What is otitis media?
Otitis media is what we normally think of as an ear infection. It should be distinguished from otitis externa "swimmer's ear" which is an infection of only the ear canal and otitis media with effusion which means there is fluid in the middle ear without any signs of infection. Otitis media is also known as a middle ear infection (an infection in the space behind the ear drum). In children, otitis media is one of the most common infections. More than 90% of children will have at least one infection by two years of age.
What causes otitis media?
Ear infections can be caused by bacteria or viruses. Risk factors include day care and second hand smoke exposure. Allergies may also contribute to ear disease but are not usually the direct cause of infections. Certain congenital syndromes like Down syndrome, Treacher-Collins, and patients with a cleft palate are at greater risk for having ear infections.
How common is otitis media?
Otitis media is one of the most common reasons children present to the doctor's office and is the most common infection for which antibiotics are prescribed for children in the United States. By age three, 30% of children will have had three or more episodes. If ear infections start before 6 months of age, your child may be otitis prone and could suffer more than the usual amount of infections during the first few years of life. Also, infections in newborns can lead to more severe complications when compared to older children.
How do I know if my child has an ear infection?
Ear infections for some children are very painful. Commonly associated symptoms include pulling on the ears, increased irritability or behavioral changes, awakening at night, fever, decreased appetite, not wanting to lie flat, or loss of balance. Some children have little or no discomfort and ear infections may be picked up by routine doctor visits. In order to make the diagnosis of acute otitis media your doctor should confirm a history of acute onset, identify signs of middle ear fluid and evaluate for the presence of signs or symptoms of middle ear inflammation.
When should I go see the doctor?
If your child has the signs or symptoms of an ear infection, see your pediatric doctor without delay. Although doctors may differ in their opinion on how to treat ear infections, it is important for your child to be followed closely until the ear infection resolves completely. This includes the active infection as well as any remaining fluid in the middle ear space.
What options are available to treat ear infections?
The most common treatment for ear infections in the Unites States remains antibiotics and pain medication (Tylenol® or Motrin®). For more severe infections, a shot may be required to help reduce the symptoms more quickly. Observation without the use of antibiotics is a reasonable alternative in selected children based on diagnostic certainty, age, illness severity and assurance of follow up. It is important that these children also receive appropriate pain medication. Decongestants and antihistamines have not been found helpful in clearing ear infections unless the child is known to have significant allergies contributing to the problem.
What are some of the complications of otitis media?
Otitis media will often resolve without any treatment at all. However, possible complications of untreated ear infections can include a hole in the ear drum, hearing loss, or mastoiditis (an infection of the hard bone felt behind the ear). There are other more serious and even life threatening complications such as meningitis, brain abscess or blood clots in the brain. These are rare but can occur.
When should I see an Ear Nose and Throat specialist?
If you are wondering when your child should be referred to an ENT specialist, the following are guidelines which have been jointly adopted by the American Academy of Pediatrics and the American Academy of Otolaryngology:
What if my doctor has recommended ear tubes?
The two most common reasons for placing ear tubes would be recurrent ear infections and persistent fluid in the middle ear with hearing loss. Both of these conditions can be improved with ear tubes. Ear tubes also help avoid other complications of chronic ear disease. Your ENT surgeon will be happy to discuss any additional questions you may have regarding the risks and benefits of ear tubes.
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