Overview
Otitis media is a middle ear infection that is most common in infants and
young children, from three months to three years of age. It has been shown
that by the age of one year, more than 60% of children will have had one or
more middle ear infections. Although a middle ear infection can occur at any
age, it's much less common in older children and adults.
Causes
The middle ear is connected to the throat by a small tube called the eustachian
tube. It's protected from the outside by a thin shield called a membrane.
Viruses and bacteria that normally live in the throat can sometimes cross into
the middle ear - through the eustachian tube - causing an infection.
Winter is high season for ear infections. They often follow a cold. Some
factors that increase a child's risk for middle ear infections include:
- crowded living or daycare conditions
- exposure to second-hand smoke
- respiratory illnesses
- close contact with siblings who have colds or ear infections
- having a cleft palate
- allergies that cause congestion on a chronic basis
Barometric trauma is another cause of ear infection. The pressure
in the middle ear rises when the airplane you are travelling on descends or
when you ascend while scuba diving. If the eustachian tube is not open, the
pressure in the middle ear cannot be equalized, and thus, may cause injury and
an acute ear infection.
Symptoms
Middle ear infections can be categorized as acute, serous, or chronic.
Common symptoms of acute otitis media are fever, pain, and irritability.
In children, the ear infection often begins after the child has had a cold for
several days.
It's more difficult to detect signs of ear infection in young babies. You
may notice a change in mood or feeding, and the infant will most likely have
a fever. Because ear infections are usually painful, many babies will be irritable.
If fluid builds up in the ear, the infection is called serous otitis media.
This occurs when the eustachian tube becomes blocked, and pressure in the middle
ear drops. Under these circumstances, the child might experience hearing loss
or impairment in the infected ear. This is usually only temporary. While this
is usually no cause for alarm, anyone who experiences hearing loss or impairment
should consult their doctor (and expect a follow-up).
Chronic otitis media refers to recurring ear infections. This is often
complicated by (or caused by) a hole in the eardrum (perforation) from any one
of the following:
- acute infection
- blocked eustachian tube
- heat or chemical burns
- injury from sudden air pressure changes
- injury from an object entering the ear
Chronic ear infections often flare up after a cold, or, if perforated, when
water enters the ear during swimming or bathing. Repeated infections can destroy
the small bones in the middle ear, leading to long-term hearing loss. More serious
complications include spread to nearby organs, appearing as inflammation of
the inner ear, facial paralysis, and brain infections.
Treatment
Otitis media is often treated with antibiotics. To lower the chances
of the infection returning, it's very important to take the antibiotics regularly,
even if the symptoms improve quickly. Many of the infections are actually caused
by viruses, and some doctors believe that a short period of watchful waiting,
rather than antibiotics, is appropriate for children who neither have recurrent
infections nor structural differences in their ears.
Cold medications (such as decongestants) may be useful for keeping the
eustachian tube from becoming blocked. Antihistamines may help people who
have allergies. But neither of these medications will cure the ear infection.
Pain relievers can be used to ease the pain of the infection and to lower a
child's fever. Holding warm cloths over the sore ear may also provide some relief.
Fluid buildup in the middle ear can be drained. In a procedure called
a myringotomy, a tiny tube is inserted into an opening of the eardrum
that drains fluid away and allows air to reach the middle ear which equalizes
the pressure and often allows drainage down the eustachian tube. The cause of
fluid accumulation must also be treated. For instance, if allergic reactions
are to blame for blocking the eustachian tube, then antihistamines will be given
to relieve allergies.
If the child has a permanent hole in his or her eardrum that's causing chronic
otitis media, the eardrum itself can be repaired by a procedure called a tympanoplasty.
It's hard to prevent ear infections since many children, especially those
who attend daycare, are susceptible to colds. Careful hand-washing regimens
can help reduce the chance of catching colds, so it's important to remind your
kids to wash up as often as possible.
Breast-feeding seems to lower the chances of developing ear infections among
infants and children by helping to boost their immunity. Another good preventative
measure is to keep your home smoke-free as smoking damages the cilia,
which are the tiny hairs on the cells that help keep the lining clean. Immunization
with the pneumococcal vaccine can lessen the likelihood of getting ear infections
caused by certain types of bacteria.
Other tips:
Based on a visual examination and description of the symptoms, your doctor
can diagnose otitis media. In an infected ear, the eardrum usually appears
red and swollen. If pus is draining from the ear, a sample can be sent for lab
analysis, to identify which type of bacteria is causing the infection.
When fluid builds up in the middle ear, the doctor can perform a tympanometry.
This is a simple hearing test that measures the pressure on both sides of the
eardrums.
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