OTITIS MEDIA

   Acute Otitis Media
   (Earache)

   Signs and Symptoms:
   Acute otitis media is an inflammation of the area behind the eardrum
   (tympanic membrane). This area is called the middle ear. Acute otitis
   media is an infection with the production of pus within the middle
   ear. The older child will often complain about ear pain, ear fullness
   or hearing loss. Younger children may demonstrate irritability,
   fussiness or difficulty in sleeping, feeding or hearing. Fever may be
   present in a child of any age.

   These symptoms are frequently associated with signs of upper
   respiratory infections such as a runny or stuffy nose or a cough.
   Severe ear infections may cause the ear drum to rupture. This should
   result in pain relief and a fall in the fever. The pus will then start
   to drain out of the middle ear and into the ear canal. The hole in the
   (tympanic membrane). This area is called the middle ear. Acute otitis
   ear drum from the rupture will usually heal with medical treatment.

   Description:

   Ear In children, the eustachian tube is shorter than in adults and
   allows bacteria and viruses to find their way into the middle ear.
   This results in acute otitis media, with a build-up of pus within the
   middle ear. The pressure and inflammation of the pus results in pain
   and the inability of the ear drum to vibrate. During the infection
   there will usually be some hearing loss.

   With proper medical treatment, the bacteria will be killed. As fluid
   and pus disappear from the middle ear, hearing will improve.

   Acute otitis media is a common childhood ailment. By the time a child
   is three, she has a two in three chance of having experienced at least
   one episode of acute otitis media.

   Acute otitis media frequently occurs with respiratory infections as
   the nasal membranes and the eustachian tube become swollen and
   congested. Bacteria are responsible for most (80-85 percent) of cases
   of acute otitis media. STREPTOCOCCUS PNEUMONIAE, HEMOPHILUS INFLUENZA
   and MORAXELLA CATARHALIS are the common bacterial offenders. Viruses
   can be found in about 15 percent of the cases. Sometimes a mixture of
   microorganisms may be found. Infants under six weeks of age often show
   a different class of bacteria called gram-negative bacteria.

   The standard therapy of acute otitis media is antibiotics. Despite the
   start of treatment, 10 percent of children do not have a response to
   their acute otitis media within the first 48 hours of treatment. Even
   after effective antibiotic treatment, 40 percent of children may
   retain a noninfected residual fluid in the middle ear that can cause
   persistent hearing loss. This may last for three to six weeks after
   the initial antibiotic therapy for acute otitis media.

   There are other types of otitis media. Otitis media with effusion is
   the presence of middle ear fluid for six weeks or longer from the
   initial acute otitis media. Some children can develop middle ear fluid
   without a prior ear infection when the eustachian tube is not
   functioning to ventilate the ear. This is called serous otitis media.

   When infection persists, the middle ear and eardrum may start to
   sustain ongoing damage. Frequent drainage through a nonhealing hole in
   the eardrum results. This is called chronic otitis media.

   The treatment of these conditions may vary or require the care of an
   Ear, Nose and Throat specialist (ENT).

   The acute ear infection type of acute otitis media may often be
   preceded by an upper respiratory infection. Although acute otitis
   media itself is not contagious, the preceding upper respiratory
   infection could well be. Once the ear is infected, the duration of the
   infection is variable. It may improve within 48 hours even without
   treatment. Typically, the doctor will prescribe a 10-day course of
   antibiotics, which should, in most cases, cure the infection, Even
   with the elimination of infection, the middle ear fluid may persist
   for weeks or months. During this time a hearing loss will persist. In
   the majority of children, this fluid will eventually clear
   spontaneously.

   More Information

   The Middle Ear
   Deep within the outer ear canal is the eardrum (tympanic membrane).
   The eardrum is a thin, transparent membrane that vibrates in response
   to sound waves. The middle ear is a small, air-containing cavity that
   sits behind the eardrum. When the eardrum vibrates, tiny bones within
   the middle ear transmit the sound signals to the inner ear. Here
   nerves are stimulated to relay the sound signals to the brain. A tiny
   passageway, the eustachian tube, connects the middle ear to the nose.
   The eustachian tube normally serves to ventilate and equalize pressure
   to the middle ear. When your child's ears "pop" when yawning or
   swallowing, it is adjusting the air pressure in the middle ear.

   Prevention:

   In infants, breast feeding helps to pass along immunities that prevent
   acute otitis media. The position of the child with breast feeding also
   is better for eustachian tube function than the position of a baby
   when bottle feeding. 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.

   Frequent upper respiratory infections lead to frequent acute otitis
   media. For this reason, exposure to large groups such as in day care
   results in more frequent colds and therefore more earaches.
   Environmental irritants, such as second hand tobacco smoke, should
   also be avoided.

   Some medical conditions are associated with frequent otitis media,
   specifically Down syndrome, cleft palate and allergies. Certain groups
   of people are also more frequent sufferers of ear infections,
   particularly Caucasians and Native Americans. Males are also more
   commonly affected than females. Children who start with acute otitis
   media when younger than the age of six months may be more prone to
   frequent bouts of ear infection.

   Children who are prone to recurrent bouts of otitis media or who have
   deficiencies in their immune system may be prescribed antibiotics or a
   tympanostomy tube by their doctor. The tube is inserted into the ear
   during surgery to permit fluid to drain from the middle ear.

   Incubation:
   The period of incubation is variable, but usually the otitis media is
   preceded by a few days of upper respiratory tract infection.

   Duration:
   The duration of the disease is variable. There may be improvement
   within 48 hours even without treatment. A week's treatment with
   antibiotics is usually effective. In some cases, fluid may persist in
   the middle ear even after antibiotic treatment for two weeks to even
   two months. In the majority, this clears spontaneously. There may be a
   reduction of hearing during this period.

   Contagiousness:
   Acute otitis media is not contagious, though the upper respiratory
   tract infection that was its primary cause could be.

   Home Treatment:
   Home treatment, after the initial physician's evaluation, relies on
   making the child comfortable. Medications to relieve pain and fever
   may be necessary so the child can sleep. The child can go outside. Can
   a child swim or fly in a plane? What little medical literature there
   is suggests that a child with serious otitis media can fly. If the
   eustachian tube is not functioning well, however, changes in outside
   pressure (such as that occurring in a plane's cabin or underwater) can
   cause discomfort. It is generally recommended that children with
   draining ears should not swim.

   Professional Treatment:
   Antibiotics may be prescribed by the physician. There are broad
   spectrum medications or drugs directed at a specific bacteria detected
   through laboratory testing. In infants younger than six weeks of age,
   intravenous antibiotics and tympanocentesis (surgical drainage of the

   infection to get a sample of pus for the laboratory) may be necessary.
   If there is drainage from the ear, antibiotic ear drops also may be
   prescribed.

   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.

   Many parents are concerned about permanent hearing loss. If
   medications are taken as directed, the chances of permanent hearing
   loss are minimal.

   When to Call Your Pediatrician:
   Unresolved otitis media can lead to complications, so children with
   earache or a sense of fullness in the ear, especially when combined
   with fever or a prior upper respiratory tract infection, should always
   be evaluated by a physician. There also are other conditions that can
   result in earaches - dental ailments (teething), a foreign object in
   the ear, ear canal injury (as from cotton swabs) or hard ear wax. The
   physician can diagnose the exact cause of the discomfort and offer
   specific therapy.