Otitis Media (cont.)
What are the risk factors for acute otitis media?
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 prone
to ear infections.
Children who have episodes of acute otitis media before six months
of
age tend to have more ear infections later in childhood.
What are the symptoms of acute otitis media?
Young children with otitis media may be irritable, fussy, or have
problems feeding or sleeping. Older children may complain about pain
and fullness in the ear (earache). Fever may be present in a child of any age.
These symptoms are often associated with signs of upper respiratory
infection such as a runny or stuffy nose, or a cough.
The buildup of pus within the middle ear causes pain and dampens
the vibrations of the eardrum (so there is usually temporary hearing
loss during the infection).
Severe ear infections may cause the eardrum to rupture. The pus
then drains from the middle ear into the ear canal. The hole in the
eardrum from the rupture usually heals with medical treatment.
How is acute otitis media treated?
The treatment for acute otitis media varies depending upon the age and
symptoms of the child. The American Academy of Pediatrics (AAP) and the American
Academy of Family Physicians (AAFP) recommend the following:
AAP and AAFP Recommendations
|
Age
|
Certain Diagnosis
|
Uncertain Diagnosis
|
<6 months
|
Antibiotics
|
Antibiotics
|
6 months-2years
|
Antibiotics
|
Antibiotics if severe illness; *Observation without antibiotics option
if non-severe illness
|
| ≥2 years |
Antibiotics if severe illness; *Observation option if non-severe illness |
*Observation option without antibiotics |
*Observation is an appropriate option only when follow-up can be ensured and antibacterial agents can be started if symptoms persist or worsen. Non-severe illness is represented by mild ear pain and fever <39°C (102.2°F) in the past 24 hours. Severe illness is moderate to severe otalgia (ear pain) or fever 39°C.
If antibiotics are initiated, Amoxicillin is usually recommended as the first line treatment. This is usually prescribed for 10 days. About 10% of children do not respond within the first 48-72 hours of treatment, and antibiotic therapy may have to be changed. Even after antibiotic treatment, 40% of children are left with some fluid in the middle ear which can cause temporary hearing loss lasting for up to 3
to 6 weeks. In most children, this fluid eventually disappears spontaneously (on its own).
Children who have recurring bouts of otitis media may be referred to an otolaryngologist (ear nose and throat specialist or ENT). Some of these children may benefit from having an ear tube placed (tympanostomy tube) to permit fluid to drain from the middle ear.
In addition, if a child has a bulging eardrum and is experiencing severe pain, a procedure to lance the eardrum (myringotomy) may be recommended to release the pus. The eardrum usually heals within a week.
Next: What causes chronic otitis media? »
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