Definition of Acute otitis media
Acute otitis media: Inflammation of the middle ear
in which there is fluid in the middle ear accompanied by signs or
symptoms of ear infection: a bulging eardrum usually accompanied by
pain; or a perforated eardrum, often with drainage of purulent
material (pus). Acute otitis media is the most frequent diagnosis in sick
children in the U.S., especially affecting infants and preschoolers.
Almost all children have one or more bouts of otitis media before age
6.
The eustachian tube is shorter in children than adults which
allows easy entry of bacteria and viruses into the middle ear,
resulting in acute otitis media. Bacteria such as Streptococcus
pneumoniae (strep) and Hemophilus influenzae (H. flu) account for
about 85% of cases of acute otitis media and viruses the remaining
15%. Babies under 6 weeks of age tend to have infections from
different bacteria in the middle ear.
Bottlefeeding is a risk factor for otitis media. Breastfeeding
passes immunity to the child that helps prevent acute otitis media.
The position of the breastfeeding child is better than the bottle-
feeding position for eustachian tube function. If a child needs to be
bottle-fed, holding the infant rather than allowing the child to lie
down with the bottle is best. A child should not take the bottle to
bed. In addition to increasing the chance for acute otitis media,
falling asleep with milk in the mouth increases the incidence of
tooth decay.
Upper respiratory infections are a prominent risk factor
for acute otitis media so exposure to groups of children as in child
care centers results in more frequent colds and therefore more
earaches. Irritants such as tobacco smoke in the air also increase
the chance of otitis media. Children with cleft palate or Down
syndrome are predisposed to ear infections. Children who have acute
otitis media before 6 months of age have more frequent later ear
infections.
Young children with otitis media may be irritable, fussy, or have
problems feeding or sleeping. Older children may complain about pain
and fullness in the ear. Fever may be present in a child of any age.
These symptoms are often associated with signs of upper respiratory
infection such as a runny or stuffy nose or a cough.
The buildup of pus within the middle ear causes pain and dampens
the vibrations of the eardrum (so there is usually transient hearing
loss during the infection). Severe ear infections may cause the
eardrum to rupture. The pus then drains from the middle ear into the
ear canal. The hole in the eardrum from the rupture usually heals
with medical treatment.
The treatment for acute otitis media is antibiotics usually for 7-
10 days. About 10% of children do not respond within the first 48
hours of treatment. Even after antibiotic treatment, 40% of children
are left with some fluid in the middle ear which can cause temporary
hearing loss lasting for up to 3-6 weeks. In most children, the
fluid eventually disappears (resorbs) spontaneously (on its own).
Children who have recurring bouts of otitis media may have a
tympanostomy tube inserted into the ear during surgery to permit
fluid to drain from the middle ear. If a child has a bulging eardrum
and is experiencing severe pain, a myringotomy (surgical incision of
the eardrum to release the pus) may be necessary. The eardrum usually
heals within a week.
Acute otitis media is not contagious (although the cold that
preceded it may be). A child with otitis media can travel by airplane
bur, if the eustachian tube is not functioning well, changes in
pressure (such as in a plane) can cause discomfort. A child with a
draining ear should, however, not fly (or swim).
Last Editorial Review: 1/16/2004
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