What are middle-ear infections?
Middle-ear infections, known clinically as otitis media, occur when bacteria or a virus invade the air space of the middle ear (the part of the ear containing three tiny bones - the hammer, anvil and stirrup) and cause inflammation and buildup of fluid behind the eardrum. Middle-ear infections are one of the most common childhood illnesses.
What causes a middle-ear infection?
The cause depends on the type of otitis media. The most common, acute otitis media (AOM), results from a cold, nose or throat infection, or an allergy. Typically, as part of the initial illness, the child's eustachian tubes (the tiny ducts that connect the middle ear to the back of the nose and throat) become swollen, causing fluid to pool in the middle ear. The trapped fluid then becomes infected by a virus or bacteria. As pus accumulates in the middle ear, the increased pressure on the eardrum causes an earache.
Also common among children is otitis media with effusion (OME). This is when the infection is cured (bacteria from a case of AOM die), but fluid remains in the ear - sometimes for three months or longer. Though it can temporarily impair hearing, OME rarely causes permanent damage if recognized and treated.
What are symptoms of an ear infection?
Acute, stabbing pain in the ear, which is often indicated in a baby by prolonged crying while rubbing or tugging at the ear.
Fever and general fussiness, especially if the child also has a cold.
Nausea and vomiting, especially in a young baby.
Temporary hearing loss.
Feeling of fullness in the ear (similar to being underwater).
Some bleeding or discharge of pus from the ear. This symptom is most likely to occur if the eardrum ruptures to relieve pressure from the fluid.
How are middle-ear infections diagnosed and treated?
Any indication of a middle-ear infection warrants a call to a family doctor or pediatrician. The doctor will examine the ear with an otoscope, looking for swelling or redness of the eardrum or evidence of middle ear fluid. Sometimes a machine called a tympanometer is used to measure the middle ear air pressure. This examination is painless.
The ear infection may go away on its own, but more often antibiotic treatment is needed. Your child's ears should be checked by the doctor after treatment to be sure the infection and ear fluid are gone and hearing is normal.
Some children develop chronic otitis media and risk permanent damage to the eardrum. In such cases, a tiny drainage tube may be surgically installed to prevent a ruptured eardrum. Sometimes removal of the adenoids (in the back of the throat) is recommended if they are the source of recurrent infections.
Why are ear infections so common in babies and toddlers?
Their immune systems aren't yet mature enough to present a strong defense against colds and other viral infections. Since colds and other viruses are major triggers for AoM, it also means they have more opportunities to get ear infections.
Their eustachian tubes are short and somewhat horizontal (compared to an adult's, which are longer and more vertical). Therefore, it's easy for germs to travel from the nose or throat into the middle ear.
Their eustachian tubes also tend to be narrow. Therefore, even a small amount of swelling in response to a cold or other respiratory illness can trap fluid in the middle ear and create a breeding ground for bacteria. Fortunately, as children grow, their immune systems become stronger and their
eustachian tubes become wider and more vertical, making otitis media less likely.
How many is too many?
It's perfectly normal for a young child to have two or three ear infections a year. There may be cause for concern if:
the child has more than six infections in a year; or
a hearing loss; or
fluid remains more than four months; or
the child falls under any of the risk factors outlined below.
Risk factors:
Tobacco smoke. Children exposed to secondhand smoke have a higher risk of developing ear infections than children who aren't exposed to smoke.
Gender. Boys tend to have more ear infections than girls.
Ethnic background. Caucasian and Native American children have higher rates of otitis media than children from other ethnic groups.
Age of onset. The younger a child is when he has his first ear infection, the more likely he will be to have repeated infections.
Family history. The risk of repeated ear infections is greater if a parent or sibling also had them.
Allergy history. Allergies that cause a stuffy nose are sometimes linked to recurrent ear infections.
Bottlefeeding. Babies who are bottlefed - especially while lying on their back - have more ear infections than those who are breastfed.
Child care. Children in group child-care settings have more ear infections than those in one-on-one care because of their heightened exposure to germs and viruses.
Facts you should know:
Ear infections strike two out of three babies before age 1. Nearly half of all children have three or more episodes before they turn 3.
Parents are the best detectors of this hard-to-spot disease.
Don't assume that your baby's earache will eventually wear-off; obtain professional medical help immediately.
Most ear infections heal with no long-term hearing loss. However, children with repeated infections or persistent ear fluid may have continued hearing difficulty. This drop in hearing may affect a child's speech and language development - and the school performance of an older child.
In addition to the tried-and-true treatments for ear infections, there are some newer alternatives to watch for: injectable antibiotics, a pneumococcus vaccine, a nasal flu vaccine, and protective chewing gum. Ask your pediatrician or family physician about these recent developments.
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