ACUTE OTITIS MEDIA

Signs and symptoms

Acute otitis media is an inflammation of the area behind the eardrum (tympanic membrane). This area is called the middle ear. Deep within the outer ear canal is the eardrum. The eardrum is a thin, transparent membrane that vibrates in response to sound waves. The middle ear is a small cavity that contains air and sits behind the eardrum.

When the eardrum vibrates, tiny bones within the middle ear transmit the sound signals to the inner ear. In the inner ear, nerves are stimulated to relay the sound signals to the brain. The eustachian tube, which connects the middle ear to the nose, normally ventilates and equalizes pressure to the middle ear. When your child's ears "pop" when yawning or swallowing, the eustachian tube is adjusting the air pressure in the middle ear.

Acute otitis media is an infection that produces pus within the middle ear. Older children will often complain about ear pain, ear fullness, or hearing loss. Younger children may demonstrate irritability, fussiness, or difficulty in sleeping, feeding, or hearing. Fever may be present in a child of any age.

These symptoms are frequently associated with signs of upper respiratory infection, such as a runny or stuffy nose or a cough. Severe ear infections may cause the eardrum to rupture. The pus will then start to drain out of the middle ear and into the ear canal. The hole in the eardrum from the rupture will usually heal with medical treatment.

The period of incubation is variable, but usually otitis media is preceded by 4 to 7 days of upper respiratory tract infection.

Description

In children, the eustachian tube is shorter than in adults and allows bacteria and viruses to find their way into the middle ear more easily. This results in acute otitis media, with a buildup of pus within the middle ear. The pressure and inflammation result in pain and the inability of the eardrum to vibrate. During the infection there will usually be some temporary hearing loss.

With proper medical treatment, the bacteria will be killed. As fluid and pus disappear from the middle ear, hearing will improve.

Acute otitis media is a common childhood ailment. Two out of three children under the age of 3 experience at least one episode of acute otitis media.

Acute otitis media frequently occurs with respiratory infections as the nasal membranes and eustachian tube become swollen and congested. Bacteria are responsible for 80% to 85% of cases of acute otitis media. STREPTOCCOCCUS PNEUMONIAE, HEMOPHILUS INFLUENZA, and MORAXELLA CATARHALIS are the common bacterial offenders. Viruses can be found in about 15% of the cases. Sometimes a mixture of microorganisms may be found. Infants under 6 weeks of age may show a different group of bacteria in the middle ear.

Standard therapy for acute otitis media is antibiotics. Despite the start of treatment, 10% of children do not respond within the first 48 hours of treatment. Even after effective antibiotic treatment, 40% of children may retain noninfected residual fluid in the middle ear that can cause some temporary hearing loss. This may last for 3 to 6 weeks after the initial antibiotic therapy.

There are other types of otitis media. Otitis media with effusion is the presence of middle ear fluid for 6 weeks or longer from the initial acute otitis media. This occurs when the eustachian tube is not functioning to ventilate the ear and middle ear fluid develops without a prior ear infection.

Chronic otitis media may develop when infection persists for more than 2 weeks. The middle ear and eardrum may start to sustain ongoing damage occasionally resulting in drainage through a nonhealing hole in the eardrum.

The treatment of these conditions may require the care of an ear, nose, and throat (ENT) specialist.

An upper respiratory infection often precedes acute otitis media. Even with the elimination of infection, the middle ear fluid may persist for weeks or months. During this time a hearing loss may persist. In the majority of children, this fluid will eventually clear spontaneously.

Duration

The duration of acute otitis media is variable. There may be improvement within 48 hours even without treatment. Treatment with antibiotics for a week to 10 days is usually effective. Even after antibiotic treatment, fluid may persist in the middle ear for 2 weeks to 2 months. In most children, acute otitis media clears spontaneously after antibiotic treatment. Hearing may be reduced during this period.

Contagiousness

Acute otitis media is not contagious, though the upper respiratory tract infection that may precede it could be.

Prevention

In infants, breastfeeding helps to pass along immunities that prevent acute otitis media. Also, the position of the child when breastfeeding is better than the bottle-feeding position for eustachian tube function. If a child needs to be bottle-fed, holding the infant rather than allowing the child to lie down with the bottle is best. A child should not take the bottle to bed. In addition to increasing the chance for acute otitis media, falling asleep with milk in the mouth increases the incidence of tooth decay.

Multiple upper respiratory infections may lead to frequent acute otitis media. For this reason, exposure to large groups of children, such as in child care centers, results in more frequent colds and therefore more earaches. Environmental irritants, such as secondhand tobacco smoke, should also be avoided.

Some medical conditions are associated with frequent otitis media, specifically Down syndrome, cleft palate, and allergies. Certain groups of people are also more frequent sufferers of ear infections, particularly Native Americans. Males are also more commonly affected than females. Children who have acute otitis media when younger than 6 months may be more prone to frequent bouts of ear infection.

Children who are prone to recurring bouts of otitis media or who have deficiencies in their immune system may be prescribed antibiotics or a tympanostomy tube by their doctor to prevent future infections. A tympanostomy tube is inserted into the ear during surgery to permit fluid to drain from the middle ear. Antibiotics are not an effective treatment for otitis media with effusion.

When to call your child's doctor

Unresolved otitis media can lead to complications, so children with earache or a sense of fullness in the ear, especially when combined with fever or a prior upper respiratory tract infection, should always be evaluated by a doctor. There are also other conditions that can result in earaches: dental ailments (teething), a foreign object in the ear, ear canal injury (as from cotton swabs), or hard ear wax. Your child's doctor can diagnose the exact cause of the discomfort by careful examination of the eardrum and offer specific therapy.

Professional treatment

Antibiotics may be prescribed by your child's doctor. There are broad spectrum medications or drugs directed at specific bacteria usually implicated in otitis media. In infants younger than 6 weeks, intravenous antibiotics and tympanocentesis (surgical drainage of the infection to get a sample of pus for the laboratory to use in identifying the germ) may rarely be necessary. If there is drainage from the ear, antibiotic ear drops also may be prescribed.

If your child has a bulging eardrum and is experiencing severe pain, a myringotomy (surgical incision of the eardrum to release the pus) may be necessary. The eardrum usually heals within a week.

Children with recurring otitis media infections may be given a low dose antibiotic treatment that will last for a few months.

Many parents are concerned about permanent hearing loss. If medications are taken as directed, the chances of permanent hearing loss are minimal.

Home treatment

The purpose of home treatment, after the initial doctor's evaluation, is to make the child comfortable. Medications to relieve pain and fever may be necessary so the child can sleep. The child can continue to go outside.

What little medical literature there is suggests that a child with otitis media can travel by airplane. If the eustachian tube is not functioning well, however, changes in outside pressure (such as that occurring in a plane or underwater) can cause discomfort. It is generally recommended that children with draining ears should not swim or travel by airplane.