Otitis media (OM) is the most common acute illness, as than the common cold, young children. Seventy-five percent of all children will experience at least one episode of OM, and 20 percent will have multiple recurrences.
Typically, an infant develops a cold, becomes irritable, cries persistently, sleeps fitfully (if at all), and loses his appetite; fever may or may not be present. Tugging at one or both ears is not a reliable indicator of an ear infection. An older child will complain specifically and continuously of ear pain. At times, band trapped behind the eardrum will build up enough pressure to rupture it. When this occurs, thick, discoloured (usually yellow or green) material will drain from the ear—a reliable sign that an infection is present and a definite reason to contact the child’s physician. Spontaneous perforation of the eardrum, which relieves pressure and results in a dramatic reduction of pain, usually heals in 7 to14 days as the infection resolves. (Before antibiotics were developed, deliberate incision of the eardrum with a tiny scalpel to drain the middle ear was the only specific treatment available for severe otitis media.)
The underlying problem in most cases of OM is a malfunction of one or both eustachian tubes, the small passages that connect each middle car to an area at the back of the throat, just above the palate (roof of the mouth). Normally the eustachian tubes drain secretions from the middle-ear cavities and prevent infected material from entering them. In infants and young children the tubes are shorter, narrower, and more nearly horizontal. As a result, any acute viral infection (specifically, a cold) can disrupt eustachian-tube function more easily. Fluid collects in the middle ear allowing bacteria also present in the nose to gain access to the ear. If an infection develops, inflammation and even more fluid in the middle ear increase pressure on the eardrum, causing pain and irritability.
A number of factors increase the risk of otitis media:
- Recurrent upper-respiratory infections (which can be a problem among children in day-care settings).
- Exposure to cigarette smoke at home.
- Chronic nasal allergy.
- Enlarged adenoids.
- Drinking from a bottle while lying flat.
- An inherited tendency for otitis media based on the shape and characteristics of the eustachian tube and middle ear. Typically, one or both parents will have had ear infections during childhood.
If your infant or child has the symptoms described above, she should be evaluated by a physician. If OM is present, antibiotics will be prescribed. It is important that your child take all the medication as pre-scribed and that any recommended f011ow-up he carried out. Usually symptoms will improve significantly within a day or two. Acetaminophen (Tylenol and other brands)or ibuprofen (Children’s Motrin and other brands) can help relieve pain. Decongestants have not been shown to have a significant impact on OM, and drops (whether oil, pain relievers, or antibiotics) should be placed in your child’s ear only if prescribed by the physician.
- Persistence of fluid (called an effusion) in the middle ear that interferes with the conduction of sound. This can result in significant hearing loss, a particularly important problem in young children because it can delay language development. In older children, hearing problems caused by chronic middle-ear effusion can contribute to school and behavior problems.
- Perforation of the eardrum, as already mentioned. Occasionally this will fail to heal on its own, resulting in ongoing or intermittent drainage along with moderate hearing loss.
- Mastoiditis, an infection of the honeycombed, bony mastoid air cells directly behind the ear. Although mastoiditis can take place in any age-group, it is unusual before the age of two (seemastoiditis).
All of these complications require appropriate care by your child’s primary-care physician and in some cases by an ear, nose, and throat (ENT) specialist. If there have been repeated bouts of otitis media and/or persistent fluid in the middle ear (especially with hearing loss), the physician may recommend a minor operation (called atympanostomy) during which a small ventilating tube is placed in the eardrum. The initial procedure drains the fluid and improves hearing. The tube then continues to equalize pressure between the middle ear and the outside atmosphere, preventing the reaccumulation of fluid, and usually reducing the number and duration of subsequent ear infections. (The insertion of ventilating tubes is the second most common surgical procedure per-formed on children under the age of five.)
When dealing with otitis media, you should call your child’s doctor if
- Your child’s pain or temperature persists after 48hours of treatment
- Persistent drainage from the ear canal is noted
- Your child becomes increasingly ill
- Your child develops a stiff neck, severe headache, nausea, or vomiting