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Medical Author:

David Perlstein, MD, MBA, FAAP

David Perlstein, MD, MBA, FAAP

Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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In this Article

• Otitis media (ear infection or inflammation) facts
• What is otitis media?
• What are the symptoms of acute middle ear infection?
• "Are ear infections contagious?
• How common is acute otitis media?
• Why do young children tend to have middle ear infections or inflammation?
• How does the Eustachian tube change as a child gets older?
• What microorganisms cause otitis media?
• What is the relationship between bottlefeeding and middle ear infection or inflammation?
• What are the risk factors for acute middle ear infection or inflammation?
• How is otitis media diagnosed?
• How is acute middle ear infection or inflammation treated?
• Are there any home remedies for acute ear infection (otitis media)?
• What causes chronic middle ear infection or inflammation?
• What happens to the eardrum in chronic middle ear infection or inflammation?
• What happens to the eardrum if a hole develops in the eardrum?
• How is chronic middle ear infection or inflammation treated?
• What are the goals of otitis media surgery?
• What is serious middle ear infection or inflammation?
• What limitations are there on a child with middle ear infection or inflammation?
• Can otitis media (middle ear infection or inflammation) be prevented?
• Ear Infection (Otitis Media) FAQs
• Patient Comments: Otitis Media - Effective Treatments
• Patient Comments: Ear Infection (Otitis Media) - Symptoms
• Find a local Ear, Nose, & Throat Doctor in your town
• Ear Infection Index

Upper respiratory infections predispose to acute otitis media. Exposure to groups of children (as in child care centers) results in more frequent colds, and therefore more earaches. Exposure to air with irritants, such as tobacco smoke, also increases the chance of otitis media. Children with cleft palate or Down syndrome are more prone to ear infections. Any problems with the Eustachian tubes (for example, blockage, malformation, inflammation) will increase the risk of otitis media.

Children who have episodes of acute otitis media before six months of age tend to have more ear infections later in childhood.

The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) have determined that three criteria are needed to diagnose acute otitis media (AOM); acute onset, middle ear effusion (MEE), and middle ear inflammation. Recurrent acute otitis media is defined as three acute otitis media episodes in 6 months, or 4 acute otitis media episodes in a year. There is no definitive lab test for acute otitis media.

Identification of the three criteria is dependent on clinical observation; middle ear effusion and middle ear inflammation are the most difficult to observe and as a consequence there are studies that suggest acute otitis media is over diagnosed. One method that helps determine acute otitis media versus otitis media with effusion is pneumatic otoscopy (normal moves readily with pressure changes) and the appearance of the tympanic membrane (acute otitis media has abnormal appearance, otitis media with effusion does not). However, no everyone is skilled at this technique; Pediatricians, Family Practice, ENT specialists, and ER doctors that work in pediatric ER's are likely to be skilled in the diagnostic procedure.