Ear Infections

Middle Ear Infection (Otitis Media)

• An ear infection of the middle ear involves the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear.^[1]
• Children are more likely than adults to get this type of ear infection.^[1:1]
• Acute otitis media (AOM), one of the most common infectious disorders during childhood, can be caused by viruses, but usually has a bacterial origin.^[2]

Signs and Symptoms

The onset of signs and symptoms is usually rapid.

• Anxiety
• Chills
• Lack of appetite
• Diarrhea
• Ear pain (Otalgia)
  • especially when lying down ^[1:2]
  • Usually unilateral ^[3]
  • Often appears at night for the first time.^[3:1]
  • The pain is strong and pulsating.^[3:2]
  • Prevents the child from sleeping peacefully.^[3:3]
• Tugging or pulling at an ear ^[1:3]
• Trouble sleeping ^[1:4]
• Crying more than usual ^[1:5]
• Fussiness, irritability ^[1:6]
• Trouble hearing or responding to sounds ^[1:7]
• Loss of balance ^[1:8]
• Fever of 100 F (38 C) or higher (occurring in approximately 50% of patients) ^[1:9]
• Drainage of fluid from the ear ^[1:10]
• Headache ^[1:11]
• Loss of appetite ^[1:12]

When to call your doctor

• Symptoms last more than a day ^[1:13]
• Child is less than 6 months of age ^[1:14]
• Bilateral (both ears) otitis media in children under 2 ^[3:4]
• Ear pain is severe ^[1:15]
• Infant/toddler is sleepless or irritable after a cold or other upper respiratory infection ^[1:16]
• You observe a discharge of fluid, pus or bloody fluid from the ear ^[1:17]

Complications

• Most ear infections don’t cause long-term complications.^[1:18]

• Ear infections that happen again and again can lead to serious complications.^[1:19]

• The most common complication of Acute Otitus Media is mastoiditis.^[3:5]

  • Mastoiditis is the inflammation of a portion of the temporal bone referred to as the mastoid air cells. The mastoid air cells are epithelium lined bone septations that are continuous with the middle ear cavity.^[4]
  • It usually appears up to 2 weeks after the end of the disease.^[3:6]

• Impaired hearing. ^[1:20]

  • Mild hearing loss that comes and goes is fairly common with an ear infection, but it usually gets better after the infection clears.
  • Ear infections that happen again and again, or fluid in the middle ear, may lead to more-significant hearing loss.
  • If there is some permanent damage to the eardrum or other middle ear structures, permanent hearing loss may occur.

• Speech or developmental delays. ^[1:21]

  • If hearing is temporarily or permanently impaired in infants and toddlers, they may experience delays in speech, social and developmental skills.

• Spread of infection. ^[1:22]

  • Untreated infections or infections that don’t respond well to treatment can spread to nearby tissues.
  • Infection of the mastoid, the bony protrusion behind the ear, is called mastoiditis.
    • This infection can result in damage to the bone and the formation of pus-filled cysts.
  • Rarely, serious middle ear infections spread to other tissues in the skull, including the brain or the membranes surrounding the brain (meningitis).

• Tearing of the eardrum. ^[1:23]

  • Most eardrum tears heal within 72 hours. In some cases, surgical repair is needed.

Prevention

• If you bottle-feed, hold your baby in an upright position. ^[1:24]
  • Avoid propping a bottle in your baby’s mouth while he or she is lying down.
  • Don’t put bottles in the crib with your baby.

Treatment

Antibiotic Therapy

• Antibiotics are not often used to treat middle ear infections, as they are often caused by a virus.^[5]
  • Antibiotics do not treat viruses.^[5:1]
  • In very young or very unwell children, the GP may prescribe a short course of antibiotics if there’s risk of bacterial infection.^[5:2]
• Episodes of acute otitis media are often self-limiting and resolve without treatment. ^[2:1]
• Antibiotics are regularly prescribed because, if persistent, this type of ear infection can develop into chronic ear disease that may lead to: ^[2:2]
  • Perforation of the tympanic membrane
  • Hearing loss
  • ( and, less frequently, ) Serious and even life-threatening complications.
• There is limited benefit of antibiotics for this disease.^[2:3]
• For many, watchful waiting alone was an acceptable or preferred approach to managing acute otitis media.^[2:4]
• Some preferred that a prescription be provided alongside watchful waiting so that they could readily access antibiotics should they feel they were required.^[2:5]
• Watchful waiting and treatment with oral analgesics is recommended if the child is not at risk of chronic suppurative otitis media (ie, persistent discharge following tympanic membrane perforation).^[2:6]
• Acute otitis media is one of the most common indications for antibiotic therapy in the pediatric population.^[3:7]
  • Antibiotic therapy is not always justified and prescribing antibiotics in the early stages of otitis in children is debatable.^[3:8]
  • In Europe, a strategy of vigilant waiting in the initial period of illness is adopted. This technique is much less popular in the United States.^[3:9]
  • The alert waiting period should last up to 48 – 72 hours and include analgesic treatment.^[3:10]
    • Ibuprofen at a dose adjusted to the patient’s body weight is considered the first-line drug in painkillers.^[3:11]
  • Chilren with one or more of the following symptomps should consider immediate antibiotic therapy:^[3:12]
    • Bilateral otitis media in children up to 2 years old (both ears infected)
    • Otitis media in children under 6 months of age
    • Ear leakage
    • Facial defects
    • Down syndrome
    • Immunodeficiency
    • Severe course, including fever above 39 ° C, vomiting
• Antibiotics cause negative changes to the microbiome in the patient’s body, which cause a negative impact on health, and abnormal changes can last longer and be more severe than the disease itself.^[6]
• Misuse of antibiotics can be harmful, especially in children, because the long-term effects of antibiotics on the macroorganism and microbiome can cause the disease to recur in adulthood.^[6:1]
• Antibacterial therapy, even when administered as indicated, causes long-term changes in the bacterial microbiome of the body.^[6:2]
  • It can disrupt the symbiosis between the microbiome and the macroorganism.^[6:3]
  • Studies have shown significant changes in the gastrointestinal microbiome not only after 7 days, but also after 11  weeks after the discontinuation of antibiotics, indicating long-term damage to the microbiome.
  • After 11  weeks, although the microbial composition changes compared to day 7, it does not return to its initial level, and potentially useful species of microorganisms, such as Akkermansia muciniphila, do not re-appear, even with long-term observation.
  • Recent studies show that the microbial communities living on the epithelial surfaces of the nasal passages are a key factor in maintaining a healthy microenvironment, influencing both pathogen resistance and immune responses.
  • A microbiological study of healthy individuals shows that the basis of the normal respiratory microbiome of the nasopharynx consists of commensal microorganisms: anaerobes: Lactobacillus spp., Bifidobacterium spp., and aerobes: S. salivarius and S. viridans, which are tested at a high population level.
  • Patients with chronic recurrent nasopharyngitis with history of several courses of antibacterial therapy, show significant changes in the respiratory microbiome:
    • A decrease in the population level of commensal microorganisms, with background colonization by opportunistic microorganisms (Staph. aureus, Staph. epidermidis, E. coli, Strept. Pyogenes) and pathogenic species of bacteria (Pneumococcus pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, Klebsiella pneumoniae) in association with Candida fungi.^[6:4]
  • Changes in oral, respiratory, skin, urogenital, vaginal, or gastrointestinal microbiome can have potentially dangerous effects, including sensitization, periodontal disease and cavities in children, opportunistic infections, vaginal candidiasis, carcinogenesis activation, etc.^[6:5]
  • To this date, a whole group of diseases caused by antibiotics has been identified.^[6:6]
  • Excessive and improper use of antibiotics and its subsequent effect on the microbiome in young children can cause the disease to manifest at a later age.^[6:7]
  • A disrupted microbiome can contribute to chronic, low-grade systemic inflammation, thus even contributing to age-related diseases.^[6:8]

The disrupted microbial spectrum of the oral and respiratory microbiome disturbs colonization resistance and supports a slow persistent inflammatory process involving biofilm formation [25]. Biofilms can enhance antimicrobial resistance and bacterial anti-immune properties tenfold, which creates conditions for the progression and persistence of inflammation, and contributes to its frequent recurrence. Studies have found that disruption of the normal nasopharyngeal microbiome composition involving biofilm formation is associated with susceptibility to acute respiratory illnesses and chronic URT diseases [26,27,28].

Natural Healing

• Unlike antibiotics, herbal medicines positively affect the patient’s microbiome and have a favourable safety profile.^[6:9]
• Herbal extracts from marigold and garlic can be useful in supportive analgesic treatment.^[3:13]
• Herbal medicinal products cannot replace antibiotics in all the cases, so delayed prescription of antibiotics with pre-treatment using herbal products can help reduce excessive and unjustified use of antibiotics.^[6:10]
• Echinacea purpurea
• Sambucus nigra
• Sanguinaria canadensis (bloodroot)
• Chamomilla recutita
• Aconitum napellus
• Capsicum annuum
• Hydrargyrum cyanatum
• Hydrastis canadensisodiu