Ear infection

Introduction

Otitis refers to any inflammation of the ear. The main forms are acute otitis media (AOM), an often infectious involvement of the middle ear, otitis externa, an infection of the ear canal, and serous or seromucous otitis, an accumulation of fluid behind the eardrum. Acute otitis media is one of the main reasons for consultations in children: it is estimated that 75% of children will have at least one episode before the age of 3. While the majority of ear infections clear up in a few days, some can lead to complications and require careful monitoring.

If you or your child experience severe ear pain or an associated fever, contact your primary care physician first. If they are unavailable, Docadom offers an emergency consultation by a doctor at home: 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 particular shape of the Eustachian tube (shorter and more horizontal). Infants in daycare, children exposed to secondhand smoke, those with a family history of ear infections, allergies, GERD or malformations of the ENT sphere, are particularly exposed. In adults, otitis externa is more common ("swimmer's ear"). Otitis media 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.

• Reduced hearing.

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

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

Otitis Externa

• Pain increased by moving the pinna of the ear or pressing on the tragus.

• Pruritus and sensation of a blocked ear.

• Clear or purulent discharge.

• Red and swollen ear canal on examination.

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

Serous Otitis

• Persistent hearing loss after an infectious episode.

• Sensation of a blocked ear, pressure.

• Little or no pain, no fever.

• In children: language delay, decreased attention, academic failure.

When to seek urgent medical attention?

An emergency consultation is necessary in the following situations:

• Severe or persistent ear pain.

• High fever, deterioration of general condition.

• Otitis in an infant under 3 months of age.

• Purulent or bloody ear discharge.

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

• Otitis after trauma or barotrauma (diving, flying).

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

What to do before calling Docadom? Give a suitable pain reliever (paracetamol), avoid inserting anything into the ear and contact your primary care physician first. If they cannot be reached or if you need a home doctor outside of opening hours, call Docadom at 021 845 45 45 or make your request directly from our smartphone app (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 germs involved are mainly Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis. Respiratory viruses (RSV, rhinovirus, influenza virus) can also be solely responsible. Promoting factors include recurrent ENT infections, sinusitis, pharyngitis, allergies, secondhand smoke, daycare attendance, hypertrophy of adenoids.

Otitis Externa

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

Serous Otitis

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

Diagnosis of Otitis

The diagnosis is based on the otoscopic examination.

Diagnostic Methods

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

• Otoscopy: key examination that visualizes the eardrum (red, bulging, congested in AOM; swollen canal in otitis externa; air-fluid level in serous otitis).

• Tympanometry and audiometry in case of persistent serous otitis.

• Bacteriological sampling in case of discharge.

• CT or MRI of the ENT sphere in case of complication or diagnostic doubt.

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

Alternative Diagnoses

• Earwax blockage.

• Temporomandibular joint dysfunction.

• Reflex otalgia linked to pharyngeal, dental, or cervical pathology.

• Herpes zoster oticus (Ramsay-Hunt).

• Mastoiditis, cholesteatoma.

Treatment of Otitis

Acute Otitis Media

• Pain relievers and fever reducers: paracetamol as first-line treatment. 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 treatment, amoxicillin-clavulanic acid as second-line treatment. Duration: 5 to 10 days.

• In children > 2 years of age with few symptoms, a monitoring period of 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.

• Pain relievers.

• No cotton swabs, no swimming during the treatment period.

Serous Otitis

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

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

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

Prevention of Otitis

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

• Prolonged breastfeeding in infants.

• Avoid secondhand smoke.

• Regular nasal washing 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 allergy and GERD in children.

Possible Complications

Complications of otitis are rare but possible, especially in the absence of appropriate treatment: acute mastoiditis, meningitis, brain abscess, facial paralysis, labyrinthitis with dizziness and deafness, thrombosis of the lateral sinus. Malignant otitis externa in diabetic patients is a serious complication requiring hospitalization. Repeated episodes of serous otitis can lead to language delay and academic failure in children. Eardrum perforation can persist and require surgical repair.

When to Contact a Doctor for an Ear Infection

Otitis is a common reason for consultation. Here is what to do:

• As a first resort: 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 by a doctor at home. Call 021 845 45 45 or make your request via our mobile application, available for free on the App Store and Google Play.

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

Conclusion: Relieve Pain, Monitor Progress

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

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

Does your child have an earache? Our pediatricians travel for pediatric emergencies at home in Lausanne, 7 days a week from 8:30 AM to 7:30 PM.