MEDIA (EAR INFECTION)
is otitis media?
Otitis media is an infection or inflammation of the middle ear.
This inflammation often begins when infections that cause sore throats,
colds, or other respiratory or breathing problems spread to the
middle ear. These can be viral or bacterial infections. Seventy-five
percent of children experience at least one episode of otitis media
by their third birthday. Almost half of these children will have
three or more ear infections during their first 3 years. It is estimated
that medical costs and lost wages because of otitis media amount
to $5 billion* a year in the United States. Although otitis media
is primarily a disease of infants and young children, it can also
do we hear?
ear consists of three major parts: the outer ear, the middle ear,
and the inner ear. The outer ear includes the pinna--the visible
part of the ear--and the ear canal. The outer ear extends to the
tympanic membrane or eardrum, which separates the outer ear from
the middle ear. The middle ear is an air-filled space that is located
behind the eardrum. The middle ear contains three tiny bones, the
malleus, incus, and stapes, which transmit sound from the eardrum
to the inner ear. The inner ear contains the hearing and balance
organs. The cochlea contains the hearing organ which converts sound
into electrical signals which are associated with the origin of
impulses carried by nerves to the brain where their meanings are
are more children affected by otitis media than adults?
are many reasons why children are more likely to suffer from otitis
media than adults. First, children have more trouble fighting infections.
This is because their immune systems are still developing. Another
reason has to do with the child's eustachian tube. The eustachian
tube is a small passageway that connects the upper part of the throat
to the middle ear. It is shorter and straighter in the child than
in the adult. It can contribute to otitis media in several ways.
eustachian tube is usually closed but opens regularly to ventilate
or replenish the air in the middle ear. This tube also equalizes
middle ear air pressure in response to air pressure changes in the
environment. However, a eustachian tube that is blocked by swelling
of its lining or plugged with mucus from a cold or for some other
reason cannot open to ventilate the middle ear. The lack of ventilation
may allow fluid from the tissue that lines the middle ear to accumulate.
If the eustachian tube remains plugged, the fluid cannot
drain and begins to collect in the normally air-filled middle ear.
more factor that makes children more susceptible to otitis media
is that adenoids in children are larger than they are in adults.
Adenoids are composed largely of cells (lymphocytes) that help fight
infections. They are positioned in the back of the upper part of
the throat near the eustachian tubes. Enlarged adenoids can, because
of their size, interfere with the eustachian tube opening. In addition,
adenoids may themselves become infected, and the infection may spread
into the eustachian tubes.
reach the middle ear through the lining or the passageway of the
eustachian tube and can then produce infection, which causes swelling
of the lining of the middle ear, blocking of the eustachian tube,
and migration of white cells from the bloodstream to help fight
the infection. In this process the white cells accumulate, often
killing bacteria and dying themselves, leading to the formation
of pus, a thick yellowish-white fluid in the middle ear. As the
fluid increases, the child may have trouble hearing because the
eardrum and middle ear bones are unable to move as freely as they
should. As the infection worsens, many children also experience
severe ear pain. Too much fluid in the ear can put pressure on the
eardrum and eventually tear it.
What are the effects of otitis media?
media not only causes severe pain but may result in serious complications
if it is not treated. An untreated infection can travel from the
middle ear to the nearby parts of the head, including the brain.
Although the hearing loss caused by otitis media is usually temporary,
untreated otitis media may lead to permanent hearing impairment.
Persistent fluid in the middle ear and chronic otitis media can
reduce a child's hearing at a time that is critical for speech and
language development. Children who have early hearing impairment
from frequent ear infections are likely to have speech and language
can someone tell if a child has otitis media?
media is often difficult to detect because most children affected
by this disorder do not yet have sufficient speech and language
skills to tell someone what is bothering them. Common signs to look
or pulling at one or both ears
draining from the ear
to quiet sounds or other signs of hearing difficulty such as sitting
too close to the television or being inattentive
anything be done to prevent otitis media?
prevention strategies applicable to all infants and children such
as immunization against viral respiratory infections or specifically
against the bacteria that cause otitis media are not currently available.
Nevertheless, it is known that children who are cared for in group
settings, as well as children who live with adults who smoke cigarettes,
have more ear infections. Therefore, a child who is prone to otitis
media should avoid contact with sick playmates and environmental
tobacco smoke. Infants who nurse from a bottle while lying down
also appear to develop otitis media more frequently. Children who
have been breast-fed often have fewer episodes of otitis media.
Research has shown that cold and allergy medications such as antihistamines
and decongestants are not helpful in preventing ear infections.
The best hope for avoiding ear infections is the development of
vaccines against the bacteria that most often cause otitis media.
Scientists are currently developing vaccines that show promise in
preventing otitis media. Additional clinical research must be completed
to ensure their effectiveness and safety.
does a child's physician diagnose otitis media?
simplest way to detect an active infection in the middle ear is
to look in the child's ear with an otoscope, a light instrument
that allows the physician to examine the outer ear and the eardrum.
Inflammation of the eardrum indicates an infection. There are several
ways that a physician checks for middle ear fluid. The use of a
special type of otoscope called a pneumatic otoscope allows the
physician to blow a puff of air onto the eardrum to test eardrum
movement. (An eardrum with fluid behind it does not move as well
as an eardrum with air behind it.)
useful test of middle ear function is called tympanometry. This
test requires insertion of a small soft plug into the opening of
the child's ear canal. The plug contains a speaker, a microphone,
and a device that is able to change the air pressure in the ear
canal, allowing for several measures of the middle ear. The child
feels air pressure changes in the ear or hears a few brief tones.
While this test provides information on the condition of the middle
ear, it does not determine how well the child hears. A physician
may suggest a hearing test for a child who has frequent ear infections
to determine the extent of hearing loss. The hearing test is usually
performed by an audiologist, a person who is specially trained to
is otitis media treated?
physicians recommend the use of an antibiotic (a drug that kills
bacteria) when there is an active middle ear infection. If a child
is experiencing pain, the physician may also recommend a pain reliever.
Following the physician's instructions is very important. Once started,
the antibiotic should be taken until it is finished. Most physicians
will have the child return for a followup examination to see if
the infection has cleared.
there are many bacteria that can cause otitis media, and some have
become resistant to some antibiotics. This happens when antibiotics
are given for coughs, colds, flu, or viral infections where antibiotic
treatment is not useful. When bacteria become resistant to antibiotics,
those treatments are then less effective against infections. This
means that several different antibiotics may have to be tried before
an ear infection clears. Antibiotics may also produce unwanted side
effects such as nausea, diarrhea, and rashes.**
the infection clears, fluid may remain in the middle ear for several
months. Middle ear fluid that is not infected often disappears after
3 to 6 weeks. Neither antihistamines nor decongestants are recommended
as helpful in the treatment of otitis media at any stage in the
disease process. Sometimes physicians will treat the child with
an antibiotic to hasten the elimination of the fluid. If the fluid
persists for more than 3 months and is associated with a loss of
hearing, many physicians suggest the insertion of "tubes"
in the affected ears. This operation, called a myringotomy, can
usually be done on an outpatient basis by a surgeon, who is usually
an otolaryngologist (a physician who specializes in the ears, nose,
and throat). While the child is asleep under general anesthesia,
the surgeon makes a small opening in the child's eardrum. A small
metal or plastic tube is placed into the opening in the eardrum.
The tube ventilates the middle ear and helps keep the air pressure
in the middle ear equal to the air pressure in the environment.
The tube normally stays in the eardrum for 6 to 12 months, after
which time it usually comes out spontaneously. If a child has enlarged
or infected adenoids, the surgeon may recommend removal of the adenoids
at the same time the ear tubes are inserted. Removal of the adenoids
has been shown to reduce episodes of otitis media in some children,
but not those who are under 4 years of age. Research, however, has
shown that removal of a child's tonsils does not reduce occurrences
of otitis media. Tonsillotomy and adenoidectomy may be appropriate
for reasons other than middle ear fluid.
should be fully restored once the fluid is removed. Some children
may need to have the operation again if the otitis media returns
after the tubes come out. While the tubes are in place, water should
be kept out of the ears. Many physicians recommend that a child
with tubes wear special ear plugs while swimming or bathing so that
water does not enter the middle ear.
research is being done on otitis media?
avenues of research are being explored to further improve the prevention,
diagnosis, and treatment of otitis media. For example, research
is better defining those children who are at high risk for developing
otitis media and conditions that predispose certain individuals
to middle ear infections. Emphasis is being placed on discovering
the reasons why some children have more ear infections than other
children. The effects of otitis media on children's speech and language
development are important areas of study, as is research to develop
more accurate methods to help physicians detect middle ear infections.
How the defense molecules and cells involved with immunity respond
to bacteria and viruses that often lead to otitis media is also
under investigation. Scientists are evaluating the success of certain
drugs currently being used for the treatment of otitis media and
are examining new drugs that may be more effective, easier to administer,
and better at preventing new infections. Most important, research
is leading to the availability of vaccines that will prevent otitis
GA. Cost-effectiveness considerations in otitis media treatment.
Otolaryngol Head Neck Sur. April 1996. 114 (4): 525-530.
is ongoing scientific discussion about the use and potential overuse
of antibiotic therapy for otitis media.
with permission from:
National Institute on Deafness and
Other Communication Disorders
31 Center Drive, MSC 2320
Bethesda, MD USA 20892-2320