Otitis Media in Children

What Is Otitis Media?

Otitis media means inflammation of the middle ear. The inflammation occurs as a result of a middle ear infection. It can occur in one or both ears. Otitis media is the most frequent diagnosis recorded for children who visit physicians for illness. It is also the most common cause of hearing loss in children.

Although otitis media is most common in young children, it also affects adults occasionally. It occurs most commonly in the winter and early spring months.

Is Otitis Media Serious?

Yes, it is serious because of the severe earache and hearing loss it can create. Hearing loss, especially in children, may impair learning capacity and even delay speech development. However, if it is treated promptly and effectively, hearing can almost always be restored to normal.

Otitis media is also serious because the infection can spread to nearby structures in the head, especially the mastoid. Thus, it is very important to recognize the symptoms (see list) of otitis media and to get immediate attention from your doctor.

How Does The Ear Work?

The outer ear collects sounds. The middle ear is a pea sized, air-filled cavity separated from the outer ear by the paper-thin eardrum. Attached to the eardrum are three tiny ear bones. When sound waves strike the eardrum, it vibrates and sets the bones in motion that transmit to the inner ear. The inner ear converts vibrations to electrical signals and sends these signals to the brain. It also helps maintain balance.

A healthy middle ear contains air at the same atmospheric pressure as outside of the ear, allowing free vibration. Air enters the middle ear through the narrow eustachian tube that connects the back of the nose to the ear. When you yawn and hear a pop, your eustachian tube has just sent a tiny air bubble to your middle ear to equalize the air pressure.

What Causes Otitis Media?

Blockage of the eustachian tube during a cold, allergy, or upper respiratory infection and the presence of bacteria or viruses lead to the accumulation of fluid (a build-up of pus and mucus) behind the eardrum. This is the infection called acute otitis media. The build up of pressurized pus in the middle ear causes earache, swelling, and redness. Since the eardrum cannot vibrate properly, you or your child may have hearing problems.

Sometimes the eardrum ruptures, and pus drains out of the ear. But more commonly, the pus and mucus remain in the middle ear due to the swollen and inflamed eustachian tube. This is called middle ear effusion or serous otitis media. Often after the acute infection has passed, the effusion remains and becomes chronic, lasting for weeks, months, or even years. This condition makes one subject to frequent recurrences of the acute infection and may cause difficulty in hearing.

What Are The Symptoms Of Otitis Media?

In infants and toddlers look for:

  • pulling or scratching at the ear, especially if accompanied by the following...
    • hearing problems
    • crying, irritability
    • fever
    • vomiting
    • ear drainage

In young children, adolescents, and adults look for:

  • earache
  • feeling of fullness or pressure
  • hearing problems
  • dizziness, loss of balance
  • nausea, vomiting
  • ear drainage
  • fever

Remember, without proper treatment, damage from an ear infection can cause chronic or permanent hearing loss.

What Will Happen At The Doctor’s Office?
During an examination, the doctor will use an instrument called an otoscope to assess the ear’s condition. With it, the doctor will perform an examination to check for redness in the ear and/or fluid behind the eardrum. With the gentle use of air pressure, the doctor can also see if the eardrum moves. If the eardrum doesn’t move and/or is red, an ear infection is probably present.
Two other tests may be performed for more information.
An audiogram tests if hearing loss has occurred by presenting tones at various pitches.
A tympanogram measures the air pressure in the middle ear to see how well the eustachian tube is working and how well the eardrum can move.

The Importance Of Medication

The doctor may prescribe one or more medications. It is important that all the medication(s) be taken as directed and that any follow-up visits be kept. Often, antibiotics to fight the infection will make the earache go away rapidly, but the infection may need more time to clear up. So, be sure that the medication is taken for the full time your doctor has indicated. Other medications that your doctor may prescribe include an antihistamine (for allergies), a decongestant (especially with a cold), or both.
Sometimes the doctor may recommend a medication to reduce fever and/or pain. Analgesic ear drops can ease the pain of an earache. Call your doctor if you have any questions about you or your child’s medication or if symptoms do not clear.

What Other Treatment May Be Necessary?

Most of the time, otitis media clears up with proper medication and home treatment. In many cases, however, further treatment may be recommended by your physician. An operation, called a myringotomy may be recommended. This involves a small surgical incision (opening) into the eardrum to promote drainage of fluid and to relieve pain. The incision heals within a few days with practically no scarring or injury to the eardrum. In fact, the surgical opening can heal so fast that it often closes before the infection and the fluid are gone. A ventilation tube can be placed in the incision, preventing fluid accumulation and thus improving hearing.

The surgeon selects a ventilation tube for your child that will remain in place for as long as required for the middle ear infection to improve and for the eustachian tube to return to normal. This may require several weeks or months. During this time, you must keep water out of the ears because it could start an infection. Otherwise, the tube causes no trouble, and you will probably notice a remarkable improvement in hearing and a decrease in the frequency of ear infections.

Otitis media may recur as a result of chronically infected adenoids and tonsils. If this becomes a problem, your doctor may recommend removal of one or both. This can be done at the same time as ventilation tubes are inserted.

Allergies may also require treatment.

So, Remember . . .

Otitis media is generally not serious if it is promptly and properly treated. With the help of your physician, you and/or your child can feel and hear better very soon.

Be sure to follow the treatment plan, and see your physician until he/she tells you that the condition is fully cured.

Risks Factors for Ear Infections

  • Colds (upper respiratory infections)
  • Winter months
  • Daycare or preschool exposure
  • Family history of middle ear problems
  • Passive smoke exposure
  • Allergy (inhalants and foods (especially dairy))
  • Pacifier use, bottle feeding on the back (unproven yet)

Treatment Options

  • Observation
  • Antibiotics for each recurrent infection with symptoms
  • Preventive antibiotics (no longer recommended!)
  • Immune boosters (Echinacea, Vitamin C, etc.)
  • Otovent Auto Ear Inflation therapy, EarPopper, autoinflation
  • Prevnar pneumococcal vaccination
  • Tympanostomy tube placement
  • Adenoidectomy
  • Aggressive allergy treatment (environmental control, dietary changes, medication, immunotherapy)

Risks for Speech Developmental Delay

The most critical time period for your child's development of speech is during the first 2 years of life. All children need auditory stimulation to develop and mature their brains for interpretation of speech and sounds. This is when children are most sensitive to auditory deprivation. Fluctuating or changing hearing loss from recurrent ear infections seem to be even more problematic than a persistent hearing loss from a chronic fluid buildup.

Although the majority of children under 2 years old will "outgrow" their ear infection using a "wait and see approach", auditory deprivation from ear infections during this critical period can have lifelong, irreversible effects on language and cognitive development. These deficits are in tasks involving discrimination of sound and speech. This subtle auditory learning disability can only be diagnosed at older ages. As a result, aggressive treatment is recommended unless improvement is expected in the short term.

Although ear infections can "permanently damage" the ear and hearing, the incidence of this is rare at this age particularly if monitored and treated by your physician. It is also important to document your child's hearing with a formal hearing test.

Fortunately, despite ear infections being the most common disease of childhood, permanent speech and hearing problems are rare. Some studies have suggested that good parenting with frequent auditory stimulation can have a protective effect on normal speech and hearing.

Suggestions for Parents of Preschool Children with ear Problems

  • Listening comes first
    Children with normal hearing spend their first 12 to 18 months of life learning to listen before they begin to talk. With repeated ear infections and a mild hearing loss, much of this important listening time is decreased. Therefore, helping your child develop good listening skills is an essential first step in learning to talk.

  • Prevent a hearing loss
    Children who have a history of repeated middle ear-problems often have a fluctuating or changing hearing loss. If your child's hearing seems to change, don't wait; trust your intuition that something is wrong. Take him/her to the doctor as soon as possible for treatment. Since audiologists can evaluate the hearing of children even in preschool years, your doctor may refer you for hearing tests. In many cases, there is no indication of pain or a temperature, even when there is fluid behind one or both eardrums. Another reason not to wait.

  • Look and listen
    Alert your child by calling his/her name before you begin to talk. We all tend to stop, turn, then look and listen when we hear our name. Children often do not respond if you talk to them while they are busy playing or looking at something interesting.

  • Control distance
    Even with a mild hearing loss, it is hard to listen at a distance. Make certain that you are in the same room and no more than 5 or 6 feet away from your child when you talk. At this distance, you give the youngster the opportunity to both look and listen. Remember: the closer you are, the louder your voice is.

  • Be a good model
    Don't try to force your child to say words clearly. You will only frustrate yourself and your child. Work on becoming a good speech model for your youngster to imitate. For example, if your child points to an empty glass and vocalizes, you might say: "You want milk." "I'm getting the milk." "Here is the milk." This simple approach helps a youngster both build better listening skills and expands their vocabulary. Again, make certain your child is looking and listening as you talk to him/her.

  • Use praise, not criticism
    When your child tries to talk, learn to praise the effort. Don't criticize and act irritated. Children usually are anxious to please. They would talk clearly if they could. So don't fall into the habit of thinking the child is being stubborn, naughty, or lazy if his speech is limited or not clear.

  • Learn to expand
    Once your child is using single words or short phrases, help him/her use sentences. For example, if he points and says "car," you should expand what he says by adding a few words and saying: "I want the car." "Here is the car." Again, be a good speech model.

  • A quiet room
    Turn off the radio or TV when talking with your child. Most of us find it more difficult to listen carefully when there is a lot of noise around us. This is even more of a problem for the young child.

  • Play and listen
    As part of each day, try to set aside a "play time" for just you and your child. Let your child choose a game, toy or book. During this time talk about your activities but keep your conversation at the child's level. Gradually introduce new ideas and words.



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