What is otitis media (OM)?
Otitis media is a localized inflammation in the middle ear. Otitis media can happen as a result of a cold, sore throat, or respiratory infection.
Facts about otitis media
More than 80 percent of children have at least one episode of otitis media before the age of 3 years.
Otitis media can also touch adults, although it is chiefly a condition that occurs in children.
Who is at risk for ear infections?
While any child can mature an ear infection, the following are some of the factors that can increase the risk of your child developing ear infections:
- Being around someone who smokes
- Family history of ear infections
- A poor immune system
- Spend time in daycare
- Lack of breastfeeding
- To have a cold
- Bottle fed while lying on your back
What Causes of otitis media?
Middle ear infections are typically the result of a malfunction of the Eustachian tube, a canal that connects the middle ear to the throat area. The Eustachian tube helps equalize the pressure between the outer ear and the middle ear. When this tube doesn't work properly, it prevents the normal drainage of fluid from the middle ear, causing fluid to build up behind the eardrum. When this fluid cannot drain, it allows bacteria and viruses to grow in the ear that can cause acute otitis media. The following are some of the reasons why the Eustachian tube may not work properly:
A cold or allergy that can cause swelling and mobbing of the lining of the nose, throat, and Eustachian tube (this swelling prevents the normal drainage of fluids from the ear).
A malformation of the Eustachian tube.
What are the different types of otitis media?
The different types of otitis media contain the following:
Acute otitis media. This middle ear infection occurs suddenly and causes swelling and redness. Fluid and mucus get trapped inside the ear, causing the child to have a fever and an earache.
Otitis media with effusion. Fluid (effusion) and mucus continue to build up in the middle ear after the initial infection subsides. The child may experience a feeling of fullness in the ear that may affect her hearing or she may have no symptoms.
Chronic otitis media with effusion. Fluid stays in the middle ear for a long time or comes back again and again, even if there is no infection. It can make it hard to fight a new infection and can affect your child's hearing.
Symptoms of otitis media
Earache is the main sign of a middle ear infection. Children can also have:
difficulty eating, drinking, or sleeping Chewing, sucking, and lying down can cause painful pressure changes in the middle ear.
Older children may complain of an earache, but a younger child may simply pull on their ear or be fussy and cry more than usual.
If the pressure of the fluid build-up increases enough, the eardrum can rupture and fluid leaks out of the ear. This is a common cause of broke eardrums in children. A child with a ruptured eardrum may feel dizzy or nauseous and have ringing or buzzing in the ear.
How do ear infections occur?
A middle ear infection usually occurs due to inflammation of one or both Eustachian tubes (which connect the middle ear to the back of the throat). The tubes allow mucus to drain from the middle ear into the throat.
A cold, sore throat, acid reflux, or allergies can cause the Eustachian tubes to swell. This blocks the drainage of mucus. The viruses or bacteria then grow in the mucus and produce pus, which collects in the middle ear.
When physicians refer to an ear infection, they usually mean otitis media rather than swimmer's ear (or otitis externa). Otitis media with effusion occurs when uninfected fluid builds up in the ear. It may not cause symptoms, but in some children, the fluid creates a feeling of fullness or "popping" in the ear.
Risk factor's for otitis media
Risk factors for ear infections include:
- Years. Children between the ages of 6 months and 2 years are more susceptible to ear infections because of the size and shape of their Eustachian tubes and because their immune systems are still developing.
- Group childcare. Children who are cared for in groups are more likely to get colds and ear infections than children who stay at home. Children in group settings are exposed to more infections, such as the common cold.
- Infant feeding. Babies who drink from a bottle, especially while lying down, tend to have more ear infections than babies who are breastfed.
- Seasonal factors. Ear infections are most common in the fall and winter. People with seasonal allergies may be at higher risk for ear infections when pollen counts are high.
- Poor air quality. Exposure to tobacco smoke or high levels of air pollution can increase the risk of ear infections.
- Alaska Native Heritage. Ear infections are more common among Alaska Natives.
- Cleft palate. Differences in bone structure and muscles in children with cleft palate can make it difficult for the Eustachian tube to drain.
Complications of otitis media
Most ear infections do not cause long-term complications. Ear infections that happen over and over can lead to serious complications:
Hearing impairment Mild hearing loss that comes and goes is fairly common with an ear infection, but usually improves after the infection clears. Ear infections that recur over and over again, or fluid in the middle ear, can lead to more significant hearing loss. If there is any permanent damage to the eardrum or other structures in the middle ear, permanent hearing loss can occur.
Delays in speech or development. If hearing is temporarily or permanently impaired in infants and young children, they may experience delays in speech, social skills, and development.
Spread of infection. Untreated infections or infections that do not respond well to treatment can spread to nearby tissues. Infection of the mastoid, the bony bump behind the ear, is called mastoiditis. This infection can result in bone damage and the formation of pus-filled cysts. In rare cases, serious middle ear infections spread to other tissues in the skull, including the brain or surrounding membranes (meningitis).
Tear of the eardrum. Most tears in the eardrum heal within 72 hours. In some cases, a surgical repair is needed.
Prevention of otitis media
The following tips can reduce the risk of developing ear infections:
- Prevents common colds and other illnesses. Teach your children to wash their hands frequently and thoroughly and not to share eating and drinking utensils. Teach your children to cough or sneeze into the crook of your arm. If possible, limit the time your child spends in group child care. A child care environment with fewer children can help. Try to keep your child from daycare or school when he is sick.
- Avoid secondhand smoke. Make sure no one smokes in your home. Outside the home, stay in smoke-free environments.
- Breastfeed your baby. If possible, breastfeed your baby for at least six months. Breast milk contains antibodies that can offer protection against ear infections.
- If bottle feeding, hold your baby upright. Avoid putting a bottle in your baby's mouth while he is lying down. Do not put bottles in the crib with your baby.
- Talk to your doctor about vaccinations. Ask your doctor which vaccines are appropriate for your child. Vaccines against seasonal flu, pneumococcal, and other bacterial vaccines can help prevent ear infections.
Diagnosis of otitis media
Your healthcare provider will look at your / your child's ear with an instrument called an otoscope. A healthy eardrum will be pinkish gray and translucent (clear). If there is infection, the eardrum may be swollen, swollen, or red.
Your healthcare provider can also check the fluid in the middle ear with a pneumatic otoscope, which injects a small amount of air into the eardrum. This should make the eardrum move back and forth. The eardrum will not move as easily if there is fluid inside the ear.
Another test, tympanometry, uses air pressure to check for fluid in the middle ear. This test does not test hearing. If necessary, your healthcare provider will order a hearing test, performed by an audiologist, to determine possible hearing loss if you or your child have had frequent or long-lasting ear infections or fluid in the middle ear that does not drain.
Your healthcare provider will also check your throat and nasal passages and listen to your breathing with a stethoscope for signs of upper respiratory infections.
Treatment of otitis media
A middle ear infection can be treated with:
- Antibiotics, by mouth or as ear drops.
- Pain medication
- Decongestants, antihistamines, or nasal steroids
For chronic otitis media with effusion, an auditory tube (tympanostomy tube).
Your healthcare provider may also ask you to try autoinflation. This helps adjust the air pressure in your ear. To do this, you pinch your nose and breathe out gently. This causes the air to return through the Eustachian tube.
The exact treatment for your ear infection will depend on the type of infection you have. In general, if your symptoms do not improve within 48 to 72 hours, contact your healthcare provider.
Middle ear infections can cause long-term problems if left untreated. They can lead to:
- Infection in other parts of the head
- Permanent hearing loss
- Paralysis of a nerve in your face
Sometimes you may need a CT scan or MRI to look for rare causes, such as a cholesteatoma or tumors. If you have a middle ear infection that does not improve, you should see an ear, nose, and throat specialist (ENT) or a specialized otologist.
Sometimes the fluid stays in the middle ear even after taking antibiotics, and the infection clears. In this case, your healthcare provider may suggest that a small tube (also called a tympanostomy tube) be placed in your ear. The tube is placed in the opening of the eardrum. The tube prevents fluid from building up and relieves pressure in the middle ear. It can also help you hear better. This procedure is sometimes called a myringotomy. It is most often done in children, but it is also done in adults. In adults, it is a routine procedure that takes less than 5 minutes in the office. The tubes usually fall off on their own after 6 months to a year. The ear tubes can be inserted by an ENT specialist or a specialized otologist.
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