Acute Otitis Media

Acute otitis media is a bacterial or viral infection of the middle ear.

What is going on in the body?

The three parts of the ear are the outer ear, the middle ear, and the inner ear. The eustachian tube connects the middle ear to the nasal cavity. The eustachian tube keeps equal ear pressure between the eardrum and the outside of the body. Any secretions formed in the middle ear flow into the nasal cavity through this tube.

Otitis media often begins when a virus, such as the one that causes colds, enters the nose. The virus travels into the eustachian tube and causes it to swell. The virus can also travel up the eustachian tube to the middle ear. When the swollen tube does open, bacteria enter the tube and the middle ear. Bacteria multiply, causing an acute infection.

What are the causes and risks of the condition?

Otitis media is an infection caused by a virus or bacteria. The following children are at higher risk for this type of infection:

• children in day care
• children under the age of 3 or 4 years
• children who live with smokers
• children who take bottles to bed
• children whose parents had childhood otitis media
• children with chronic allergies or sinusitis
• Native American and Eskimo children

Individuals who have very small or poorly functioning tubes are also at a higher risk for infections. Children with head and face abnormalities often have eustachian tube problems. This includes children with Down syndrome and cleft palate.

What are the signs and symptoms of the condition?

The symptoms of otitis media vary depending upon the age of the child. An infant with an acute infection of the middle ear may show the following symptoms:

• fever
• inconsolable crying
• loss of appetite
• restlessness and interrupted sleep
• tugging or batting at the ear
• vomiting

In an older child, symptoms of an ear infection can include:

• ataxia, or loss of balance
• drainage from the ear
• ear pain
• fever
• vomiting and diarrhea

If the infection is more severe, the eardrum may bulge. There may be pus behind the eardrum. If the drum has ruptured, there is often clear or pus-like material in the ear canal.

How is the condition diagnosed?

Diagnosis of acute otitis media begins with a medical history and physical exam. The healthcare provider will look at the child’s eardrum through an otoscope.

What can be done to prevent the condition?

If a child has abnormalities of the eustachian tube, there is often no way to prevent the disease. These children often need ventilation tubes placed through their eardrums to bypass the poorly functioning eustachian tube.

There are methods to help prevent infections:

• Allergies should be treated promptly.
• A child fed before bedtime or awaked at night for a feeding should be held with its head above the stomach. This prevents formula or juice from pooling around the eustachian tube openings.
• Children with frequent ear infections should have vaccines as recommended by the healthcare provider. These may include flu and pneumonia vaccines.
• Parents of children at risk of developing ear infections should not smoke. If parents cannot stop smoking, they should not smoke around children.
• Preventing colds is important. Avoiding other sick children and frequent hand washing can reduce the spread of cold viruses.

If ear infections continue in spite of preventive efforts, the healthcare provider may recommend other measures. If the ear infections follow colds, starting an antibiotic at the same time the cold starts can be helpful. Antibiotics do not treat the viral infection. They reduce the bacteria where the eustachian tubes drain. The provider may also recommend a preventive dose of antibiotics to be given daily during the cold season.

What are the long-term effects of the condition?

Fortunately, there are very few long-term effects if the infection is properly treated. In rare cases, an infection may cause damage to the nerve of the inner ear. This can result in deafness. Rarely, an ear infection can lead to meningitis or brain abscess.

What are the risks to others?

Acute otitis media is not contagious. It causes no risk to others.

What are the treatments for the condition?

Up to 60% of cases of acute otitis heal without antibiotics. Antibiotics are generally used to reduce the symptoms, make the child more comfortable, and prevent serious complications. Common antibiotics for ear infections include:

• amoxicillin
• amoxicillin combined with clavulanate
• azithromycin
• ceftriaxone
• cefuroxime
• clarithromycin
• erythromycin and sulfisoxazole
• trimethoprim and sulfamethoxazole

If the child does not respond to the antibiotic, the dose may be increased or the antibiotic may be changed. If a child has repeated infections, surgery to insert ear tubes may be performed.

What are the side effects of the treatments?

Antibiotics may cause stomach upset, diarrhea, and allergic reactions. Surgery can cause bleeding, infection, and allergic reaction to anesthesia.

What happens after treatment for the condition?

If the infection has been properly treated, the fluid behind the eardrum usually goes away with time. As long as fluid is present, there will be some hearing loss. Once the fluid goes away, hearing will return to normal. If the fluid lasts for more than 3 months, it will probably not go away. The healthcare provider may recommend ear tube insertion at that time.

How is the condition monitored?

The condition is mostly monitored by the child’s symptoms. Some healthcare providers recommend a return visit after the antibiotics are gone. Any new or worsening symptoms should be reported to the healthcare provider.