Otitis media

Introduction:

Otitis media is an infection of the middle ear, the area just behind the eardrum. It happens when the
eustachian tubes, which connect the middle ear to the nose, become blocked with fluid. With the
infection, mucus, pus, and bacteria can also pool behind the eardrum, causing pressure and pain. Ear
infections usually begin with a cold. Although adults can get ear infections, they are most common in
infants and young children. That's because a child's eustachian tubes are narrower and shorter than
an adults', and it's easier for fluid to get trapped in the middle ear. In fact, otitis media occurs in 75%
of all children. It occurs most commonly between the ages of 6 - 11 months. By age 1, 60% of
children will have had at least one episode of otitis media and 17% will have 3 or more episodes. Ear
infections usually clear up on their own. Although it was common for doctors to give antibiotics to
children with ear infections, now guidelines from the American Academy of Pediatricians suggest
taking a wait and see approach for the first 72 hours.

With a severe ear infection, pressure may build up and cause the eardrum to rupture. Pus and blood
may drain out. This usually relieves pain and pressure, and in most cases the eardrum heals on its
own.

Signs and Symptoms:

There are two main types of ear infections: acute otitis media (AOM), and otitis media with
effusion (OME), where fluid remains trapped in the ear even after the infection is gone.

Acute otitis media causes pain, fever, and difficulty in hearing. If a child is too young to talk, signs
of an ear infection can include crying, irritability, trouble sleeping, and pulling on the ears.

Other symptoms that may be associated with an ear infection include sore throat (pharyngitis), neck
pain, nasal congestion and discharge (rhinitis), headache, and ringing (tinnitus), buzzing, or other
noise in the ear.

Causes:

Blockage of the eustachian tubes may be caused by:

 Respiratory infection (cold)

 Allergies
 Exposure to cigarette smoke
 Infected or overgrown adenoids (tonsils)
 For infants, being fed lying down (drinking a bottle while lying on the back)
Ear infections occur most often in the winter. They are not contagious, but a cold may spread among a
group of children and cause some of them to get ear infections.

Risk Factors:

Risk factors for otitis media include:

 Age (children between 6 - 36 months are most likely to get ear infections)
 Attending daycare
 Recent illness (such as a cold or sinus infection)
 History of allergies (like hay fever, also called allergic rhinitis, or sinusitis)
 Exposure to secondhand smoke
 Having family members who are prone to ear infections
 Using a pacifier

Diagnosis:

The doctor will ask questions about whether you (or your child) have had ear infections in the past
and ask you to describe the current symptoms. He or she will use an otoscope to look inside the ear.
If infected, there may be areas of dullness or redness or there may be air bubbles or fluid behind the
eardrum. The fluid may be bloody or filled with pus. The doctor will also check for any sign of
perforation (hole or holes) in the eardrum.

Your doctor may also do other tests:

Tympanometry, which uses a small handheld instrument to measure changes in air pressure in the
ear and can indicate if the eardrum is ruptured

Reflectometry, in which a small instrument is placed near the ear and makes a sound, allowing the
doctor to see if fluid is present behind the eardrum.

A hearing test may be recommended if your child has had persistent ear infections.

Preventive Care:

You can reduce your child's risk of ear infection. Here are some tips:

 Don't expose your child to secondhand smoke.

 Keep your child away from other children who are sick.
 Always hold your infant in an upright, seated position during bottle feeding.
 Breastfeeding for at least 6 months can make a child less prone to ear infections.
 Don't use a pacifier.
 The pneumococcal vaccine (Prevnar) prevents infections such as pneumonia and meningitis,
and studies show it slightly reduces the risk of ear infections.

Treatment Approach:

The goals for treating ear infections include curing the infection, relieving pain and other symptoms,
and preventing future ear infections. If a bacterial infection is present, your doctor may prescribe
antibiotics (see section entitled Medications).

However, most ear infections clear up on their own. One recent review of the scientific literature found
that the symptoms of otitis media resolved in two thirds of children by 24 hours and in 80% of
children at 2 - 7 days. Because antibiotics tend to be overused for treating ear infections, the
Academy of Pediatricians and the American Academy of Family Physicians guidelines suggest taking a
wait and see approach for 72 hours if:

 The child is older than 6 months

 The child is otherwise healthy
 The child has mild symptoms or an unclear diagnosis.

Your doctor may suggest using an over the counter pain reliever (see Medications). There are also
alternative ways to treat the symptoms of ear infections and to prevent persistent and recurrent ear
infections. For example, herbal ear drops and homeopathic remedies can be helpful for treating or
preventing ear infections.

Before giving any medication to a child, whether over the counter, and herbal remedy, or a dietary
supplement, you should talk to your pediatrician.

Lifestyle

Applying a warm, moist cloth over the affected ear may help relieve pain.

Medications

 Antibiotics -- If your doctor prescribes antibiotics, be sure to give your child the entire course.
The antibiotic most often prescribed for an ear infection is amoxicillin, unless your child is allergic
to penicillin. If that's the case, there are several options. Children who are treated with antibiotics
are more likely to develop vomiting, diarrhea, or a rash.
 Ear drops -- If your child has recurring ear infections, a perforated eardrum, or develops
infection after ear tubes have been placed (see Surgery and Other Procedures), your doctor may
prescribe antibiotic ear drops instead of oral antibiotics, to be used over a period of time (like a
few months). If your child doesn't have ear tubes in place and doesn't have any drainage from the
ear, your doctor may also prescribe anesthetic ear drops to relieve pain.
 Ibuprofen, acetaminophen -- Ask your doctor about using over the counter oral medications
for pain and/or fever, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). Children
under 18 should not take aspirin, due to the risk of developing a rare but serious illness called
Reye's syndrome.

Surgery and Other Procedures

Drainage tubes (myringotomy) -- If your child has recurring ear infections that don't respond to
antibiotics or if the fluid in the child's ear affects his hearing, your doctor may suggest putting in
drainage tubes. During this surgery, which requires general anesthesia, the surgeon inserts a small
drainage tube through the eardrum. Fluid behind the eardrum can drain out, equalizing the pressure
between the middle and outer ear, which should improve your child's hearing. The tubes usually come
out on their own as your child grows and the drainage holes heal.

If ear infections persist after age 4, your doctor may suggest having your child's adenoids (tonsils)
removed.

Nutrition and Dietary Supplements

Because supplements (like those described below) may have side effects or interact with medications,
you should take them only under the supervision of a knowledgeable health care provider. If you think
your child has an ear infection, you should always talk to your doctor -- don't try to treat the child
yourself.

 Lactobacillus -- A probiotic or "friendly" bacteria, it may help reduce the number of colds your
child gets (and thus reduce the number of ear infections). One study found that children in
daycare centers who drank milk fortified withLactobacillus had fewer and less severe colds.
 Xylitol -- A sugar alcohol produced naturally in birch, strawberries, and raspberries, it may
help fight a type of bacteria that's associated with ear infections. In one study, children who
chewed sugarless gum sweetened with xylitol reduced their risk of developing an ear infection by
more than a third. However, children in the study were given the gum 5 times a day, which makes
it hard to be compliant. Another study found that taking xylitol 3 times per day didn't work. More
research is needed.
 Elimination diet -- Some doctors believe food allergies contribute to chronic ear infections.
Your doctor may ask you to try an elimination diet, which cuts out common food allergens such as
wheat or dairy. If symptoms improve, you gradually add back the foods until an ear infection
returns. Then you are able to identify and avoid the particular food.

Herbs
Other Considerations:

Warnings and Precautions

If you think your child has an ear infection, especially if your child is under 2, call your pediatrician.

Let your doctor know if your child's symptoms (pain, fever, or irritability) do not get better within 24 -
48 hours.

If severe pain suddenly stops, it may indicate a ruptured eardrum.

Swimming and diving underwater may make an ear infection worse. If your child has a ruptured
eardrum, he should avoid swimming or diving completely. If your child has ear tubes, use earplugs or
cotton balls coated with petroleum jelly when swimming to prevent infection.

Prognosis and Complications

Generally, an ear infection is a simple condition without complications. Most children will have minor,
temporary hearing loss during and right after an ear infection. Permanent hearing loss is extremely
rare, but the risk increases if the child has a lot of ear infections. Other potential complications
include:

 Ruptured or perforated eardrum (usually heals on its own)

 Chronic, recurrent ear infections
 Enlarged adenoids or tonsils
 Mastoiditis (an infection of the bones around the skull)
 Speech or language delay in a child who suffers lasting hearing loss from multiple, recurrent
ear infections; very rare
Otitis media refers to inflammation of the middle ear. When infection occurs, the
condition is called "acute otitis media." Acute otitis media occurs when a cold,
allergy, or upper respiratory infection, and the presence of bacteria or viruses lead
to the accumulation of pus and mucus behind the eardrum, blocking the Eustachian
tube. This causes earache and swelling.
When fluid forms in the middle ear, the condition is known as "otitis media with
effusion." This occurs in a recovering ear infection or when one is about to occur.
Fluid can remain in the ear for weeks to many months. When a discharge from the
ear persists or repeatedly returns, this is sometimes called chronic middle ear
infection. Fluid can remain in the ear up to three weeks following the infection. If
not treated, chronic ear infections have potentially serious consequences such as
temporary or permanent hearing loss.

How does otitis media What is otitis media?

affect a child’s hearing?

All children with middle ear infection or fluid have some degree of hearing loss. The
average hearing loss in ears with fluid is 24 decibels...equivalent to wearing ear
plugs. (Twenty-four decibels is about the level of the very softest of whispers.)
Thicker fluid can cause much more loss, up to 45 decibels (the range of
conversational speech).
Your child may have hearing loss if he or she is unable to understand certain words
and speaks louder than normal. Essentially, a child experiencing hearing loss from
middle ear infections will hear muffled sounds and misunderstand speech rather
than incur a complete hearing loss. Even so, the consequences can be significant –
the young patient could permanently lose the ability to consistently understand
speech in a noisy environment (such as a classroom) leading to a delay in learning
important speech and language skills.
Types of hearing loss
Conductive hearing loss is a form of hearing impairment due to a lesion in the
external auditory canal or middle ear. This form of hearing loss is usually temporary
and found in those ages 40 or younger. Untreated chronic ear infections can lead to
conductive hearing loss; draining the infected middle ear drum will usually return
hearing to normal.
The other form of hearing loss is sensorineural hearing loss, hearing loss due to a
lesion of the auditory division of the 8th cranial nerve or the inner ear. Historically,
this condition is most prevalent in middle age and older patients; however,
extended exposure to loud music can lead to sensorineural hearing loss in
adolescents.
When should a hearing test be performed?
A hearing test should be performed for children who have frequent ear infections,
hearing loss that lasts more than six weeks, or fluid in the middle ear for more than
three months. There are a wide range of medical devices now available to test a
child’s hearing, Eustachian tube function, and reliability of the ear drum. They
include the otoscopy, tympanometer, and audiometer.
Do children lose their hearing for reasons other than chronic otitis media?
Children can incur temporary hearing loss for other reasons than chronic middle ear
infection and Eustachian tube dysfunction. They include:
 Cerumen impaction (compressed earwax)
 Otitis externa: Inflammation of the external auditory canal, also called
“swimmer's ear.”
 Cholesteatoma: A mass of horn shaped squamous cell epithelium and
cholesterol in the middle ear, usually resulting from chronic otitis media.
 Otosclerosis: This is a disease of the otic capsule (bony labyrinth) in the
ear, which is more prevalent in adults and characterized by formation of soft,
vascular bone leading to progressive conductive hearing loss. It occurs due
to fixation of the stapes (bones in the ear). Sensorineural hearing loss may
result because of involvement of the cochlear duct.
 Trauma: A trauma to the ear or head may cause temporary or permanent
hearing loss.
Related Pages:

Consequences

of otitis media

OME can have several consequences.

■ Hearing loss

The hearing loss associated with OME

generally averages 15-30dB and falls in the

mild to moderate category. The degree of

hearing loss can vary with the progress of the

infection, and it may remain undetected for a

long time. Small children do not complain

and a surprising number of parents fail to

notice that their children are hard of

hearing. Often children are accused of not

paying attention or being naughty and

stubborn or just not wanting to hear.

■ Developmental problems
Although there is some debate over the

psychological, educational and social

consequences of the conductive hearing loss

associated with OME, the general consensus

is that there is a connection, especially when

middle ear disease occurs in the first three

years of life. There is evidence that even a

mild, temporary hearing impairment can

cause difficulties in school.

What is Otitis Media?

Otitis Media is a common childhood infection which affects the middle ear. Because of the
infection, the Eustachian tube (see picture below) gets blocked and stops the airflow that keeps
the middle ear healthy. If infection persists, fluid builds up in the middle ear and can become
thick like glue.

What causes it?

 Colds, flu and chest infections.

 Prematurity ie, being born too early.
 Smoking around children.

What reduces the rate of middle ear infections?

 Taking a shower each day, washing hands and face and washing clothes
regularly.
 Good nutrition - fresh food, cutting down on "junk food".
 A bed for each child - overcrowding increases infection.

Parts of the ear

This picture shows different parts of the ear:

(Look at the glossary, at the end of this fact sheet, for the meanings of the different
words in the picture and in this fact sheet.)

Who is at risk?

Otitis Media is a big problem for Aboriginal children. Many children get Otitis Media but
Aboriginal children are ten times more likely to get it than non-Aboriginal children.

Some factors about Otitis Media (Middle Ear Infection)

 Otitis Media (OM) is a common childhood disease - 75% of all children have had
one episode of O< by the age of five and for some it may continue throughout
school life.
 As many as eight out of ten Aboriginal children could have a middle ear infection
and hearing loss at some time during the school year.
 Hearing loss can make things much harder at school for Aboriginal children,
especially if English is a second language, and the teachers are not aware of all
the problems.
 If children can't hear properly, they can't learn properly.
 A child with Otitis Media may have fluctuating hearing loss. This means that
hearing loss will vary, depending on how bad the ear infection is.

Signs of Otitis Media

Signs of Otitis Media include:

 Ear ache or pain in the ear.

 Cranky or upset or behaviour problems.
  Temperature or high fever.
 Rubbing or pulling ears.
 Not paying attention or always saying "what".
 TV must be louder.
 Doing badly at school or pre-school.
 Off balance.

How does it affect learning?

The build up of the sticky fluid makes it hard to hear. The sticky fluid in the ear can
cause hearing loss. If a child cannot hear what is being said it makes it hard for them to
listen. They can have trouble hearing in the classroom or at home. Because of hearing
loss they can have learning problems or behaviour problems.

What can you do to help?

 Take your child for regular check-ups to help find Otitis Media.
 Breast feeding helps to protect against infection.
 Teach your child how to blow their nose so they can get rid of mucus
(REMEMBER TO BLOW NOT WIPE).
 Make sure you and your children eat healthy foods.
 Try to get housing that is not over crowded - eg one child per bed.
 Don't smoke around children, in the car or in the home, because smoking makes
it easier to get Otitis Media.
 Always make sure your child is seen by the doctor or nurse so you can get help for Otitis Media
that may not be getting better.
 Ask for your child's hearing to be tested if he/she does not seem to be speaking or hearing
properly or if he/she is not doing well at school.
 Ask for your child to see an Ear, Nose and Throat Specialist if he/she does not get better quickly.
 DO NOT give baby a bottle to drink in the cot or bed.
 When feeding baby, hold his/her head in an upright position.

How can parents help the child learn to speak and listen?
 Get your child's attention before speaking and talk loudly, looking at their face so that they can
see you and see your face expressions.
 Talk to your child a lot and read lots of books/stories in a quiet area so they can hear you. By
caring and spending time with your child it will help them to learn.
 Let teachers or carers know that your child has a hearing problem. Ask them to be patient and
help your child learn to listen.