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Otitis media among children

Ear infections are one of the most common reasons parents take their children to the doctor. While there are different types of ear infections, the most common is called otitis media or infection of the middle ear . 75% of all children experience at least one episode before they turn 3 years old. . The following article will help you understand what otitis media is, as well as its causes, symptoms, diagnosis, and treatment options.

Our ears are very specialzed organs that allow us to hear and keep our balance.

The ear consists of three major parts :

Ear anatomy

1. The outer ear includes the pinna, which is the visible part of the ear, and the ear canal. It is separated from the middle ear by the tympanic membrane or eardrum.

2. The middle ear is an air-filled space that contains three tiny bones (malleus, incus and stapes) that transmit sound from the eardrum to the inner ear.

3. The inner ear contains the hearing and balance organs, it converts sound into electrical signals carried by nerves to the brain where their meaning is understood.

The Eustachian tube is a small passageway that connects the middle ear to the throat; normally it opens to allow fresh air into the middle ear. It also equalizes middle ear pressure in response to air pressure changes.

What is otitis media?

Otitis media is an infection or inflammation of the middle ear (the area behind the tympanic membrane)

  • This inflammation often begins when infections (viral or bacterial) that cause sore throats, colds or respiratory problems spread to the middle ear: Bacteria or viruses reach the middle ear through the Eustachian tube.
  • To fight this infection, white blood cells attack and kill the germs, and by doing so, they die and form pus (a thick yellowish white fluid) in the middle ear.
  • As a result, the Eustachian tube may get blocked, the middle ear becomes swollen and the eardrum and middle ear bones are unable to move as freely as they should. The child can experience severe pain, perforation of the eardrum (due to the pressure of the fluid) and hearing impairment.

Middle ear infection (otitis media)

Why children are more affected than adults?

There are 3 main reasons why children are more likely to suffer from otitis media:

1- Children have more trouble fighting infections because their immune system is still developing.The immune system is responsible for fighting germs in the body.

2- The Eustachian tube of children (the passageway that connects the throat to the middle ear) is shorter and straighter than of adults, which allows viruses to find their way into the middle ear more easily. Adults' Eustachian tubes are steeper so they drain better than children's do.

3- The adenoids are special glands that help fight infections. They are located in the upper back of the throat near the Eustachian tube. In childhood, they are larger than they are in adult age. They are positioned in the back of the throat near the Eustachian tube. Enlarged adenoids interfere with the Eustachian tube by narrowing its entrance. In addition, they may become themselves infected, and hence let the infection spread to the Eustachian tube.

How can I tell if my child has otitis media?
Most children affected by this disorder do not yet have sufficient speech and language skills to tell what is bothering them. Common signs to look for are:

  • Usual irritability
  • Difficulty sleeping
  • Decreased appetite
  • Tugging or pulling one or both ears
  • Fever
  • Fluid draining from the ear
  • Loss of balance
  • Unresponsiveness to quiet sounds, or other signs of hearing difficulty such as sitting too close to the television or being inattentive

What are the effects of otitis media?

Although the hearing loss caused by otitis media is usually temporary, untreated otitis media may lead to permanent hearing impairment. Persistent fluid in the middle ear and chronic (persistent) otitis media can reduce a child's hearing at a time that is critical for speech and language development. Without good hearing a child cannot learn to speak and verbalize different sounds and may develop speech and language disabilities.

At our school , an ear exam is performed to all students during the yearly medical check up. If a learner is found to have otitis media, the parents are notified immediately to initiate the treatment. The child's pediatrician or otolaryngologist (ear, nose and throat specialist) decides the convenient treatment modality for the child, depending on the case history and ear examination findings. On the other hand, if a child is detected with a certain delay in speech, parents are requested to perform a thorough ear exam for their child, in order to treat any potential underlying hearing problem as early as possible.

How is otitis media diagnosed and treated?

A doctor detects a middle ear infection by looking in the ear with an otoscope. The otoscope shines a light in the ear, showing the eardrum and allowing the doctor to see if it is inflamed.

Many physicians recommend the use of antibiotic (a drug that kills bacteria) when there is an active middle ear infection. If a child is experiencing pain, the physician may also recommend a pain reliever . Once started, the antibiotic should be taken for as long as it is prescribed. Most physicians will have the child return for a follow up examination, to see if the infection has cleared up.

Unfortunately, many bacteria that cause otitis have become resistant to antibiotic, which means that different antibiotics may have to be tried.

Once the infection clears, fluid may remain in the middle ear for several months. Middle ear fluid that is not infected often disappears after 3 to 6 weeks. If the fluid persists for more than 3 months and is associated with a loss of hearing, many physicians suggest tympanostomy, which is the insertion of a tube in the affected ears. This operation is called a myringotomy; it is done by an otolaryngologist.While the child is asleep under general anesthesia the surgeon makes a small opening in the child's eardrum, then a small metal or plastic tube is inserted into this opening. The tube ventilates the middle ear and helps keep the air pressure in the middle ear equal to the air pressure in the environment. The tube normally stays in the eardrum for 6 to 12 months, after which it usually comes out by itself.

If a child has enlarged or infected adenoids, the surgeon may recommend their removal. At the same time, the ear tubes are inserted.This operation is called adenoidectomy.

Hearing should be fully restored once the accumulated fluid is removed. Some children may need to have the operation repeated if otitis media returns after the tubes come out.

While the tubes are in place, water should be kept out of the ears. Special ear plugs must be weared while swimming or bathing.

Can anything be done to prevent otitis media?

With children who are prone to recurrent otitis media, the following is advised:

  • Do not let your child get in contact with sick playmates
  • Do not expose your child to environmental tobacco smoke
  • Do not bottle-feed your baby while it is lying down
  • Adopt breastfeeding, as children who have been breastfed have better immunity and hence fewer ear infections.

Recognizing the symptoms of otitis media in your child is important before the infection causes serious damage to hearing. Fortunately, nowadays otitis media is easily diagnosed and treated, allowing children to develop with normal hearing and language skills.