Otitis media (middle ear infection)

What is otitis media (OM)?

Otitis media is inflammation located in the middle ear. The middle ear is the space behind the eardrum. Otitis media can occur as a result of a cold, sore throat, or respiratory infection.

Facts about otitis media:

  • About 75 percent of children have at least one episode of otitis media by the time they are 3 years of age.
  • Nearly half of these children have three or more episodes by the time they are 3 years of age.
  • Otitis media can also affect adults, although it is primarily a condition that occurs in children.
  • Otitis media is the most common diagnosis for children in the US.
  • About 30 million visits to the pediatrician each year are due to otitis media.
  • Otitis media occurs most often in children younger than 7 years of age and even more frequently in children between the ages of 6 months and 3 years.
  • Otitis media is more common in boys than girls.
  • Otitis media occurs more often in the winter and early spring.

Who is at risk for getting ear infections?

While any child may develop an ear infection, the following are some of the factors that may increase your child's risk of developing ear infections:

  • Spends time in a daycare setting.
  • Being around someone who smokes.
  • Family history of ear infections.
  • A poor immune system.
  • Absence of breastfeeding.
  • Having a cold.
  • Bottlefed while laying on the back.

What causes otitis media?

Middle ear infections are usually a result of a poorly functioning eustachian tube, a canal that links the middle ear with the throat area. When this tube is working properly it:

  1. Allows air to ventilate into the middle ear.
  2. Allows drainage of fluid out of the middle ear.
  3. Protects the middle ear from bacteria and viruses.

When the eustachian tube in not functioning properly bacteria and viruses are more likely to grow in the middle ear and lead to acute otitis media. Fluid is more likely to build up behind the eardrum. When this fluid cannot drain, it allows for the growth of bacteria and viruses in the ear that can lead to acute otitis media. The following are some of the reasons that the eustachian tube may not work properly:

  • A cold or allergy which can lead to swelling and congestion of the lining of the nose, throat, and eustachian tube (this swelling prevents the normal flow of fluids).
  • A malformation of the eustachian tube.

What are the different types of otitis media?

Different types of otitis media include the following:

  • Acute otitis media (AOM) - the middle ear infection occurs abruptly causing swelling and redness. Fluid and mucus become trapped inside the ear, causing the child to have a fever, ear pain and hearing loss.
  • Otitis media with effusion (OME) - fluid (effusion) and mucus continue to accumulate in the middle ear after an initial infection subsides. The child may experience a feeling of fullness in the ear and hearing loss.

What are the symptoms of otitis media?

The following are the most common symptoms of otitis media. However, each child may experience symptoms differently. Symptoms may include:

  • Unusual irritability.
  • Difficulty sleeping or staying asleep.
  • Tugging or pulling at one or both ears.
  • Fever.
  • Fluid draining from ear(s).
  • Loss of balance.
  • Hearing difficulties.
  • Ear pain.
  • Nausea and vomiting.
  • Diarrhea.
  • Decreased appetite.
  • Congestion.

The symptoms of otitis media may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is otitis media diagnosed?

In addition to a complete medical history and physical examination, your child's physician will inspect the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the physician to see inside the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.

If fluid remains in the ear(s) for longer than three months, or your child has repeated ear infections, your child's physician may suggest that small tubes be placed in the ear(s). This surgical procedure, called myringotomy, involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating. The child's hearing is restored after the fluid is drained. The tubes usually fall out on their own after about twelve months.

Your child's surgeon may also recommend the removal of the adenoids (lymph tissue located in the space above the soft roof of the mouth, also called nasopharynx). Removal of the adenoids has shown to help some children with otitis media.

What are the effects of otitis media?

In addition to the symptoms of otitis media listed above, untreated otitis media can result in any or all of the following:

  • Infection in other parts of the head.
  • Permanent hearing loss.
  • Problems with speech and language development.

Antibiotic overuse

Antibiotic overuse in children has become a common problem, aggravated by parental pressure for the medication, according to the American Academy of Pediatrics (AAP). In 1980, 4.2 million prescriptions were written for amoxicillin, an oral antibiotic to treat ear infections. In 1992, the number of prescriptions had grown to 12.3 million (194 percent increase). Use of another antibiotic to treat ear infections, cephalosporins, increased from 876,000 prescriptions in 1980 to 6.8 million in 1992 (a 687 percent increase).

Overuse of antibiotics is leading to strains of diseases that are becoming resistant to the medication, making it harder to treat patients. All too often, antibiotics have been prescribed for conditions such as colds, fluid in the middle ear or bronchitis, which do not respond to antibiotics, according to the Centers for Disease Control and Prevention (CDC). Antibiotics are only effective in treating bacterial infections.

The key to preventing overuse of antibiotics is education of the parents and physicians in the appropriate use of antibiotics, according to the AAP. Some tips to remember when taking antibiotics, according to the American Medical Association (AMA), include the following:

  • Take the antibiotics as prescribed.
  • Finish the full course of antibiotics, as prescribed.
  • Do not save or reuse antibiotics.

Always consult your child's physician for more information.