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How Do I Know If I Have Otitis Media?

If you or your child has an earache accompanied by a stuffy or runny nose and a sore throat and fever, it is likely that the problem is otitis media. Your doctor will most likely examine the eardrum with an instrument called an otoscope for signs of infection - not an easy task if the patient is a fussy infant. The doctor may also check for blockage of the middle ear using a pneumatic otoscope, which blows a little air at the eardrum. This air should cause the eardrum to move back and forth. If fluid is present or the canal is blocked, the eardrum will not move as readily.

Another test is tympanometry, which uses sound and air pressure to check for fluid in the middle ear. If needed, an audiologist will perform a hearing test to determine if there is hearing loss.

To check for a bacterial infection, a doctor may, on rare occasions, make an opening in the eardrum, draw out a sample of fluid from the middle ear, then culture the sample in a laboratory. This more extreme measure is usually used only for serious or particularly stubborn infections.

What Are the Treatments?

The goal of most doctors and therapists is to rid the middle ear of infection before more serious complications set in. Treatment usually involves eliminating the causes of otitis media, killing any invading bacteria, boosting the immune system and reducing swelling in the eustachian tubes.

Conventional Medicine

Otitis media is often caused by a viral infection, in which case the only relief doctors can offer is treatment of the symptoms. This may involve trying to reduce swelling in the eustachian tubes with a decongestant, such as pseudoephedrine, and an antihistamine, possibly diphenhydramine. (Note: Antihistamines will not cure otitis media, and they may cause minor side effects, including drowsiness and nervousness.)

To ease the pain, your doctor may recommend a pain reliever, typically acetaminophen or ibuprofen, which also helps reduce a fever. Aspirin should be avoided in children because of the threat of Reye's syndrome.

A controversy surrounds the use of antibiotics in treating bacterial middle ear infections. Some physicians initially treat only the symptoms of otitis media, without the help of bacteria-killing drugs. Studies have shown that the majority of otitis media cases will get better when treated this way. Other research, in fact, suggests that many otitis media cases are viral in origin and therefore will not respond to antibiotics.

But many doctors, particularly in the U.S., are concerned that without antibiotics, bacteria lurking inside the middle ear can grow out of control, possibly causing a serious complication such as hearing loss or mastoiditis. After all, they point out, these complications have become rare, largely as a result of antibiotic therapy. To be on the safe side, many American physicians treat all otitis media cases as if bacteria were present.

Amoxicillin is the antibiotic of choice for treating bacterial otitis media. The drug is highly effective: A single course of amoxicillin can knock out an ear infection in seven to 10 days, at little cost.

Lately, however, doctors have noticed trouble with this wonder drug. As it turns out, some types of bacteria have grown resistant to amoxicillin. Critics of routine antibiotic use in the U.S. charge that the millions of prescriptions of amoxicillin written for otitis media that had no bacterial element helped to create these resistant bacterial strains.

Whatever their origin, amoxicillin-resistant bacteria have shown up in a number of communities, prompting many doctors to prescribe other antibiotics for otitis media. Some of these substitutes, which tend to be more expensive than amoxicillin, are taken from a class of medications called cephalosporins. Others are combination drugs - amoxicillin and clavulanate, for instance. For those allergic to amoxicillin, doctors may prescribe sulfamethoxazole and trimethoprim, or erythromycin mixed with a sulfa drug like sulfisoxazole.

If a case of otitis media develops serious complications or if fluid remains in the ear for more than three months, physicians may suggest surgery to eliminate infection or drain the middle ear. One technique, called myringotomy, involves piercing the eardrum to release fluid from the middle ear. If the eustachian tubes become completely closed off due to swelling, a surgeon may insert a ventilation tube inside to keep them open. However, this procedure - called tympanostomy - is often expensive and may lead to infection and scarring. If recurring infections in the adenoids or tonsils cause repeated episodes of otitis media, a physician may suggest having those glands removed.

At-Home Remedies

• You can provide a great deal of symptomatic relief for an infected ear at home. Many find that warmth, perhaps from a warm compress, brings comfort. Steam inhalations may also help, but take care not to burn yourself; protect your eye area as well.
• Taking antihistamines may dry out your throat and respiratory passages; sip water frequently.
• Gargling with salt water helps soothe an aggravated throat and clear the eustachian tubes.
• Holding your head erect can help drain your middle ear.