Otitis media

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HEALTH GUIDE REFERENCE FROM A.D.A.M

Otitis media is an infection of the middle ear, the area just behind the eardrum. It happens when the eustachian tubes, which connect the middle ear to the nose, become blocked with fluid. With the infection, mucus, pus, and bacteria can also pool behind the eardrum, causing pressure and pain. Ear infections usually begin with a cold. Although adults can get ear infections, they are most common in infants and young children. That's because a child's eustachian tubes are narrower and shorter than an adults, and it's easier for fluid to get trapped in the middle ear. Ear infections usually clear up on their own. Although it was common for doctors to give antibiotics to children with ear infections, now guidelines from the American Academy of Pediatricians suggest taking a wait-and-see approach for the first 72 hours.

With a severe ear infection, pressure may build up and cause the eardrum to rupture. Pus and blood may drain out. This usually relieves pain and pressure, and in most cases the eardrum heals on its own.


Signs and Symptoms

There are two main types of ear infections: acute otitis media (AOM), and otitis media with effusion (OME), where fluid remains trapped in the ear even after the infection is gone.

Acute otitis media causes pain, fever, and difficulty in hearing. If a child is too young to talk, signs of an ear infections can include crying, irritability, trouble sleeping, and pulling on the ears.

Other symptoms that may be associated with an ear infection include sore throat (pharyngitis), neck pain, nasal congestion and discharge (rhinitis), headache, and ringing (tinnitus), buzzing, or other noise in the ear.


Causes

Blockage of the eustachian tubes may be caused by:

  • Respiratory infection (cold)
  • Allergies
  • Exposure to cigarette smoke
  • Infected or overgrown adenoids (tonsils)
  • For infants, being fed lying down (drinking a bottle while lying on the back)

Ear infections occur most often in the winter. They are not contagious, but a cold may spread among a group of children and cause some of them to get ear infections.


Risk Factors

  • Age (children between six and 18 months are most likely to get ear infections)
  • Attending daycare
  • Recent illness (such as a cold or sinus infection)
  • History of allergies (like hay fever, also called allergic rhinitis, or sinusitis)
  • Exposure to secondhand smoke
  • Having family members who are prone to ear infections
  • Using a pacifier


Diagnosis

The doctor will ask questions about whether you (or your child) have had ear infections in the past and ask you to describe the current symptoms. He or she will use an otoscope to look inside the ear. If infected, there may be areas of dullness or redness or there may be air bubbles or fluid behind the eardrum. The fluid may be bloody or filled with pus. The doctor will also check for any sign of perforation (hole or holes) in the eardrum.

Your doctor may also do other tests:

Tympanometry, which uses a small handheld instrument to measure changes in air pressure in the ear and can indicate if the eardrum is ruptured

Reflectometry, in which a small instrument is placed near the ear and makes a sound, allowing the doctor to see if fluid is present behind the eardrum.

A hearing test may be recommended if your child has had persistent ear infections.


Preventive Care

You can reduce your child's risk of ear infection. Here are some tips:

  • Don't expose your child to secondhand smoke.
  • Keep your child away from other children who are sick.
  • Always hold your infant in an upright, seated position during bottle feeding.
  • Breastfeeding for at least six months can make a child less prone to ear infections.
  • Don't use a pacifier.
  • The pneumococcal vaccine (Prevnar) prevents infections such as pneumonia and meningitis, and studies show it slightly reduces the risk of ear infections.


Treatment Approach

The goals for treating ear infections include curing the infection, relieving pain and other symptoms, and preventing future ear infections. If a bacterial infection is present, your doctor may prescribe antibiotics (see section entitled Medications).

However, most ear infections clear up on their own. Because antibiotics tend to be overused for treating ear infections, the Academy of Pediatricians and the American Academy of Family Physicians guidelines suggest taking a wait-and-see approach for 72 hours if

  • The child is older than six months
  • Are otherwise healthy
  • Have mild symptoms or an unclear diagnosis.

Your doctor may suggest using an over-the-counter pain reliever (see Medications). There are also alternative ways to treat the symptoms of ear infections and to prevent persistent and recurrent ear infections. For example, herbal ear drops and homeopathic remedies can be helpful for treating or preventing ear infections.

Before giving any medication to a child, whether over-the-counter, and herbal remedy, or a dietary supplement, you should talk to your pediatrician.

Lifestyle

Applying a warm, moist cloth over the affected ear may help relieve pain.

Medications

  • Antibiotics — If your doctor prescribes antibiotics, be sure to give your child the entire course. The antibiotic most often prescribed for an ear infection is amoxicillin, unless your child is allergic to penicillin. If that's the case. there are several others for your doctor to choose from.
  • Ear drops — If your child has recurring ear infections, a perforated eardrum, or develops infection after ear tubes have been placed (see Surgery and Other Procedures), your doctor may prescribe antibiotic ear drops instead of oral antibiotics, to be used over a period of time (like a few months). If your child doesn't have ear tubes in place and doesn't have any drainage from the ear, your doctor may also prescribe anesthetic ear drops to relieve pain.
  • Ibuprofen, acetaminophen — Ask your doctor about using over-the-counter oral medications for pain and/or fever, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). Children under 18 should not take aspirin, due to the risk of developing a rare but serious illness called Reye's syndrome.

Surgery and Other Procedures

Drainage tubes (myringotomy) — If your child has recurring ear infections that don't respond to antibiotics or if the fluid in the child's ear affects his hearing, your doctor may suggest putting in drainage tubes. During this surgery, which requires general anesthesia, the surgeon inserts a small drainage tube through the eardrum. Fluid behind the eardrum can drain out, equalizing the pressure between the middle and outer ear, which should improve your child's hearing. The tubes usually come out on their own as your child grows and the drainage holes heal.

If ear infections persist after age 4, your doctor may suggest having your child's adenoids (tonsils) removed.

Nutrition and Dietary Supplements

Because supplements (like those described below) may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider. If you think your child has an ear infection, you should always talk to your doctor — don't try to treat the child yourself.

  • Lactobacillus — A probiotic or "friendly" bacteria, it may help reduce the number of colds your child gets (and thus reduce the number of ear infections). One study found that children in daycare centers who drank milk fortified with Lactobacillus had fewer and less severe colds.
  • Xylitol – A sugar alcohol produced naturally in birch, strawberries, and raspberries, it may help fight a type of bacteria that's associated with ear infections. In one study, children who chewed sugarless gum sweetened with xylitol reduced their risk of developing and ear infection by more than a third. However, children in the study were given the gum five times a day, which makes it hard to be compliant. Another study found that taking xylitol three times per day didn't work. More research is needed.
  • Elimination diet — Some doctors believe food allergies contribute to chronic ear infections. Your doctor may ask you to try an elimination diet, which cuts out common food allergens such as wheat or dairy. If symptoms improve, you gradually add back the foods until an ear infection returns. Then you are able to identify and avoid the particular food.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a healthcare practitioner. Before giving any herbs to a child to treat an ear infection, talk to your pediatrician.

  • Herbal ear drops (Calendula officinalis, Hypericum perfoliatum, Verbascum thapsus, Allium sativum) — A few studies suggest that ear drops containing calendula, mullein, St. John's wort, and garlic were as effective at relieving pain as prescription ear drops. However, using oily ear drops can make it hard for the doctor to examine your child's middle ear, so always talk to your doctor first before using them.
  • Echinacea (Echinacea purpurea) — Although it has not been studied for ear infections, some doctors may suggest echinacea to help prevent recurring ear infections. Only give echinacea to a child under your doctor's supervision.
  • Belladonna (Atropa belladonna) — Belladonna is used as a homeopathic remedy for ear infections (see Homeopathy). Although herbal belladonna is toxic, it is safe when prescribed by a homeopath because homeopathic solutions use extremely diluted amounts. Do not use belladonna without the supervision of a trained homeopath.

Homeopathy

Although not many studies have examined the effectiveness of specific homeopathic therapies in general, there have been several studies evaluating homeopathy for ear infections. Some of the homeopathic remedies included in such studies or that a professional homeopath might consider for the treatment of ear infections are listed below. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

  • Aconitum — for throbbing ear pain that comes on suddenly after exposure to cold or wind; and in children with high fever and whose ears have a bright red coloring
  • Belladonna — for sudden onset of infection with piercing pain that often spreads to the neck, flushed face including reddened ears, agitation (even impaired consciousness and nightmares), wide-eyed stare, high fever, and swollen glands; this remedy is most appropriate for children who feel relief when sitting upright and from warm compresses to the ear; this remedy should not be used in children whose symptoms have persisted for more than 3 days
  • Chamomilla — for intense ear pain and extreme irritability and anger (including screaming); this remedy is most appropriate for children who are difficult to comfort unless being rocked or carried by a person who is walking back and forth
  • Hepar Sulphuricum — for sharp pains and a smelly, yellowish-green discharge that occur in the middle and late stages of an ear infection, particularly when the child is extremely moody and clearly angry; this remedy is most appropriate for individuals whose symptoms are worsened by cold air and improved by warmth
  • Lycopedium — for right-side ear pain that is worse in the late afternoon and early evening; the child will generally say that his ears feel stuffed up and he may hear a ringing or buzzing sound; the appropriate individual tends to be insecure and need others around, although the personality type may act like a bully as a defense mechanism
  • Mercurius — good for chronic ear infections; for acute or chronic pain that is worse at night and may extend down into the throat; relief comes from nose blowing; and the appropriate child may sweat or drool a lot and have bad breath
  • Pulsatilla — for infection following exposure to cold or damp weather; the ear is often red and may have a yellowish/greenish discharge; ear pain worsens when sleeping in a warm bed and is relieved somewhat by cool compresses; this remedy is most appropriate for children who tend to be gentle, weepy, and mildly whiny and are easily soothed by affection
  • Silica — for chronic or late stage infection when the child feels chilly, weak and tired; sweating may also be present.


Other Considerations


Warnings and Precautions

If you think your child has an ear infection, especially if your child is under 2, call your pediatrician.

Let your doctor know if your child's symptoms (pain, fever, or irritability) do not get better within 24 to 48 hours.

If severe pain suddenly stops, it may indicate a ruptured eardrum.

Swimming and diving underwater may make an ear infection worse. If your child has a ruptured eardrum, he should avoid swimming or diving completely. If your child has ear tubes, use earplugs or cotton balls coated with petroleum jelly when swimming to prevent infection.

Prognosis and Complications

Generally, an ear infection is a simple, non-serious condition without complications. Most children will have minor, temporary hearing loss during and right after an ear infection. Permanent hearing loss is extremely rare, but the risk increases if the child has a lot of ear infections. Other potential complications include:

  • Ruptured or perforated eardrum (usually heals on its own)
  • Chronic, recurrent ear infections
  • Enlarged adenoids or tonsils
  • Mastoiditis (an infection of the bones around the skull)
  • Speech or language delay in a child who suffers lasting hearing loss from multiple, recurrent ear infections; very rare


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