Middle Ear Infections: An Overview of Otitis Media

Otitis Media is an infection in the space behind the ear drum, the "middle ear". It's one of the most common childhood problems that doctors see and treat. More than 70% of all children have at least one middle ear infection by the age of six years.

What causes Otitis Media?

Otitis Media occurs when fluid accumulates behind the ear drum, failing to drain from the tiny passageway (the "eustachian tube") which connects the ear to the nose. In children, the eustachian tube often functions poorly because it isn't mature or strong enough, and is unable to drain the middle ear very well. Bacteria from the nasal passages invade this fluid and cause an ear infection. This explains why Otitis Media occurs so often during or shortly after a cold, when the nose is congested or stuffy.
The Normal Ear and The Infected Ear

How do I know if my child has Otitis Media?

Doctor Checking Child for Ear InfectionA child with Otitis Media often complains of ear pain, may tug at his or her ear, be irritable, and may possibly have a fever. But fever can sometimes be the only symptom, or there may even be no apparent symptoms at all.

If you suspect your child may have a middle ear infection, consult a physician, who can diagnose Otitis Media by examining the ear with a special instrument called an otoscope. Through the otoscope, the infected eardrum is usually red, and may bulge from the pressure created by the accumulated infected fluid behind it.

How is Otitis Media treated?

Otitis Media is treated with antibiotics which are prescribed for a total of up to ten days. The antibiotics must be taken for the total prescribed period, even if symptoms improve or disappear before the medication is finished. Failure to finish the medication may lead to complications of the infection, or may cause the infection to recur. Symptoms should start to improve within 48 hours after starting the antibiotics. Meanwhile, acetaminophen may be given as needed for relief of pain and/or fever, in doses appropriate to the child's age and weight. If the child is still suffering from symptoms more than 48 hours after antibiotic treatment has started, the antibiotic may have failed. In this case the child should be re-examined to determine if the antibiotic needs to be changed. After the full course of antibiotics, a follow-up examination is necessary in order to make sure that the infection has cleared up completely.

Are antibiotics absolutely necessary?

The use of antibiotics to treat ear infections has been questioned recently by those who argue that some ear infections, like colds, are caused by viruses rather than bacteria. Antibiotics are not effective in treating viruses, and many people are justifiably concerned about the overuse of antibiotics. Studies have also shown that about 30% of middle ear infections do not heal on their own without the use of antibiotic treatment. This means that about 70% of infections go away on their own. The difficulty is, that it is impossible, just by examining the ear, to identify the 30% of children who will need the antibiotics. Identifying these children is important, as untreated Otitis Media has the potential to develop serious infectious complications.

Today, in certain situations, such as an older child with a mild infection(red tympanic membrane, without any fluid in the middle ear), some physicians may choose not to treat the Otitis Media right away with antibiotics, but may rather follow the child closely making sure that the infection clears on its own. On the other hand, if the infection is severe(and with obvious fluid in the middle ear), especially in the younger child, an antibiotic will be prescribed. Which treatment approach a physician selects depends entirely on the individual situation.

What are the possible complications of Otitis Media?

The most common complications of Otitis Media are recurrence or persistence of ear infections, and/or continued presence of fluid in the middle ear despite antibiotic treatment. By blocking or muffling sound transmission, the fluid causes hearing loss. This hearing loss can lead to delayed language development, especially in younger children. When the problem of Otitis Media persists or recurs despite repeated courses of antibiotics, there are generally two options. One is to keep the child on low dose daily antibiotics for several months as a preventative measure. The other treatment option aims directly at keeping the middle ear space dry. This minor surgical process performed by an Ear-Nose-Throat (ENT) Specialist involves the insertion of a small plastic tube through the ear drum to allow fluid in the middle ear to drain through to the outside. In a sense, this drain or tube is used while awaiting the ear's natural drainage, the Eustachian Tube to mature. This simple procedure is by far the most common type of surgery performed on children in North America - a reflection of how common Otitis Media is.

Serious complications of Otitis Media are rare, but have been seen. These include the development of an infection in the tissues covering the brain (meningitis), extension of the infection to the bone around the ear, and spread of the bacteria to the blood.

Because of the risk of complications, antibiotics are used to treat most children with Otitis Media. Fortunately, the vast majority of children outgrow Otitis Media and have absolutely no hearing loss or other long term complications as a result of childhood middle ear infections.

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