Otitis media is an infection of the middle ear, the area just behind the eardrum. It happens when the eustachian tubes, which drain fluid and bacteria from the middle ear out to the throat, become blocked. Otitis media is common in infants and children, because their immune systems are immature and their eustachian tubes are easily clogged. Ear infections rarely happen in adults, however.

Acute otitis media causes pain, fever, and difficulty in hearing. In infants, the clearest sign of otitis media is often irritability and inconsolable crying. Infants may not want to drink their bottle or they may pull on their ears (although this may be due to teething or just being tired).

Other symptoms that may be associated with an ear infection include sore throat (pharyngitis), neck pain, nasal congestion and discharge (rhinitis), headache, and ringing (tinnitus), buzzing, or other noise in the ear.

Blockage of the eustachian tubes may be caused by the following.

• Respiratory infection
• Allergies
• Tobacco smoke or other environmental irritants
• Infected or overgrown adenoids
• Sudden increase in pressure (such as during an airplane take off or landing)
• Drinking while lying on the back, such as with a propped bottle
• Excess mucus and saliva produced during teething
• Ruptured eardrum

Otitis media occurs most frequently in the winter. It is not contagious in itself, but a cold may spread among a group of children and cause some of them to get ear infections.

• Recent illness (such as a cold or sinus infection)
• History of allergies (like hay fever, also called allergic rhinitis, or sinusitis)
• Attending day care, especially with more than 6 children at the center
• Large adenoids
• Exposure to second hand smoke
• Crowded or unsanitary living conditions
• Family members who are prone to ear infections
• High altitude
• Cold climate
• Bottle feeding
• Pacifier use

The doctor will ask questions about whether you (or your child) have had ear infections in the past and will want you to describe the current symptoms, including whether you have had any symptoms of a cold or allergies recently. Your health care provider will examine your throat, sinuses, head, neck, and lungs. Using an instrument called an otoscope he or she will look inside your ears. If infected, there may be areas of dullness or redness or there may be air bubbles or fluid behind the eardrum. The fluid may be bloody or purulent (filled with pus). The physician will also check for any sign of perforation (hole or holes) in the eardrum.

A hearing test may be recommended if your child has had persistent (that is chronic and recurrent) ear infections. It is difficult to test hearing if your child is under two years old.

You can reduce your child's risk of ear infection by the following practices:

• Don't expose your child to second hand smoke.
• Reduce your child's exposure to respiratory infections. For example, attending a day care with six or fewer children can lessen your child's chances of getting a cold or similar infection; this, in turn, leads to fewer ear infections. Similarly, frequent hand and toy washing is also helpful.
• Always hold your infant in an upright, seated position during bottle feeding. This prevents pooling of fluid and its associated risk of becoming infected.
• Breastfeeding can make a child less prone to ear infections.
• Avoid the use of pacifiers.
• Pneumococcal vaccine prevents infections from the organism that most commonly causes acute ear infections and many respiratory infections.
• Giving lots of affection and helping your child learn to relax may help prevent colds and, therefore, ear infections.

The goals for treating ear infections include curing the infection, relieving pain and other symptoms, and preventing recurrent ear infections. If a bacterial infection is present, antibiotics are necessary (see section entitled Medications).

With that said, antibiotics tend to be overused for the treatment of ear infections. Many studies suggest that uncomplicated ear infections in children over two years old can resolve within one week without antibiotics. In general, antibiotics are overused in the Western culture, leading to the growth and development of organisms that are resistant to these drugs. Finally, many ear infections are caused by a virus, not a bacterium; antibiotics are intended to treat bacterial infections.

Antibiotics should generally be used in children under two years old. Those older than two should be assessed individually and antibiotics given selectively.

Luckily, there are many alternative ways to treat the symptoms of ear infections and to prevent persistent and recurrent ear infections. For example, herbal ear drops and homeopathic remedies can be helpful for treating or preventing ear infections.

Applying warm compresses (for example, using a warm clot or hot water bottle filled with warm water) may help relieve pain.

• Antibiotics are prescribed to treat a bacterial infection. It is essential that the instructions for taking the drug (that is, how much, how often, and for how long) be followed carefully. The entire course of the antibiotic must be completed in order to avoid a relapse. The antibiotic most often prescribed for acute otitis media is amoxicillin, unless your child is allergic to penicillin in which case, there are several others from which your doctor will choose. If your doctor suspects a resistant organism (see earlier explanation), a different antibiotic will be selected.

For chronic otitis media (that is, recurrent and persistent ear infections) or if your child has a perforated eardrum or develops infection after tympanostomy tubes have been placed (see Surgery and Other Procedures), antibiotic ear drops may be prescribed instead of oral antibiotics and continued for a long period of time (like a few months).

• Nasal sprays, nose drops, oral decongestants, or, occasionally, oral antihistamines may be used to promote drainage of fluid through the eustachian tubes.

• Ear drops may be prescribed to relieve pain.

• Over the counter oral medications for pain and/or fever may be used, like ibuprofen or acetaminophen. Aspirin should not be used in children.

• Rarely, oral corticosteroids may be prescribed to reduce inflammation.

If there is fluid in the middle ear and the condition persists, even with antibiotic treatment, a healthcare provider may recommend myringotomy (surgical opening of the eardrum) to relieve pressure and allow drainage of the fluid. This may or may not involve the insertion of typanostomy tubes (often referred to as ear tubes). In this procedure, a tiny tube is inserted into the eardrum, keeping open a small hole through which fluids can drain to the outside. Tympanostomy tube insertion is done under general anesthesia. Usually the tubes fall out by themselves or are removed in your provider's office.

If your adenoids and tonsils are enlarged, surgical removal may be considered, especially if you have chronic, recurrent ear infections. Similarly, surgical repair of a ruptured eardrum may be necessary to prevent recurrent ear infections.

Foods rich in antioxidants and other important chemicals that help boost immune function are important to include in your child's daily diet. Such foods include fresh, darly colored fruits and vegetables. Eating plenty of omega-3 fatty acids (a group of essential fatty acids that tend to reduce inflammation) may be important as well. Sources of omega-3 include fish, walnuts, and flaxseeds. Children should not have these foods prior to ages 2 to 3 years old.

Because supplements (like those described below) may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider.

Lactobacillus– a probiotic or "friendly"/healthy bacteria, may reduce the incidence of respiratory infections, like colds and sinusitis, and their associated complications such as ear infections. More research in this area would be helpful.

Xylitol – a sugar alcohol produced naturally in birch, strawberries, and raspberries has properties that fight pneumococcus, a bacteria that commonly causes ear and upper respiratory infections. Some studies are reporting that children who chew gum (if they are old enough) or take a syrup containing xylitol experience fewer ear infections than children who do not take xylitol. More research is needed on this subject.

The use of herbs is a time-honored approach to strengthen the body and treat disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care and only under the supervision of a practitioner knowledgeable in the field of herbal medicine.

Calendula, St. John's wort, Mullein flower, Garlic

Herbal specialists will often prescribe herbal ear drops containing one or all of these ingredients for ear pain or infection. In a study conducted in Israel, 103 children with ear infections were given herbal ear drops or drops containing pain-relieving medications. The herbal ear drops contained a variety of herbal extracts including calendula, St. John's wort, mullein flower, and garlic. The researchers found that the combination of herbs in the ear drops was as effective as the medication ear drops in reducing the childrens' ear pain.

Echinacea

The Native American medicinal plant known as coneflower (Echinacea angustifolia/Echinacea pallida/Echinacea purpurea) is one of the most popular herbs in America today. Used primarily to reduce the symptoms and duration of the common cold and flu and to alleviate the symptoms associated with them, such as sore throat (pharyngitis), cough, and fever, many herbalists also recommend echinacea to help boost the activity of the immune system and to help the body fight infections. For this reason, professional herbalists may recommend echinacea to treat ear infections.

Eucalyptus

Parts of the eucalyptus plant have the ability to fight infection, reduce inflammation, and lower fever. For this reason, eucalyptus is often found in remedies used to treat the common cold. Similarly, some herbalists prescribe a tincture made from eucalyptus leaves for chronic ear infections. It is important to note that children under 6 years old should not take eucalyptus leaves or oil by mouth and children under 2 should not apply the oil to the face or nose. Therefore, use of eucalyptus ear drops should be reserved for children older than 2 years and oral eucalyptus for children older than 6 years.

Other

Some preliminary animal studies suggest that capsaicin, an active ingredient found in cayenne, may help prevent the development of ear infections for those at risk. Much more research is needed before knowing if this same benefit applies to people. Also, capsaicin has been used in homeopathic doses to treat ear infections.

In test tube laboratory studies, tea tree oil demonstrates ability to fight many of the organisms that cause ear infections. Whether this will translate into helpful treatment for otitis media in people is unknown at this time, however. Like capsaicin, much more research is needed, particularly since one early animal study raises the possibility that tea tree oil may cause hearing damage in guinea pigs.

Chiropractors report and preliminary evidence suggests that spinal manipulation treatments may benefit some children with otitis media. In one study involving 315 children with otitis media, a total of five spinal manipulations significantly improved symptoms after 11 days.

Although not many studies have examined the effectiveness of specific homeopathic therapies in general, there have been several studies evaluating the use of homeopathy for ear infections. Some of the homeopathic remedies included in such studies or that a professional homeopath might consider for the treatment of ear infections are listed below. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Aconitum -- for throbbing ear pain that comes on suddenly after exposure to cold or wind; and in children with high fever and whose ears have a bright red coloring
• Belladonna -- for sudden onset of infection with piercing pain that often spreads to the neck, flushed face including reddened ears, agitation (even impaired consciousness and nightmares), wide-eyed stare, high fever, and swollen glands; this remedy is most appropriate for children who feel relief when sitting upright and from warm compresses to the ear; this remedy should not be used in children whose symptoms have persisted for more than 3 days
• Chamomilla -- for intense ear pain and extreme irritability and anger (including screaming); this remedy is most appropriate for children who are difficult to comfort unless being rocked or carried by a person who is walking back and forth
• Hepar Sulphuricum -- for sharp pains and a smelly, yellowish-green discharge that occur in the middle and late stages of an ear infection, particularly when the child is extremely moody and clearly angry; this remedy is most appropriate for individuals whose symptoms are worsened by cold air and improved by warmth
• Lycopedium– for right sided ear pain that is worse in the late afternoon and early evening; the child will generally say that his ears feel stuffed up and he may hear a ringing or buzzing sound; the appropriate individual tends to be insecure and need others around, although the personality type may act like a bully as a defense mechanism
• Mercurius– good for chronic ear infections; for acute or chronic pain that is worse at night and may extend down into the throat; relief comes from nose blowing; and the appropriate child may sweat or drool a lot and have bad breath
• Pulsatilla -- for infection following exposure to cold or damp weather; the ear is often red and may have a yellowish/greenish discharge; ear pain worsens when sleeping in a warm bed and is relieved somewhat by cool compresses; this remedy is most appropriate for children who tend to be gentle, weepy, and mildly whiny and are easily soothed by affection
• Silica– for chronic or late stage infection when the child feels chilly, weak and tired; sweating may also be present.

For a child under two, let the doctor know right away if he or she is experiencing a fever, even if no other symptoms are present. Also, if high fever or severe pain is present in a child, of any age, the doctor should be seen right away as well.

Let your health care provider know if your child's symptoms (namely, pain, fever, or irritability) do not improve within 24 to 48 hours.

If severe pain suddenly stops hurting, this may indicate a ruptured eardrum.

It is possible that swimming will exacerbate an ear infection, particularly the pain from changes in pressure if swimming under water. If a ruptured eardrum is present, swimming is out of the question and even without a rupture, diving and swimming underwater should be avoided with an ear infection. If your child has ear tubes, use earplugs or cotton balls coated with petroleum jelly when swimming to prevent infection.

Generally, an ear infection is a simple, non-serious condition without complications. Most children will have minor, temporary hearing loss during and right after an ear infection. This is due to fluid lingering in the ear. Permanent hearing loss is extremely rare, but the risk increases if the child has a lot of ear infections. Other potential complications from otitis media include:

• Ruptured or perforated eardrum
• Chronic, recurrent ear infections
• Enlarged adenoids or tonsils
• Mastoiditis (an infection of the bones around the skull)
• Meningitis (an infection of the brain)
• Formation of an abscess or a cyst (called cholesteatoma) from chronic, recurrent ear infections
• Speech or language delay in a child who suffers lasting hearing loss from multiple, recurrent ear infections; again, this is very unusual

Barnett ED, Levatin JL, Chapman EH, et al. Challenges of evaluating homeopathic treatment of acute otitis media. Pediatr Infect Dis J. 2000;19(4):273-275.

Basak S, Turkutanit S, Sarierler M, Metin KK. Effects of capsaicin pre-treatment in experimentally-induced secretory otitis media. J Laryngol Otol. 1999;113(2):114-117.

Bitnun A, Allen UD. Medical therapy of otitis media: use, abuse, efficacy and morbidity. J Otolaryngol. 1998;27(suppl 2):26-36.

Bizakis JG, Velegrakis GA, Papadakis CE, Karampekios SK, Helidonis ES. The silent epidural abscess as a complication of acute otitis media in children. Int J Pediatr Otorhinolaryngol. 1998;45:163-166.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:118-123.

Brown CE, Magnuson B. On the physics of the infant feeding bottle and middle ear sequela: ear disease in infants can be associated with bottle feeding. Int J Pediatr Otorhinolaryngol. 2000;54(1):13-20.

Cohen R, Levy C, Boucherat M, Langue J, de la Rocque F. A multicenter, randomized, double-blind trial of 5 versus 10 days of antibiotic therapy for acute otitis media in young children. J Pediatr. 1998;133:634-639.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 127-129.

Eskola J, Kilpi T, Palmu A, et al. Pneumococcal conjugate vaccine against acute otits media. NEJM. 2001;344(6):403-409.

Fallon JM. The role of the chiropractic adjustment in the care and treatment of 332 children with otitis media. J ClinChiropractic Pediatr. 1997;2(2):167-183.

Frei H, Thurneysen A. Homeopathy in acute otitis media in children: treatment effect or spontaneous resolution? Br Homeopath J. 2001;90(4):178-179.

Friese KH. Acute otitis media in children: a comparison of conventional and homeopathic treatment. Biomedical Therapy. 1997;15(4):462-466.

Gehanno P, Nguyen L, Barry B, et al. Eradication by ceftriaxone of streptococcus pneumoniae isolates with increased resistance to penicillin in cases of acute otitis media. Antimicrob Agents Chemother. 1999;43:16-20.

Hatakka K, Savilahti E, Ponka A, et al. Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial. BMJ. 2001;322(7298):1327.

Ilicali OC, Keles N, Deger K, Savas I. Relationship of passive cigarette smoking to otitis media. Arch Otolaryngol Head Neck Surg. 1999;125(7):758-762.

Jacobs J, Springer DA, Crothers D. Homeopathic treatment of acute otitis media in chiildren: a preliminary ransomized placebo-controlled trial. Pediatr InfectDis J. 2001;20(2):177-183.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 171-172.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:243-245.

Kemper AR, Krysan DJ. Reevaluating the efficacy of naturopathic ear drops. Arch Pediatr Adolesc Med. 2002;156(1):88-89.

Klein JO.Changes in management of otitis media: 2003 and beyond. Pediatr Ann. 2002;31(12):824-826, 829.

Klein JO. Pneumococcal vaccines for infants and children – past, present, and future. Curr Clin Top Infect Dis. 2002;22:252-265.

Manis D, Greiver M. New conugated pneumococcal vaccine. Does it decrease the incidence of acute otits media? Can Fam Physician. 2002;48:1777-1779.

Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health Care Professionals. London, England: The Pharmaceutical Press; 1996:108.

Sarrell EM, Mandelberg A, Cohen HA. Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media. Arch Pediatr Adolesc Med. 2001;155(7):796-799.

Stathis SL, O'Callaghan DM, Williams GM, Najman JM, Andersen MJ, Bor W. Maternal cigarette smoking during pregnancy is an independent predictor for symptoms of middle ear disease at five years' postdelivery. Pediatrics. 1999;104(2):e16.

Uhari M, Kontiokari T, Koskela M, Niemela M. Xylitol chewing gum in prevention of acute otitis media: double-blind randomised trials. Br Med J. 1996;313:1180-1184.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 78-81.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 178-179.

Wright ED, Pearl AJ, Manoukian JJ. Laterally hypertrophic adenoids as a contributing factor in otitis media. Int J Pediatr Otorhinolaryngol. 1998;45:207-214.

Zhang SY, Robertson D. A study of tea tree oil ototoxicity. Audiol Neurootol. 2000;5(2):64-68.