called a bilateral myringotomy and can help reduce the frequency and severity of an ear infection and its symptoms.
If the infection has spread, more surgery may be needed to repair or replace the affected tiny bones or eardrum of the middle ear. If the infection has spread to the mastoid bone behind the ear, a surgeon will perform a mastoidectomy to remove the infected area.
- Wash hands frequently to reduce the spread of viruses and bacteria—often the root cause of the infection in the first place.
- Breastfeed infants to reduce upper respiratory illnesses, recommends the AAP.
- Stop smoking and eliminate exposure to second-hand smoke.
- Keep vaccinations up to date for pneumonia, meningitis, and influenza. Since 2000, when the pneumococcal vaccine was introduced, the incidence of ear infections has dropped by over 20 percent.
- Finally, be sure to have a follow-up exam at your doctor’s recommendation to ensure that the infection has been cured completely.
For more updates on family health matters, such as chronic ear infections, please visit our Ear, Nose and Throat medical services page on our website.
Ear infections can lead to meningitis, brain abscess and other neurological complications
The article was written by Loyola Medicine otolaryngologists Michael Hutz, MD, Dennis Moore, MD, and Andrew Hotaling, MD.
Otitis media occurs when a cold, allergy or upper respiratory infection leads to the accumulation of pus and mucus behind the eardrum, causing ear ache and swelling. In developed countries, about 90 percent of children have at least one episode before school age, usually between the ages of six months and four years. Today, secondary complications from otitis media occur in approximately 1 out of every 2,000 children in developed countries.
The potential seriousness of otitis media was first reported by the Greek physician Hippocrates in 460 B.C. “Acute pain of the ear with continued high fever is to be dreaded for the patient may become delirious and die,” Hippocrates wrote.
The deadliest complication of otitis media is a brain abscess, an accumulation of pus in the brain due to an infection. The most common symptoms are headache, fever, nausea, vomiting, neurologic deficits and altered consciousness. With modern neurosurgical techniques, most brain abscesses can be suctioned or drained, followed by IV antimicrobial treatment for six to eight weeks. During the past 50 years, mortality worldwide from brain abscesses has decreased from 40 percent to 10 percent and the rate of full recovery has increased from 33 percent to 70 percent.
Other complications include:
Bacterial meningitis: Symptoms include severe headache, high fever, neck stiffness, irritability, altered mental status and malaise. As the infection spreads, the patient develops more severe restlessness, delirium and confusion. Treatment is high-dose IV antibiotics for 7 to 21 days.
Acute mastoiditis: This is an infection that affects the mastoid bone located behind the ear. It must be treated to prevent it from progressing to more serious complications. Treatments include IV antibiotics and placement of a drainage tube.
Hearing loss: Permanent hearing loss is rare, occurring in about 2 out of every 10,000 children who have otitis media.
Facial paralysis: Prior to antibiotics, this debilitating complication occurred in about 2 out of 100 cases of otitis media. Since antibiotics, the rate has dropped to 1 in 2,000 cases. It should be treated as an emergency. About 95 percent of otitis media patients who develop facial paralysis recover completely.
“Antibiotic therapy has greatly reduced the frequency of complications of otitis media,” Drs. Hutz, Moore and Hotaling wrote. “However, it is of vital importance to remain aware of the possible development of neurologic complication. . . . In order to reduce morbidity, early deployment of a multidisciplinary approach with prompt imaging and laboratory studies is imperative to guide appropriate management.”
Dr. Hutz is a resident, Dr. Moore is an assistant professor and Dr. Hotaling is a professor emeritus in Loyola Medicine’s department of otolaryngology. Their paper is titled, “Neurological Complications of Acute and Chronic Otitis Media.”
Young mother died from brain abscess after doctor diagnosed her with minor ear infection
The hearing was told the tragedy began on February 12 last year after Miss Adams, from Rusholme, Manchester went to see her GP Dr Praful Patel complaining of pains in her ear.
The doctor examined her ear including the bone structure but thought the symptoms pointed to an outer ear infection. He prescribed her with antibiotics and asked her to come back in three weeks if she did not get any better.
On March 1 Miss Adams called a triage nurse working for the Out-of-Hours Go To Doc service saying her ear was ”very painful” and was ”nine out of ten” on the pain scale.
She was referred to a doctor at an out-of-hours surgery based at Wythenshawe Hospital who thought it was an infection of the middle ear but prescribed antibiotics and advised her to come back in a few days if the pain persisted or became worse.
On March 16, Miss Adams spoke to another out-of-hours nurse complaining of headache and earache and four days later she was admitted to hospital.
The Manchester hearing was told after her admission, she did not display signs of illness, such as high temperature or changed mental state, that could have prompted doctors to send her for a brain scan that might have discovered the abscess.
Although she was seen to be very distant the night before she died, that was put down to the pressures of coping with young children.
She last seen alive going to the lavatory at around 4am after being kept in hospital overnight. She died on the ward later that day.
Consultant ear, nose and throat surgeon, Andrew Camilleri, who carried out an investigation for the hospital into Zoe’s death, told the inquest that there was around a one-in-4,000 chance of an ear infection leading to a brain abscess.
He said he was satisfied the hospital had taken all the steps possible to treat Miss Adams and said by looking at her, no one would have suspected she had a brain abscess.
Recording a verdict of death by natural causes, Coroner Nigel Meadows said the diagnosis of a ”relatively minor” ear infection by Dr Patel had been ”completely appropriate”.
Mr Meadows said the out-of-hours service had taken a sensibly cautious approach to Miss Adams condition and he thought they could not have done anymore to prevent her death.
Mr Meadows said Miss Adams did not display any normal signs of somebody with a cerebral abscess and added: “Zoe has just been extremely unlucky to contract this infection and to have a robust constitution.”
He added: ”There was no evidence that her condition justified a CT scan. It would be unrealistic to expect that the hospital perform a CT scan on everybody who has an ear infection.
”Even if she was given an emergency CT scan the night she died then there is also no evidence to suggest she would have been able to be saved.
”It is a very unfortunate series of events. The vast majority of people who have ear infections don’t have a cerebral abscess. She has been extremely unlucky to contract this infection.”
Speaking afterwards, Zoe’s mother Michelle Holt, said she accepted the verdict, adding: “It’s been a very, very hard time. My daughter was like me and had a very strong pain threshold.”
Middle-Ear Infection (Otitis Media)
What Is It?
Published: February, 2019
The middle ear is the space behind the eardrum, which is connected to the back of the throat by a passageway called the Eustachian tube. Middle ear infections, also called otitis media, can occur when congestion from an allergy or cold blocks the Eustachian tube. Fluid and pressure build up, so bacteria or viruses that have traveled up the Eustachian tube into the middle ear can multiply and cause an ear infection.
Middle ear infections are the most common illness that brings children to a pediatrician and the most common cause of hearing loss in children. Middle ear infections can also cause a hole (perforation) in the eardrum or spread to nearby areas, such as the mastoid bone. Adults also can get middle ear infections.
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