Acute Otitis Media
Acute Otitis Media
Description, Causes and Risk Factors:
Acute otitis media (AOM) is defined as an inflammatory process of the middle ear associated with an effusion. AOM results from bacterial or viral infections of the middle ear space along with blockage of the eustachian tube. The Eustachian tube runs from the middle ear to the back of the nose and usually drains fluid produced in the middle ear. Several factors can cause the eustachian tube obstruction, including allergies, extra saliva or mucus produced during teething, cold/sinus infections, enlarged or infected adenoids or irritation from tobacco smoke. AOM is very common in children and infants because their eustachian tubes can be easily blocked, but AOM may also occur in adults.
Certain environmental factors influence acute otitis media. Breast-fed infants tend to get fewer ear infections earlier in life than do formula-fed babies. Children who attend large daycare centers have greater risk than those who do not. Thirdly, children exposed to cigarette smoke on a regular basis may develop more infections. Ear infections are more common in fall, winter, and early spring, when upper respiratory infections are more common than in other seasons.
Approximately one third of children in the United States are especially prone to developing ear infections, with these children having at least three infections each by the time they are three years of age. Male children, Native Americans, and some other ethnic and geographical groups have a higher risk of ear infections than do other children. Children who develop their first infections within the first few months of life or have a sibling with recurrent AOM are also at higher risk of being "otitis prone". Additionally, children who were not breast-fed as infants are at a greater risk.
• The older child will complain of ear pain and the younger child may awake at night with some discomfort.
• Otorrhea: Spontaneous rupture of the tympanic membrane.
• Decreased hearing.
• Vertigo, nystagmus, tinnitus, and facial paralysis are unusual presenting symptoms.
• Eye drainage: infections secondary to non-typable H. influenza are often associated with conjunctivitis.
The diagnosis of AOM is generally made on clinical grounds: by observing the appearance of the tympanic membrane (eardrum) for redness, buldging, and lack of movement when an air jet is directed at the eardrum. The most precise way to diagnose an ear infection is to take a sample of fluid from the inner ear by sticking a needle through the tympanic membrane. This exposes children to unnecessary risk, however, and is done only in extreme circumstances or resistant infections.
Acute otitis media is treated with antibiotics. In general, amoxicillin and ampicillin are the most common antibiotics in children who are not allergic to penicillin. Patients allergic to penicillin are generally treated with erythromycin, although many alternatives are available and acceptable. Bacteria that are resistant to these antibiotics are still relatively uncommon in the U.S. The need for antibiotics is still debated, as many cases of AOM caused by bacteria will resolve without antibiotics. In addition, approximately one-third of AOM cases are caused by viruses, which do not require antibiotic treatment. Therefore, approximately 60% of ear infections will get better without any treatment. Acute otitis media can cause complications including hearing impairment, infection of the bones of the inner ear and mastoid (a skull bone), and even learning disabilities if ear infections cause sustained hearing impairment. Because of these potential complications, OM is routinely treated in the U.S.
Tympanostomy tubes (tubes that go through the eardrum and drain the middle ear fluid into the ear canal) are sometimes placed in children in which one or more of the following occurs: AOM does not resolve with antibiotics, the infection recurs frequently (at least three episodes in six months), or AOM is associated with hearing loss or an infection of bone. In some children with recurrent ear infections, antibiotics are given continuously to attempt to prevent infection, which is sometimes done before tubes are placed.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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