Test for ear infection: Ear infection (middle ear) – Diagnosis and treatment

02.05.197620.10.2021 by alexxlab

Содержание

Symptoms, Causes, Prevention & Treatment

Overview

What is an ear infection?

The commonly used term “ear infection” is known medically as acute otitis media or a sudden infection in the middle ear (the space behind the eardrum). Anyone can get an ear infection — children as well as adults — although ear infections are one of the most common reasons why young children visit healthcare providers.

In many cases, ear infections clear up on their own. Your healthcare provider may recommend a medication to relieve pain. If the ear infection has worsened or not improved, your healthcare provider may prescribe an antibiotic. In children younger than the age of two years, an antibiotic is usually needed for ear infections.

It’s important to see your healthcare provider to make sure the ear infection has healed or if you or your child has ongoing pain or discomfort. Hearing problems and other serious effects can occur with ongoing ear infections, frequent infections and when fluid builds up behind the eardrum.

Where is the middle ear?

The middle ear is behind the eardrum (tympanic membrane) and is also home to the delicate bones that aid in hearing. These bones (ossicles) are the hammer (malleus), anvil (incus) and stirrup (stapes). To provide the bigger picture, let’s look at the whole structure and function of the ear:

The ear structure and function

There are three main parts of the ear: outer, middle and inner.

The outer ear is the outside external ear flap and the ear canal (external auditory canal).
The middle ear is the air-filled space between the eardrum (tympanic membrane) and the inner ear. The middle ear houses the delicate bones that transmit sound vibrations from the eardrum to the inner ear. This is where ear infections occur.
The inner ear contains the snail-shaped labyrinth that converts sound vibrations received from the middle ear to electrical signals. The auditory nerve carries these signals to the brain.

Other nearby parts

The eustachian tube regulates air pressure within the middle ear, connecting it to the upper part of the throat.
Adenoids are small pads of tissue above the throat and behind the nose and near the eustachian tubes. Adenoids help fight infection caused by bacteria that enters through the mouth.

Who is most likely to get an ear infection (otitis media)?

Middle ear infection is the most common childhood illness (other than a cold). Ear infections occur most often in children who are between age 3 months and 3 years, and are common until age 8. Some 25% of all children will have repeated ear infections.

Adults can get ear infections too, but they don’t happen nearly as often as they do in children.

Risk factors for ear infections include:

Age: Infants and young children (between 6 months of age and 2 years) are at greater risk for ear infections.
Family history: The tendency to get ear infections can run in the family.
Colds: Having colds often increases the chances of getting an ear infection.
Allergies: Allergies cause inflammation (swelling) of the nasal passages and upper respiratory tract, which can enlarge the adenoids. Enlarged adenoids can block the eustachian tube, preventing ear fluids from draining. This leads to fluid buildup in the middle ear, causing pressure, pain and possible infection.
Chronic illnesses: People with chronic (long-term) illnesses are more likely to develop ear infections, especially patients with immune deficiency and chronic respiratory disease, such as cystic fibrosis and asthma.
Ethnicity: Native Americans and Hispanic children have more ear infections than other ethnic groups.

Symptoms and Causes

What causes an ear infection?

Ear infections are caused by bacteria and viruses. Many times, an ear infection begins after a cold or other respiratory infection. The bacteria or virus travel into the middle ear through the eustachian tube (there’s one in each ear). This tube connects the middle ear to the back of the throat. The bacteria or virus can also cause the eustachian tube to swell. This swelling can cause the tube to become blocked, which keeps normally produced fluids to build up in the middle ear instead of being able to be drained away.

Adding to the problem is that the eustachian tube is shorter and has less of a slope in children than in adults. This physical difference makes these tubes easier to become clogged and more difficult to drain. The trapped fluid can become infected by a virus or bacteria, causing pain.

Medical terminology and related conditions

Because your healthcare provider may use these terms, it’s important to have a basic understanding of them:

Acute otitis media (middle ear infection): This is the ear infection just described above. A sudden ear infection, usually occurring with or shortly after cold or other respiratory infection. The bacteria or virus infect and trap fluid behind the eardrum, causing pain, swelling/bulging of the eardrum and results in the commonly used term “ear infection.” Ear infections can occur suddenly and go away in a few days (acute otitis media) or come back often and for long periods of time (chronic middle ear infections).
Otitis media with effusion: This is a condition that can follow acute otitis media. The symptoms of acute otitis media disappear. There is no active infection but the fluid remains. The trapped fluid can cause temporary and mild hearing loss and also makes an ear infection more likely to occur. Another cause of this condition is a block in the eustachian tube not related to the ear infection.
Chronic suppurative otitis media: This is a condition in which the ear infection won’t go away even with treatment. Over time, this can cause a hole to form in the eardrum.

What are the symptoms of otitis media (middle ear infection)?

Symptoms of ear infection include:

Ear pain: This symptom is obvious in older children and adults. In infants too young to speak, look for signs of pain like rubbing or tugging ears, crying more than usual, trouble sleeping, acting fussy/irritable.
Loss of appetite: This may be most noticeable in young children, especially during bottle feedings. Pressure in the middle ear changes as the child swallows, causing more pain and less desire to eat.
Irritability: Any kind of continuing pain may cause irritability.
Poor sleep: Pain may be worse when the child is lying down because the pressure in the ear may worsen.
Fever: Ear infections can cause temperatures from 100° F (38 C) up to 104° F. Some 50% of children will have a fever with their ear infection.
Drainage from the ear: Yellow, brown, or white fluid that is not earwax may seep from the ear. This may mean that the eardrum has ruptured (broken).
Trouble hearing: Bones of the middle ear connect to the nerves that send electrical signals (as sound) to the brain. Fluid behind the eardrums slows down movement of these electrical signals through the inner ear bones.

Diagnosis and Tests

How is an ear infection diagnosed?

Ear exam

Your healthcare provider will look at your or your child’s ear using an instrument called an otoscope. A healthy eardrum will be pinkish gray in color and translucent (clear). If infection is present, the eardrum may be inflamed, swollen or red.

Your healthcare provider may also check the fluid in the middle ear using a pneumatic otoscope, which blows a small amount of air at the eardrum. This should cause the eardrum to move back and forth. The eardrum will not move as easily if there is fluid inside the ear.

Another test, tympanometry, uses air pressure to check for fluid in the middle ear. This test doesn’t test hearing. If needed, your healthcare provider will order a hearing test, performed by an audiologist, to determine possible hearing loss if you or your child has had long lasting or frequent ear infections or fluid in the middle ears that is not draining.

Other checks

Your healthcare provider will also check your throat and nasal passage and listen to your breathing with a stethoscope for signs of upper respiratory infections.

Management and Treatment

How is an ear infection treated?

Treatment of ear infections depends on age, severity of the infection, the nature of the infection (is the infection a first-time infection, ongoing infection or repeating infection) and if fluid remains in the middle ear for a long period of time.

Your healthcare provider will recommend medications to relieve you or your child’s pain and fever. If the ear infection is mild, depending on the age of the child, your healthcare provider may choose to wait a few days to see if the infection goes away on its own before prescribing an antibiotic.

Antibiotics

Antibiotics may be prescribed if bacteria are thought to be the cause of the ear infection. Your healthcare provider may want to wait up to three days before prescribing antibiotics to see if a mild infection clears up on its own when the child is older. If your or your child’s ear infection is severe, antibiotics might be started right away.

The American Academy of Pediatrics has recommended when to prescribe antibiotics and when to consider waiting before prescribing based on your child’s age, severity of their infection, and your child’s temperature. Their recommendations are shown in the table below.

American Academy of Pediatrics Treatment Guide for Acute Otitis Media (AOM)

Child’s Age	Severity of AOM / Temperature	Treatment
6 months and older; in one or both ears	Moderate to severe for at least 48 hours or temp of 102.2° F or higher	Treat with antibiotic
6 months through 23 months; in both ears	Mild for < 48 hours and temp < 102.2	Treat with antibiotic
6 months to 23 months; in one ear	Mild for < 48 hours and temp < 102.2° F	Treat with antibiotic OR observe. If observe, start antibiotics if child worsens or doesn’t improve within 48 to 72 hours of start of symptoms
24 months or older; in one or both ears	Mild for < 48 hours and temp < 102.2° F	Treat with antibiotic OR observe. If observe, start antibiotics if child worsens or doesn’t improve within 48 to 72 hours of start of symptoms

If your healthcare provider prescribes an antibiotic, take it exactly as instructed. You or your child will start feeling better a few days after starting treatment. Even if you feel better and when pain has gone away, don’t stop taking the medication until you were told to stop. The infection can come back if you don’t take all of the medication. If the antibiotic prescribed for your child is a liquid, be sure to use a measuring spoon designed for liquid medications to be sure that you give the right amount.

A hole or tear in your eardrum caused by a severe infection or an ongoing infection (chronic suppurative otitis media) is treated with antibiotic eardrops and sometimes by using a suctioning device to remove fluids. Your healthcare provider will give you specific instructions about what to do.

Pain-relieving medications

Over-the-counter acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) can help relieve earache or fever. Pain-relieving eardrops can also be prescribed. These medications usually start to lessen the pain within a couple hours. Your healthcare provider will recommend pain-relieving medications for you or your child and provide any additional instructions.

Never give aspirin to children. Aspirin can cause a life-threatening condition called Reye’s Syndrome.

Earaches tend to hurt more at bedtime. Using a warm compress on the outside of the ear may also help relieve pain. (This is not recommended for infants.)

Ear tubes (tympanostomy tubes)

Sometimes ear infections can be ongoing (chronic), frequently recurring or the fluid in the middle ear can even remain for months after the infection has cleared (otitis media with effusion). Most children will experience an ear infection by age 5 and some children may have frequent ear infections. Telltale signs of an ear infection in a child can include pain inside the ear, a sense of fullness in the ear, muffled hearing, fever, nausea, vomiting, diarrhea, crying, irritability and tugging at the ears (especially in very young children). If your child has experienced frequent ear infections (three ear infections in six months or four infections in a year), had ear infections that weren’t resolved with antibiotics, or experienced hearing loss from fluid buildup behind the eardrum, you may be a candidate for ear tubes. Ear tubes can provide immediate relief and are sometimes recommended for small children who are developing their speech and language skills. You may be referred to an ear, nose and throat (ENT) specialist for this outpatient surgical procedure, which is called a myringotomy with placement of tube. During the procedure, a small metal or plastic tube is inserted through a tiny incision (cut) in the eardrum. The tube lets air into the middle ear and allows fluid to drain. The procedure is very short — approximately 10 minutes — and there’s a low complication rate with this procedure. This tube usually stays in place from six to 12 months. It often falls out on its own, but it can also be removed by your doctor. The outer ear will need to be kept dry and free of dirty water, like lake water, until the hole in the eardrum heals completely and closes.

What are the harms of fluid buildup in your ears or repeated or ongoing ear infections?

Most ear infections don’t cause long-term problems, but when they do happen, complications can include:

Loss of hearing: Some mild, temporary hearing loss (muffling/distortion of sound) usually occurs during an ear infection. Ongoing infections, infections that repeatedly occur, damage to internal structures in the ear from a buildup of fluid can cause more significant hearing loss.
Delayed speech and language development: Children need to hear to learn language and develop speech. Muffled hearing for any length of time or loss of hearing can significantly delay or hamper development.
Tear in the eardrum: A tear can develop in the eardrum from pressure from the long-lasting presence of fluid in the middle ear. About 5% to 10% of children with an ear infection develop a small tear in their eardrum. If the tear doesn’t heal on its own, surgery may be needed. If you have drainage/discharge from your ear, do not place anything into your ear canal. Doing so can be dangerous if there is an accident with the item touching the ear drum.
Spread of the infection: Infection that doesn’t go away on its own, is untreated or is not fully resolved with treatment may spread beyond the ear. Infection can damage the nearby mastoid bone (bone behind the ear). On rare occasions, infection can spread to the membranes surrounding the brain and spinal cord (meninges) and cause meningitis.

Prevention

What can I do to prevent ear infections in myself and my child?

Here are some ways to reduce risk of ear infections in you or your child:

Don’t smoke. Studies have shown that second-hand smoking increases the likelihood of ear infections. Be sure no one smokes in the house or car — especially when children are present — or at your day care facility.
Control allergies. Inflammation and mucus caused by allergic reactions can block the eustachian tube and make ear infections more likely.
Prevent colds. Reduce your child’s exposure to colds during the first year of life. Don’t share toys, foods, drinking cups or utensils. Wash your hands frequently. Most ear infections start with a cold. If possible, try to delay the use of large day care centers during the first year.
Breastfeed your baby. Breastfeed your baby during the first 6 to 12 months of life. Antibodies in breast milk reduce the rate of ear infections.
Bottle feed baby in upright angle. If you bottle feed, hold your baby in an upright angle (head higher than stomach). Feeding in the horizontal position can cause formula and other fluids to flow back into the eustachian tubes. Allowing an infant to hold his or her own bottle also can cause milk to drain into the middle ear. Weaning your baby from a bottle between nine and 12 months of age will help stop this problem.
Watch for mouth breathing or snoring. Constant snoring or breathing through the mouth may be caused by large adenoids. These may contribute to ear infections. An exam by an otolaryngologist, and even surgery to remove the adenoids (adenoidectomy), may be necessary.
Get vaccinations. Make sure your child’s immunizations are up to date, including yearly influenza vaccine (flu shot) for those 6 months and older. Ask your doctor about the pneumococcal, meningitis and other vaccines too. Preventing viral infections and other infections help prevent ear infections.

Outlook / Prognosis

What should I expect if I or my child has an ear infection?

Ear infections are common in children. Adults can get them too. Most ear infections are not serious. Your healthcare provider will recommend over-the-counter medications to relieve pain and fever. Pain relief may begin as soon as a few hours after taking the drug.

Your healthcare provider may wait a few days before prescribing an antibiotic. Many infections go away on their own without the need for antibiotics. If you or your child receives an antibiotic, you should start to see improvement within two to three days.

If you or your child has ongoing or frequent infections, or if fluid remains in the middle ear and puts hearing at risk, ear tubes may be surgically implanted in the eardrum to keep fluid draining from the eustachian tube as it normally should.

Never hesitate to contact your healthcare provider if you have any concerns or questions.

Living With

When should I return to my healthcare provider for a follow-up visit?

Your healthcare provider will let you know when you need to return for a follow-up visit. At that visit, you or your child’s eardrum will be examined to be certain that the infection is going away. Your healthcare provider may also want to test you or your child’s hearing.

Follow-up exams are very important, especially if the infection has caused a hole in the eardrum.

When should I call the doctor about an ear infection?

Call your healthcare provider immediately if:

You or your child develops a stiff neck.
Your child acts sluggish, looks or acts very sick, or does not stop crying despite all efforts.
Your child’s walk is not steady; he or she is physically very weak.
You or your child’s ear pain is severe.
You or your child has a fever over 104° F (40° C).
Your child is showing signs of weakness in their face (look for a crooked smile).
You see bloody or pus-filled fluid draining from the ear.

Call your healthcare provider during office hours if:

The fever remains or comes back more than 48 hours after starting an antibiotic.
Ear pain is not better after three days of taking an antibiotic.
Ear pain is severe.
You have any questions or concerns.

Why do children get many more ear infections than adults? Will my child always get ear infections?

Children are more likely than adults to get ear infections for these reasons:

The eustachian tubes in young children are shorter and more horizontal. This shape encourages fluid to gather behind the eardrum.
The immune system of children, which in the body’s infection-fighting system, is still developing.
The adenoids in children are relatively larger than they are in adults. The adenoids are the small pads of tissue above the throat and behind the nose and near the eustachian tubes. As they swell to fight infection, they may block the normal ear drainage from the eustachian tube into the throat. This blockage of fluid can lead to a middle ear infection.

Most children stop getting ear infections by age 8.

Do I need to cover my ears if I go outside with an ear infection?

No, you do not need to cover your ears if you go outside.

Can I swim if I have an ear infection?

Swimming is okay as long as you don’t have a tear (perforation) in your eardrum or have drainage coming out of your ear.

Can I travel by air or be in high altitudes if I have an ear infection?

Air travel or a trip to the mountains is safe, although temporary pain is possible during takeoff and landing when flying. Swallowing fluids, chewing on gum during descent, or having a child suck on a pacifier will help relieve discomfort during air travel.

Are ear infections contagious?

No, ear infections are not contagious.

When can my child return to normal daily activities?

Children can return to school or day care as soon as the fever is gone.

What are other causes of ear pain?

Other causes of ear pain include:

A sore throat.
Teeth coming in in a baby.
An infection of the lining of the ear canal. This is also called “swimmer’s ear.”
Pressure build up in the middle ear caused by allergies and colds.

Symptoms, Causes, Prevention & Treatment

Overview

What is an ear infection?

Where is the middle ear?

The ear structure and function

There are three main parts of the ear: outer, middle and inner.

The outer ear is the outside external ear flap and the ear canal (external auditory canal).
The middle ear is the air-filled space between the eardrum (tympanic membrane) and the inner ear. The middle ear houses the delicate bones that transmit sound vibrations from the eardrum to the inner ear. This is where ear infections occur.
The inner ear contains the snail-shaped labyrinth that converts sound vibrations received from the middle ear to electrical signals. The auditory nerve carries these signals to the brain.

Other nearby parts

The eustachian tube regulates air pressure within the middle ear, connecting it to the upper part of the throat.
Adenoids are small pads of tissue above the throat and behind the nose and near the eustachian tubes. Adenoids help fight infection caused by bacteria that enters through the mouth.

Who is most likely to get an ear infection (otitis media)?

Adults can get ear infections too, but they don’t happen nearly as often as they do in children.

Risk factors for ear infections include:

Age: Infants and young children (between 6 months of age and 2 years) are at greater risk for ear infections.
Family history: The tendency to get ear infections can run in the family.
Colds: Having colds often increases the chances of getting an ear infection.
Allergies: Allergies cause inflammation (swelling) of the nasal passages and upper respiratory tract, which can enlarge the adenoids. Enlarged adenoids can block the eustachian tube, preventing ear fluids from draining. This leads to fluid buildup in the middle ear, causing pressure, pain and possible infection.
Chronic illnesses: People with chronic (long-term) illnesses are more likely to develop ear infections, especially patients with immune deficiency and chronic respiratory disease, such as cystic fibrosis and asthma.
Ethnicity: Native Americans and Hispanic children have more ear infections than other ethnic groups.

Symptoms and Causes

What causes an ear infection?

Medical terminology and related conditions

Because your healthcare provider may use these terms, it’s important to have a basic understanding of them:

Acute otitis media (middle ear infection): This is the ear infection just described above. A sudden ear infection, usually occurring with or shortly after cold or other respiratory infection. The bacteria or virus infect and trap fluid behind the eardrum, causing pain, swelling/bulging of the eardrum and results in the commonly used term “ear infection.” Ear infections can occur suddenly and go away in a few days (acute otitis media) or come back often and for long periods of time (chronic middle ear infections).
Otitis media with effusion: This is a condition that can follow acute otitis media. The symptoms of acute otitis media disappear. There is no active infection but the fluid remains. The trapped fluid can cause temporary and mild hearing loss and also makes an ear infection more likely to occur. Another cause of this condition is a block in the eustachian tube not related to the ear infection.
Chronic suppurative otitis media: This is a condition in which the ear infection won’t go away even with treatment. Over time, this can cause a hole to form in the eardrum.

What are the symptoms of otitis media (middle ear infection)?

Symptoms of ear infection include:

Ear pain: This symptom is obvious in older children and adults. In infants too young to speak, look for signs of pain like rubbing or tugging ears, crying more than usual, trouble sleeping, acting fussy/irritable.
Loss of appetite: This may be most noticeable in young children, especially during bottle feedings. Pressure in the middle ear changes as the child swallows, causing more pain and less desire to eat.
Irritability: Any kind of continuing pain may cause irritability.
Poor sleep: Pain may be worse when the child is lying down because the pressure in the ear may worsen.
Fever: Ear infections can cause temperatures from 100° F (38 C) up to 104° F. Some 50% of children will have a fever with their ear infection.
Drainage from the ear: Yellow, brown, or white fluid that is not earwax may seep from the ear. This may mean that the eardrum has ruptured (broken).
Trouble hearing: Bones of the middle ear connect to the nerves that send electrical signals (as sound) to the brain. Fluid behind the eardrums slows down movement of these electrical signals through the inner ear bones.

Diagnosis and Tests

How is an ear infection diagnosed?

Ear exam

Other checks

Your healthcare provider will also check your throat and nasal passage and listen to your breathing with a stethoscope for signs of upper respiratory infections.

Management and Treatment

How is an ear infection treated?

Antibiotics

American Academy of Pediatrics Treatment Guide for Acute Otitis Media (AOM)

Child’s Age	Severity of AOM / Temperature	Treatment
6 months and older; in one or both ears	Moderate to severe for at least 48 hours or temp of 102.2° F or higher	Treat with antibiotic
6 months through 23 months; in both ears	Mild for < 48 hours and temp < 102.2	Treat with antibiotic
6 months to 23 months; in one ear	Mild for < 48 hours and temp < 102.2° F	Treat with antibiotic OR observe. If observe, start antibiotics if child worsens or doesn’t improve within 48 to 72 hours of start of symptoms
24 months or older; in one or both ears	Mild for < 48 hours and temp < 102.2° F	Treat with antibiotic OR observe. If observe, start antibiotics if child worsens or doesn’t improve within 48 to 72 hours of start of symptoms

Pain-relieving medications

Never give aspirin to children. Aspirin can cause a life-threatening condition called Reye’s Syndrome.

Earaches tend to hurt more at bedtime. Using a warm compress on the outside of the ear may also help relieve pain. (This is not recommended for infants.)

Ear tubes (tympanostomy tubes)

What are the harms of fluid buildup in your ears or repeated or ongoing ear infections?

Most ear infections don’t cause long-term problems, but when they do happen, complications can include:

Loss of hearing: Some mild, temporary hearing loss (muffling/distortion of sound) usually occurs during an ear infection. Ongoing infections, infections that repeatedly occur, damage to internal structures in the ear from a buildup of fluid can cause more significant hearing loss.
Delayed speech and language development: Children need to hear to learn language and develop speech. Muffled hearing for any length of time or loss of hearing can significantly delay or hamper development.
Tear in the eardrum: A tear can develop in the eardrum from pressure from the long-lasting presence of fluid in the middle ear. About 5% to 10% of children with an ear infection develop a small tear in their eardrum. If the tear doesn’t heal on its own, surgery may be needed. If you have drainage/discharge from your ear, do not place anything into your ear canal. Doing so can be dangerous if there is an accident with the item touching the ear drum.
Spread of the infection: Infection that doesn’t go away on its own, is untreated or is not fully resolved with treatment may spread beyond the ear. Infection can damage the nearby mastoid bone (bone behind the ear). On rare occasions, infection can spread to the membranes surrounding the brain and spinal cord (meninges) and cause meningitis.

Prevention

What can I do to prevent ear infections in myself and my child?

Here are some ways to reduce risk of ear infections in you or your child:

Don’t smoke. Studies have shown that second-hand smoking increases the likelihood of ear infections. Be sure no one smokes in the house or car — especially when children are present — or at your day care facility.
Control allergies. Inflammation and mucus caused by allergic reactions can block the eustachian tube and make ear infections more likely.
Prevent colds. Reduce your child’s exposure to colds during the first year of life. Don’t share toys, foods, drinking cups or utensils. Wash your hands frequently. Most ear infections start with a cold. If possible, try to delay the use of large day care centers during the first year.
Breastfeed your baby. Breastfeed your baby during the first 6 to 12 months of life. Antibodies in breast milk reduce the rate of ear infections.
Bottle feed baby in upright angle. If you bottle feed, hold your baby in an upright angle (head higher than stomach). Feeding in the horizontal position can cause formula and other fluids to flow back into the eustachian tubes. Allowing an infant to hold his or her own bottle also can cause milk to drain into the middle ear. Weaning your baby from a bottle between nine and 12 months of age will help stop this problem.
Watch for mouth breathing or snoring. Constant snoring or breathing through the mouth may be caused by large adenoids. These may contribute to ear infections. An exam by an otolaryngologist, and even surgery to remove the adenoids (adenoidectomy), may be necessary.
Get vaccinations. Make sure your child’s immunizations are up to date, including yearly influenza vaccine (flu shot) for those 6 months and older. Ask your doctor about the pneumococcal, meningitis and other vaccines too. Preventing viral infections and other infections help prevent ear infections.

Outlook / Prognosis

What should I expect if I or my child has an ear infection?

Never hesitate to contact your healthcare provider if you have any concerns or questions.

Living With

When should I return to my healthcare provider for a follow-up visit?

Follow-up exams are very important, especially if the infection has caused a hole in the eardrum.

When should I call the doctor about an ear infection?

Call your healthcare provider immediately if:

You or your child develops a stiff neck.
Your child acts sluggish, looks or acts very sick, or does not stop crying despite all efforts.
Your child’s walk is not steady; he or she is physically very weak.
You or your child’s ear pain is severe.
You or your child has a fever over 104° F (40° C).
Your child is showing signs of weakness in their face (look for a crooked smile).
You see bloody or pus-filled fluid draining from the ear.

Call your healthcare provider during office hours if:

The fever remains or comes back more than 48 hours after starting an antibiotic.
Ear pain is not better after three days of taking an antibiotic.
Ear pain is severe.
You have any questions or concerns.

Why do children get many more ear infections than adults? Will my child always get ear infections?

Children are more likely than adults to get ear infections for these reasons:

The eustachian tubes in young children are shorter and more horizontal. This shape encourages fluid to gather behind the eardrum.
The immune system of children, which in the body’s infection-fighting system, is still developing.
The adenoids in children are relatively larger than they are in adults. The adenoids are the small pads of tissue above the throat and behind the nose and near the eustachian tubes. As they swell to fight infection, they may block the normal ear drainage from the eustachian tube into the throat. This blockage of fluid can lead to a middle ear infection.

Most children stop getting ear infections by age 8.

Do I need to cover my ears if I go outside with an ear infection?

No, you do not need to cover your ears if you go outside.

Can I swim if I have an ear infection?

Swimming is okay as long as you don’t have a tear (perforation) in your eardrum or have drainage coming out of your ear.

Can I travel by air or be in high altitudes if I have an ear infection?

Are ear infections contagious?

No, ear infections are not contagious.

When can my child return to normal daily activities?

Children can return to school or day care as soon as the fever is gone.

What are other causes of ear pain?

Other causes of ear pain include:

A sore throat.
Teeth coming in in a baby.
An infection of the lining of the ear canal. This is also called “swimmer’s ear.”
Pressure build up in the middle ear caused by allergies and colds.

Symptoms, Causes, Prevention & Treatment

Overview

What is an ear infection?

Where is the middle ear?

The ear structure and function

There are three main parts of the ear: outer, middle and inner.

The outer ear is the outside external ear flap and the ear canal (external auditory canal).
The middle ear is the air-filled space between the eardrum (tympanic membrane) and the inner ear. The middle ear houses the delicate bones that transmit sound vibrations from the eardrum to the inner ear. This is where ear infections occur.
The inner ear contains the snail-shaped labyrinth that converts sound vibrations received from the middle ear to electrical signals. The auditory nerve carries these signals to the brain.

Other nearby parts

The eustachian tube regulates air pressure within the middle ear, connecting it to the upper part of the throat.
Adenoids are small pads of tissue above the throat and behind the nose and near the eustachian tubes. Adenoids help fight infection caused by bacteria that enters through the mouth.

Who is most likely to get an ear infection (otitis media)?

Adults can get ear infections too, but they don’t happen nearly as often as they do in children.

Risk factors for ear infections include:

Age: Infants and young children (between 6 months of age and 2 years) are at greater risk for ear infections.
Family history: The tendency to get ear infections can run in the family.
Colds: Having colds often increases the chances of getting an ear infection.
Allergies: Allergies cause inflammation (swelling) of the nasal passages and upper respiratory tract, which can enlarge the adenoids. Enlarged adenoids can block the eustachian tube, preventing ear fluids from draining. This leads to fluid buildup in the middle ear, causing pressure, pain and possible infection.
Chronic illnesses: People with chronic (long-term) illnesses are more likely to develop ear infections, especially patients with immune deficiency and chronic respiratory disease, such as cystic fibrosis and asthma.
Ethnicity: Native Americans and Hispanic children have more ear infections than other ethnic groups.

Symptoms and Causes

What causes an ear infection?

Medical terminology and related conditions

Because your healthcare provider may use these terms, it’s important to have a basic understanding of them:

Acute otitis media (middle ear infection): This is the ear infection just described above. A sudden ear infection, usually occurring with or shortly after cold or other respiratory infection. The bacteria or virus infect and trap fluid behind the eardrum, causing pain, swelling/bulging of the eardrum and results in the commonly used term “ear infection.” Ear infections can occur suddenly and go away in a few days (acute otitis media) or come back often and for long periods of time (chronic middle ear infections).
Otitis media with effusion: This is a condition that can follow acute otitis media. The symptoms of acute otitis media disappear. There is no active infection but the fluid remains. The trapped fluid can cause temporary and mild hearing loss and also makes an ear infection more likely to occur. Another cause of this condition is a block in the eustachian tube not related to the ear infection.
Chronic suppurative otitis media: This is a condition in which the ear infection won’t go away even with treatment. Over time, this can cause a hole to form in the eardrum.

What are the symptoms of otitis media (middle ear infection)?

Symptoms of ear infection include:

Ear pain: This symptom is obvious in older children and adults. In infants too young to speak, look for signs of pain like rubbing or tugging ears, crying more than usual, trouble sleeping, acting fussy/irritable.
Loss of appetite: This may be most noticeable in young children, especially during bottle feedings. Pressure in the middle ear changes as the child swallows, causing more pain and less desire to eat.
Irritability: Any kind of continuing pain may cause irritability.
Poor sleep: Pain may be worse when the child is lying down because the pressure in the ear may worsen.
Fever: Ear infections can cause temperatures from 100° F (38 C) up to 104° F. Some 50% of children will have a fever with their ear infection.
Drainage from the ear: Yellow, brown, or white fluid that is not earwax may seep from the ear. This may mean that the eardrum has ruptured (broken).
Trouble hearing: Bones of the middle ear connect to the nerves that send electrical signals (as sound) to the brain. Fluid behind the eardrums slows down movement of these electrical signals through the inner ear bones.

Diagnosis and Tests

How is an ear infection diagnosed?

Ear exam

Other checks

Your healthcare provider will also check your throat and nasal passage and listen to your breathing with a stethoscope for signs of upper respiratory infections.

Management and Treatment

How is an ear infection treated?

Antibiotics

American Academy of Pediatrics Treatment Guide for Acute Otitis Media (AOM)

Child’s Age	Severity of AOM / Temperature	Treatment
6 months and older; in one or both ears	Moderate to severe for at least 48 hours or temp of 102.2° F or higher	Treat with antibiotic
6 months through 23 months; in both ears	Mild for < 48 hours and temp < 102.2	Treat with antibiotic
6 months to 23 months; in one ear	Mild for < 48 hours and temp < 102.2° F	Treat with antibiotic OR observe. If observe, start antibiotics if child worsens or doesn’t improve within 48 to 72 hours of start of symptoms
24 months or older; in one or both ears	Mild for < 48 hours and temp < 102.2° F	Treat with antibiotic OR observe. If observe, start antibiotics if child worsens or doesn’t improve within 48 to 72 hours of start of symptoms

Pain-relieving medications

Never give aspirin to children. Aspirin can cause a life-threatening condition called Reye’s Syndrome.

Earaches tend to hurt more at bedtime. Using a warm compress on the outside of the ear may also help relieve pain. (This is not recommended for infants.)

Ear tubes (tympanostomy tubes)

What are the harms of fluid buildup in your ears or repeated or ongoing ear infections?

Most ear infections don’t cause long-term problems, but when they do happen, complications can include:

Loss of hearing: Some mild, temporary hearing loss (muffling/distortion of sound) usually occurs during an ear infection. Ongoing infections, infections that repeatedly occur, damage to internal structures in the ear from a buildup of fluid can cause more significant hearing loss.
Delayed speech and language development: Children need to hear to learn language and develop speech. Muffled hearing for any length of time or loss of hearing can significantly delay or hamper development.
Tear in the eardrum: A tear can develop in the eardrum from pressure from the long-lasting presence of fluid in the middle ear. About 5% to 10% of children with an ear infection develop a small tear in their eardrum. If the tear doesn’t heal on its own, surgery may be needed. If you have drainage/discharge from your ear, do not place anything into your ear canal. Doing so can be dangerous if there is an accident with the item touching the ear drum.
Spread of the infection: Infection that doesn’t go away on its own, is untreated or is not fully resolved with treatment may spread beyond the ear. Infection can damage the nearby mastoid bone (bone behind the ear). On rare occasions, infection can spread to the membranes surrounding the brain and spinal cord (meninges) and cause meningitis.

Prevention

What can I do to prevent ear infections in myself and my child?

Here are some ways to reduce risk of ear infections in you or your child:

Don’t smoke. Studies have shown that second-hand smoking increases the likelihood of ear infections. Be sure no one smokes in the house or car — especially when children are present — or at your day care facility.
Control allergies. Inflammation and mucus caused by allergic reactions can block the eustachian tube and make ear infections more likely.
Prevent colds. Reduce your child’s exposure to colds during the first year of life. Don’t share toys, foods, drinking cups or utensils. Wash your hands frequently. Most ear infections start with a cold. If possible, try to delay the use of large day care centers during the first year.
Breastfeed your baby. Breastfeed your baby during the first 6 to 12 months of life. Antibodies in breast milk reduce the rate of ear infections.
Bottle feed baby in upright angle. If you bottle feed, hold your baby in an upright angle (head higher than stomach). Feeding in the horizontal position can cause formula and other fluids to flow back into the eustachian tubes. Allowing an infant to hold his or her own bottle also can cause milk to drain into the middle ear. Weaning your baby from a bottle between nine and 12 months of age will help stop this problem.
Watch for mouth breathing or snoring. Constant snoring or breathing through the mouth may be caused by large adenoids. These may contribute to ear infections. An exam by an otolaryngologist, and even surgery to remove the adenoids (adenoidectomy), may be necessary.
Get vaccinations. Make sure your child’s immunizations are up to date, including yearly influenza vaccine (flu shot) for those 6 months and older. Ask your doctor about the pneumococcal, meningitis and other vaccines too. Preventing viral infections and other infections help prevent ear infections.

Outlook / Prognosis

What should I expect if I or my child has an ear infection?

Never hesitate to contact your healthcare provider if you have any concerns or questions.

Living With

When should I return to my healthcare provider for a follow-up visit?

Follow-up exams are very important, especially if the infection has caused a hole in the eardrum.

When should I call the doctor about an ear infection?

Call your healthcare provider immediately if:

You or your child develops a stiff neck.
Your child acts sluggish, looks or acts very sick, or does not stop crying despite all efforts.
Your child’s walk is not steady; he or she is physically very weak.
You or your child’s ear pain is severe.
You or your child has a fever over 104° F (40° C).
Your child is showing signs of weakness in their face (look for a crooked smile).
You see bloody or pus-filled fluid draining from the ear.

Call your healthcare provider during office hours if:

The fever remains or comes back more than 48 hours after starting an antibiotic.
Ear pain is not better after three days of taking an antibiotic.
Ear pain is severe.
You have any questions or concerns.

Why do children get many more ear infections than adults? Will my child always get ear infections?

Children are more likely than adults to get ear infections for these reasons:

The eustachian tubes in young children are shorter and more horizontal. This shape encourages fluid to gather behind the eardrum.
The immune system of children, which in the body’s infection-fighting system, is still developing.
The adenoids in children are relatively larger than they are in adults. The adenoids are the small pads of tissue above the throat and behind the nose and near the eustachian tubes. As they swell to fight infection, they may block the normal ear drainage from the eustachian tube into the throat. This blockage of fluid can lead to a middle ear infection.

Most children stop getting ear infections by age 8.

Do I need to cover my ears if I go outside with an ear infection?

No, you do not need to cover your ears if you go outside.

Can I swim if I have an ear infection?

Swimming is okay as long as you don’t have a tear (perforation) in your eardrum or have drainage coming out of your ear.

Can I travel by air or be in high altitudes if I have an ear infection?

Are ear infections contagious?

No, ear infections are not contagious.

When can my child return to normal daily activities?

Children can return to school or day care as soon as the fever is gone.

What are other causes of ear pain?

Other causes of ear pain include:

A sore throat.
Teeth coming in in a baby.
An infection of the lining of the ear canal. This is also called “swimmer’s ear.”
Pressure build up in the middle ear caused by allergies and colds.

How To Check Children for Ear Infections at Home

If your child gets ear infections often, you may wonder if you could save time and money by checking them for one at home. You might be able to, but you shouldn’t if there’s any pus or blood coming from the ear, if the skin around the ear hole is swollen, or the bone behind the ear is red. If that’s the case, call your child’s doctor.

If you do decide to check for an ear infection at home, be sure to talk with the doctor first to make sure it’s OK and to get guidance on the best instrument to buy and how to use it.

What Is an Otoscope?

It’s an instrument doctors use to see inside the ear. You don’t have to be a doctor to buy or use one, but it’s not as simple as just putting it into your child’s ear and looking around.

The otoscope comes with several pointed tips, called specula. Choose one that’s slightly smaller than the opening of your child’s ear. If the ear hole is too small for the smallest tip, don’t try to check for an infection at home.

Clean the speculum, unless you’re using disposable ones, and fit it to the viewing end of the otoscope. Turn on the instrument’s light.

If your child is older than 12 months, pull the outer ear gently up and back. (If they’re younger than 12 months, pull the outer ear gently straight back.) This will straighten the ear canal and make it easier to see inside.

Hold the otoscope at the handle with your pinky finger outstretched. When the instrument is in the ear canal, your pinky should rest on your child’s cheek. This will keep it from going too far inside their ear canal and possibly hurting them.

Next, slowly put the speculum into your child’s ear while looking into the viewing end of the otoscope. The ear canal is sensitive, so don’t put pressure on the instrument or push it too far.

Move the otoscope and the ear very gently until you can see the eardrum. Angle the viewing piece slightly toward your child’s nose, so it follows the normal angle of the ear canal.

Two important things to keep in mind:

The ear is very sensitive, so don’t be rough. Children tend to wriggle or turn their heads to see what’s going on, so be careful not to hurt the ear.
Tell your child what you’re doing each step of the way. Ask them to tell you if it hurts so you can take the otoscope out right away.
Because the ear canal isn’t straight, you’ll probably have to move the outer ear and the otoscope a few times to get it lined up and see inside. This will get easier with practice. You may want to try on a healthy adult first.

Signs of Infection

Here are some things to look for:

A red, bulging eardrum
Clear, yellow, or greenish fluid behind the eardrum. There may also be some blood.
Earwax buildup
A hole in the eardrum (perforated eardrum)

If you notice any of these, or aren’t sure, call your child’s doctor. Home otoscopes often don’t have the picture quality of otoscopes used by professionals.

What Is an Ear Infection? (for Kids)

Do you remember having an ear infection? Even if you don’t remember, you probably had one. Most kids have at least one middle ear infection before they are 2 years old. These infections can cause ear pain and a fever.

What Is a Middle Ear Infection?

Middle ear infections are one of the most common childhood problems. Let’s start by talking about infections. An infection (say: in-FEK-shun) happens when germs like bacteria and viruses get inside the body and cause trouble. Germs can get into your ears. The ear is divided into three parts: outer, middle, and inner. When the germs bother your outer ear, it’s called swimmer’s ear.

The middle ear is a small pocket of air behind the eardrum. You have a middle ear infection when germs get into the middle ear and the area fills up with fluid (or pus), which contains germ-fighting cells. When the pus builds up, your ear starts to feel like a balloon that is ready to pop, which can really hurt.

How Do I Get an Ear Infection?

Between your middle ear and your throat there is a passage called the eustachian (say: yoo-STAY-she-un) tube. The eustachian tubes (you have one on each side) keep pressure from building up by letting air move in and out of your middle ear. When you were young, especially before you turned 3, the eustachian tubes were very small and less able to keep germs out.

The eustachian tubes get longer and usually work better in older kids, but they can still cause problems. If you have allergies or catch a cold, the eustachian tubes can get blocked up and let germs get in the middle ear. Then the number of germs can grow inside your middle ear and cause an infection.

You do not catch ear infections from other people, though you might catch a cold that then leads to an ear infection. If you have an ear infection, you might have ear pain, a fever, or trouble hearing. If you have any of these problems, tell your parent so he or she can take you to the doctor.

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What Does the Doctor Do?

The doctor will look into your ear with a special flashlight called an otoscope (say: OH-te-skope). With the otoscope, the doctor can see your eardrum, the thin membrane between your outer and middle ear.

The doctor may use the otoscope to blow a little puff of air in your ear. Why? To see if the air causes your eardrum to move the way a healthy eardrum does. An infected eardrum won’t move as it should because the pus presses against it and may make it bulge. An infection also can make the eardrum red.

If you have an ear infection, the doctor will make a decision about what to do next. He or she might ask your parent to watch you over the next day or two to see if you get any better. The doctor also might suggest a pain reliever to keep you comfortable.

If bacteria are causing the problem, the doctor might prescribe a medicine called an antibiotic (say: an-ty-by-AH-tik), which usually clears up a bacterial infection, so you’ll feel better in a few days.

If you are given an antibiotic, it’s very important to keep taking the medicine for as many days as the doctor instructs — even if your ear stops hurting. If you don’t take all the medicine, the infection could come back and your ear will start hurting again.

A kid who has chronic, or frequent, ear infections might need a few other tests. They include an audiogram (say: AW-dee-uh-gram), which tests your hearing, and a tympanogram (say: tim-PAH-noh-gram), a machine that checks whether your eardrum moves normally.

How to Prevent Ear Infections

What can kids do to prevent ear infections? You can avoid places where people are smoking, for one. Cigarette smoke can keep your eustachian tubes from working properly.

You also can try not to catch colds. These steps can help:

Stay away from people who have colds, if possible.
Wash your hands regularly.
Try not to touch your nose and eyes.

Good luck staying clear of colds and keeping those pesky germs out of your ears!

Middle ear infection (otitis media)

Otitis media is an infection of the middle ear that causes inflammation (redness and swelling) and a build-up of fluid behind the eardrum.

Anyone can develop a middle ear infection but infants between six and 15 months old are most commonly affected.

It’s estimated that around one in every four children experience at least one middle ear infection by the time they’re 10 years old.

Symptoms of a middle ear infection

In most cases, the symptoms of a middle ear infection (otitis media) develop quickly and resolve in a few days. This is known as acute otitis media. The main symptoms include:

earache
a high temperature (fever)
being sick
a lack of energy
slight hearing loss – if the middle ear becomes filled with fluid

In some cases, a hole may develop in the eardrum (perforated eardrum) and pus may run out of the ear. The earache, which is caused by the build-up of fluid stretching the eardrum, then resolves.

Signs in young children

As babies are unable to communicate the source of their discomfort, it can be difficult to tell what’s wrong with them. Signs that a young child might have an ear infection include:

raised temperature
pulling, tugging or rubbing their ear
irritability, poor feeding or restlessness at night
coughing or a runny nose
unresponsiveness to quiet sounds or other signs of difficulty hearing, such as inattentiveness
loss of balance

When to seek medical advice

Most cases of otitis media pass within a few days, so there’s usually no need to see your GP.

However, see your GP if you or your child have:

symptoms showing no sign of improvement after two or three days
a lot of pain
a discharge of pus or fluid from the ear – some people develop a persistent and painless ear discharge that lasts for many months, known as chronic suppurative otitis media
an underlying health condition, such as cystic fibrosis or congenital heart disease, which could make complications more likely

Read more about diagnosing middle ear infections

How middle ear infections are treated

Most ear infections clear up within three to five days and don’t need any specific treatment. If necessary, paracetamol or ibuprofen should be used to relieve pain and a high temperature.

Make sure any painkillers you give to your child are appropriate for their age. Read more about giving your child painkillers.

Antibiotics aren’t routinely used to treat middle ear infections, although they may occasionally be prescribed if symptoms persist or are particularly severe.

Read more about treating middle ear infections

What causes middle ear infections?

Most middle ear infections occur when an infection such as a cold, leads to a build-up of mucus in the middle ear and causes the Eustachian tube (a thin tube that runs from the middle ear to the back of the nose) to become swollen or blocked.

This mean mucus can’t drain away properly, making it easier for an infection to spread into the middle ear.

An enlarged adenoid (soft tissue at the back of the throat) can also block the Eustachian tube. The adenoid can be removed if it causes persistent or frequent ear infections. Read more about removing adenoids.

Younger children are particularly vulnerable to middle ear infections as:

the Eustachian tube is smaller in children than in adults
a child’s adenoids are relatively much larger than an adults

Certain conditions can also increase the risk of middle ear infections, including:

having a cleft palate – a type of birth defect where a child has a split in the roof of their mouth
having Down’s syndrome – a genetic condition that typically causes some level of learning disability and a characteristic range of physical features

Can middle ear infections be prevented?

It’s not possible to prevent middle ear infections, but there are some things you can do that may reduce your child’s risk of developing the condition. These include:

make sure your child is up-to-date with their routine vaccinations – particularly the pneumococcal vaccine and the DTaP/IPV/Hib (5-in-1) vaccine
avoid exposing your child to smoky environments (passive smoking)
don’t give your child a dummy once they’re older than six to 12 months old
don’t feed your child while they’re lying flat on their back
if possible, feed your baby with breast milk rather than formula milk

Avoiding contact with other children who are unwell may also help reduce your child’s chances of catching an infection that could lead to a middle ear infection.

Further problems

Complications of middle ear infections are fairly rare, but can be serious if they do occur.

Most complications are the result of the infection spreading to another part of the ear or head, including:

the bones behind the ear (mastoiditis)
the inner ear (labyrinthitis)
the protective membranes surrounding the brain and spinal cord (meningitis)

Rarely, infections can leave a perforation or hole in the eardrum.

If complications do develop, they often need to be treated immediately with antibiotics in hospital.

Read more about the complications of middle ear infections

Ear infection – acute | UF Health, University of Florida Health

Definition

Ear infections are one of the most common reasons parents take their children to the health care provider. The most common type of ear infection is called otitis media. It is caused by swelling and infection of the middle ear. The middle ear is located just behind the eardrum.

An acute ear infection starts over a short period and is painful. Ear infections that last a long time or come and go are called chronic ear infections.

Middle ear infection (otitis media)

Alternative Names

Otitis media – acute; Infection – inner ear; Middle ear infection – acute

Causes

Video: Ear infection – acute

The eustachian tube runs from the middle of each ear to the back of the throat. Normally, this tube drains fluid that is made in the middle ear. If this tube gets blocked, fluid can build up. This can lead to infection.

Ear infections are common in infants and children because the eustachian tubes are easily clogged.
Ear infections can also occur in adults, although they are less common than in children.

Eustachian tube

Anything that causes the eustachian tubes to become swollen or blocked makes more fluid build up in the middle ear behind the eardrum. Some causes are:

Allergies
Colds and sinus infections
Excess mucus and saliva produced during teething
Infected or overgrown adenoids (lymph tissue in the upper part of the throat)
Tobacco smoke

Ear infections are also more likely in children who spend a lot of time drinking from a sippy cup or bottle while lying on their back. Milk may enter the eustachian tube, which may increase the risk of an ear infection. Getting water in the ears will not cause an acute ear infection unless the eardrum has a hole in it.

Other risk factors for acute ear infections include:

Attending day care (especially centers with more than 6 children)
Changes in altitude or climate
Cold climate
Exposure to smoke
Family history of ear infections
Not being breastfed
Pacifier use
Recent ear infection
Recent illness of any type (because illness lowers the body’s resistance to infection)
Birth defect, such as deficiency in eustachian tube function

Ear Infection Myths & Facts Quiz

Symptoms

In infants, often the main sign of an ear infection is acting irritable or crying that cannot be soothed. Many infants and children with an acute ear infection have a fever or trouble sleeping. Tugging on the ear is not always a sign that the child has an ear infection.

Symptoms of an acute ear infection in older children or adults include:

Ear pain
Fullness in the ear
Feeling of general illness
Nasal congestion
Cough
Lethargy
Vomiting
Diarrhea
Hearing loss in the affected ear
Drainage of fluid from the ear
Loss of appetite

The ear infection may start shortly after a cold. Sudden drainage of yellow or green fluid from the ear may mean the eardrum has ruptured.

All acute ear infections involve fluid behind the eardrum. At home, you can use an electronic ear monitor to check for this fluid. You can buy this device at a drugstore. You still need to see a health care provider to confirm an ear infection.

Exams and Tests

Your provider will take your medical history and ask about symptoms.

The provider will look inside the ears using an instrument called an otoscope. This exam may show:

Areas of marked redness
Bulging of tympanic membrane
Discharge from the ear
Air bubbles or fluid behind the eardrum
A hole (perforation) in the eardrum

The provider might recommend a hearing test if the person has a history of ear infections.

Treatment

Some ear infections clear on their own without antibiotics. Treating the pain and allowing the body time to heal itself is often all that is needed:

Apply a warm cloth or warm water bottle to the affected ear.
Use over-the-counter pain relief drops for ears. Or, ask the provider about prescription eardrops to relieve pain.
Take over-the-counter medicines such as ibuprofen or acetaminophen for pain or fever. DO NOT give aspirin to children.

All children younger than 6 months with a fever or symptoms of an ear infection should see a provider. Children who are older than 6 months may be watched at home if they DO NOT have:

A fever higher than 102°F (38.9°C)
More severe pain or other symptoms
Other medical problems

If there is no improvement or if symptoms get worse, schedule an appointment with the provider to determine whether antibiotics are needed.

ANTIBIOTICS

A virus or bacteria can cause ear infections. Antibiotics will not help an infection that is caused by a virus. Most providers don’t prescribe antibiotics for every ear infection. However, all children younger than 6 months with an ear infection are treated with antibiotics.

Your provider is more likely to prescribe antibiotics if your child:

Is under age 2
Has a fever
Appears sick
Does not improve in 24 to 48 hours

If antibiotics are prescribed, it is important to take them every day and to take all of the medicine. DO NOT stop the medicine when symptoms go away. If the antibiotics do not seem to be working within 48 to 72 hours, contact your provider. You may need to switch to a different antibiotic.

Side effects of antibiotics may include nausea, vomiting, and diarrhea. Serious allergic reactions are rare, but may also occur.

Some children have repeat ear infections that seem to go away between episodes. They may receive a smaller, daily dose of antibiotics to prevent new infections.

SURGERY

If an infection does not go away with the usual medical treatment, or if a child has many ear infections over a short period of time, the provider may recommend ear tubes:

If a child more than 6 months old has had 3 or more ear infections within 6 months or more than 4 ear infections within a 12-month period
If a child less than 6 months old has had 2 ear infections in a 6- to 12-month period or 3 episodes in 24 months
If the infection does not go away with medical treatment

In this procedure, a tiny tube is inserted into the eardrum, keeping open a small hole that allows air to get in so fluids can drain more easily (myringotomy).

The tubes often eventually fall out by themselves. Those that don’t fall out may be removed in the provider’s office.

If the adenoids are enlarged, removing them with surgery may be considered if ear infections continue to occur. Removing tonsils does not seem to help prevent ear infections.

Outlook (Prognosis)

Most often, an ear infection is a minor problem that gets better. Ear infections can be treated, but they may occur again in the future.

Most children will have slight short-term hearing loss during and right after an ear infection. This is due to fluid in the ear. Fluid can stay behind the eardrum for weeks or even months after the infection has cleared.

Speech or language delay is uncommon. It may occur in a child who has lasting hearing loss from many repeated ear infections.

Possible Complications

In rare cases, a more serious infection may develop, such as:

Tearing of the eardrum
Spreading of infection to nearby tissues, such as infection of the bones behind the ear (mastoiditis) or infection of the brain membrane (meningitis)
Chronic otitis media
Collection of pus in or around the brain (abscess)

Mastoiditis – redness and swelling behind ear

When to Contact a Medical Professional

Contact your provider if:

You have swelling behind the ear.
Your symptoms get worse, even with treatment.
You have high fever or severe pain.
Severe pain suddenly stops, which may indicate a ruptured eardrum.
New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles.

Let the provider know right away if a child younger than 6 months has a fever, even if the child doesn’t have other symptoms.

Prevention

You can reduce your child’s risk of ear infections with the following measures:

Wash your hands and your child’s hands and toys to decrease the chance of getting a cold.
If possible, choose a day care that has 6 or fewer children. This can reduce your child’s chances of getting a cold or other infection.
Avoid using pacifiers.
Breastfeed your baby.
Avoid bottle feeding your child when they are lying down.
Avoid smoking.
Make sure your child’s immunizations are up to date. The pneumococcal vaccine prevents infections from the bacteria that most commonly cause acute ear infections and many respiratory infections.

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References

Haddad J, Dodhia SN. General considerations and evaluation of the ear. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson, KM. eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 654.

Kerschner JE, Preciado D. Otitis media. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson, KM. eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 658.

Pelton SI. Otitis externa, otitis media, and mastoiditis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 61.

Ranakusuma RW, Pitoyo Y, Safitri ED, et al, Systemic corticosteroids for acute otitis media in children. Cochrane Database Syst Rev. 2018;15;3(3):CD012289. PMID: 29543327 pubmed.ncbi.nlm.nih.gov/29543327/.

Rosenfeld RM, Schwartz SR, Pynnonen MA, et al. Clinical practice guideline: tympanostomy tubes in children. Otolaryngol Head Neck Surg. 2013;149(1 Suppl):S1-S35. PMID: 23818543 pubmed.ncbi.nlm.nih.gov/23818543/.

Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2016;154(1 Suppl):S1-S41. PMID: 26832942 pubmed.ncbi.nlm.nih.gov/26832942/.

Schilder AGM, Rosenfeld RM, Venekamp RP. Acute otitis media and otitis media with effusion. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 199.

Sowing of discharge from the ear for microflora, determination of sensitivity to antimicrobial drugs and bacteriophages (Ear Culture, Routine. Bacteria Identification. Antibiotic Susceptibility and Bacteriophage Efficiency testing)

Interpretation of results

Interpretation of test results contains information for the attending physician and is not a diagnosis. The information in this section cannot be used for self-diagnosis and self-medication. An accurate diagnosis is made by a doctor, using both the results of this examination and the necessary information from other sources: anamnesis, results of other examinations, etc.d.

Interpretation of the results of the study “Sowing of discharge from the ear to the microflora, determination of sensitivity to antimicrobial drugs and bacteriophages”

Units of measurement: CFU / swab.

Form for issuing results

If growth is detected as a result, indicate the number of opportunistic microorganisms that have grown in the inoculation, their genus and species. For etiologically significant microorganisms, the results of determining the sensitivity to antimicrobial drugs and bacteriophages are indicated.

The list of AMPs is determined by the type of pathogens identified; the lists can be found here.

The choice of bacteriophages is determined by the type of pathogens identified; the lists can be found here.

If the growth of normal, concomitant and opportunistic flora in a low titer (≤10 ⁴ CFU / swab), which has no diagnostic value, is detected, the determination of antibiotic sensitivity is not carried out, as a corresponding comment is given.

In the complete absence of growth, the result is “no microflora growth detected.”In the case of the growth of microorganisms for which there is no standardized method for determining the sensitivity and evaluation criteria, the determination of the sensitivity is not possible.

Attention! It is not possible to order the determination of the sensitivity to the extended AMP spectrum; for this purpose, test No. 473-P should be ordered.

Interpretation

Normal growth is absent. In case of contamination from the skin, saprophytic or opportunistic bacteria grow in a low titer (≤10 ⁴ CFU / swab).

In case of disease, etiologically significant bacteria are excreted in the diagnostic titer (≥ 10 ⁵ CFU / swab).

According to the literature, 60-98% of inflammatory diseases of the outer ear are bacterial in nature. The microbe landscape with otitis externa has changed over time. If earlier in 70-90% of clinical cases Staphylococcus aureus was sown, and Pseudomonas aeruginosa was present in 10-20% of cases, then recently the role of Pseudomonas aeruginosa has increased on average to 78%, while Staphylococcus aureus occurs only in 9-27% of cases …Less often, in inflammatory diseases of the outer ear, Staphylococcus epidermidis, Streptococcus pyogenes, Streptococcus pneumonia, Enterococcae, Escherichia coli, Proteus, Klebsiella pneumoniae, Mycoplasma pneumoniae, anaerobes and other microorganisms are also detected. In addition to the bacterial flora, pathogenic fungi play an essential role in the development of otitis externa. In some cases, bacterial or bacterial-fungal associations act as an etiotropic factor.

The main causative agents of acute otitis media (AOM) are Streptococcus pneumoniae and Haemophilus influenzae, which together account for approximately 60% of bacterial pathogens of the disease, as well as various types of streptococci.About 20% of cultures from the tympanic cavity are sterile. It is believed that up to 10% of NDEs can be caused by viruses.

Labyrinthitis is always a complication of another inflammatory process. The disease can be caused by various viruses, bacteria and their toxins.

The absence of bacterial growth does not exclude the presence of infections caused by microorganisms that cannot be isolated within the framework of this study, in particular, anaerobes, mycoplasmas and other types of microorganisms that require special cultivation conditions.

Otolaryngologist

An otolaryngologist is a doctor who treats diseases of the ear, throat and nose. More often he is called an ENT doctor. The reason why these three organs were united in one medical specialty is very simple: the infection tends to wander from the nose to the ear, and from the throat to the nose, so it is wiser to treat everything in a complex.

Most infections are transmitted by airborne droplets, so the nose and throat are the first things they encounter on the way into our body.SARS, influenza are the most common infectious diseases and their consequences often bring many problems.

Acute purulent otitis media is an acute inflammatory disease characterized by the involvement of the mucous membrane of the middle ear (auditory tube, tympanic cavity, caves and air cells of the mastoid process) in the pathological process.

Stage 1 preperforative

(lasts 1-3 days) – characterized by a diffuse inflammatory process in the ear without delimitation.
The onset of the disease is acute, pronounced shooting, throbbing pain in the ear, which itself covers other ear manifestations: hearing loss, noise, sensation of fluid overflow in the ear.
There are pronounced symptoms of general intoxication: high body temperature, chills and general malaise.
The nipple is slightly painful.
There may be vestibular manifestations: dizziness, nausea, nystagmus, significant hearing loss.

2 stage perforated

lasts 4-7 days.
characterized by the occurrence of spontaneous perforation of the tympanic membrane, which most often occurs 24-48 hours after the onset of the disease.
After the occurrence of perforation and outflow of exudate from the middle ear, the pain quickly subsides, the body temperature decreases.

3 stage resolution

The stage of reverse development or reparative, continues until the end of the 3rd week.
The amount of discharge decreases, they become mucous, flow out without periodic jolts.
The tympanic membrane turns pale, small perforations are closed.

Treatment of a patient with acute purulent otitis media should be differentiated depending on the stage of the disease, the severity of clinical symptoms and take into account the peculiarities of the patient’s somatic status.

Treatment targets:

Regression of inflammatory changes in the middle ear, normalization of hearing and general condition of the patient, restoration of working capacity.

Indication for hospitalization:

patient’s age up to two years
also, regardless of age, severe and (or) complicated course of acute otitis media

Therapies

1. Antibiotic therapy: the prescription of antibiotics in the pre-perforative stage is certainly indicated for severe pain syndrome and an increase in body temperature. The drug of choice in the treatment of complicated forms of otitis media in adults is amoxicillin inside 0.5 g 3 times in CVT for 7-10 days.If there is no effect after three days of therapy with amoxicillin, the antibiotic should be changed to inhibitor-protected penicillins: augmentin / amoxiclav (0.625-1.0 g orally 2-3 times a day) or cephalosporins: cefuroxime axetil orally (0.25 or 0.5 d 2 times a day). For allergies to lactam antibiotics, modern macrolides are prescribed (0.15 g rulid orally 2 times a day; spiramycin 1.5 million IU orally 2 times a day). Even with the onset of a sharp improvement in the general condition of the patient and the mitigation of local symptoms, one should not stop the course of antibiotic therapy ahead of time, its duration is at least 7-10 days.Premature withdrawal of drugs contributes to the recurrence of the disease and the formation of adhesions in the tympanic cavity, which leads to persistent hearing loss.

2. Vasoconstrictive nasal drops solutions of 0.05 – 0.1% naphthyzin, sanorin, galazolin, otrivin, nasivin), which are necessary not only to treat the cause of otitis media (rhinopharyngitis, sinusitis, adenoiditis), but also to ensure the drainage function of the inflamed auditory pipes.

3. Instillation of painkillers, warmed up to the patient’s body temperature, into the sore ear.The most commonly used alcohol is 70º, boric alcohol with which a swab inserted into the external auditory canal up to the tympanic membrane is moistened several times a day. A more powerful local anesthetic effect is possessed by otinum, otipax (4 drops in the ear canal in a heated form).

4. Antipyretics and analgesics inside (paracetomol, perfolgan, NSAIDs (ketorol, nise, novigan, ortofen, etc.), analgin).

5. Antihistamines and anti-inflammatory drugs (fenspiride / erespal) – to potentiate the action of painkillers, reduce swelling of the mucous membrane of the middle ear and prevent side effects of antibiotics (suprastin, tavegil, erius, claritin, zirtek, etc.).

6. Physiotherapy (sollux, UHF), thermal procedures, a warming compress on the behind the ear area) is prescribed only when the function of the auditory tube is restored. These measures improve blood supply and metabolic processes in the affected organ, the delivery of antibiotics to it with blood, as well as natural immune defense factors (antibodies, lymphocytes, macrophages).

The appointment of such a complex conservative therapy is important for the prevention of otogenic intracranial complications, which most often occur during the stage of acute otitis media.However, this treatment is effective in most, though not all, patients.

HOW TO RECOGNIZE OTIT IN A CHILD AND HOW TO PREVENT IT? – clinic “Dobrobut”

Meanwhile, three quarters of all children have ear problems at least once before the age of three.

Why are ear infections so common in children?

Let’s take a look into the middle ear to understand why small ears are so often affected by pathogens.The canal, called the Eustachian (auditory) tube, connects the nasopharynx and the middle ear cavity and performs many important functions: helps to compare pressure, provides ventilation and protection. But it is in the nasopharynx that most bacteria find nutrient moisture as a breeding ground. Since the child’s Eustachian tube is short, wide and placed horizontally, mucous discharge from the throat and nose, as well as any microorganisms in them, it is easier to get through it into the middle ear cavity.The child’s immune system has not yet been fully formed, therefore, it is vulnerable – it takes more time to fight many unfamiliar bacteria. This is how otitis media often develops in many young children.

Why is it important to properly treat baby ears?

Your child’s hearing depends on the correct vibration of the eardrum and the condition of other parts of the middle ear. Repeated infections can damage the eardrum, while the accumulation of fluid in the middle ear cavities negatively affects (seems to muffle) the vibration of the eardrum – in the end, both interfere with normal hearing of the baby.This is why it is important to take treatment for otitis media seriously, especially as your child is learning to speak. Partial hearing loss can lead to a delay in the development of speech or even impairment of pronunciation, later affecting the speech habits and the child’s success in learning.

How to identify otitis media in a child?

It is unlikely that your baby will say: “Something unpleasant is happening in my ear and it hurts me. Please take me to the doctor! »But early diagnosis of otitis media and timely treatment will have better results and prevent complications of otitis media.

Temperature . This is not an obligatory symptom of otitis media. The baby’s temperature rises against the background of a respiratory infection. But when the baby’s temperature is above 37.5 ° C, be sure to consult with your pediatrician. The following additional symptoms or a direct referral from your doctor will tell you about the need to contact a pediatric otolaryngologist.

Runny nose . The most common cause of otitis media is the common cold, which is accompanied by a runny nose.The same mucus secreted from a child’s nose can also get into the Eustachian tube. As a rule, a runny nose in babies begins with an intense production of a transparent liquid secretion in the nasal mucosa, but after a few days it becomes yellow-green and becomes thicker. It is at this stage that it is important to thoroughly rinse the child’s nose and remove mucus (if the child cannot do this on his own, nasal aspirators should be used) to prevent secretions from entering the middle ear cavity.

Bad sleep. If a child wakes up more often at night, cries, is capricious or in some other way expresses that she is in pain, especially during an acute respiratory viral infection, this is also an alarming signal.

Unusual behavior and poor health. Parents can also pay attention to other manifestations of otitis media, which make themselves felt by a change in the child’s usual behavior and a deterioration in her well-being in general:

pain in the ear forcing the baby to touch the head and ears itself all the time;

90,057 the child’s hearing may deteriorate;

the child does not fall asleep well and will have restless sleep
digestive disorders are possible: from impaired appetite, refusal to eat, to vomiting and diarrhea.

However, as a rule, you can suspect an ear infection with a sharp crying of the child, caused by severe pain, especially when you touch her ears.

Should you see a doctor if you suspect otitis media?

This is usually the case. It is very difficult to prescribe the correct treatment in the presence of otitis media without a preliminary examination. The doctor must determine the condition of the eardrum, check the nose and throat in order to choose the correct appropriate complex therapy. In addition, the doctor will be able to advise you on how to prevent the development of the inflammatory process in the ear in the future and what painkillers can be used when the baby’s ear begins to ache (and this often happens in the middle of the night!).

For mild to moderate ear infections, complete recovery can be achieved with topical anti-inflammatories. In this case, you need to carefully monitor the baby’s condition in order to notice the deterioration of the situation in time, and strictly follow the recommendations of the otolaryngologist. If the situation does not improve within two to three days, or in acute otitis media at the first visit, the doctor may prescribe antibiotic therapy.

It is forbidden to treat a child with antibiotics on your own, without a doctor’s prescription! Antibiotics are given only when other treatments may not work.In this case, the doctor takes into account the age and weight of the child in order to correctly calculate the dosage and duration of the course of treatment.

If a child jerks his ear – is he sick?

A child’s habit of touching their ears does not necessarily indicate otitis media. The child may simply be interested in examining her ears, or she likes to pull on them, or her teeth are erupting, irritating nerve endings and forcing the child to constantly tug on her ears. But if the baby’s increased interest in his ears is combined with crying, irritability, fever, runny nose, conjunctivitis, colds in general – you should take this signal seriously.Very often, for attentive mothers, intuition helps in time to notice and recognize an ear infection in a child – especially when they already know what it is and how it can manifest itself.

How to prevent otitis media in children?

Breastfeeding during the first year of life. Mother’s milk provides natural immunity for the baby and contains antibodies that can reduce the risk of developing various infections, including ear infections. If you are bottle feeding your baby, keep him upright (at least 30 degrees tilted) and keep him upright for a few minutes after feeding.Milk can enter the middle ear if the baby sucks while lying down.

No allergens. Irritation of the nasal mucosa due to allergens leads to excessive mucus production and edema of the mucous membranes, which in turn causes blockage of fluid in the middle ear cavities. So get rid of any allergens. Even if your child is not allergic to certain pathogens, there is no place for pets, dust and the accumulation of stuffed toys in the crib in the room where she sleeps. And it is absolutely forbidden to smoke in the presence of a child!

Discard pacifiers. Studies have shown a link between the frequency of pacifier use and otitis media. Try to avoid using a pacifier when your baby is asleep and asleep, especially if your baby is over six months old.

Increase immunity. Provide your child with a balanced and balanced diet, adequate outdoor exposure, and healthy habits to strengthen the immune system.

Get vaccinated to prevent influenza. Research shows that vaccination of a child to prevent influenza reduces the risk of SARS, and with it otitis media.

Be patient. The good news is that as your little one gets older, his Eustachian tube gets longer and narrower, making it harder for fluids to get into the middle ear. Meanwhile, the child’s immune system also becomes stronger, minimizing the risks of infection.

Epley maneuver (exercises) for benign paroxysmal positional vertigo (BPPV)

Relevance

Benign paroxysmal positional vertigo (BPPV) is caused by rapid changes in head movement.A person feels that everything around him or her is moving or spinning. The most common causes are head trauma or ear infections. BPPV can be caused by otolith debris in the semicircular canals of the ear, which continues to move after the head stops moving. This causes a feeling of constant The Epley Maneuver is a treatment that is performed by a physician (or other trained healthcare professional, such as an audiologic researcher, physical therapist) and involves a series of four head and body movements from a position sitting to lying position, coups and returning back to sitting position.This [exercise] is understood to work by removing the otoliths from the semicircular canal. This video demonstrates how the Epley maneuver is performed.

Characteristics of research

We included 11 studies with a total of 745 participants in the review. Five studies (334 patients) compared the effectiveness of the Epley maneuver against the sham maneuver, three others against other particle repositioning maneuvers (Semont, Brandt-Daroff, and Hans), and the following three – with control (no treatment, only drugs, postural restrictions).In eight studies, patients were treated in otolaryngology departments (ear, throat, nose) of hospitals, in two studies by family doctors. All patients were adults between the ages of 18 and 90, with a male to female ratio of 1: 1.5.

Key Outcomes

The Epley maneuver was significantly more effective than the sham maneuver or control for relieving vertigo (vertigo). None of the studies that compared the Epley maneuver to other particle repositioning techniques reported relief of vertigo as an outcome.

When studies in patients looked at switching from a positive to a negative Dix-Hallpike test (a test to diagnose BPPV), the results showed significant advantages in the Epley maneuver treatment group compared to the sham maneuver or control. There was no difference between Epley’s maneuver versus Semont’s or Hans’s. In one study, a one-time Epley treatment was more effective than Brandt-Daroff exercises done three times a day for a week.

Adverse effects were often not reported. There were no serious adverse effects of the treatment. The incidence of nausea during the repositioning maneuver ranged from 16.7% to 32%. Some patients were unable to tolerate the maneuver due to cervical spine (neck) problems.

This review of clinical trials found the Epley maneuver to be safe and effective in the short term. Other specific sequences of physical movements, the maneuvers of Semont and Hans, have similar results.

Quality of evidence

In the included studies, the overall risk of bias was low. All trials were randomized, with five studies using a sealed envelope or external distribution methods. Seven trials blinded patients in treatment groups, and in most studies, treatment outcomes for all types of patient outcomes were hidden for all participants. The evidence is current to January 2014.

Ultraviolet irradiation (UFO) procedure in the Vyborg district of St. Petersburg

Why is UFO (ultraviolet irradiation) necessary?

Otorhinolaryngology is a field of medicine that diagnoses and treats diseases of the ear, nose and throat (ENT organs). Such diseases are very common among people of all ages. The increased attention of doctors to this group of diseases is explained by the high risk of serious complications developing against the background of these diseases.

Otolaryngologists have made significant progress in the development of tools and techniques for the treatment of diseases (tonsillitis, rhinitis, otitis media, tonsillitis, etc.). Physiotherapy in general and ultraviolet irradiation (UFO) in particular plays a significant role in the recovery of such patients. Under the influence of ultraviolet radiation, the treated surface is disinfected from pathogenic bacteria and viruses. The beneficial effects of ultraviolet rays are not limited to superficial effects: they affect the deeper tissues of the human body.

UFO improves tissue regeneration, increases blood circulation, thereby improving metabolism.

This procedure has an effect on the body that is similar in its mechanism to the natural influence of the ultraviolet component of sunlight. Correctly selected UFO technique in the presence of the necessary indications allows to achieve excellent results in the treatment and prevention of diseases of the ENT organs.

Indications for UFO

Indications for UFO in otorhinolaryngology are considered to be:

bacterial pharyngitis
tonsillitis
rhinitis
angina
acute and chronic inflammatory processes
ARVI.

As an adjunct treatment, this procedure can be used in the treatment of sinusitis after the acute phase of the disease.

For the treatment of otitis media, tonsillitis and rhinosinusitis in young children, UFO can also be used, but not during the exacerbation period and in doses appropriate to the child’s age. The otolaryngologist of our clinic will help you make the final decision on the need for UFO.

Contraindications

Obvious contraindications to the use of the UFO procedure for diseases of the ENT organs include:

existing malignant and benign neoplasms;
diseases during an exacerbation;
Increased sensitivity to ultraviolet (UV) radiation.

Methodology of the procedure

The method of the procedure is selected by the doctor of our clinic in accordance with the diagnosis and the patient’s condition, taking into account all the factors affecting the outcome of the treatment. These factors include:

the age of the patient
the degree of damage and the condition of the diseased organ
the presence or absence of other chronic diseases.

Medium-wave and short-wave ultraviolet radiation is used for the treatment and prevention of respiratory and hearing diseases.

Medium wave radiation treats : tonsillitis and acute respiratory diseases are used

Shortwave radiation treats : acute inflammatory diseases of the nasopharynx, inner ear and tonsils.

Field of application

The procedure is carried out locally, i.e. the device synthesizes and directs a beam of UV rays directly to the target area using a special nozzle of the appropriate shape. In the treatment of acute rhinitis, the technique of irradiating the surface of the patient’s feet is sometimes used. In order to protect the eyes from accidental exposure to UV rays, it is necessary to follow the recommendations of the attending personnel .

In order to achieve the maximum effect without getting a burn of the mucous membrane of the nose, larynx and inner ear, the doctor of our clinic in St. Petersburg will select your individual therapeutic dose of radiation. As the course progresses, this dose will increase from session to session.

The number of sessions is prescribed by your attending physician, and rarely when the course exceeds 10 procedures.

In the treatment of chronic diseases, such as chronic tonsillitis, it is recommended to carry out UFO regularly 2 times a year.

The maximum therapeutic effect of the UFO procedure is achieved if it is carried out correctly and in combination with other components of the treatment.

See also : Treatment of snoring, Otolaryngologist’s appointment, Tonsil lavage, Nasal lavage (Cuckoo).

In Moscow, you can make a free express test for COVID-19 at 50 points

Moscow continues to expand the possibilities of free express testing for COVID-19.Free express diagnostics are now available at 50 points throughout the city. This was announced by the Deputy Mayor of Moscow for Social Development, the head of the operational headquarters for control and monitoring of the situation with coronavirus in Moscow, Anastasia Rakova.

“ In an environment of increasing incidence, it is very important to identify new cases in time and interrupt the chains of the virus at the earliest stage. We see interest from residents – more than 20 thousand Muscovites have already passed express tests at the MFC and shopping centers.Such express diagnostics helps people who are worried that they may get sick or who are generally interested in periodic diagnostics in order to remove doubts about the presence or absence of the disease. Therefore, we are expanding the network of free express testing points for COVID-19, now 50 points will operate throughout the city. Starting today, in addition to the 20 that are already operating in the centers of public services “My Documents”, popular public places and shopping centers, we are opening 30 more: in 13 MFCs, 10 shopping centers and 7 transport hubs.We are using TPU for the first time – these are points with high daily traffic, so it will be convenient for a large number of residents to undergo express diagnostics there. They will be able to take a rapid test, for example, on their way home from work. This is a quick process – no pre-registration is required, the result will need to be waited on the spot for 15 minutes. I would like to emphasize that these points are not intended for testing residents who already have symptoms of the disease, we ask them to immediately contact a doctor , ”the vice mayor said.

A positive rapid test result will not confirm a disease. At the same time, for additional diagnostics, they will take a smear for a PCR study for free on the spot without queuing and making an appointment. Within 1-2 days, he will receive a result, and only if it turns out to be positive, the diagnosis will be considered confirmed, a doctor will be sent to the house, and treatment will begin. The PCR result will come via SMS and will also be displayed in the electronic medical record.

You can now get free express diagnostics daily according to their work schedule in 13 centers of state services “My Documents” in the districts:

Kosino-Ukhtomsky (12 Svyatoozyorskaya Street)
Izmailovo (3rd Parkovaya Street, 24)
Dorogomilovo (Kievskiy Vokzal Square, 2)
Savelki (Zelenograd, k337)
Beskudnikovskiy and Vostochnoye Degunino (Dubninskaya Street, 40Ak1)
Babushkinskiy (Letchik Babushkina Street, 1k1)
Pokrovskoe-Streshnevo, 1758 Tushinskaya Street
Yakimanka (Yakimansky lane, 6s1)
Nagorny and Nagatino-Sadovniki (Varshavskoe shosse, 47k4)
Donskoy (5th Donskoy proezd, 15s8)
Lefortovo (passage of the Plant Serp and Molot, 10)
Severnoye Butovo ( Kulikovskaya street, 6)
Troparevo-Nikulino (Pokryshkina street, d.4)

You can take an express test for COVID-19 at 7 points in transport hubs daily from 09:00 to 21:00:

TPU Gagarin Square (in the underground passage between Leninsky Prospekt metro station and MCC station Gagarin Square)
TPU Luzhniki (on the second floor of the main building, to the right of the central entrance)
TPU Panfilovskaya (on the second floor near the escalator to the platform towards Streshnevo station)
TPU Zorge (opposite the exit from the overhead passage to exit 1 (towards st.Berzarina))
TPU Lokomotiv (on the second floor of the northern (No. 2) concourse, opposite the turnstiles)
TPU Izmailovskaya (on the second floor of the TPU in the center of the hall between escalators)
TPU Nizhegorodskaya (opposite the main entrance at the end of the hall, next to cash desks)

You can also do this in 10 shopping centers according to their schedule:

Kvartal West (Aminevskoe highway, building 6)
“City” (Entuziastov highway, building 12, building 2)
“Gagarinsky” (Vavilova street, building 3)
“Shangal” (Zeleny prospect, 62A)
“Salaris” (Kiev highway, 23rd kilometer, building 1)
“Kuntsevo Plaza” (Yartsevskaya street, building 19)
Solnechny (Borovskoe shosse, 6)
Evropeyskiy (Kievskaya square, building 2)
Daria (Stroginsky boulevard, building 1)
Kaluzhsky (Profsoyuznaya street 61A)

Make this express -test is free for everyone.To do this, you only need a passport for an adult or a birth certificate for a child and an OMS policy number, if available. Children can undergo express testing only in the presence of their parents. Residents who test positive on a rapid test will be asked to stay at home until the PCR test result is received. He will come in SMS, and will also be displayed in the electronic medical record. If the result of the PCR test is positive, the case will be considered confirmed. A doctor from a polyclinic will come to the patient’s home, prescribe treatment and give out the necessary medications.With a negative result of the PCR test and in the absence of symptoms of the disease, the person is considered healthy.

A rapid test for antigen to coronavirus infection is a quick diagnosis that makes it possible to detect COVID-19 in a person with a high degree of probability in 15 minutes, but its result does not mean a diagnosis, but only shows the likelihood of the disease. The diagnosis of “coronavirus infection” must be made by a medical professional by performing PCR testing. Express testing is carried out using the same technology (taking a swab from the nose) as PCR, but to obtain the result, the biomaterial is immediately placed in a specialized solution and a test system.

A complete list of free express testing points for COVID-19 is published on the mos.ru portal. Let us remind you that you can also take the express test free of charge in 10 shopping centers and public spaces according to their working hours: GUM, TSUM, RIO shopping centers on Dmitrovskoye Shosse and Leninsky Prospekt, L-153, Yerevan Plaza, Kaleidoscope “,” Oceania “,” Pike “, food mall” DEPO “. Daily from 10 am to 10 pm you can take the express test at the flagship offices of My Documents of the Central Administrative District (Afimall City shopping center, Presnenskaya nab.( in the Leroy Merlin building, Ryazanskiy prospect, 2, building 3), South-Western Administrative District (TC Spektr, Novoyasenevskiy prospect, 1), as well as in the centers of public services of the districts Krylatskoe (Rublevskoe highway 42, building 1), Losinoostrovsky (st. Izumrudnaya, 18), Mitino (Novotushinsky prospect, 10), Nevrasovka (Maresyeva st., 1).

90,000 Strange interview with the Princess of Monaco amplified rumors of family strife among the monarchs

A native of Zimbabwe, 43-year-old Charlene Wittstock has been married to Prince Albert II since 2011.The princess of Monaco spent most of this year in South Africa, and her long stay in this country gave rise to rumors that the royal couple might be about to divorce.

According to the Daily Mail, Monaco denied rumors of a family split in the royal family and said that Charlene’s absence from the principality is due to the fact that she contracted a “serious sinus infection”, which does not allow her to travel and forces her to miss key events. including her 10th wedding anniversary and her kids’ first school trip.

In a new interview, which took place in early October and was posted on Charlene’s Instagram page, the prince said that she “misses her children, Prince Jacques and Princess Gabriella terribly,” adding: “If there is any mother who having to be separated from her children for several months, she will feel the same as me. ”

In the video, Princess Charlene said: “I came to South Africa to oversee several of the foundation’s projects. At that time, I quietly contracted an infection.They began to treat her immediately. Unfortunately, she detained me in South Africa for several months. I had one procedure – it was very successful. I’m fine, I feel much stronger. I have one more procedure. After that I can’t wait to return home to my children, whom I miss terribly. ”

Referring to the anti-poaching work she has been doing in South Africa this year, the Princess said, “I am determined to return and continue the work I set out to do, as I have done in many countries in Africa and South Africa.Conservation, preservation, restoration and education. This is what my foundation stands for. We are saving lives. ”

The interview was published a few days after a source at the palace said that the princess’s latest surgery to treat an ear, nose, and throat infection she contracted in May “went very well.”

The operation in South Africa was carried out under general anesthesia, and this is the last operation that Princess Charlene had to undergo after an ENT infection. She will be under surveillance for 48 hours, the source told the French news agency AFP.

Earlier this month, Prince Albert insisted that his wife is likely to be back in Monaco by the end of the month, telling RMC Radio, “She will be back very soon, we need to talk to the doctors in a few days.”

This comes amid reports that Albert “applied for sovereign immunity” in court proceedings to counter claims that he fathered a third illegitimate child before marrying Charlene. The 63-year-old prince, who has already recognized two illegitimate children, is said to have had a relationship with a Brazilian woman, which resulted in the birth of a daughter in 2005.The lawsuit, which his lawyers dismissed as a “hoax,” is particularly painful since Albert was dating Charlene Wittstock, a former Olympic swimmer at the time.

Last year it was reported that the case would go to court in Milan in February, however, according to Town & Country, the prince’s lawyers claimed sovereign immunity and the case was adjourned.

Lawyer Erich Grimaldi, who acts on behalf of the Brazilian woman, said he hopes the judge will reject Albert’s request and he waits for the case to be returned to court, which he believes will happen “soon.”The 34-year-old plaintiff, whose name cannot be named for legal reasons, claims that she had a passionate affair with Albert, which led to the birth of their daughter, whose name is also classified, on July 4, 2005.

Albert received a handwritten letter from a child who is now 16 years old in September last year, which said: “I do not understand why I grew up without a father, and now that I found you, you do not want to see me.”

Legal paperwork was also filed last December as Plaintiff’s attorneys urged Albert to undergo a DNA test – just as he did before he was finally identified as the father of two illegitimate children, born in the 1990s and early 2000s.

“This was before Charlene and Albert began dating, but the last case concerns the time when she was already in love with him,” said then a source who works closely with the princely family of Monaco. “Charlene has had a terrible year: one family crisis after another, including Albert, who fell ill with the coronavirus, and now she is preparing for this hell.”

The princess, whose maiden name was Charlene Wittstock, was an Olympic swimmer from South Africa when she first met Albert at a water event in Monaco in 2000.The two began dating shortly thereafter, before Charlene married Grimaldi in a stellar wedding in July 2011. Their twins – daughter Gabriella and son Jacques – were born three years later and are considered the official heirs of the princely family. By this time, Charlene had come to terms with Albert’s difficult legal battles with the women, who ultimately achieved financial settlements over the children they had from Albert, although he initially denied their claims.

In May 2005, shortly before he was enthroned as Prince of Monaco, Albert confirmed to be the biological father of Alexander, whose mother was Nicole Costa, a former Air France flight attendant from Togo.A DNA test in May 2006 also confirmed that Albert was the father of Jazmine Grace as a result of an affair with Tamara Rotolo, an American real estate agent he met while she was on vacation in the south of France.

Jazmine was born in the 1990s and Alexander in 2003. The Brazilian woman says she traveled the world with the prince in the 2000s. Grimaldi’s lawyer said he filed paperwork detailing his client’s love affair with Albert, including travel to Brazil, the United States, France and Russia.

Albert’s lawyer, Thierry Lacoste, called the allegations a “hoax”, stating: “There are no intimate photographs, no material facts related to a possible relationship.” According to the financial agreements concluded, neither Albert’s 28-year-old daughter Jazmine Grace Grimaldi, nor his son, 17-year-old Alexander Grimaldi-Costa, can claim the throne of Monaco.

Instead, the lineage favors six-year-old princes Jacques and Princess Gabriella, who frequently appear in their parents’ social media posts.

The latest revelations came a few days after it was revealed that the return of Princess Charlene to Monaco was delayed due to further operations in South Africa.

The Princess Charlene Foundation of Monaco will be placed under general anesthesia during her last procedure … The Princess Charlene Foundation of Monaco wishes her all the best for this latest operation and for her recovery.

The exact nature of the procedure was not disclosed, and it remains unclear how long Charlene will remain in the hospital.

In August, the former Olympian underwent “four-hour surgery under general anesthesia,” although it is unclear if this was due to a sinus infection.

Charlene and Albert met shortly thereafter, for the first time in months after the monarch and their six-year-old twins Jacques and Gabriella flew to South Africa, but the photographs of the couple embracing were called “uncomfortable” by a body language expert.

In the past few weeks, Prince Albert has denied rumors of marital problems, insisting that Charlene “did not leave in disgust” and remains in South Africa only because of “medical complications” following “severe ear, nose and throat infections.”

A royal spokesman told People that speculation about the state of his relationship with the Olympic swimmer “influenced” both of them, but he didn’t address it sooner because he was “focusing on childcare.”

In recent weeks, lifestyle magazines across Europe have been feverish about the royal couple preparing for divorce. French magazine Madame Figaro said the images “did not convince the Monegasques” amid reports that Charlene was looking for a home in Johannesburg.

Historian Philippe Delorme said that “many were under the impression that this was an arranged marriage” between Charlene and Albert, adding: “Albert chose a wife who was similar to his mother, and Charlene clearly felt very uncomfortable in this role.