Ear Infections

Related Terms

  • Middle Ear Infection
  • Otitis Media


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Acute otitis media (AOM) is a painful infection of the middle ear, the portion of the ear behind the eardrum. (Another form of ear infection, otitis externa or swimmer's ear, is entirely different and is not covered here.)AOM often follows a cold, sore throat, or other respiratory illness. Although it can affect adults, this occurs primarily in infants and young children. It's estimated that by age 7, up to 95% of all children in the US will have experienced at least one bout of AOM—it's the most common reason parents take a child to the doctor.When the Eustachian tube connecting the upper part of the throat to the middle ear is blocked by a cold's mucus and swelling, fluids pool behind the eardrum, providing an ideal place for bacteria to grow; an infection may set in, generating even more fluid. The pressure this exerts on the eardrum can be intensely painful. The eardrum turns red and bulges. Children too young to explain their discomfort cry, fuss, and pull at their ears. They might also appear unresponsive because they can't hear well—fluid buildup in the middle ear prevents the eardrum and small bones in the ear from moving, causing temporary hearing loss.In addition, a complication called secretory otitis media (fluid build-up in the middle ear) may develop and cause continuous hearing loss for months. Other possible, though rare, complications of AOM include mastoiditis (an infection of the bone behind the ear) and spinal meningitis. Without treatment, most middle ear infections resolve on their own, often through a harmless rupture of the eardrum. 1 In the Netherlands, pediatricians take a conservative approach, generally waiting 24 to 72 hours until they are certain an ear infection warrants antibiotics. 2,32 US doctors, however, tend to initiate treatment early. This practice has been criticized on several grounds. First, aggressive antibiotic treatment has not been found effective in preventing complications, such as serous otitis, 3 pneumococcal meningitis, 4 or hearing loss. 33 In addition, antibiotic treatment does not even appear to help AOM itself very much. For example, a double-blind, placebo-controlled trial of 240 children ages 6 months to 2 years found so little benefit with antibiotic treatment that the authors recommended physician-supervised watchful waiting rather than immediate treatment. 5 In other published reviews, the benefits of antibiotics for AOM have also been found less than impressive. A review of 33 randomized trials involving 5,400 children concluded that antibiotics modestly improved the rate of recovery. 6 An evaluation of six randomized, controlled studies concluded that early antibiotic use had only slight benefit, reducing pain and fever in a small percentage of children and helping to prevent the development of infection in the other ear, but not significantly speeding up recovery of hearing. 7 Modest benefits were also seen in a more recent trial of 315 children. 8 Another study found that children with recurrent ear infections do not appear to benefit from preventive antibiotic treatment. 9 A meta-analysis (formal statistical review) concluded that antibiotic treatment may be helpful in children younger than two years old who have infections in both ears, and in children with drainage from the ear, but for other children it may be preferable to delay use of antibiotics. 36 However, the claim (often made in alternative medicine circles) that early antibiotic treatment causes an increased rate of ear infection recurrence does not appear to be correct. 10Note : Despite the issues raised above, simply withholding antibiotic treatment can be dangerous. Any child who appears to have an ear infection should be seen by a physician. When ear infections do reoccur frequently, a physician may insert a tube into the infected ear to drain fluids and relieve pressure, a procedure called tympanostomy. Nearly one million American children undergo this procedure each year; however, its usefulness is somewhat controversial. 11-13

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