Ear infection

Introduction

Otitis refers to any inflammation of the ear. The main forms are acute otitis media (AOM), an often infectious condition of the middle ear, otitis externa, an infection of the ear canal, and otitis media with effusion (OME) or seromucous otitis, fluid accumulation behind the eardrum. Acute otitis media is one of the leading reasons for medical consultations in children: it is estimated that 75% of children will have at least one episode before the age of 3. Although most ear infections resolve within a few days, some can progress to complications and require close follow-up.

If you or your child present with severe ear pain or an associated fever, first contact your primary care physician. If they are unavailable, Docadom offers an emergency consultation by a home-visiting doctor : call 021 845 45 45 or use our application, available on the App Store and Google Play.

Who is at risk?

Children between 6 months and 3 years are the most affected, due to the specific shape of the Eustachian tube (shorter and more horizontal). Infants in daycare, children exposed to second-hand smoke, those with a family history of ear infections, allergies, GERD or malformations of the ENT area are particularly exposed. In adults, otitis externa is more common ("swimmer's ear"). Middle ear infections in adults should prompt a search for tubal obstruction (nasopharyngeal cancer, chronic sinusitis).

Symptoms of Otitis

Symptoms vary depending on the type of otitis. Diagnosis is based on examination of the eardrum with an otoscope.

Acute Otitis Media

• Ear pain (otalgia) often intense, throbbing, especially at night.

• Fever, sometimes high.

• Decreased hearing.

• Discharge (otorrhea) in case of eardrum perforation: the pain then suddenly subsides.

• In infants: unexplained crying, irritability, refusal to eat, vomiting, rubbing of the ear, restless sleep, sometimes diarrhea.

Otitis Externa

• Pain increased by moving the outer ear or applying pressure to the tragus.

• Pruritus and a feeling of a blocked ear.

• Clear or purulent discharge.

• Red and swollen ear canal upon examination.

• History of swimming, manipulation of the canal (cotton swabs).

Otitis Media with Effusion

• Persistent hearing loss following an infectious episode.

• Sensation of a blocked ear, pressure.

• Little to no pain, no fever.

• In children: speech delay, decreased attention, academic difficulties.

When to Seek Emergency Care?

An emergency consultation is necessary in the following situations:

• Severe or persistent ear pain.

• High fever, deterioration of general health.

• Ear infection in an infant under 3 months of age.

• Purulent or bloody discharge from the ear.

• Signs of complications: redness or pain behind the ear (suspected mastoiditis), facial paralysis, dizziness, neurological symptoms — call 144.

• Ear infection following trauma or barotrauma (diving, flying).

• Ear infection in a diabetic or immunocompromised patient (risk of malignant otitis externa).

What to do before calling Docadom? Give a suitable analgesic (paracetamol), avoid introducing anything into the ear and contact your primary care physician first. If they are unreachable or if you need a home-visiting doctor outside of regular hours, call Docadom at 021 845 45 45 or make your request directly from our smartphone application (App Store and Google Play). In case of signs of complications (facial paralysis, stiff neck, severe dizziness, redness behind the ear), dial 144 without delay.

Causes of Otitis

Acute Otitis Media

Most often infectious, following a viral rhinopharyngitis that obstructs the Eustachian tube. The bacteria involved are primarily Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis. Respiratory viruses (RSV, rhinovirus, influenza virus) can also be the sole cause. Contributing factors include recurrent ENT infections, sinusitis, pharyngitis, allergies, second-hand smoke, exposure to group childcare, and adenoid hypertrophy.

Otitis Externa

Inflammation of the external ear canal, often caused by bacteria (Pseudomonas aeruginosa, Staphylococcus aureus) or fungi. It is promoted by swimming ("swimmer's ear"), humidity, scratching, the use of cotton swabs, and certain skin conditions (eczema, psoriasis).

Otitis Media with Effusion

Related to dysfunction of the Eustachian tube and the accumulation of fluid behind the eardrum. Common after an episode of AOM, in adenoid hypertrophy, allergies, GERD, and more rarely a nasopharyngeal tumor in adults.

Diagnosis of Otitis

Diagnosis is based on otoscopic examination.

Diagnostic Methods

• Anamnesis : age, symptoms, context (rhinopharyngitis, swimming), ENT history.

• Otoscopy : a key exam that visualizes the eardrum (red, bulging, congested in AOM; swollen canal in otitis externa; air-fluid level in otitis media with effusion).

• Tympanometry and audiometry in case of persistent otitis media with effusion.

• Bacteriological swab in case of discharge.

• CT scan or MRI of the ENT area in case of complications or diagnostic doubt.

• Specialized ENT examination in adults with persistent unilateral otitis (searching for an obstructive cause).

Alternative Diagnoses

• Earwax impaction.

• Temporomandibular joint dysfunction.

• Referred ear pain related to pharyngeal, dental, or cervical pathology.

• Herpes zoster oticus (Ramsay Hunt syndrome).

• Mastoiditis, cholesteatoma.

Treatment of Otitis

Acute Otitis Media

• Analgesics and antipyretics : paracetamol as first-line defense. NSAIDs are possible.

• Antibiotics : indicated in children < 2 years of age, in case of significant general symptoms, otitis with discharge, or in case of recurrent otitis. Amoxicillin as first-line, amoxicillin-clavulanic acid as second-line. Duration: 5 to 10 days.

• In children > 2 years of age with mild symptoms, monitoring for 48-72 hours can be proposed before starting an antibiotic.

• No indication for ear drops in case of AOM with an intact eardrum.

Otitis Externa

• Topical antibiotics in ear drops: ofloxacin, ciprofloxacin, sometimes combined with a corticosteroid. Duration: 7 to 10 days.

• Keep the ear dry during treatment.

• Analgesics.

• No cotton swabs, no swimming for the duration of treatment.

Otitis Media with Effusion

• Simple monitoring in the majority of cases (spontaneous resolution in a few weeks to 3 months).

• Regular nose blowing, treatment of any associated rhinitis, sinusitis or allergy.

• If persisting > 3 months with audiological impact: insertion of tympanostomy tubes (ear tubes, grommets), sometimes removal of adenoids.

Prevention of Otitis

• Vaccination : pneumococcal, influenza, COVID-19, Haemophilus influenzae.

• Prolonged breastfeeding in infants.

• Avoid second-hand smoke.

• Regular nasal rinsing with saline solution in case of rhinitis.

• Early treatment of rhinitis, sinusitis and pharyngitis.

• Do not insert cotton swabs into the ear canal.

• Careful drying of the ears after swimming.

• Earplugs for regular swimmers.

• Management of respiratory allergies and GERD in children.

Possible Complications

Complications of otitis are rare but possible, especially in the absence of suitable treatment: acute mastoiditis, meningitis, brain abscess, facial paralysis, labyrinthitis with vertigo and hearing loss, lateral sinus thrombosis. Malignant otitis externa in patients with diabetes is a serious complication requiring hospitalization. Repeated episodes of otitis media with effusion can lead to speech delay and academic difficulties in children. Eardrum perforation may persist and require surgical repair.

When to Contact a Doctor for an Ear Infection

Otitis is a frequent reason for consultation. Here is what you should do:

• First-line contact : contact your primary care physician, who can examine the eardrum and prescribe the appropriate treatment.

• If your primary care physician is unavailable (evenings, weekends, holidays), Docadom offers an emergency consultation with a home-visiting doctor. Call 021 845 45 45 or make your request via our mobile app, available for free on the App Store and Google Play.

• In case of warning signs (facial paralysis, stiff neck, severe dizziness, redness behind the ear, ear infection in an infant under 3 months), dial 144 immediately.

Conclusion: relieving pain, monitoring evolution

Otitis is a benign condition in the majority of cases, but it can cause severe pain and, exceptionally, serious complications. It is characterized by otalgia, fever, decrease in hearing or ear discharge, which can lead to complications like mastoiditis, eardrum perforation, or speech delay in children. Vaccination, ENT hygiene, and early management of respiratory infections reduce its frequency. Treatment combines analgesics and, depending on the case, antibiotics or the placement of tympanostomy tubes.

If in doubt, first seek advice from your primary care physician. If they are not available, Docadom provides an emergency doctor at home 7 days a week: call 021 845 45 45 or use our mobile app (App Store, Google Play) to request an emergency consultation.