Both children and adults can get ear infections, but anatomical differences make children much more susceptible to getting them. According to the National Institute on Deafness and other Communication Disorders, ear infections are the most popular reason that parents bring their children into the doctor, and 75 percent of children will experience at least one ear infection before they are three. Treatment options depend on the type, duration and frequency of the ear infections.
Causes
The ear is made up of three parts, the outer, the middle and the inner ear. Otitis media, or middle ear infection, occurs when the middle ear becomes inflamed, trapping fluid behind the eardrum. The only way for this fluid to drain is by release through the Eustachian tube, which runs from the middle ear to the back of the throat. In children, the Eustachian tube is smaller and more horizontal, making drainage more difficult than in adults. Additionally, infants spend a lot of time on their backs, which exacerbates the problem. The infection can be bacterial or viral and will often accompany a cold. Some children are considered more at risk for developing otitis media. These include children with a family history of the disease, low socio-economic status, exposure to tobacco, abnormalities of the head and neck, and risk factors for speech and language problems.
Types
Acute otitis media comes on quickly and only lasts a few weeks. The inflammation causes fluid to build up in the middle ear space. The fluid pushes up against the eardrum causing pain, fever and the potential for the eardrum to rupture.
Chronic otitis media is inflammation and fluid that is present for a month or more. The presence of the fluid weakens the eardrum, causing a hole to develop and constant drainage from the ear.
Treatment of Acute Otitis Media
There are two treatment courses recommended by the American Academy of Pediatrics: the observation option and treatment with antibiotics. The first option is recommended if the diagnosis is not certain, the symptoms are not severe or risk factors for development of chronic otitis media are not present. If this option is chosen, management of pain is still important. This could include over-the-counter medicines, such as ibuprofen or acetaminophen, or prescription topical numbing drops. The second option is treatment with antibiotics such as Amoxicillin or Azithromycin.
Treatment of Chronic Otitis Media
The two options for treatment of chronic otitis media are watchful waiting and surgical intervention. Watchful waiting is recommended only for children who are not at risk for developing speech, language or learning difficulties. The three-month period of observation must include periodic visits to health-care professionals to monitor hearing levels and observe the eardrum and the course of the disease. Surgery is recommended when drainage lasts for more than four months and another condition applies such as the presence of hearing loss, risk for permanent damage to the eardrum or the bones in the middle ear, or the child is considered high risk for speech, language, hearing or learning difficulties. The primary recommended surgical procedure is the placement of ear tubes. The small plastic tubes are inserted through an incision made in the eardrum, allowing fluid to drain out of the ear. The tubes stay in place for six months or more and are designed to work their way out on their own. In some cases, the removal of tonsils and adenoids is also recommended.
Alternative and Complementary Medicine
Middle ear fluid can possibly be treated with complementary alternative medicine including chiropractic, homeopathic, dietary exclusion, herbal supplements, acupuncture and acupressure. According to the American Academy of Pediatrics, "Evidence concerning complementary alternative medicine is insufficient to determine whether the outcomes achieved for otitis media differ from those achieved by watchful waiting and spontaneous resolution. There are no randomized, controlled trials with adequate sample sizes on the efficacy of complementary alternative medicine for otitis media." Most of the alternative treatments are harmless, but some can interfere with recommended treatments or cause additional damage. It is important to discuss any alternative treatments with your health-care provider.
References
- National Institute on Deafness and Other Communication Disorders: Ear Infections in Children
- American Speech Language Hearing Association: Causes of Hearing Loss in Children
- The American Academy of Pediatrics; Clinical Practice Guideline, Diagnosis and Management of Acute Otitis Media
- The American Academy of Pediatrics; Clinical Practice Guideline, Otitis Media With Effusion
