Middle ear infection (also called as otitis media) is an infection of the air-filled space behind the eardrum.

More than 80% of children have suffered from at least one episode of otitis media in their first 3 years of life.

CAUSES/RISK FACTORS

The following risk factors can make the Eustachian tube (tube that connects middle ear to the back of the throat) swell and blocks the mucus from draining. Then bacteria or virus grow in the mucus and produce pus, which builds up in the middle ear.

• Age – It is common in children than adults as they have shorter Eustachian tubes which let bacteria and viruses find their way more easily into the middle ear.
• Recurrent attacks of common cold, sore throat, sinus infection, nasal allergies, and exposure to tobacco smoke. 
• Family history of ear infection.
• Rapid descent during air flight, under water diving (Aero-otitis media).

SYMPTOMS

Kids 

• Ear pain with high degree of fever, restless and trouble sleeping.
• Temporary hearing loss, child may not respond to sounds, talks louder. 
• Pulling at the ear and cry more than usual.

Adults 

• Pain in ear with disturbed sleep.
• Difficulty in hearing with ringing sounds in ear. 
• Ear discharge with relief of pain and fever.

INVESTIGATIONS

• Diagnosis mostly done by clinical examination.
• Hearing tests – Tuning fork test or audiogram.

COMPLICATIONS

When left untreated for a long-term, it may lead to:

• Hearing loss
• Paralysis of facial nerve
• Infection may spread to other parts of head

GENERAL MANAGEMENT

Prevention

• Breast feeding for at least 6 months to increase the immunity. Avoid bottle feeding. 

• Don’t put your baby down with a feeding bottle for a nap or for the night.

• Protect your baby from cigarette smoke. It may increase the chance of getting respiratory infections.

• Thoroughly dry your ears after swimming. 

Pain Management

• Cold or warm compress – on the affected ear 
• Olive oil – by putting few warmed drops of olive oil can give some pain relief. Make sure that olive oil is not warmer than your body temperature by using thermometer.
• Sleep position – Sleep with your head elevated by using extra pillows to avoid pressure on affected ear.
• Neck exercises – Neck rotation exercises are beneficial in relieving pressure in the ear canal.

HOMEOPATHIC MANAGEMENT

• In a study, 230 children with middle ear infection (otitis media) were treated with either Homeopathy or unmedicated pills. The Homeopathy group achieved pain control in 72% of patients after 12 hours. It was 2.4 times faster than patients treated with unmedicated pills. There were no complications observed in the homeopathically treated group, and when compared to conventional treatment the approach was 14% less expensive.
• Both the clinicians and researchers have concluded that homeopathy is useful and effective in the treatment of middle ear infections.
• Middle ear infections are very common and usually painful. Consult your doctor when you have high fever or bad ear pain, an ear discharge that lasts more than a day. If your doctor prescribes medicine, it is important that your child finishes the whole course of treatment.

REFERENCES

1. Diseases of EAR,NOSE and THROAT & HEAD and NECK SURGERY – by PL Dhingra, Shruti Dhingra – Disorders of Middle Ear – Page No: 62-85
2. https://medlineplus.gov/ency/article/000638.htm 
3. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/middle-ear-infections 
4. https://www.nidcd.nih.gov/health/ear-infections-children 
5. https://www.cdc.gov/antibiotic-use/ear-infection.html 
6. https://pubmed.ncbi.nlm.nih.gov/9247843/ 
7. https://www.stanfordchildrens.org/en/topic/default?id=otitis-media-middle-ear-infection-90-P02057 
8. https://www.entcolumbia.org/health-library/otitis-media-middle-ear-infection-adults 
9. https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616 
10. https://kidshealth.org/en/parents/otitis-media.html 
11. https://my.clevelandclinic.org/health/diseases/8613-ear-infection-otitis-media 
12.  https://www.winchesterhospital.org/health-library/article?id=38323 
13. https://www.homeopathyusa.org/guide-to-research/eb/otitis-media.html 
14. https://www.healthline.com/health/11-effective-earache-remedies#olive-oil 
15. https://health.clevelandclinic.orh/3-home-remedies-for-an-ear-infection/