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Childhood Illnesses
and Conditions
: 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.
How do I know if my child has Otitis Media?
A 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, wihtout 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 infecton 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.
RELATED DR.PAUL LINKS:
Are antibiotics needed
to treat ear infections?
Pacifier use: another
possible cause of ear infections
Tubes can help restore
hearing in children with recurrent ear infections
Tubes for ear infections
fact sheet
Other Childhood Illnesses
and Conditions |
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The information provided in this site is
designed to be an educational aid only. It is not intended to
replace the advice and care of your child's physician, nor is
it intended to be used for medical diagnosis or treatment. If
you suspect that your child has a medical condition, always
consult a physician.
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