Otitis Media (Ear Infection)

Children at Risk for Getting Ear Infection           Antibiotics & Otitis Media
Causes of Otitis Media                                      Diagnostic of Otitis Media
Different Types of Otitis Media                          Treatment of Otitis Media
Symptoms of Otitis Media                                 Effects of Otitis Media

Otitis media is inflammation located in the middle ear. The middle ear is the space behind the eardrum. In children, otitis media often follows or is associated with a cold or respiratory tract infection. 

About 75 percent of children have at least one episode of otitis media by the time they are 3 years of age. Otitis media is the most common diagnosis for children in the US. About 30 million visits to the pediatrician each year are due to otitis media.

Otitis media occurs most often in children younger than 7 years of age and even more frequently in children between the ages of 6 months and 3 years.

Children at Risk for Getting Ear Infection

Any child may develop an ear infection, the following are some of the factors that may increase your child's risk of developing ear infections: 

• Spends time in a daycare setting 
• Being around someone who smokes 
• Family history of ear infections 
• Absence of breastfeeding 
• Having a cold
• A poor immune system 

Causes of Otitis Media

Middle ear infections are usually a result of a poorly functioning eustachian tube. The eustachian tube is a canal that links the middle ear with the throat area. When this tube is working properly it: 

• Allows air to ventilate into the middle ear 
• Allows drainage of fluid out of the middle ear 
• Protects the middle ear from bacteria and viruses

When the eustachian tube in not functioning properly bacteria and viruses are more likely to grow in the middle ear and lead to acute otitis media. Fluid is more likely to build up behind the eardrum. When this fluid cannot drain, it allows for the growth of bacteria and viruses in the ear that can lead to acute otitis media. 

The following are some of the reasons that the eustachian tube may not work properly: 

• A cold or allergy which can lead to swelling and congestion of the lining of the nose, throat, and eustachian tube (this swelling prevents the normal flow of fluids)
• A malformation of the eustachian tube 

Different Types of Otitis Media

Different types of otitis media include:

• Acute otitis media (AOM) - the middle ear infection occurs abruptly causing swelling and redness. Fluid and mucus become trapped inside the ear, causing the child to have a fever, ear pain, and hearing loss.
• Otitis media with effusion (OME) - fluid (effusion) and mucus continue to accumulate in the middle ear after an initial infection subsides. The child may experience a feeling of fullness in the ear and hearing loss.

Symptoms of Otitis Media 

The following are the most common symptoms of otitis media. However, each child may experience symptoms differently. Symptoms may include: 

• Unusual irritability 
• Ear pain
• Hearing difficulties
• Difficulty sleeping or staying asleep 
• Tugging or pulling at one or both ears 
• Fever 
• fluid draining from ear(s) 
• loss of balance 
• decreased appetite 
• congestion 

The symptoms of otitis media may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis. 

Diagnosis of Otitis Media

In addition to a complete medical history and physical examination, your child's physician will inspect the outer ears and eardrums using an otoscope. The otoscope is a lighted instrument that allows the physician to see inside the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement. 

Tympanometry, is a test that can be performed in most physicians' offices to help determine how the middle ear is functioning. It does not tell if the child is hearing or not, but helps to detect any changes in pressure in the middle ear. 

A hearing test may be performed for children who have frequent ear infections. There are new types of hearing tests that can be performed on a child of any age.  No child is too young for a hearing test!

Treatment of Otitis Media

Specific treatment for otitis media will be determined by your child's physician based on the following:

• Your child's age, overall health, and medical history
• Extent of the condition
• Your child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference 

• Antibiotic medication by mouth or ear drops 
• Medication for pain or fever and watchful waiting to see if the symptoms persist before prescribing an antibiotic 

If your child develops repeated ear infections that require antibiotic treatment or has fluid remaining behind the eardrum after the ear infection for longer than three months, your child's doctor may suggest that a pediatric otolaryngologist evaluate your child. 

The pediatric otolaryngologist may then determine that your child needs small tubes placed in the ears. This surgical procedure, called myringotomy, involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating.

The child's hearing is generally restored after the fluid is drained. The tubes usually fall out on their own after about twelve months.

Your child's surgeon may also recommend the removal of the adenoids (lymph tissue located in the space above the soft roof of the mouth, also called nasopharynx). Removal of the adenoids has shown to help some children with otitis media.

Effects of Otitis Media

In addition to the symptoms of otitis media listed above, untreated otitis media can result in any/all of the following: 

• Infection in other parts of the head 
• Ppermanent hearing loss 
• Problems with speech and language development 

Antibiotics and Otitis Media

There has been much written about antibiotics and ear infections in recent years. Over the past several years there has been increasing difficulty with microbial antibiotic resistance. This means that the antibiotics used to kill the bacteria causing ear infections are much less effective. 

Many of the bacteria that cause ear infections have developed defenses against many of the antibiotics which are commonly used to fight these bacteria. If you have questions about the types of antibiotics or the number of antibiotics your child has been treated with for their ear infections, you should discuss this topic with your doctor.