Acute Bacterial Middle Ear Infection
Middle ear infection is mainly a problem in children, although it also occurs in adults.
During colds, the tube from the back of the throat to the middle ear (eustachian tube) no longer functions well and pressure in the middle ear is abnormal in up to 75% of patients. (42-45)
Anatomy of the Adenoid, Eustachian Tube, and Middle Ear. The narrow eustachian tube connects the back of the throat with the middle ear and maintains normal air pressure in the middle ear. A common cold may cause swelling of the adenoid or accumulation of thick secretions in the eustachian tube leading to its obstruction. If this happens, fluid collects in the middle ear causing serous otitis media. If bacteria are trapped in the middle ear, an infection results (bacterial otitis media).
The abnormalities in eustachian tube function and middle ear pressure usually clear after a cold. (42-45) With closely spaced colds, such as occur in children, repeated eustachian tube and pressure abnormalities may lead to fluid collection in the ear.
The eustachian tube and middle ear pressure abnormalities of colds are thought to be a major predisposing factor for the collection of sterile fluid in the middle ear and also for secondary and bacterial infection at this site. (51)
Bacterial infection of the middle ear typically causes ear pain. Also, examination of the ear drum may show redness, bulging, and pus behind the drum. (51)
The important bacteria causing middle ear infection are the pneumococcus , Hemophilus influenza, Moraxella, and other Streptococcus species. (51)
Bacterial infection of the middle ear requires antibiotics treatment to reduce the duration of infection and illness and to prevent serious complications such as bacterial mastoiditis and meningitis. (51) Also, chronic draining ears and hearing loss may occur in children who do not receive proper antibiotic treatment for acute bacterial otitis media.
Some children have repeated episodes of acute bacterial infection of the middle ear. More often children have recurrent collections of sterile fluid in the ear. Prolonged antibiotic administration has been used in recent years to reduce the occurrence of recurrent otitis media in children. This practice may have contributed to the rapid increase in antibiotic resistance of the pneumococcus in the United States in recent years. (52) Antibiotic administration to prevent recurrent otitis media is not recommended as standard practice. An acceptable alternative for this problem with no ecological consequences is placement of ear drainage tubes.
