Acute otitis media (AOM) is a painful infection of the middle ear, the
portion of the ear behind the eardrum. (Another form of ear infection, otitis
externa or swimmers ear, is entirely different, and is not covered here.) AOM
often follows a cold, sore throat, or other respiratory illness. Although it can
affect adults, this occurs primarily in infants and young children. Its
estimated that by age 7, up to 95% of all U.S. children will have experienced at
least one bout of AOM—its the most common reason parents take a child to the
doctor.
When the Eustachian tube connecting the upper part of the throat to the middle ear is blocked by a colds mucus and swelling, fluids pool behind the eardrum, providing an ideal place for bacteria to grow; an infection may set in, generating even more fluid. The pressure this exerts on the eardrum can be intensely painful. The eardrum turns red and bulges. Children too young to explain their discomfort cry, fuss, and pull at their ears. They might also appear unresponsive because they cant hear well—fluid buildup in the middle ear prevents the eardrum and small bones in the ear from moving, causing temporary hearing loss.
Most hearing loss associated with AOM ends when the infection is treated. However, recurring ear infections and their accompanying short-term hearing losses may affect a childs speech and language development. In addition, a complication called secretory otitis media (fluid build-up in the middle ear) may develop and cause continuous hearing loss for months. Other possible complications of AOM include mastoiditis (an infection of the bone behind the ear) and, occasionally, spinal meningitis.
Without treatment, most middle ear infections resolve on their own, often through a harmless rupture of the eardrum. In the Netherlands, pediatricians take a conservative approach, generally waiting 24 to 72 hours until they are certain an ear infection warrants antibiotics.
However, U.S. doctors tend to initiate treatment early. This practice has been criticized on several grounds. First, antibiotic treatment has not been found effective in preventing complications such as serous otitis or pneumococcal meningitis.
In addition, antibiotic treatment does not even appear to help AOM itself very much. For example, a double-blind placebo-controlled trial of 240 children ages 6 months to 2 years found so little benefit with antibiotic treatment that the authors recommended physician-supervised watchful waiting rather than immediate treatment. In other published reviews, the benefits of antibiotics for AOM have also been found less than impressive. A review of 33 randomized trials involving 5,400 children concluded that antibiotics modestly improved the rate of recovery. An evaluation of six randomized, controlled studies concluded that early antibiotic use had only slight benefit, reducing pain and fever in a small percentage of children and helping to prevent the development of infection in the other ear, but not significantly speeding up recovery of hearing. Modest benefits were also seen in a more recent trial of 315 children. Finally, children with recurrent ear infections do not appear to benefit from preventive antibiotic treatment.
However, another criticism, that early antibiotic treatment causes an increased rate of ear infection recurrence, does not appear to be correct.
Note: Despite the issues raised above, simply withholding antibiotic treatment can be dangerous. Any child who appears to have an ear infection should be seen by a physician.
When ear infections do reoccur frequently, a physician may insert a tube into the infected ear to drain fluids and relieve pressure, a procedure called tympanostomy. Nearly 1 million U.S. children undergo this procedure each year; however, its usefulness is somewhat controversial.
When the Eustachian tube connecting the upper part of the throat to the middle ear is blocked by a colds mucus and swelling, fluids pool behind the eardrum, providing an ideal place for bacteria to grow; an infection may set in, generating even more fluid. The pressure this exerts on the eardrum can be intensely painful. The eardrum turns red and bulges. Children too young to explain their discomfort cry, fuss, and pull at their ears. They might also appear unresponsive because they cant hear well—fluid buildup in the middle ear prevents the eardrum and small bones in the ear from moving, causing temporary hearing loss.
Most hearing loss associated with AOM ends when the infection is treated. However, recurring ear infections and their accompanying short-term hearing losses may affect a childs speech and language development. In addition, a complication called secretory otitis media (fluid build-up in the middle ear) may develop and cause continuous hearing loss for months. Other possible complications of AOM include mastoiditis (an infection of the bone behind the ear) and, occasionally, spinal meningitis.
Without treatment, most middle ear infections resolve on their own, often through a harmless rupture of the eardrum. In the Netherlands, pediatricians take a conservative approach, generally waiting 24 to 72 hours until they are certain an ear infection warrants antibiotics.
However, U.S. doctors tend to initiate treatment early. This practice has been criticized on several grounds. First, antibiotic treatment has not been found effective in preventing complications such as serous otitis or pneumococcal meningitis.
In addition, antibiotic treatment does not even appear to help AOM itself very much. For example, a double-blind placebo-controlled trial of 240 children ages 6 months to 2 years found so little benefit with antibiotic treatment that the authors recommended physician-supervised watchful waiting rather than immediate treatment. In other published reviews, the benefits of antibiotics for AOM have also been found less than impressive. A review of 33 randomized trials involving 5,400 children concluded that antibiotics modestly improved the rate of recovery. An evaluation of six randomized, controlled studies concluded that early antibiotic use had only slight benefit, reducing pain and fever in a small percentage of children and helping to prevent the development of infection in the other ear, but not significantly speeding up recovery of hearing. Modest benefits were also seen in a more recent trial of 315 children. Finally, children with recurrent ear infections do not appear to benefit from preventive antibiotic treatment.
However, another criticism, that early antibiotic treatment causes an increased rate of ear infection recurrence, does not appear to be correct.
Note: Despite the issues raised above, simply withholding antibiotic treatment can be dangerous. Any child who appears to have an ear infection should be seen by a physician.
When ear infections do reoccur frequently, a physician may insert a tube into the infected ear to drain fluids and relieve pressure, a procedure called tympanostomy. Nearly 1 million U.S. children undergo this procedure each year; however, its usefulness is somewhat controversial.