Infection, ear (acute middle)

a bulging eardrum usually accompanied by pain; or a perforated eardrum, often with drainage of purulent material (pus).

Otitis media is the most frequent diagnosis in sick children in the U.S., especially affecting infants and preschoolers. Almost all children have one or more bouts of otitis media before age 6.

The eustachian tube is shorter in children than adults which allows easy entry of bacteria and viruses into the middle ear, resulting in acute otitis media. Bacteria such as Streptococcus pneumoniae (strep) and Haemophilus influenzae (H. flu) account for about 85% of cases of acute otitis media and viruses the remaining 15%. Babies under 6 weeks of age tend to have infections from different bacteria in the middle ear.

Bottle-feeding is a risk factor for otitis media. Breastfeeding temporarily passes the mother’s immunity to the baby which helps prevent acute otitis media. The position of the breastfeeding child is better than the bottle-feeding position for eustachian tube function. If a child needs to be bottle-fed, holding the infant rather than allowing the child to lie down with the bottle is best. A child should not take the bottle to bed. (Falling asleep with milk in the mouth increases the incidence of tooth decay).

Upper respiratory infections are a prominent risk factor for acute otitis media so exposure to groups of children as in child-care centers results in more frequent colds and therefore more ear infections. Irritants such as tobacco smoke in the air also increase the chance of otitis media. Children with cleft palate or Down syndrome are predisposed to ear infections. Children who have acute otitis media before 6 months of age have more frequent later ear infections.

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. 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 transient 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.

The treatment for acute otitis media is antibiotics usually for 7-10 days. About 10% of children do not respond within the first 48 hours of treatment. 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 3-6 weeks. In most children, the fluid eventually disappears (resorbs) spontaneously (on its own). Children who have recurring bouts of otitis media may have a tympanostomy tube (ear tube) placed into the ear during surgery to permit fluid to drain from the middle ear. If a child has a bulging eardrum and is experiencing severe pain, a myringotomy (surgical incision of the eardrum) to release the pus may be done. The eardrum usually heals within a week.

Acute otitis media is not contagious (although the cold that preceded it may be). A child with otitis media can travel by airplane but, if the eustachian tube is not functioning well, changes in pressure (such as in a plane) can cause discomfort. A child with a draining ear should, however, not fly (or swim).