FitSugar

Keep Your Earbuds to Yourself!

FitSugar — Tue, 20 Jan 2009 08:00:00 -0800

While we know that listening to loud music can cause hearing loss, now we have a new thing to worry about when it comes to using earbuds. A study published in the Online Journal of Health and Allied Sciences has found that frequent use of earphones greatly increases the bacterial growth in the ear. If you share earbuds with a friend, say on the bus or while watching a movie on a laptop, bacteria can transfer from your friend's earbud to your ear. If that happens, it can lead to a painful ear infection. So the bottom line is to use your own earbuds, or thoroughly clean the set you're going to share.

Source

Into Swimming? Avoid Swimmer's Ear

FitSugar — Thu, 21 Aug 2008 13:00:00 -0700

If Michael Phelps and Dara Torres have inspired you to hit the pool, let me warn you about an unwanted side effect of spending lots of time in the water - swimmer's ear. When your ear is exposed to excess moisture, (whether you're swimming or bathing), water can stay trapped in your ear canal. Then the skin inside your ear can become soggy and begin to break down. When this happens, water dilutes the acidity of the ear canal allowing bacteria or fungi to penetrate the skin, causing a painful swimmer's ear infection. Actually, you don't even have to be near water in order to contract swimmer's ear since anything that causes a break in the skin of your ear canal can lead to this infection. That's why cleaning your ear with a cotton swab (or sticking anything else in your ear for that matter) is not recommended. Once there's damage to the skin, you're at risk for an infection.

To find out how you can prevent swimmer's ear read more.

Swimmer's ear can cause pain, tenderness, ringing, and itchiness in your ear, so you want to avoid it at all costs. As soon as you're finished with a swim or shower, shake your head to one side and then the other to get excess water out of your ear. Over the counter drops that contain a dilute solution of acetic acid or alcohol can also help dry up your ear canal. Wearing ear plugs while swimming is also a good way to prevent water from entering your ear in the first place. Of course, whether you swim or not, you also want to stop cleaning your ear with cotton swabs.

Source

DrSugar Answers: Deadly Pools?

FitSugar — Fri, 11 Jul 2008 08:00:00 -0700

DrSugar is in the house and answering your questions.

DrSugar,
I have a friend who was banned from swimming as a child. She grew up with a pool in her backyard and developed a serious ear infection that landed her in the hospital. Her doctor told her that if she ever swam again she could die. Is this lifelong ban from swimming warranted? Is there such an ear infection that could kill you? I cannot imagine not swimming.
Missing Mermaid

To see DrSugar's answer, just read more.

When you dive into the matter, swimming pools can be a mine field of dangers for adults and children alike, ranging from sunburns to dreaded cramps if you swim less than 30 minutes after eating, from skin infections or ear infections. The list of hazards also includes drowning and thermal shock. But swimming is a common form of recreation and with it come some side effects.

Outer ear infections, called otitis externa, are relatively common among aquatic athletes and those who spend a lot of time in the water. The infection is caused by bacteria or fungi, and symptoms include ear pain, a feeling of fullness in the ear and itching. It is generally a mild condition easily treatable with antibiotic ear drops. Common risk factors for developing an outer ear infection include swimming and diving in polluted or infected waters, such as a lake populated with waterfowl, hot and humid weather, eczema of the ears, and any trauma to the ear canal such as aggressive cleaning with cotton swabs.

While outer ear infections are usually relatively benign, there is a very small risk of developing a more serious condition known as malignant or necrotizing otitis externa. Essentially a more severe infection, it can spread to the skull or even the brain. This infection is more common in untreated outer ear infections and people with severe immunosuppresion such as diabetes. Having an outer ear infection also puts you at higher risk for developing another outer ear infection again in the future. To answer your question, it’s unclear why the doctor in this situation banned the girl from swimming forever, but she should definitely consult with an ear, nose and throat (ENT) specialist before jumping into the pool with you.

If you have a question for DrSugar, send me a private message here and I will forward it to the good doctor.

DrSugar's posts are for informational purposes only and should not be considered medical advice, diagnosis, or treatment recommendations. Click here for more details.

When an Earache Needs Medical Attention

FitSugar — Fri, 07 Dec 2007 16:30:00 -0800

Last month we went over the signs and symptoms of realizing when a stomachache may require a visit to the doctor, recently I was confronted with a similar issue - an earache. I used to think that ear infections were just a problem for babies and small children, but adults can suffer from them, too. While earaches can be a symptom of a cold, that ache can turn into an infection. Since ear infections require antibiotics (earaches generally subsides when the cold goes away), your ears might need some medical attention.

Here are symptoms to look for when an earache has evolved into an ear infection, meaning time to visit your doctor.

Loss of appetite. This may be apparent in young children, especially during bottle feedings. Pressure changes in the middle ear as the child swallows, causing more pain.
Irritability.
Poor sleep. Pain may be more persistent when lying down as fluid is shifting.
Fever. Ear infections can cause temperatures up to 104°F.
Vertigo. You may have a sense of spinning.
Drainage from the ear. Yellow, brown, or white fluid that isn't earwax may seep from the ear, indicating the eardrum has ruptured.
Difficulty hearing. Fluid build-up in the middle ear prevents the eardrum from functioning properly. The sound is then unable to be transmitted to the bones of the middle ear and from there to the brain.

Source

Prevent Swimmer's Ear

FitSugar — Wed, 20 Jun 2007 17:15:00 -0700

Your ears are pretty remarkable. Their unique design helps to tip water out of your ear canal, so you can usually bathe, shower, swim, and even walk in the rain with no problems. The ear canal is also acidic which prevents against bacterial and fungal infections.

However, if your ear is exposed to excess moisture (like if you're swimming a lot), the water can stay trapped in your ear canal. This skin can then get soggy and break down, diluting the acidity and allowing bacteria or fungi to penetrate through the skin, causing an infection called swimmer's ear.

The weird thing is that you don't have to swim to get swimmer's ear. Anything that causes a break in the skin of your ear canal will cause this infection - that's why cleaning your ear with a cotton swab is NOT recommended - if you damage the skin, you could risk getting swimmer's ear.

What are the symptoms? PAIN! The ear may also feel itchy or full. The outer ear may turn red or get swollen, and the lymph nodes around the ear may become enlarged and tender. There may be discharge - clear at first, but then turn cloudy, yellowish, and pus-like. Hearing, understandably, is affected as well.

Fun stuff, huh? So what do you do if you have swimmer's ear? To find out, read more

If your infection is severe, your doctor will prescribe drops that contain antibiotics for 7-10 days to fight the infection, and steroids to reduce swelling. Oral meds like ibuprofen or aspirin may also be suggested to help reduce the pain.

Fit's Tips: To prevent this painful infection during the summer, as soon as you're done swimming, shake your head to one side and then the other to get excess water out of your ear. OTC drops that contain a dilute solution of acetic acid or alcohol can also help dry up your ear canal. If you or your child is prone to swimmer's ear, wearing ear plugs may also be a good option.

Source

Is it an Ear Infection? Find Out With EarCheck

FitSugar — Fri, 16 Mar 2007 11:00:00 -0700

If you have young kids, you already know ear infections are a part of childhood. Children are susceptible to them because when they're sick, kids have a hard time getting the mucus out of their body. They're just beginning to learn the vital skill of blowing their nose. The mucus ends up draining into their ears, causing severely painful infections.

You can make many a trip to your pediatrician to have your kid's ears examined. Wouldn't it be great if you could check your children's ears at home without a doctor?

The EarCheck Middle Ear Monitor might be just the gadget you need. For $49.95, you can check your own child's ear to see if they have an infection. Just like the one at the doctor's office, this one uses sound waves to detect if there is fluid in the middle ear.

Checking your child's ear is quick and painless - if you can get them to hold still (I always find that element a problem). The EarCheck Monitor has an easy to read display and with the information you can decide if a doctor's visit is necessary.

Now that the weather is warming up, we'll be heading swimming. This monitor can also check for Swimmer's Ear. So it could be handy to have one on hand so you can spend more time enjoying the weather outside, and less time sitting in a doctor's office.

Ear infections

FitSugar — Wed, 08 Oct 2008 17:35:31 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Highlights

Ear Infections

Middle ear (otitis media) infections are very common in young children. They include:

Acute otitis media (AOM) is an inflammation caused by bacteria that travel to the middle ear from fluid trapped in the Eustachian tube. Children with AOM exhibit signs of an ear infection including pain, fever, and tugging at the ear.
Otitis media with effusion (OME) refers to fluid that accumulates in the middle ear without obvious signs of infection. OME usually produces no symptoms, but some children will have difficulty hearing or complain of “plugged up” ears.

Prevention

Preventing colds and influenza (“flu”) is the best way to prevent ear infections. Make sure children wash their hands frequently and receive an influenza vaccine annually. The pneumococcal vaccine is also very helpful for preventing ear infections.

Treatment

Most ear infections resolve without antibiotic treatment.
For most children with AOM, doctors recommend waiting 48 - 72 hours before prescribing antibiotics. However, children younger than 6 months should receive immediate antibiotic treatment. Parents can give children 6 months and older ibuprofen or acetaminophen to help relieve pain.
Antibiotics are not helpful for most cases of OME. Doctors usually monitor children with OME for 3 months to see if their condition improves. Some children with hearing loss and developmental problems may eventually need surgery. Inserting tubes into the ear drum (tympanostomy) is the usual surgery for this problem.

Introduction

The ear is the organ of hearing and balance. It has three parts: the outer, middle, and inner ear.

The outer ear collects sound waves, which move through the ear canal to the tympanic membrane, commonly called the eardrum.
The tympanic membrane, or ear drum, is lined with mucus. When incoming sound waves strike this membrane, it vibrates like a drum, and converts the sound waves into mechanical energy.
This energy echoes through the middle ear. The middle ear is a complex structure filled with air and made of tiny bones. These bones vibrate to the rhythm of the eardrum and pass the sound waves on to the inner ear.
The inner ear is filled with fluid. Here, hair-like structures stimulate nerves to change sound waves into electrochemical impulses that are carried to the brain, which senses these impulses as sounds.
The inner ear also contains three semi-circular canals that function as the body's gyroscope, regulating balance.
The Eustachian tube, an important structure in the ear, runs from the middle ear to the passages behind the nose and the upper part of the throat. This tube helps equalizes the air pressure in the middle ear to the outside air pressure. Problems here are primary factors in most cases of ear infection.

The ear consists of external, middle, and inner structures. The eardrum and the three tiny bones conduct sound from the eardrum to the cochlea.

Acute Otitis Media (AOM). An inflammation in the middle ear is known as "otitis media." AOM is a middle ear infection caused by bacteria that traveled to middle ear from fluid build-up in the Eustachian tube. AOM may develop during or after a cold or the flu.

Middle ear infections are extremely common in children, but they are infrequent in adults.
In children, ear infections often recur, particularly if they first develop in early infancy.

Otitis Media with Effusion (OME). This condition occurs when fluid, called an effusion, becomes trapped behind the eardrum in one or both ears, even when there is no infection. In chronic and severe cases, the fluid is very sticky and is commonly called "glue ear."

It is usually not painful. Sometimes the only clue that it is present is a feeling of stuffiness in the ears, which can feel like "being under water."
It may impair children's hearing.
Children who are susceptible to OME can have frequent episodes for more than half of their first 3 years of life.
Most episodes will resolve within 3 months, but 30 - 40% of children may have recurrent episodes. Only 5 - 10% of episodes last longer than 1 year.

Chronic Otitis Media. This condition refers to persistent fluid behind the tympanic membrane without any infection present. It is called suppurative chronic otitis when there is persistent inflammation in the middle ear or mastoids, or chronic rupture of the eardrum with drainage.

Swimmer’s Ear (Acute Otitis Externa). Acute otitis externa (AOE) is an inflammation or infection of the outer ear and ear canal. It can be triggered by water that gets trapped in the ear. The trapped water can cause bacteria to breed. AOE can also be precipitated by overly aggressively scratching or cleaning ears or when an object gets stuck in the ears.

In 2006, the American Academy of Otolaryngology -- Head and Neck Surgery Foundation (AAO-HNSF) issued their first guidelines for management of AOE. A key recommendation is that AOE should be treated with topical (not oral) antibiotics. For pain relief, over-the-counter remedies such as acetaminophen or nonsteroidal anti-inflammatory drugs (such as ibuprofen) usually help, but in severe cases opioid drugs may be prescribed. With eardrops, most cases of AOE will clear up within 2 - 3 days.

Causes

Bacteria. Certain bacteria are the primary causes of acute otitis media (AOM). They are detected in about 60% of cases. The bacteria most commonly causing ear infections are:

Streptococcus pneumoniae (also called S. pneumoniae or pneumococcus) is the most common bacterial cause of acute otitis media, causing about 40 - 80% of cases in the U.S.
Haemophilus influenzae, the next most common culprit, is responsible for 20 - 30% of acute infections.
Moraxellacatarrhalis is responsible for 10 - 20% of infections.
Other bacteria include Streptococcus pyogenes and Staphylococcus aureus.

Viruses. Rhinovirus is a common virus that causes a cold and plays a leading role in the development of ear infections. It is not the direct infecting organism, however. But other viruses, such as respiratory syncytial virus (RSV, a virus responsible for childhood respiratory infections) and influenza (flu), may be the actual causes of some ear infections. Increasing evidence suggests that both viruses and bacteria play a role in ear infections. Viruses can increase middle ear inflammation and interfere with antibiotics’ efficacy in treating bacterial-causes ear infections. HIV or other immunocompromised states also increase the risk for ear infections.

Acute otitis media (middle ear infection) is usually due to a combination of factors that increase susceptibility to infections by specific organisms in the middle ear. The infection typically evolves as follows:

The primary setting for ear infections is in a child's Eustachian tube, which runs from the middle ear to the nose and upper throat. The Eustachian tube is shorter and smaller in children than adults, and therefore more vulnerable to blockage. It is also more horizontal in younger children and therefore does not drain as well.
Changes in middle ear pressure occur in about two-thirds of children with colds. Colds and respiratory infections are caused by viruses, such as the rhinovirus. Viruses play an important role in many ear infections, and can set the scene for a bacterial infection.
However, many bacteria normally thrive in the passages of the nose and throat. Most are not harmful. In fact, some can even block harmful bacteria from getting out of control. An additional defense system in the airways, such as mucus, prevents the harmful bacteria from spreading and infecting deeper passages, such as those in the ear.
If a cold does occur, the virus can cause the membranes along the walls of the inner passages to swell and obstruct the airways. If this inflammation blocks the narrow Eustachian tube, the middle ear may not drain properly. Fluid builds up. The defense systems described above become inefficient, and the fluid becomes a breeding ground for bacteria and subsequent infection.

Respiratory viruses may also contribute directly to the infection. Allergens can also produce inflammation and blockage in the Eustachian tube, which creates an environment favorable to bacteria.

The rise in ear infections has paralleled the increasing incidences of other upper and lower airway disorders such as asthma, allergies, and sinusitis. For example, the same bacteria are often responsible for both ear infections and sinusitis. In one study, 38% of children with ear infections also had sinusitis, and other studies have reported that nearly half of children with OME have concurrent sinusitis. Data indicate that nearly a third of infants and toddlers with upper respiratory infections go on to develop acute otitis media.

Medical or Physical Conditions that Affect the Middle Ear. Any medical or physical condition that reduces the ear's defense system can increase the risk for ear infections. Children with shorter than normal and relatively horizontal Eustachian tubes are at particular risk for initial and recurrent infections. Inborn structural abnormalities, such as cleft palate, increase risk. Genetic conditions, such as Kartagener's syndrome in which the cilia (hair-like structures) in the ear are immobile and cause fluid build up, also increase the risk. Children with Down syndrome or Fetal Alcohol Syndrome may also be at increased risk due to anatomical abnormalities.

Otitis media with effusion (OME) may occur spontaneously following an episode of acute otitis media. Susceptibility to OME may also be due to an abnormal or malfunctioning Eustachian tube that causes a negative pressure in the middle ear, which allows fluid to leak in through capillaries.

Risk Factors

Acute ear infections account for 15 - 30 million visits to the doctor each year in the U.S. In fact, ear infections are the most common reason why an American child sees the doctor. Furthermore, the rate of acute otitis media has been rising over the past decades.

Acute Otitis Media (AOM). About two-thirds of children will have a least one attack of AOM by age 3, and a third of these children will have at least 3 episodes. Boys are more likely to have infections than girls.

AOM generally affects children ages 6 - 18 months. The earlier a child has a first ear infection, the more susceptible they are to recurrent episodes (for instance, 3 or more episodes within a 6-month period).

As children grow, however, the structures in their ears enlarge and their immune systems become stronger. By 16 months, the risk for recurrent infections is rapidly declining. After age 5, most children have outgrown their susceptibility to any ear infections.

Otitis Media with Effusion. OME is very common in children aged 6 months to 4 years, with about 90% of children having OME at some point. More than 50% of children have OME before the age of 1, and more than 60% by age 2.

Ear infections are more likely to occur in the fall and winter. The following conditions also put children at higher risk for ear infection:

Allergies. Some experts believe that an increase in allergies is also partially responsible for the higher number of ear infections, which is unlikely to be related to day care attendance. Studies indicate that 40 - 50% of children over 3 years old who have chronic otitis media also have allergic rhinitis (hay fever). Allergies can cause inflammation in the airways, which may contribute to ear infections. Allergies are also associated with asthma and sinusitis. However, a causal relationship between allergies and ear infections has not been definitively established.
Enrollment in day care. Although ear infections themselves are not contagious, the respiratory infections that precipitate them can pose a risk for children with close and frequent exposure to other children. Some experts believe that the increase in ear and other infections may be due to the higher attendance of very small children, including infants, in day care centers beginning in the 1970s.
Exposure to second-had cigarette smoke. Parents who smoke pose a significant risk for both otitis media with effusion (OME) and recurrent acute otitis media (AOM) in their children. (Passive smoking does not appear to be a cause of initial ear infections, however.)
Being bottle-fed as infants. Babies who are bottle-fed may have a higher risk for otitis media than breastfed babies. The American Academy of Pediatrics recommends breastfeeding for at least the baby's first 6 months.
Pacifier use. Several studies have found that the use of pacifiers place children at even higher risk for ear infections. Sucking increases production of saliva, which helps bacteria travel up the Eustachian tubes to the middle ear.
Obesity. Obesity has been associated with the occurrence of OME.
Having siblings with recurrent ear infections.
Anatomical abnormalities of upper airways.

Symptoms

Symptoms of acute otitis media usually develop suddenly and can include:

Pain or discomfort in the ear. However, it is difficult to determine if an infant or child who hasn't yet learned to speak has an ear infection. Some children may indicate pain if they have trouble swallowing food and rejecting it. Some parents believe that tugging on the ear indicates an infection, but this gesture is more likely to indicate pain from teething.
Coughing
Nasal congestion
Fever
Irritability
Sleeplessness
Loss of appetite
Vomiting
Diarrhea
Listlessness

If the ear infection is severe, the tympanic membrane may rupture, causing the parent to notice pus draining from the ear. (This usually brings relief from pain.) Pus in the ear may cause hearing loss in some children.

Fevers and colds often make children irritable and fussy, so it is difficult to determine if acute otitis media is present as well. Symptoms are not apparent in about a third of children with acute middle ear infection.

OME often has no symptoms at all. Some hearing loss may occur, but it is often fluctuating and hard to detect, even by observant parents. The only sign to a parent that the condition exists may be when a child complains of "plugged up" hearing. Other symptoms can include loud talking, not responding to verbal commands, and turning up the television or radio.

Older children with OME may have difficulty targeting specific sounds in a noisy room. In such cases, some parents or teachers may attribute their behavior to lack of attention or even to an attention deficit disorder. OME is often diagnosed during a regular pediatric visit.

Prognosis

Doctors should carefully evaluate ear infections in infants fewer than 3 months old, and consider more serious infections, such as meningitis.

While severe cases of recurrent acute otitis media or persistent otitis media with effusion (OME) are associated with impaired hearing for a period of time, the long-term consequences resulting from this hearing loss may not be significant in most children.

Hearing loss in children may temporarily slow down language development and reading skills. However, results from a high quality study strongly indicate that uncomplicated chronic middle ear effusion poses no danger for developmental delays. Researchers evaluated children who had either prompt insertion of ear tubes to drain fluid when they were younger than age 3, or delayed insertion of tubes many months later. When the children were tested at ages 9 - 11, researchers found no differences in speech and language, auditory processing, attention, behavior, social skills, and academic achievement. As the majority of chronic ear effusion cases eventually clear up on their own, many experts now recommend against surgical intervention for most children.

Occasionally, patients with chronic otitis media develop involvement of the inner ear. In these situations hearing loss can potentially be permanent. Most of these patients will also have problems with vertigo.

Serious complications or permanent physical injuries from ear infections are very uncommon, but may include:

Structural damage. Certain children with severe or recurrent otitis media may be at risk for structural damage in the ear, including erosion of the ear canal.
Cholesteatomas. Cysts in the ear called cholesteatomas are an uncommon complication of recurrent or severe ear infections.
Calcifications. In rare cases, even after a mild infection, some children develop calcification and hardening in the middle and, occasionally, in the inner ear. This may be due to immune abnormalities.

Before the introduction of antibiotics, mastoiditis (an infection in the bones located in the skull), was a serious, albeit rare, complication of otitis media. This condition is difficult to treat and requires intravenous antibiotics and drainage procedures. Surgery may be necessary.

If pain and fever persist in spite of antibiotic treatment of otitis media, the doctor should check for mastoiditis. Most cases of mastoiditis are generally not associated with ear infections.

If an infection of the mastoid air cells cannot be controlled with antibiotics, surgery may be needed.

Impaired Balance. Some studies have indicated that children with chronic OME have problems with motor development and balance.

Facial Paralysis. Very rarely, a child with acute otitis media may develop facial paralysis, which is temporary and usually relieved by antibiotics or possibly drainage surgery. Facial paralysis may also occur for patients with chronic otitis media and a cholesteatoma (cyst in the middle ear). Surgery is often necessary to correct this condition.

Diagnosis

The doctor should be sure to ask the parent if the child has had a recent cold, flu, or other respiratory infection. If the child complains of pain or has other symptoms of otitis media, such as redness and inflammation, the doctor should rule out any other causes. These may include, but are not limited to, the following:

Otitis media with effusion. OME is commonly confused with acute otitis media. It must be ruled out because it does not respond to antibiotics.
Dental problems (such as teething).
Infection in the outer ear. Symptoms include pain, redness, itching, and discharge. Infection in the outer ear, however, can be confirmed by wiggling the ears, which will produce pain. (This movement will have no significant effect if the infection is in the middle ear.)
Foreign objects in the ear. This can be dangerous. A doctor should always check for this first when a small child indicates pain or problems in the ear.
Viral infection can produce redness and inflammation. Such infections, however, are not treatable with antibiotics and resolve on their own.
A parent's or child's attempts to remove earwax.
Intense crying can cause redness and inflammation in the ear.

Instruments Used for Examining the Ear. An ear examination should be part of any routine physical examination in children, particularly because the problem is so common and may not cause symptoms.

The doctor first removes any ear wax (called cerumen) in order to get a clear view of the middle ear.
The doctor uses a small flashlight-like instrument called an otoscope to view the ear directly. This is the most important diagnostic step. The otoscope can reveal signs of acute otitis media, bulging eardrum, and blisters.

An otoscope is a tool that shines a beam of light to help visualize and examine the condition of the ear canal and eardrum. Examining the ear can reveal the cause of symptoms such as an earache, the ear feeling full, or hearing loss.

To determine an ear infection, the doctor should always use a pneumatic otoscope. This device detects any reduction in eardrum motion. It has a rubber bulb attachment that the doctor presses to push air into the ear. Pressing the bulb and observing the action of the air against the eardrum allows the doctor to gauge the eardrum's movement.
Some doctors may use tympanometry to evaluate the ear. In this case, a small probe is held to the entrance of the ear canal and forms an airtight seal. While the air pressure is varied, a sound with a fixed tone is directed at the eardrum and its energy is measured. This device can detect fluid in the middle air and also obstruction in the Eustachian tube.
A procedure similar to tympanometry, called reflectometry, also measures reflected sound. It can detect fluid and obstruction, but does not require an airtight seal at the canal.

Neither tympanometry nor reflectometry are substitutes for the pneumatic otoscope, which allows a direct view of the middle ear.

Findings Indicating AOM or OME. A diagnosis of AOM requires all three of the following criteria:

History of recent sudden symptoms. Symptoms may include fever, pulling on the ear, pain, irritability, or discharge (otorrhea) from the ear.
Presence of fluid in the middle ear. This may be indicated by fullness or bulging of the eardrum or limited mobility.
Signs and symptoms of inflammation. These may include redness of the eardrum as well as assessment of the child's discomfort. Ear pain that is severe enough to interfere with sleep may indicate inflammation.

AOM (fluid and infection) is often difficult to differentiate from OME (fluid without infection). It is important for a doctor to make this distinction as OME does not require antibiotic treatment. In patients with OME, an air bubble may be visible and the eardrum is often cloudy and very immobile. A scarred, thick, or opaque eardrum may make it difficult for the doctor to distinguish between acute otitis media and OME.

Parents can also use a sonar-like device, such as the EarCheck Monitor, to determine if there is fluid in their child's middle ear. EarCheck uses acoustic reflectometry technology, which bounces sound waves off the eardrum to assess mobility. When fluid is present behind the middle ear (a symptom of AOM and OME), the eardrum will not be as mobile. The device works like an ear thermometer and is painless. Results indicate the likelihood of the presence of fluid and may help patients decide whether they need to contact their child's doctor. However, it is not recommended that children be treated with antibiotics based on the findings using this device.

On rare occasions the doctor may need to draw fluid from the ear using a needle for identifying specific bacteria, a procedure called tympanocentesis. This procedure can also relieve severe ear pain. This is most often performed by an ear, nose, and throat (ENT) specialist, and usually only in severe or recurrent cases. In most cases, tympanocentesis is not necessary in order to obtain an accurate enough diagnosis for effective treatment.

Hearing tests performed by an audiologist are usually recommended for children with persistent otitis media with effusion. A hearing loss below 20 decibels usually indicates problems.

Determining Impaired Hearing in Infants and Small Children. Unfortunately, it is very difficult to test children under 2 years old for hearing problems. One way to determine hearing problems in infants is to gauge the baby's language development:

At 4 - 6 weeks most babies with normal hearing make cooing sounds.
By around 5 months, infants should be laughing out loud and making one-syllable sounds with both a vowel and consonant.
Between 6 - 8 months, babies should be able to make word-like sounds with more than one syllable.
Usually starting around 7 months, and by 10 months, babies babble (making many word-like noises).
Around 10 months, babies can identify and use some term for a parent, such as dada, baba, or mama.
Babies speak their first word usually by the end of their first year.

If a child's progress is significantly delayed beyond these times, a parent should suspect possible hearing problems.

Determining Impaired Hearing in Older Children. Hearing loss in older children may be detected by the following behaviors:

They may not respond to speech spoken beyond 3 feet away.
They may have difficulty following directions.
Their vocabulary may be limited.
They may have social and behavioral problems.

Prevention

The best way to prevent ear infections is to prevent colds and flu.

Good Hygiene. Colds and flus are spread primarily when an infected person coughs or sneezes near someone else. A very common method for transmitting a cold is by shaking hands. Everyone should always wash their hands before eating and after going outside. Ordinary soap is sufficient. Waterless hand cleaners that contain an alcohol-based gel are also effective for everyday use and may even kill cold viruses. (They are less effective, however, if extreme hygiene is required. In such cases, alcohol-based rinses are needed.) Antibacterial soaps add little protection, particularly against viruses. In fact, one study suggests that common liquid dish washing soaps are up to 100 times more effective than antibacterial soaps in killing respiratory syncytial virus (RSV), which is known to cause pneumonia and has been associated with ear infections. Wiping surfaces with a solution that contains 1 part bleach to 10 parts water is very effective in killing viruses.

The American Academy of Pediatrics (AAP) and the U.S. Centers for Disease Control (CDC) recommend annual influenza vaccination for all children 6 months to 5 years of age. Preventing influenza (the "flu') may be a more important protective measure against ear infections than preventing bacterial infections. For example, studies report that children who are vaccinated against influenza experience a third fewer ear infections during flu season than unvaccinated children.

Flu Vaccines. Flu vaccines produce an immune response that attacks the active virus. Vaccines are typically given by injection, usually between October and December. Antibodies to the influenza virus generally develop within 2 weeks of vaccination, and immunity peaks within 4 - 6 weeks, then gradually wanes. An intranasal vaccine called FluMist is approved for children ages 2 years and older. FluMist is made from a live but weakened influenza virus; flu shots use inactivated (not live) viruses. Children younger than 2 years old, and children younger than age 5 who have asthma or recurrent wheezing, should not receive FluMist.

Possible side effects include:

Allergic Reaction. Newer vaccines contain very little egg protein, but an allergic reaction still may occur in people with strong allergies to eggs.
Soreness at the Injection Site. Up to two-thirds of people who receive the influenza vaccine develop redness or soreness at the injection site for 1 - 2 days afterward.
Flu-like Symptoms. Other side effects include mild fatigue and muscle aches and pains. They tend to occur between 6 - 12 hours after the vaccination and last up to 2 days. These symptoms are not influenza itself but an immune response to the virus proteins in the vaccine. Anyone with a fever, however, should not be vaccinated until the ailment has subsided.

Antiviral Drugs. Antiviral drugs are available to treat influenza. One such drug, oseltamivir (Tamiflu), is approved for use in children age 1 year and older. Studies report significant reduction in symptoms and in the incidence of ear infections with this drug. In another study, when the antiviral drug, zanamivir (Relenza), was administered in the nasal passages of adults with influenza, middle ear abnormalities were reduced by more than half, to 32%. This drug is available for children older than 7 years for treatment of influenza, but no research has determined its value for preventing or treating otitis media in children.

[For more information, see In-Depth Report #94: Colds and influenza.]

Preventive Antibiotics. Antibiotics have been used to prevent bacterial infections in children with recurrent ear infections (4 or more episodes a year). Studies suggest, however, that overall they only prevent 1 episode a year, and are not generally recommended for prevention, except for specific situations.

Pneumococcal Vaccine. The pneumococcal conjugate vaccine (PCV) protects against S. pneumoniae (also called pneumococcal) bacteria in children, the most common cause of middle ear infections, pneumonia, and other respiratory infections. It is included in the Recommended Childhood Immunization Schedule and is specifically approved for preventing otitis media. High quality evidence indicates these vaccinations could result in over 1.5 million fewer office visits, over 20% fewer procedures for tube implants, and significantly fewer antibiotic prescriptions. The recommended schedule of pneumococcal immunization is four doses, given at 2, 4, 6, and 12 - 15 months of age.

Still, the pneumococcal vaccine does not completely protect against otitis media. The current pneumococcal vaccine does not protect against all subtypes of S. pneumoniae. Also, other types of bacteria can cause the problem. Scientists are working on developing a new type of pneumococcal vaccine that combines S. pneumoniae and H. influenzae strains that are not influenced by the currently available H. influenzae vaccine. Researchers hope this investigational vaccine may eventually help prevent middle ear infection caused by these organisms.

Healthy Diet. Daily diets should include foods such as fresh, dark-colored fruits and vegetables, which are rich in antioxidants and other important food chemicals that help boost the immune system.

Probiotics ("Good" Bacteria). Researchers are studying the possible protective value of certain strains of lactobacilli, bacteria found in the intestines. Some of these strains, particularly acidophilus, are used to make yogurt. Studies have been mixed on probiotics’ benefits for preventing ear infections.

Xylitol. Xylitol, a sugar alcohol produced naturally in birch, strawberries, and raspberries, has properties that fight Streptococcal pneumonia bacteria. A few studies have reported that children who chew gum or swallow a syrup containing xylitol experience fewer ear infections, but other studies have not shown that xylitol is helpful.

Parents or others should not smoke around children. Several studies have found that children who live with smokers have a significant risk for ear infections.

Breastfeeding offers protection against many early infections, including ear infections. Mother's milk provides immune factors that help protect the child from infections. Also, infants are held during breast-feeding in a position that allows the Eustachian tubes to function well. In addition, a 2006 study suggested that breastfeeding can help protect even those children who are genetically susceptible to ear infections.

If possible, new mothers should breast-feed their infants for at least 4 - 6 months. According to the American Academy of Pediatrics, exclusively breast-feeding for a baby’s first 6 months helps to prevent ear and other respiratory infections. For bottle-fed babies, to improve protection mothers should not lay babies down with their bottle; they should hold the infants in the same way they would to breast-feed them.

Treatment

Treatments for ear infections cost the U.S. $3 - 4 billion each year, and many of these treatments, particularly heavy antibiotic use and surgical procedures, are often unnecessary in many children.

Experts continue to argue about the best approach for treating ear infections. The major debates rest on the use of antibiotics, surgery, and watchful waiting in both acute otitis media (AOM) and otitis media with effusion (OME).

Until recently, nearly every American child with an ear infection who visited a doctor received antibiotics. In one region of the U.S., more than 70% of children received antibiotics before they were 7 months old, and the most common reason for these medications was acute otitis media.

Major studies now indicate that antibiotics are unnecessary in most cases of acute otitis media. Between 80 - 90% of all children with uncomplicated ear infections recover within a week without antibiotics. Likewise, receiving antibiotics for an acute ear infection does not seem to prevent children from having fluid behind the ears after the infection is cleared up. Antibiotics are rarely recommended for otitis media with effusion.

Antibiotic Resistance. The intense and widespread use of antibiotics is leading to a serious global problem of bacterial resistance to common antibiotics. In the U.S., nearly a quarter of S. pneumoniae are currently resistant to at least three antibiotics. High rates of resistance strains are even being observed in infants. In general, regions and institutions with the highest rate of resistance are those in which antibiotics are the most heavily prescribed.

Watchful Waiting for AOM. Because of the high rate of antibiotic resistance, and the fact that non-severe AOM usually resolves on its own without antibiotics, many pediatric guidelines recommend a “watchful waiting” period before antibiotics are prescribed. Current guidelines released by the American Academy of Pediatrics and the American Academy of Family Physicians recommend an initial observation period of 48 - 72 hours for select children. Pain relief can initially be given with acetaminophen (Tylenol), ibuprofen (Advil), or topical benzocaine drops.

If there is no improvement or symptoms worsen, parents can schedule an appointment with the child's doctor to determine if antibiotics are needed. (Parents should contact the doctor within the first 24 hours if their child is 6 months or younger and has fever or other severe symptoms.) Another option is to ask the doctor for a Safety Net Antibiotic Prescription (SNAP) that can be filled if symptoms do not improve within 48 - 72 hours

While children with non-severe AOM given antibiotics may recover slightly more quickly, they often have a high number of side effects and antibiotic-resistant bacterial strains. Studies have found that giving parents the option of delaying antibiotic treatment helps to reduce the unnecessary use of antibiotics without causing any health problems for the children. Unfortunately, surveys indicate that although medical guidelines recommend watchful waiting, few doctors regularly practice it.

The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) guidelines and recent evidence support the following recommendations:

Accurate diagnosis of AOM including differentiation from OME.
Children fewer than 6 months of age should receive immediate antibiotic treatment.
Children 6 months or older should be treated for pain within the first 24 hours with either acetaminophen or ibuprofen.
An initial observation period of 48 - 72 hours is recommended for select children to determine if the infection will resolve on its own without antibiotic treatment. (Most children do improve within 72 hours.)
For children aged 6 months - 2 years, criteria for recommending an observation period are an uncertain diagnosis of AOM and a determination that the AOM is not severe. For children older than 2 years, the observation period criteria are non-severe symptoms or uncertain diagnosis. Severe AOM symptoms include moderate to severe pain and a fever of at least 102.2° F (39° C).
Antibiotic prophylaxis may be recommended for recurrent acute otitis media. Which children should be treated this way, as well as which antibiotics and for how long, have not been clearly determined.

The American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) released updated clinical practice guidelines for OME in 2004. These guidelines include the following treatment recommendations:

Watchful Waiting for OME. The child is typically monitored for the first 3 months. Antibiotics are not helpful for most patients with OME. For one, the condition resolves without treatment in nearly all children, especially those whose OME followed an acute ear infection. About 75 - 90% of OME cases that result from AOM resolve within 3 months. If OME last longer than 3 months, a hearing test should be conducted. Even if OME lasts for longer than 3 months, the condition generally resolves on its own without any long term effects on language or development and intervention may not be necessary. The doctor will re-evaluate the child at periodic intervals to determine if there is risk for hearing loss.

Drug Treatment. It is important for parents to recognize that persistent fluid behind the eardrum after treatment for acute otitis media does not indicate failed treatment. Antibiotics, decongestants, antihistamines and corticosteroids do not help and are not recommended for routine management of OME. These drugs are not effective for OME, either when used alone or in combination. Antihistamines and decongestants may cause more harm than good by provoking side effects such as stomach upset and drowsiness. At present, there is no compelling evidence to indicate that allergy treatment can assist with OME management nor has a causal relationship between allergies and OME been established.

Surgery. The decision to pursue surgery must be determined on an individual basis. Children with OME lasting longer than 4 months may be considered candidates for surgery if they have:

Hearing loss greater than 40 dB
Hearing loss between 21 - 39 dB (Children in this group may be observed or considered for surgery)
Hearing loss of 20 dB or less, when speech, language, or developmental problems are observed
OME and structural damage to the ear canal, eardrum, or middle ear

Tympanostomy (the insertion of tubes into the eardrum) is the first choice for surgical intervention. Adenoidectomy (removal of adenoids) plus myringotomy (removal of fluid), with or without tube insertion, is sometimes recommended as a repeat surgical procedure. (Myringotomy alone is not recommended for OME treatment. Between 20 - 50% of children who undergo this procedure may have OME relapse and need additional surgery). Tube insertion may be advised for children younger than 4 years of age. Adenoidectomy is not recommended as an initial procedure unless some other condition (chronic sinusitis, nasal obstruction, adenoiditis) is present.

Tonsillectomy (removal of tonsils) is not recommended for OME treatment.

Home Remedies

Careful monitoring of the child's condition (watchful waiting) along with home remedies may be a viable alternative to antibiotic treatment for many children with a first episode of acute otitis media. However, in some situations parents should contact their medical professional immediately:

Seek immediate medical attention for high fever, severe pain, or other signs of complications.
Parents of infants should contact their doctor immediately if they have any fever, regardless other symptoms.

Before antibiotics, parents used home remedies to treat the pain of ear infections. Now, with current concern over antibiotic overuse, many of these remedies are again popular.

Depending on regional cultures, parents may have pressed a warm water bottle or warm bag of salt against the ear. Such old-fashioned remedies may still help to ease ear pain.
Due to the high risk of burns, ear candles should not be used to remove wax from ears. There is no evidence to indicate that these candles are safe or effective for treatment of AOM or other ear conditions.

Herbal remedies are not standardized or regulated, and their quality and safety are largely unknown. Parents should never give their child herbal remedies, including oral remedies, without approval from a doctor.

Valsalva's Maneuver. A simple technique called the Valsalva's maneuver is useful in opening the Eustachian tubes and providing occasional relief from the chronic stuffy feeling accompanying otitis media with effusion. It may also be useful for unplugging ears during air travel descent as well. It works as follows:

The child takes a deep breath and closes the mouth.
The child then blows the nose gently while, at the same time, pinching it firmly shut.
The parent should be sure to instruct the child not to blow too hard or the eardrum could be harmed.

Do not use this technique if an infection is present.

A number of pain relievers are available to help relieve symptoms.

Either acetaminophen (Tylenol) or ibuprofen (Advil) is the pain-reliever of choice in children.
Older children may be able to take prescription pain relievers that contain codeine if the pain is severe.
Eardrops containing anesthetics (Auralgan) are also available by prescription. Auralgan provides short-acting pain relief and may help children endure ear discomfort until an oral pain reliever takes effect. Parents should check with a doctor before using them. Eardrops could cause damage in children who have a ruptured eardrum. This might be indicated by fluid drainage from the ear canal.

Note: Aspirin and aspirin-containing products are not recommended for children or adolescents. Reports of Reye syndrome, a very serious condition, have been associated with aspirin use in children who have chicken pox or flu.

Many non-prescription products are available that combine antihistamines, decongestants, and other ingredients, and some are advertised as cold remedies for children. Researchers have found little or no benefits for acute otitis media or for otitis media with effusion using decongestants (either oral or nasal sprays or drops), antihistamines, or combination product. Their use is not recommended for AOM or OME. Recent research has questioned the general safety of these products and they are currently banned for use in children under age 2 years.

Swimming can pose specific risks for children with current ear infections or previous surgery. Water pollutants or chemicals may exacerbate the infection, and underwater swimming causes pressure changes that can cause pain. The following precautions should be taken:

Children with ruptured acute otitis media (drainage from ear canal) should not go swimming until their infections are completely cured.
Children with AOM that is not ruptured should not dive or swim underwater.
Some doctors recommend that children with implanted ear tubes should use earplugs or cotton balls coated in petroleum jelly when swimming to prevent infection. Others say earplugs are only necessary if the child will be diving underwater. Parents should consult their child's doctor.

Medications

When antibiotics are needed, a number of different classes are available for treating acute ear infections. Amoxicillin is a penicillin antibiotic and the drug of first choice. Other antibiotics are available for children who are allergic to penicillin or who do not respond within 2 - 3 days.

Duration. If a child needs antibiotics for acute otitis media, experts recommend they be taken for the following periods of time:

A 10-day course of antibiotics is usually recommended for children younger than 6 years of age, and for those with severe AOM.
Antibiotic therapy for 5 - 7 days is recommended for children 6 years of age or older with mild-to-moderate symptoms.

Parents should be sure their child finishes the entire course of therapy. Failure to finish is a major factor in the growth of bacterial strains that are resistant to antibiotics.

What to Expect. Earaches usually resolve within 24 hours after taking an antibiotic, although about 10% of children who are treated do not respond. This may occur when a virus is present or if the bacteria causing the ear infection is resistant to the prescribed antibiotic. A different antibiotic may be needed.

In some children whose treatment is successful, fluid will still remain in the middle ear for weeks or months, even after the infection has resolved. During that period, children may have some hearing problems, but eventually the fluid almost always drains away. Antibiotics should not be used to treat residual fluid.

Follow-Up. Your child should return to the doctor's office:

Two to 3 weeks after therapy, if initial therapy cleared up the infection and the child is less than 15 months old, or has risk factors for reinfection
Three to 6 weeks after treatment, if initial therapy cleared up the infection and the child is older than 15 months old and has no specific risk factors
Within 48 hours of taking the last antibiotic dose if signs of infection are still present (for example, there is still pus in the ear)

When suspecting complications, consult with an ear, nose, and throat specialist (otolaryngologist) . This specialist may perform a tympanocentesis or myringotomy, procedures in which fluid is drawn from the ear and examined for specific organisms. But, this is reserved for severe cases.

The selection of an antibiotic is determined in part by the severity of the child's condition as well as a history of response/non-response to antibiotic therapy. Treatment decisions take into account whether the child's condition is severe or non-severe.

Amoxicillin is generally recommended for first-line treatment of AOM. The combination drug amoxicillin-clavunate is prescribed for patients who have severe pain or a fever higher than 102.2° F(39° C). Other drug classes may be prescribed if a child is allergic to penicillin or does not respond to the initial therapy.

The following treatment guidelines provide general recommendations based on the severity of a child's AOM.

First-line treatment for non-severe AOM:

Amoxicillin 80 - 90 mg/kg per day orally. Amoxicillin is a penicillin antibiotic.

If the patient has an allergy or a history of non-response to penicillin drugs, one of the following antibiotics may be prescribed:

Azithromycin or clarithromycin. These drugs are in the macrolide class and are administered orally.
Cefdinir, cefuroxime, or cefpodoxime. These drugs, classified as cephalosporins, are taken by mouth. They may cause reactions in penicillin-allergic patients.

If the patient does not respond to amoxicillin or alternative antibiotic drugs after 48 - 72 hours, one of the following drugs may be prescribed:

Amoxicillin-clavulanate, clindamycin, or ceftriaxone. Ceftriaxone is injected intramuscularly. The other two drugs are administered orally. Each of these drugs is a different type of antibiotic. Amoxicillin-clavulanate (Augmentin) is classified as a penicillin; ceftriaxone (Rocephin) is a cephalosporin; clindamycin (Cleocin) is a lincosamide.

First-line treatment for severe AOM:

Amoxicillin-clavulanate (Augmentin). This antibiotic is known as an augmented penicillin. It works against a wide spectrum of bacteria and is administered orally.

Second-line treatment for severe AOM:

Ceftriaxone. Ceftriaxone (Rocephin) is an injectable cephalosporin that may be prescribed as an alternative to amoxicillin-clavulanate, especially for children who have vomiting or other conditions that hamper oral administration.
Tympanocentesis or clindamycin. Patients with severe AOM who have failed to respond to amoxicillin-clavulanate after 48 - 72 hours may require the withdrawal of fluid from the ear (tympanocentesis) in order to identify the bacterial strain causing the infection. If tympanocentesis cannot be performed, clindamycin may be prescribed orally to treat penicillin-resistant pathogens that have not responded to prior drug therapy.

The most common side effects of nearly all antibiotics are gastrointestinal problems, including cramps, nausea, vomiting, and diarrhea. This can be a significant problem in infants and small children. One study reported that giving such children a soy-based formula that contained fiber (Isomil DF) was helpful in reducing these side effects.
Amoxicillin use during infancy may lead to enamel defects and discolorations of permanent teeth.
Allergic reactions can also occur with all antibiotics but are most common with medications derived from penicillin or sulfa. These reactions can range from mild skin rashes to rare but severe, even life-threatening, anaphylactic shock.
Some drugs, including certain over-the-counter medications, interact with antibiotics. Parents should tell the doctor about all medications their children are taking.

Surgery

A tympanostomy involves the insertion of tubes to allow fluid to drain from the middle ear. The procedure involves:

A general anesthetic (asleep, no pain). Children typically recover completely within a few hours.
Myringotomy (removal of fluid) is performed first.
After myringotomy, the doctor inserts a tube to allow continuous drainage of the fluid from the middle ear.

Click the icon to see an illustrated series detailing ear tube insertion.

Postoperative Effects. Tympanostomy is a simple procedure, and the child almost never has to spend the night in the hospital. Acetaminophen (Tylenol) or ibuprofen (Advil) is sufficient for any postoperative pain in most children. Some children, however, may need codeine or other powerful pain relievers.

Generally, the tubes stay in the eardrum for at least several months before coming out on their own. On rare occasions, they will need to be surgically removed.

Complications. Otorrhea, drainage of secretion from the ear, is the most common complication after surgery and can be persistent in some children. It is usually treated with antibiotic eardrops. One study suggests that wearing earplugs may help the problem.

More serious complications from the operation are very uncommon, but may include:

General anesthetic risks. Rarely, allergic reactions or other complications, such as throat spasm or obstruction, may occur. The risk is highest in children who have other medical conditions, most commonly upper respiratory infections, lung disease, or GERD. Anesthetic-related risks are nearly always easily treated.
Tube blockage. Sometimes the tubes become blocked from sticky secretions or clotted blood after the operation.
Persistent eardrum perforation. This condition occurs when the eardrum does not close after the tubes have come out. It is the most common serious complication, but it is very rare.
Scarring can also occur, particularly in children who need more than one procedure, but it almost never affects hearing.
Small keratin (skin cell) containing cysts called cholesteatomas develop around the tube site in around 1% of patients.

Success Rates. Hearing is almost always restored following tympanostomy. Failure to achieve normal or near-normal hearing is usually due to complicated conditions, such as preexisting ear problems or persistent OME in children who have had previous multiple tympanostomies. Persistent fluid is the main reason for continued impaired hearing. Only a small percentage of hearing loss cases can be attributed to complications of the operation itself.

Earplugs as a Precaution. Many doctors feel that children should use earplugs when swimming while the tubes are in place in order to prevent infection. Others feel that as long as the child does not dive or swim underwater, earplugs may not be necessary. Parents should talk to their child's doctor about this subject. Cotton balls coated with petroleum jelly are effective alternatives to ear plugs. Children do not need to wear earplugs while showering.

Follow-Up. Eventually, the tubes fall out as the hole in the eardrum closes. This may happen after several months or more than a year later. It is painless. In fact, the patient and parents may not even be aware that the tubes are out.

About 20 - 50% of children may have OME relapse and need additional surgery that involves adenoidectomy and myringotomy. Tube reinsertion may be recommended for children younger than 4 years of age.

Myringotomy is used to drain the fluid and may be used (with or without ear tube insertion) in combination with adenoidectomy as a repeat surgical procedure if initial tympanostomy is not successful. It is not effective as a sole surgical procedure. Myringotomy involves the following steps:

The surgeon makes a very small incision in the eardrum.
Fluid is sucked out using a vacuum-like device.
The fluid is usually examined for identifying specific bacteria.
The eardrum heals in about a week.

Adenoids are collections of spongy lymph tissue in the back of the throat, similar to the tonsils. Removal of the adenoids, called adenoidectomy, is usually only considered for OME if a pre-existing condition exists such as chronic sinusitis, nasal obstruction, or chronic adenoiditis (inflammation of the adenoids). Unless these conditions exist, adenoidectomy is not recommended for treatment of OME.

Adenoidectomy plus myringotomy (removal of fluid) may be performed if an initial tympanostomy (tube insertion) procedure is unsuccessful in resolving OME. This combination procedure works best in children ages 4 years or older. Tube insertion is recommended for children under 4 years of age. It is not necessary to perform an adenoidectomy along with tube insertion for children under 4 years of age.

Click the icon to see an image of the adenoids.

Laser-assisted myringotomy is a technique that is being investigated as an alternative to conventional tympanostomy and myringotomy. At present, there is not enough evidence to say whether it is as good as ear tubes, the standard procedure. Some clinical trials have suggested that the success rate for laser-assisted myringotomy is half that of standard tympanostomy/myringotomy. Many insurance companies consider laser-assisted myringotomy to be an investigational procedure and will not pay for it.

Resources

www.nidcd.nih.gov -- National Institute on Deafness and Other Communication Disorders
www.aap.org -- American Academy of Pediatrics
www.entnet.org -- American Academy of Otolaryngology, Head and Neck Surgery

References

American Academy of Family Physicians; American Academy of Otolaryngology-Head and Neck Surgery; American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. Otitis media with effusion. Pediatrics. 2004 May;113(5):1412-29.

American Academy of Pediatrics Committee on Infectious Diseases. Recommended immunization schedules for children and adolescents -- United States, 2007. Pediatrics. 2007 Jan;119(1):207-8.

American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004 May;113(5):1451-65.

Belshe RB, Edwards KM, Vesikari T, Black SV, Walker RE, Hultquist M, et al. Live attenuated versus inactivated influenza vaccine in infants and young children. N Engl J Med. 2007 Feb 15;356(7):685-96.

Dohar J, Giles W, Roland P, Bikhazi N, Carroll S, Moe R, et al. Topical ciprofloxacin/dexamethasone superior to oral amoxicillin/clavulanic acidin acute otitis media with otorrhea through tympanostomy tubes. Pediatrics. 2006 Sep;118(3):e561-9.

Griffin GH, Flynn C, Bailey RE, Schultz JK. Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003423.

Hatakka K, Blomgren K, Pohjavuori S, Kaijalainen T, Poussa T, Leinonen M, et al. Treatment of acute otitis media with probiotics in otitis-prone children-a double-blind, placebo-controlled randomised study. Clin Nutr. 2007 Jun;26(3):314-21. Epub 2007 Mar 13.

Hautalahti O, Renko M, Tapiainen T, Kontiokari T, Pokka T, Uhari M. Failure of xylitol given three times a day for preventing acute otitis media. Pediatr Infect Dis J. 2007 May;26(5):423-7.

Koopman L, Hoes AW, Glasziou PP, Cees L, Appelman L, Burke P, et al. Antibiotic therapy to prevent the development of asymptomatic middle ear effusion in children with acute otitis media: a meta-analysis of individual patient data. Arch Otolaryngol Head Neck Surg. Feb 2008;134(2):128-132.

Leach AJ, Morris PS. Antibiotics for the prevention of acute and chronic suppurative otitis media in children. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD004401.

Little P. Delayed prescribing -- a sensible approach to the management of acute otitis media. JAMA. 2006 Sep 13;296(10):1290-1.

Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Rockette HE, Pitcairn DL, et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med. 2007 Jan 18;356(3):248-61.

Prymula R, Peeters P, Chrobok V, Kriz P, Novakova E, Kaliskova E, et al. Pneumococcal capsular polysaccharides conjugated to protein D for prevention of acute otitis media caused by both Streptococcus pneumoniae and non-typable Haemophilus influenzae: a randomised double-blind efficacy study. Lancet. 2006 Mar 4;367(9512):740-8.

Ramakrishnan K, Sparks RA, Berryhill WE. Diagnosis and treatment of otitis media. Am Fam Physician. 2007 Dec 1;76(11):1650-8.

Smith JA, Danner CJ. Complications of chronic otitis media and cholesteatoma. Otolaryngol Clin North Am. 2006 Dec;39(6):1237-55.

Rosenfeld RM, Brown L, Cannon CR, Dolor RJ, Ganiats TG, Hannley M, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. 2006 Apr;134(4 Suppl):S4-23.

Rosenfeld RM, Singer M, Wasserman JM, Stinnett SS. Systematic review of topical antimicrobial therapy for acute otitis externa. Otolaryngol Head Neck Surg. 2006 Apr;134(4 Suppl):S24-48.

Rovers MM, Glasziou P, Appelman CL, Burke P, McCormick DP, Damoiseaux RA, et al. Antibiotics for acute otitis media: a meta-analysis with individual patient data. Lancet. 2006 Oct 21;368(9545):1429-35.

Ruohola A, Meurman O, Nikkari S, Skottman T, Salmi A, Waris M, et al. Microbiology of acute otitis media in children with tympanostomy tubes: prevalences of bacteria and viruses. Clin Infect Dis. 2006 Dec 1;43(11):1417-22.

Spiro DM, Tay KY, Arnold DH, Dziura JD, Baker MD, Shapiro ED. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA. 2006 Sep 13;296(10):1235-41.

Review Date:
2/19/2008
Reviewed By:
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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adam.com

Ear infection - acute

admin — Wed, 03 Sep 2008 17:51:05 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Ear infections are one of the most common reasons parents take their children to the doctor. While there are different types of ear infections, the most common is called otitis media, which means an inflammation and infection of the middle ear. The middle ear is located just behind the eardrum.

The term "acute" refers to a short and painful episode. An ear infection that lasts a long time or comes and goes is called chronic otitis media.

For links to other types of ear infections, see otitis.

Alternative Names

Otitis media - acute; Infection - inner ear; Middle ear infection - acute

Causes, incidence, and risk factors

Ear infections are common in infants and children in part because their eustachian tubes become clogged easily. For each ear, a eustachian tube runs from the middle ear to the back of the throat. Its purpose is to drain fluid and bacteria that normally occurs in the middle ear. If the eustachian tube becomes blocked, fluid can build up and become infected.

Anything that causes the eustachian tubes and upper airways to become inflamed or irritated, or cause more fluids to be produced, can lead to a blocked eustachian tube. These include:

Colds and sinus infections
Allergies
Tobacco smoke or other irritants
Infected or overgrown adenoids
Excess mucus and saliva produced during teething

Ear infections are also more likely if a child spends a lot of time drinking from a sippy cup or bottle while lying on his or her back. Contrary to popular opinion, getting water in the ears will not cause an acute ear infection, unless the eardrum has a hole from a previous episode.

Ear infections occur most frequently in the winter. An ear infection is not itself contagious, but a cold may spread among children and cause some of them to get ear infections.

Risk factors include the following:

Not being breast-fed
Recent ear infection
Recent illness of any type (lowers resistance of the body to infection)
Day care (especially with more than 6 children)
Pacifier use
Genetic factors (susceptibility to infection may run in families)
Changes in altitude or climate
Cold climate

Symptoms

An acute ear infection causes pain (earache). In infants, the clearest sign is often irritability and inconsolable crying. Many infants and children develop a fever or have trouble sleeping. Parents often think that tugging on the ear is a symptom of an ear infection, but studies have shown that the same number of children going to the doctor tug on the ear whether or not the ear is infected.

Other possible symptoms include:

Fullness in the ear
Feeling of general illness
Vomiting
Diarrhea
Hearing loss in the affected ear

The child may have symptoms of a cold, or the ear infection may start shortly after having a cold.

All acute ear infections include fluid behind the eardrum. You can use an electronic ear monitor, such as EarCheck, to detect this fluid at home. The device is available at pharmacies.

Signs and tests

The doctor will ask questions about whether your child (or you) have had ear infections in the past and will want you to describe the current symptoms, including whether your child has had any symptoms of a cold or allergies recently. Your doctor will examine your child's throat, sinuses, head, neck, and lungs.

Using an instrument called an otoscope, the doctor will look inside your child's ears. 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 purulent (filled with pus). The physician will also check for any sign of perforation (hole or holes) in the eardrum.

A hearing test may be recommended if your child has had persistent (chronic and recurrent) ear infections.

Treatment

The goals for treating ear infections include relieving pain, curing the infection, preventing complications, and preventing recurrent ear infections. Most ear infections will safely clear up on their own without antibiotics. Often, treating the pain and allowing the body time to heal itself is all that is needed:

Apply a warm cloth or warm water bottle.
Use over-the-counter pain relief drops for ears.
Take over-the counter medications for pain or fever, like ibuprofen or acetaminophen. DO NOT give aspirin to children.
Use prescription ear drops to relieve pain.

ANTIBIOTICS

Some ear infections require antibiotics to clear the infection and to prevent them from becoming worse. This is more likely if the child is under age 2, has a fever, is acting sick (beyond just the ear), or is not improving over 24 to 48 hours.

However, for several years there was a tendency to over-prescribe antibiotics, leading to the increasing numbers of bacteria that are resistant to these drugs. Joint guidelines from the American Academy of Pediatrics and the American Academy of Family Physicians are aimed at using antibiotics for ear infections when they are most needed. If the antibiotics do not seem to be working within 48 to 72 hours, contact your doctor to consider switching to a stronger antibiotic. Usually there is no benefit to more than two, or at the most three, rounds of appropriate antibiotics.

SURGERY

If there is fluid in the middle ear and the condition persists, even with antibiotic treatment, a healthcare provider may recommend myringotomy (surgical opening of the eardrum) to relieve pressure and allow drainage of the fluid. This may or may not involve the insertion of tympanostomy tubes (often referred to as ear tubes). In this procedure, a tiny tube is inserted into the eardrum, keeping open a small hole that allows air to get in so fluids can drain more easily down the eustachian tube. Tympanostomy tube insertion is done under general anesthesia. Usually the tubes fall out by themselves. Those that don't may be removed in your doctor's office.

If the adenoids are enlarged, surgical removal may be considered, especially if you have chronic, recurrent ear infections. Removing tonsils does not seem to help with ear infections.

Expectations (prognosis)

Ear infections are curable with treatment but may recur. They are not life threatening but may be quite painful.

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. This is due to fluid lingering in the ear.

Although this fluid can go unnoticed, any fluid that lasts longer than 8-12 weeks is cause for concern. In children, hearing problems may cause speech to develop slowly. Permanent hearing loss is extremely rare, but the risk increases if the child has a lot of ear infections.

Other potential complications from otitis media include:

Ruptured or perforated eardrum
Chronic, recurrent ear infections
Enlarged adenoids or tonsils
Mastoiditis (an infection of the bones around the skull)
Meningitis (an infection of the brain)
Formation of an abscess or a cyst (called cholesteatoma) from chronic, recurrent ear infections
Speech or language delay in a child who suffers lasting hearing loss from multiple, recurrent ear infections

Calling your health care provider

Call your child's doctor if:

Pain, fever, or irritability do not improve within 24 to 48 hours
At the start, the child seems sicker than just an ear infection
Your child has a high fever or severe pain
Severe pain suddenly stops hurting -- this may indicate a ruptured eardrum
Symptoms worsen
New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles

For a child younger than 6 months, let the doctor know right away if the child has a fever, even if no other symptoms are present.

Prevention

You can reduce your child's risk of ear infections with the following practices:

Wash hands and toys frequently. Also, day care with 6 or fewer children can lessen your child's chances of getting a cold or similar infection. This leads to fewer ear infections.
Avoid pacifiers, especially at daycare.
Breastfeed -- this makes a child much less prone to ear infections. But, if bottle feeding, hold your infant in an upright, seated position.
Don't expose your child to secondhand smoke.
The pneumococcal vaccine prevents infections from the organism that most commonly causes acute ear infections and many respiratory infections.
Some evidence suggests that xylitol, a natural sweetener, may reduce ear infections.
Avoid overusing antibiotics.

References

American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004 May;113(5):1451-65. Review.

Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001.

Gershon, AA, Hotez, PJ, and Katz, SL, eds. Krugman’s Infectious Diseases of Children. 11th ed. St. Louis, Mo: Mosby; 2004.

Long, SS, Pickering, LK, and Prober, CG, eds. Principles and Practice of Pediatric Infectious Diseases. 2nd ed. New York, NY: Churchill Livingstone, 2003.

Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Rockette HE, Pitcairn DL, et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med. 2007 Jan 18;356(3):248-61.

Ramakrishnan K, Sparks RA, Berryhill WE. Diagnosis and treatment of otitis media. Am Fam Physician. 2007 Dec 1;76(11):1650-8.

Review Date: 4/25/2008

Reviewed By: Mark Levin, MD, Division of Infectious Disease, MacNeal Hospital, Berwyn, IL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M. Copyright

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Middle ear infection (otitis media)

admin — Thu, 04 Sep 2008 19:29:28 -0700

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HEALTH GUIDE REFERENCE FROM A.D.A.M

Otitis media is an inflammation and/or infection of the middle ear. Acute otitis media (acute ear infection) occurs when there is bacterial or viral infection of the fluid of the middle ear, which causes production of fluid or pus. Chronic otitis media occurs when the eustachian tube becomes blocked repeatedly due to allergies, multiple infections, ear trauma, or swelling of the adenoids.

Review Date: 10/17/2006

Reviewed By: Benjamin W. Van Voorhees, MD, MPH, Assistant Professor of Medicine and Pediatrics, The University of Chicago, Chicago, IL. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

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Middle ear infection

admin — Thu, 04 Sep 2008 19:30:52 -0700

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HEALTH GUIDE REFERENCE FROM A.D.A.M

A middle ear infection is also known as otitis media. It is one of the most common of childhood infections. With this illness, the middle ear becomes red, swollen, and inflamed because of bacteria trapped in the eustachian tube.

Review Date: 5/3/2006

Reviewed By: Kevin Fung, MD, FRCS(C), Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor, MI. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

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Ear infections

In This Report

Highlights

Introduction

Causes

Risk Factors

Symptoms

Prognosis

Diagnosis

Prevention

Treatment

Home Remedies

Medications

Surgery

Resources

References

Ear infection - acute

Overview

Illustrations

Definition

Alternative Names

Causes, incidence, and risk factors

Symptoms

Signs and tests

Treatment

Expectations (prognosis)

Complications

Calling your health care provider

Prevention

References

Middle ear infection (otitis media)

Middle ear infection