Otitis Media

GENERAL INFORMATION:

Middle ear infection is caused by bacteria and viruses that enter the middle ear space from the nose or throat by way of the eustachian tube. In children, this tube is short and narrow, and its membranes become swollen and plugged as germs travel through it. Once inside, germs multiply and accumulate inside the middle ear. This may cause fluid and pus to build-up and create pressure behind the ear drum. The ear drum becomes red, tender, and swollen.

Middle ear infections are common in children, especially under the age of 3 years. Almost half of all children will have an ear infection during the first year of life. Many will have reoccurrences. Because ear infections often accompany a cold, they are especially frequent during the fall and winter months. Middle ear infections usually come from inside the throat or nose, NOT FROM THE OUTER EAR WHERE WIND OR WATER MAY ENTER. Middle ear infections are more frequent among children who attend daycare centers and those whose parents smoke at home.

THE ILLNESS

PAIN is the most common symptom of middle ear infections. Older children usually complain of fullness, hearing loss, or a sharp, stabbing pain in the affected ear(s). Infants may also be fussy and irritable, tug at their ears and shake their heads, not feed well, have a change in sleep pattern, and/or develop green or yellow discharge from the eyes. Fever may develop in some children, occasionally as high as 104 F.

Elevated temperatures are more common in infants and toddlers than in older children. Ear drainage may be present. Sometimes the ear drum bursts when pressure from the infection causes it to stretch and break. Although pus and blood may drain from the ear canal when this occurs, the tear in the ear drum is usually quite small and seals itself off in two or three days.

TREATMENT

If your child has a red, tender, infected middle ear space, antibiotics will be prescribed to clear the infection. It is important to complete the course of antibiotics as prescribed to minimize the risk of recurrence. The vast majority of ear infections will respond well to simple, inexpensive drugs such as Amoxicillin .

Some people think that these medications won't work because their child had an infection at some point which didn't clear with these drugs. The fact is that each ear infection involves a new bacteria, and it is the bacteria that you are treating with the antibiotic. If your child has been on multiple antibiotics in recent weeks, then he or she may require stronger antibiotics to clear the infection. Please bear in mind, though, that if your child has not been on antibiotics recently, you should give Amoxicillin a try again, saving the stronger antibiotics for when they are truly needed.

COMFORT MEASURES

Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can provide temporary relief of pain and fever.

SPREAD

Middle ear infections are not contagious, although the viral colds which frequent accompany them can be transmitted to other children. Children with ear infections may return to school or the daycare center when they feel well and have no fever.

Since fluid can remain in the middle ear space for weeks or even months after successful treatment of the
infection, your child may experience a temporary hearing problem.

COMMON CONCERNS

Ear infections that respond well to antibiotics almost never result in permanent changes in hearing. However, while the infection is present or during those times when the middle ear is filled with fluid, there be decreased hearing due to the fluid's dampening effects on the ear drum vibrations. This is a temporary condition that should resolve as the ear drains and the fluid is reabsorbed.

Children with ear infections who do not have pus or blood draining from the ear canal can usually be permitted to go swimming. Diving or placing the head too deeply under water - below 2 feet - may cause severe pain. It is generally safe to travel by airplane or to higher altitudes. It is advisable for the infant to suck or swallow or the older child to drink and swallow or chew gum during take-off and landing when cabin pressure may change. This helps equalize pressure on the ear drum.