The diagnosis of a middle ear infection (also known as otitis media) is the most common diagnosis made by doctors who take care of children. Past research has shown almost 50% of children have had at least one episode of otitis media by one year of age. By age three, 70% of children have had one episode while 33% have had more than three. Over 2 billion dollars are spent each year on the medical and surgical treatment of this disease.

         Back to Top

Many factors often combine to cause the infections. Some of these factors can be controlled while others cannot.  Some of the factors, which can influence the number of middle ear infections your child, include:

1: Age. Otitis media occurs most often in children between ages 6 months and 2 years. The incidence generally decreases as age increases; however, there is a second increase incidence between ages 4 and 6 years when children enter school.

2: Sex. Boys have a higher rate of otitis media than girls do.

3: Race. American Indian, Eskimo and Hispanic children have a relatively high number of middle ear infections. African-American children have a lower incidence than Caucasian children do.

4: Eustachian tube. The single most common cause of otitis media appears to mainly be due to Eustachian tube problems. The Eustachian tube is a narrow canal with collapsible walls, which links the middle ear with the nasopharynx. The nasopharynx is the airspace directly behind the nose. The Eustachian tube is about the thickness of a pencil. It opens hundreds of times a day, usually every 3-4 swallows and every yawn. The Eustachian tube always remains closed until opened by the pull of muscles attached to the roof of the mouth. When the Eustachian tube opens, air enters the canal and travel to the middle ear.

The Eustachian tube has three main functions: To protect the middle ear from fluids and bacteria located in the nasopharynx, to allow air to enter the middle ear space, and to drain fluid from the middle ear space.

A child's Eustachian tube is different from an adult's in several ways. It is shorter, wider, and more floppy. It is also more horizontal, entering almost straight into the back of the nose without the angle found in adult Eustachian tubes. When your doctor says your child will probably outgrow his ear infections after 5 years, he is partly referring to the fact that the Eustachian tube's angle, length and stiffness will have increased enough to become more protective.

5. Cleft palate. A cleft palate is a defect where there is an opening in the roof of the mouth. Children with a cleft palate do not have normal muscles to open the Eustachian tube. Even after the cleft palate is repaired with surgery, ear infections often continue to be a problem.

6: Down syndrome. Almost 75% of children with the Down syndrome suffer from middle ear problems, and the problems tend to continue into adulthood. The muscles, which open the Eustachian tube, do not function properly in these children.

7: Inheritance. Children who have recurrent otitis media often have brothers, sisters or parents with the same history.

8: Allergy. Allergy may be a contributing cause of recurrent otitis media or persistent middle ear fluid in children over 4.

9: Immunity. Your child is susceptible to infections during infancy. As your child grows older, antibodies develop to fight infection.

10: Adenoids. The adenoids are a growth of lymphoid tissue, similar to the tonsils, which lie in the back of the nose in the nasopharynx (the space at the back of the nose). This location puts the adenoids near the opening of the Eustachian tube. When adenoids become too large or swollen with infection, they may block the Eustachian tube and increase chances of an ear infection.

11. Bottle propping. This is a common practice, which can increase ear infections because the milk or juice collects in the back of the nose and mouth and enters directly into the Eustachian tube.

12. Cigarette smoke. Otitis media has been shown to occur more often in children who live with smokers or have a primary caretaker who smokes. Cigarette smoke can irritate the tissues inside the nose and ears, which can stimulate an ear infection.

13. Day care. Children normally experience many colds and illnesses during the first five years of life. The increasing use of large day care centers has led to a rise in the number of cases of otitis media.

         Back to Top

There is a wide range of symptoms of otitis media. Ear pain is a hallmark symptom, which is due to infected fluid putting pressure on the eardrum. As the amount of fluid increases, it pushes more on the eardrum causing more pain.

Symptoms of this "acute" or active stage may include: fever, irritability, crying, sleeplessness, and ear drainage. Your child may show no symptoms of ear pain until the eardrum has ruptured and caused ear drainage. Other children show signs of illness as soon as the fluid begins to collect. Each child's symptoms of ear discomfort are unique and may vary from one infection to the next depending upon how severe it is.

After your child has had several ear infections, you may notice the subtle symptoms or behavior changes before severe ear pain develops. Many infants and toddlers pull or tug on their ears when they have an ear infection. However, tugging on ears does not necessarily mean your child has an ear infection. This habit can be compared to sucking the thumb, which is done as a self-comforting gesture to mean they are hungry or tired.

         Back to Top

It is important to understand what is meant when a doctor makes a diagnosis of otitis media. You should specifically ask what he means. He may mean that an infected fluid (or pus) is bulging against the eardrum causing pain. Or he may mean that he sees fluid or fluid bubbles but does not see any active infection.

The diagnosis of acute otitis media implies active infection, which will benefit from antibiotics. This is the type of infection usually associated with fever, severe ear pain, irritability, or possible rupture of the eardrum. The diagnosis of middle ear fluid is common after the acute infection has been successfully treated with antibiotics. The pus has now been converted into non-infected fluid. There may be no symptoms or there may be symptoms such as ear pulling, head tilting, head banging, irritability while lying flat, hearing loss or balance problems.

The middle ear fluid present after the acute ear infection may last for many weeks or months, often without any symptoms. Seventy percent of children have fluid in their middle ear spaces two weeks after an acute ear infection, 20% after eight weeks, 10% after twelve weeks and 5% after 16 weeks. It is very important to understand this natural progression of ear infections. This explains why your doctor may keep telling you the ear has not totally returned to normal, yet he does not give you any further treatment.

Fluid in the middle ear	Acute ear infection

         Back to Top

The rate of complications from ear infections is 5%. Many doctors feel the rate of serious complications is so low because of a more aggressive treatment plan against acute ear infections.

The most common complication of otitis media is an eardrum perforation or rupture. Most ruptured eardrums heal up on their own within 24-48 hours. If the perforation does not heal, surgical closure may be needed when the child is older.

Long term complications can arise if recurrent ear infections are ignored. There are two basic types of sequelae: 1) Structural- due to scar tissue affecting the ear drum and middle ear bones, 2) Developmental-which occurs when hearing loss causes speech and language delays or learning problems.

         Back to Top

Some types of preventive measures, which may help to reduce ear infections, include:

1) Do not put your infant or toddler to bed with a bottle

2) Breast-feed your infant for 3-6 months to improve the immune  system

3) Do not smoke around your child

4) Choose day care settings with as few other children as possible

5) Obtain preventative antibiotics from your doctor. A small daily dose of antibiotics may decrease ear infections and allow middle ear fluid to go away

6) Consider placement of ear tubes.

         Back to Top

Initial treatment of the acute ear infection begins at home with you. When your child wakes up in the middle of the night screaming in pain, your first thoughts should be to relieve the discomfort.

Pain relievers such as Tylenol and Motrin are best, especially when accompanied by a warm towel or washcloth to the painful ear. The ever and pain of the acute ear infection will often go away within 24 hours, so waiting before going to the doctor is a reasonable plan. If the symptoms last more than 24 hours, a doctor should examine your child.

The doctor may prescribe antibiotics to relieve pain and treat infection. He may also provide you with eardrops to numb the infected eardrum until the antibiotics begin to take effect. If recurrent infections or persistent ear fluid is a problem for your child, you can encourage your child to swallow more often, open his mouth wide by chewing gum, or sucking on a pacifier. By swallowing more often, the Eustachian tube will open more often which will help air to enter into the middle ear.

Decongestants and antihistamines are often prescribed for children with a runny nose associated with an ear infection. The doctor believes that by treating the nose congestion, there is less chance that infected mucus can travel up the Eustachian tube into the middle ear.

Ear tubes (also known as ventilation tubes, tympanostomy tubes, or pressure equalizing tubes) and are final methods to treat and prevent ear infections. More information about ear tubes can be found in the Surgical procedures section of this site.

         Back to Top

The information provided on this web site is not intended to take the place of consultation with your physician. You should always consult a physician whenever you require diagnosis or treatment.