Otitis Media
What is otitis media?
Otitis media is inflammation of the middle ear. Otitis media can be acute or chronic.
Acute otitis media is usually of rapid onset and short duration. Acute otitis media typically causes fluid accumulation in the middle ear together with signs or symptoms of ear infection; a bulging eardrum usually accompanied by pain, or a perforated eardrum, often with drainage of purulent material (pus).
Chronic otitis media is a persistent inflammation of the middle ear. This condition can cause ongoing damage to the middle ear and eardrum and there may be continuing drainage through a hole in the eardrum.
How common is acute otitis media?
Otitis media is the most common diagnosis in sick children in the U.S. Young children, infants, and preschoolers are particularly prone. Almost every child has at least one bout of acute otitis media before the age of 6.
Why do young children tend to have ear infections?
The eustachian tube is shorter and more horizontal in young children than in older children and adults. This allows easier entry into the middle ear for the microorganisms that cause infection and lead to otitis media.
What is the eustachian tube?
The eustachian tube is a canal that runs from the middle ear to the pharynx (the throat). The function of the eustachean tube is to protect, aerate and drain the middle ear (and mastoid). Occlusion of the eustachian tube leads to the development of middle ear inflammation (otitis media).
The eustachian tube is also called the otopharyngeal tube (because it connects the ear to the pharynx) and the auditory tube (and in Latin, the tuba acustica, tuba auditiva, and tuba auditoria).
The pharynx (throat) is subdivided into 3 parts: the upper part called the nasopharynx, the middle part called the oropharynx, and the lower part called the hypopharynx. The eustachian tube opens into the nasopharynx.
How does the eustachian tube change as a child gets older?
The eustachian tube measures only 17-18 mm and is horizontal at birth. As it grows to double that length, it grows to be at an incline of 45 degrees in adulthood so that the nasopharyngeal orifice (opening) in the adult is significantly below the tympanic orifice (the opening in the middle ear near the ear drum).
The shorter length and the horizontality of the eustachian tube in infancy protects the middle ear poorly, makes for poor drainage of fluid from the middle ear, and predisposes infants and young children to middle ear infection. The greater length and particularly the slope of the tube as it grows serves more effectively to protect, aerate and drain the middle ear.
The eustachian tube in the adult is opened by two muscles (the tensor palati and the levator palati) but the anatomy of children permits only one of these muscles (the tensor palati) to work.
Why do children with a cleft palate tend to have ear infections?
Ear infections are a particular problem for children born with cleft palate because they have poor function of the tensor palati muscle, the only muscle than can open the eustachian tube in children. Children with cleft palate therefore suffer from eustachian tube and middle ear problems until the second muscle (the levator palati) capable of opening the eustachian tube begins to function.
What microorganisms cause otitis media?
Bacteria and viruses cause otitis media. Bacteria such as Streptococcus pneumoniae (pneumococcus) and Hemophilus influenzae (H. flu) account for about 85% of cases of acute otitis media. Viruses account for the remaining 15%. Affected infants under 6 weeks of age tend to have infections from a variety of different bacteria in the middle ear.
What is the relationship between bottle-feeding and otitis media?
Bottle-feeding is a risk factor for developing otitis media. The position of the breast-feeding child is better than that of the bottle-feeding position in terms of function of the eustachian tube that leads into the middle ear. If a child needs to be bottle-fed, it is best to hold the infant rather than allow the child to lie down with the bottle. Ideally, the 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 enhances the risk of tooth decay.)
What are the risk factors for acute otitis media?
Upper respiratory infections predispose to acute otitis media. Exposure to groups of children (as in child care centers) results in more frequent colds, and therefore more earaches. Exposure to air with irritants, such as tobacco smoke, also increases the chance of otitis media. Children with cleft palate or Down syndrome are prone to ear infections.
Children who have episodes of acute otitis media before 6 months of age tend to have more ear infections later in childhood.
What are the symptoms of acute otitis media?
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 temporary 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.
How is acute otitis media treated?
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, this fluid eventually disappears spontaneously (on its own).
Children who have recurring bouts of otitis media may have a an ear tube placed (tympanostomy tube) in the ear to permit fluid to drain from the middle ear.
If a child has a bulging eardrum and is experiencing severe pain, a procedure to lance the eardrum (myringotomy) may be recommended to release the pus. The eardrum usually heals within a week.
What is serous otitis media?
Serous otitis media is inflammation in the middle ear without infection. Typically, the eustachian tube is not functioning and cannot ventilate the ear normally. As a result, fluid accumulates in the middle-ear. This can lead to a dullness or fullness within the ear along with diminished hearing.
What limitations are there on a child with otitis media?
Otitis media is not contagious (although the initial cold that caused it may be). A child with otitis media can travel by airplane but, if the eustachian tube is not working well, the pressure change as the plane descends may cause the child pain. It is best not to fly (or swim) with a draining ear. - Otitis media is the most common diagnosis in sick children in the U.S.
- Otitis media is infection and inflammation of the middle ear.
- Otitis media causes fluid buildup in the middle ear.
- A cold or other respiratory infection can lead to otitis media.
- Exposure to other children's colds, as in daycare, raises the risk.
- Bottle-feeding increases the risk of otitis media in babies.
- Otitis media features fever, ear pain and fullness, as well as fussiness and feeding problems in young children.
- Middle ear pus causes pain and temporary hearing loss.
- Rupture of the eardrum allows the pus to drain into the ear canal.
- Otitis media is treated with antibiotics and ear tubes .
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