Otitis media

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Overview

Otitis media (OM) is any inflammation of the middle ear (see the images below), without reference to etiology or pathogenesis. It is very common in children. Acute otitis media with purulent effusion behind a bulging tympanic membrane. Chronic otitis media with a retraction pocket of the pars flaccida.

Symptoms

Unusual irritability.

Difficulty sleeping or staying asleep.

Tugging or pulling at one or both ears.

Fever, especially in infants and younger children.

Fluid draining from ear(s)

Loss of balance.

Hearing difficulties.

Ear pain.

Causes

Ear infections are caused by bacteria and viruses. Many times, an ear infection begins after a cold or other respiratory infection. The bacteria or virus travel into the middle ear through the eustachian tube (there’s one in each ear). This tube connects the middle ear to the back of the throat. The bacteria or virus can also cause the eustachian tube to swell. This swelling can cause the tube to become blocked, which keeps normally produced fluids to build up in the middle ear instead of being able to be drained away.

Adding to the problem is that the eustachian tube is shorter and has less of a slope in children than in adults. This physical difference makes these tubes easier to become clogged and more difficult to drain. The trapped fluid can become infected by a virus or bacteria, causing pain.

Risk factors

Prematurity and low birth weight.

Young age.

Early onset.

Family history.

Race - Native American, Inuit, Australian aborigine.

Altered immunity.

Craniofacial abnormalities.

Neuromuscular disease.

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Complications

Hearing loss (conductive and sensorineural)

TM perforation (acute and chronic)

Chronic suppurative otitis media (with or without cholesteatoma)

Cholesteatoma.

Tympanosclerosis.

Mastoiditis.

Petrositis.

Labyrinthitis.

Prevention

Here are some ways to reduce risk of ear infections in you or your child:

Don’t smoke. Studies have shown that second-hand smoking increases the likelihood of ear infections. Be sure no one smokes in the house or car — especially when children are present — or at your day care facility.

Control allergies. Inflammation and mucus caused by allergic reactions can block the eustachian tube and make ear infections more likely.

Prevent colds. Reduce your child's exposure to colds during the first year of life. Don’t share toys, foods, drinking cups or utensils. Wash your hands frequently. Most ear infections start with a cold. If possible, try to delay the use of large day care centers during the first year.

Breastfeed your baby. Breastfeed your baby during the first 6 to 12 months of life. Antibodies in breast milk reduce the rate of ear infections.

Bottle feed baby in upright angle. If you bottle feed, hold your baby in an upright angle (head higher than stomach). Feeding in the horizontal position can cause formula and other fluids to flow back into the eustachian tubes. Allowing an infant to hold his or her own bottle also can cause milk to drain into the middle ear. Weaning your baby from a bottle between nine and 12 months of age will help stop this problem.

Watch for mouth breathing or snoring. Constant snoring or breathing through the mouth may be caused by large adenoids. These may contribute to ear infections. An exam by an otolaryngologist, and even surgery to remove the adenoids (adenoidectomy), may be necessary.

Get vaccinations. Make sure your child’s immunizations are up to date, including yearly influenza vaccine (flu shot) for those 6 months and older. Ask your doctor about the pneumococcal, meningitis and other vaccines too. Preventing viral infections and other infections help prevent ear infections.