Otitis

Inflammation of the ear is common in children, but even adults can get it. Ear inflammation can be very painful, especially at night as the pressure in the ear increases when lying down. Ear inflammation often goes away by itself but sometimes treatment is needed.

An ear infection often starts with a cold. The cold virus makes it more difficult for the mucous membranes of the nose and ears to defend against bacteria. Even healthy people can have bacteria that can cause ear inflammation in the body. But the bacteria are given the opportunity to cause disease only when the viral infection paved the way for them.

Symptoms of Otitis

Common symptoms of otitis are

  • pain in the ear, especially when lying down and sleeping
  • fever
  • a feeling of lids in the ear or poor hearing.

Children under one year often get fever and a lot of pain from ear infections. Slightly older children can sometimes only have more general symptoms of otitis such as poor appetite, difficulty sleeping, and general irritation.

Sometimes the eardrum bursts. It is not dangerous but it can hurt. Then it flows out into the ear canal and out through the ear. Before the eardrum breaks, it usually hurts, but then the pain decreases when the eardrum has burst. 

When should I seek care?

Children and adults who are otherwise healthy and do not have a very high fever or otherwise feel bad do not need to seek care in the evening or night. It can wait until the next day.

Seek care at a health center or emergency room if you as an adult or your child

  • have pain in the ear and the pain has not diminished in a day
  • has a fluid that runs out of the ear.

Seek care directly at an emergency room if you as an adult or your child

  • has ear pain and at the same time is stiff in the neck and feels very tired and weak
  • have ear pain, have a high fever and appear seriously ill
  • is red and swollen behind the ear or if the ear has started to stand out.

Contact an emergency room if you, as an adult or your child, have ear pain or problems with a runny ear for 2 to 3 days after a doctor has assessed the inconvenience. Also, seek care at a health care center if you as an adult or your child are getting worse after an examination. This applies whether or not you received treatment.  

Contact a health care center if you, as an adult or your child, have a feeling of ear lid, hearing impairment, ringing or beeps in the ears that have not gone over after three months. Seek care earlier if the problems are very large.

Is an ear infection contagious?

The inflammation of the ear itself is caused by bacteria that are not usually infected, but the inflammation is often associated with a viral infection that infects.

How can I avoid ear inflammation?

As an adult, the risk of ear infections is quite small. It may be difficult to avoid ear infections completely in children, but you can try to:

  • Keep breastfeeding your baby, if you already do. Breastfeeding has a protective effect during the child’s first year.
  • Avoid smoky environments.

Children and adults who get many ear infections can have a  tube implanted in the ear. It can prevent you from getting more ear infections.

What can I do for myself?

Most ear infections heal on their own. There are some things you can try to relieve the symptoms.

Keep your head high

Both children and adults feel better about keeping their heads high in case of ear inflammation. Then the swelling in the nose and ears decreases and it hurts less. It can be good to also have your head high when sleeping. You can do this by bedding with extra thick pillows or by placing a pillow under the mattress.

Young children, under one year, also feel better about having their heads high if they are cold or have an ear infection. Try to have the baby in a baby carrier, let them sit in their lap or in a babysitter. You can also raise the head end of the child’s bed, for example, by placing thick books under the bed legs at the head end.

The nasal spray makes it easier to breathe

Nasal drops and nasal spray that reduce nasal congestion can make it easier to breathe but do not help with the inflammation of the ear itself. This applies to both children and adults. But you should not use the decongestant nasal spray for more than ten days as long-term use can instead provide nasal congestion that is difficult to get rid of.

Saline

You can also try rinsing your nose with a saline solution. There are ready-made saline drops and saline spray to buy at pharmacies. You can also make a saline solution yourself by mixing one milliliter – a spice measure – salt in one deciliter of water. The solution can be boiled and cooled down, but no boiling is necessary. To get the saline solution into your nose, you can use a special nasal rinse or a small plastic syringe available at pharmacies.

Medication for pain and fever in children

  • You can give medicines containing paracetamol to children from three months of age. 
  • You can give medicines containing ibuprofen from the age of six months. 

The drugs are available in several different forms that are suitable for children, for example, tablets that melt in the mouth and in liquid form. Ask a pharmacy what is right for your child.

Follow the instructions on the package carefully and do not combine different medicines. Here you can read about combining paracetamol and ibuprofen. 

You can read more about medicine in the package leaflet that comes with the package. You can also look up the drug at fass.se and read the package leaflet there.

Drugs for pain and fever in adults

There are several different prescription drugs. Examples are drugs containing paracetamol and drugs belonging to the NSAID group, or cox inhibitors.

Here you can read about which prescription drugs are available and which may be suitable for you. 

How is the investigation going?

To find out if it is ear inflammation, the doctor examines the eardrum. They then see if the eardrum is red if there is fluid behind it that causes it to curve, what the liquid looks like and if the eardrum is moving as usual. The doctor uses an instrument called an otoscope. It looks like a handle with a small funnel and lamp at the top. Even better is seeing the doctor with an ear microscope that is like a pair of binoculars.

To examine the movement of the eardrum, the doctor usually attaches a small balloon to the otoscope. With the help of the balloon, they can blow air to the eardrum to see if it is moving. Sometimes the doctor uses a tympanometer to examine the movement of the eardrum and the pressure in the middle ear. The doctor then places a small soft plug in the opening of the ear canal and connects an apparatus to the plug. The device emits a hissing sound, but it does not hurt.

Other examination methods

In some cases, the doctor takes a bacterial culture. The culture is taken in the throat behind the nose with a culture stick through the nose.

The ear-nose-throat specialist

The doctor may write a referral to an ear-nose-throat if, for example, you as an adult or your child have had multiple ear infections in succession or if the acute infection seems severe. 

Treatment of Otitis

Most ear infections heal on their own. But sometimes, ear infections may need to be treated with antibiotics, such as penicillin.

Those who should always be treated if they have ear inflammation are

  • children under one year
  • children under two years who have ear inflammation in both ears
  • The children over the age of twelve and adults
  • all children and adults who have cracked eardrums. 

For children between about one and twelve years, ear inflammation usually heals without antibiotics. But also their inflammation should be treated if:

  • The child has a high fever.
  • The child has a lot of pain in the ear.
  • There is some evidence that the infection may spread or if the child has some other serious illness.

The process is different in different ages

The reason that the treatment of otitis is different in different ages is that the risk of complications varies with age. If an adult becomes infected with ear inflammation, the infection is often more severe. On the other hand, children of preschool age can have ear problems even in less severe infections. As a result, the benefits of antibiotic treatment vary.

You always get antibiotics if there is a hole in the eardrum

Regardless of your age, you always receive antibiotic treatment if the eardrum has cracked. Then the doctor also usually prints ear drops to be used for a few days. After two to three days, it stops draining from the ear. If it has not, contact the healthcare provider again. The actual hole in the eardrum usually heals by itself, quite quickly.

Often people are called on a return visit to see that the eardrum has healed properly and to see that the hearing is as usual again.

Protect your ear from water when showering or bathing

You should not bathe in case of ongoing ear problems with pain or float from the ear.

If you have had ear inflammation where there is a hole in the eardrum, you should avoid getting water in your ears for a week after it has stopped draining from the ear. You can then use grease wax or earplugs in the shower or bath.

A ventilation tube can be operated into the ear

Children and adults who have a lot of fluid in the ear or recurrent ear infections may get a  tube in the ear. It is done at an ear clinic.

Then a small plastic tube is operated into the eardrum so that air can enter the middle ear. This allows the eardrum to move more easily, to collect less fluid behind the eardrum and to hear better. The tube can reduce the risk of new ear infections.

It is important that you understand the information

In order for you to be active in your care and to make decisions, it is important that you understand the information you receive from the healthcare personnel. Ask questions if you don’t understand. You can also ask to have the information printed so that you can read it peacefully.

What is the cause of ear inflammation?

The ear has three parts: the outer ear, middle ear, and inner ear. The outer ear consists of the visible parts of the ear on the outside and the ear canal. At the far end of the ear canal is the eardrum, a few centimeters from the opening of the ear canal. Inside the eardrum lies the middle ear, a small cavity that is normally filled with gas.

From the throat behind the nose, there is a thin passage to the middle ear, the so-called ear trumpet. During that time, it normally passes air when we swallow or yawn. In the middle ear, there are also the small auditory bones, called the hammer, the anvil and the stirrup. They connect the eardrum to the inner ear.

The Sound that is carried into the ear canal causes the eardrum to move. Through the auditory bones, the vibrations are transmitted to the inner ear. In the inner ear, the vibrations are transformed into nerve impulses that are transmitted to the brain via the auditory nerve. In the inner ear is also the balance organ.

Ear inflammation is often due to colds

An ear infection often starts with a cold. The cold virus makes it more difficult for the mucous membranes of the nose and ears to defend against bacteria.

The bacteria can then cause an infection in the middle ear and you get an ear infection. The eardrum becomes red and thick and its forms were behind the eardrum. The eardrum can bend outward and move worse. That it hurts is because of the swelling and pressure in the middle ear increases. Sometimes the pressure gets so high that the eardrum breaks.

Ear inflammation is the second most common infectious disease in children, after a cold. Especially during the winter months, many children become ill. Even adults can get ear infections, but this is not as common. Then the infection is often more severe.

Ear inflammation usually starts suddenly and goes on for a few days. It is therefore called acute ear inflammation or acute otitis.

Children can be extra sensitive

Virtually all children get ear infections at some point, but some children often get ear infections. It is more common if the child easily gets infections. An increased risk of ear inflammation can be hereditary.

It is most common for children to get ear infections between one and two years of age. At the age of two, three out of four children had at least one ear infection. About ten percent of children get many ear infections.

Other forms of ear inflammation

There are also other forms of ear inflammation that can cause similar problems.   

Oronkatarr

Ear catarrh, or secretory otitis, means that clear fluid has been collected in the middle ear. This is because the mucous membrane of the ear trumpet swells, which causes too little air to enter the middle ear. It gets suppressed and a liquid is formed, which fills the middle ear partially or completely. This means that the eardrum does not become as moving, the sound waves are attenuated and the hearing can temporarily become worse. It feels like you have a lid on your ear and the sound is muted.

It is common for children to get an ear catarrh after a cold or an ear infection. The symptoms of otitis often go away on their own and should not be treated with antibiotics. Even adults can have problems with fluid in the middle ear, for example, if you cannot equalize pressure during flight or diving. Often, adults also experience problems with colds. If the problems do not go away quickly, adults should always seek medical attention. This is especially true for those who only have problems on one page.

Children with prolonged hearing loss associated with a cold and sniff should be examined by a doctor.

Ear canal eczema

You can also have inflammation in the ear canal itself. It is called ear canal eczema and the symptoms are sometimes reminiscent of ear inflammation. 

Ear trouble during a flight

People who have ear problems can get hurt in their ears when flying. This is because the air pressure changes at takeoff and landing. If the ear trumpet does not work properly, a pressure difference will occur between the inside and outside of the eardrum. In some, the ear trumpet always works poorly. For example, there may be people who have had a lot of ear problems and in children. Colds and ear infections cause the ear trumpet to temporarily malfunction in everyone.

Pressure equalization

Pressure equalization helps the ear to relieve pressure and reduce pain. You do this by holding your nose and at the same time trying to blow air through your nose. The air is then pressed up through the ear trumpet instead. It is a little easier to even out the pressure if you use nasal drops or nasal spray which reduces the swelling of the mucous membranes. At pharmacies, there are aids that make it easier to equalize pressure. Some examples are Otovent and Earplanes.

It can also help chewing gum during take-off and landing as the ear trumpet is then opened during chewing. To help young children to equalize pressure, you can let them suck on something, such as a pacifier or drink from a pacifier bottle. 

In some cases, the pressure difference causes the eardrum to burst. It’s not dangerous, but it can hurt a lot. One can test to equalize pressure before the flight. If it fails and it hurts the ear and it feels like a lid to the ear, it might be good to avoid flying if possible. 

Complications and sequelae

The vast majority of ear infections heal on their own in a few days. Sometimes fluid remains behind the eardrum for some time after being healed, which can temporarily impair hearing. It is good to contact a doctor if the symptoms of otitis remain for several weeks or get worse. Children younger than four years who have had inflammation in both ears should always go back after three months. The check is done by a doctor at a health center. If the doctor discovers that the hearing is not fully restored or if the eardrum does not look healthy, a referral is written to an ear-nose-throat surgery.

In some cases, the reason for hearing becoming worse after ear inflammation may be that the pressure in the ear has changed or that there is fluid remaining in the ear. The hassles can disappear by applying pressure equalizer several times each day.

Ear inflammation can lead to mastoiditis or other complications

In a few cases of ear inflammation, the infection spreads and causes a complication. Mastoiditis is the most common complication of ear inflammation and means that ear inflammation spreads to the skull bone behind the ear. The symptoms are severe pain in and behind the ear, fever and protruding ears. In young children, the complication can come so quickly that you have not noticed the ear inflammation. The disease is serious and if you think your child has had mastoiditis, seek medical attention at an emergency room immediately. Children with mastoiditis may remain in the hospital and receive antibiotics directly into the bloodstream. Most become healthy after that treatment of otitis but sometimes surgery is required.

Ear inflammation can also cause, for example, facial paralysis and meningitis if it spreads. In case of suspicion of complications, you as an adult or your child should be examined immediately. 

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