Otitis media (middle ear infection)

• What is Otitis Media (Middle Ear Infection)?
• Statistics
• Risk Factors
• Progression
• Symptoms
• Clinical Examination
• Prognosis
• Treatment
• References

What is Otitis Media (Middle Ear Infection)?

Otitis media is an infection of the middle ear. There are two major types of otitis media:

• Acute otitis media
• Otitis media with effusion

Otitis media is diagnosed by your doctor by taking a history and doing an examination of the ear canal.

Acute otitis media is defined by the following:

• History of acute onset of signs and symptoms of fluid in the middle ear, and middle ear inflammation
• Presence of fluid in the middle ear:
  • Bulging of the ear drum
  • Limited or absent mobility of the ear drum
  • Discharge from the ear
• Signs and symptoms of middle ear inflammation:
  • Reddening of the ear drum
  • Pain in the ears that interferes with daily activities or sleep

Otitis media with effusion is defined by the following:

• Fluid in the middle ear without the signs and symptoms of acute ear infection

Statistics

1 in 10 children suffer from otitis media annually. This is 10 times the amount of adults who suffer from the same condition annually. Otitis media is one of the most common reasons for children below the age of 4 with a fever to visit a general practitioner. It composes 8% of all childhood disease, and accounts for 1.3% of presentations to general practice.

Chronic otitis media with effusion interferes with the hearing of approximately 5% of 5 year olds.

Risk Factors

Predisposing factors for otitis media are:

• Age: This is the most important risk factor for developing otitis media. Most commonly, it occurs between the ages of 6 and 18 months. The younger the child, the more severe the disease and greater the risk of complications.
• Daycare
• Non-breastfed children
• Tobacco smoke
• Pacifier use
• Genetic factors: Increased incidence among twins
• Social and economic conditions
• Sleep position
• Season: Increased incidence during autumn and winter.
• Altered host defenses
• Underlying disease (e.g. cleft palate, Down’s syndrome, allergic rhinitis)
• Ethnicity (e.g. Aboriginal and Torres Strait Islanders)
• Children in developing areas
• Family history of otitis media

Progression

In acute otitis media, usually you start with the symptoms of a common cold (e.g. runny nose, cough, fever and tiredness). The symptoms of otitis media (e.g. ear pain) develop soon after that.

In children, the pain can be difficult to locate, so it is important to take your child to the doctor to be checked for otitis media whenever they have a fever.

The pain in the ear usually resolves over a few days. Sometimes it resolves abruptly when the ear drum perforates and the fluid drains out of the ear canal. Perforation of the ear drum is not a catastrophic event since the drum can repair itself quickly and easily.

There are many complications of otitis media. They are classified as those that occur outside of the brain (extracranial) and those that occur within the brain (intracranial). These complications are extremely rare and usually occur in very young children, or those with serious medical conditions.

Symptoms

Some of the common symptoms of otitis media that a parent should look out for are:

• Rubbing ear
• Earache
• Excessive crying
• Diarrhoea
• Fever
• Vomiting
• Vertigo
• Other signs and symptoms of an upper respiratory tract infection (e.g. rhinorrhoea, cough, malaise)
• History of atopic disease (e.g. hayfever, eczema, asthma)

Clinical Examination

When you visit your doctor and they think that your child may be suffering from otitis media your doctor may perform the following examinations:

• Examination of your childs ear using an otoscope: This is usually performed with your child on your lap, especially if they are young. This is a very important part of the visit because examination of the ear canal is essential for making an accurate diagnosis. At the same time, your doctor may need to remove some wax from your child’s ear to help see the ear drum. This should not be painful for your child.
• Examination of the nose and throat
• Examination of the lungs and general well being

Prognosis

The severity of the symptoms and the age of the patient determines the likelihood of success of antibiotic treatment.

Acute otitis media in children below the age of 2 has a poor prognosis. It is associated with an increased number of recurrences of acute otitis media, as well as the development of otitis media with effusion 6 months later in 35% of children.

Acute otitis media in older age groups usually resolves on its own without antibiotic treatment.

Treatment

Most people with otitis media respond well to general measures such as pain relief and increased fluid intake.

Pain relief should be given according to your doctor’s instructions. It is especially important to use the correct dose in young children.

Fluid intake is important, especially if your child has a fever or diarrhoea. In infants, fluids should be maintained by continuing breastfeeding or formula feeding. In older children, regular intake of water and not juices or sweetened drinks is important. If your child is severely dehydrated, your doctor may give your child an oral rehydration solution which contains all the essential minerals needed to maintain your child’s body fluids.

Antibiotics have been shown to have little effect on the course of acute otitis media, and they are not used in all circumstances.

• In children without fever and vomiting, antibiotics are not given unless the child’s symptoms have not resolved within 2 days, or unless the child is less than 2 years of age.
• In children with fever and vomiting, antibiotics are generally given. Amoxycillin is the antibiotic of choice.

In otitis media with effusion, a longer course of antibiotics is generally needed. Children should be referred to specialists if they experience learning difficulties or structural damage to the ear drum.

References

1. Bhetwal N, McConaghy JR. The evaluation and treatment of children with acute otitis media. Primary Care Clinics in Office Practice. 2007; 24(1): 59-70.
2. Casselbrant ML, Mandel EM. Genetic susceptibility to otitis media. Current Opinion in Allergy and Clinical Immunology. 2005; 5(1): 1-4.
3. Chandler SM, Garcia SM, McCormick DP. Consistency of diagnostic criteria for acute otitis media: A review of the recent literature. Clinical Pediatrics. 2007; 46(2): 99-108.
4. Corbeel L. What is new in otitis media? European Journal of Pediatrics. 2007; 166(6): 511-9.
5. Del Mar C. Childhood otitis media. Australian Prescriber. 1994; 17(4): 82-4.
6. Smith JA, Danner CJ. Complications of chronic otitis media and cholesteatoma. Otolaryngology Clinics of North America. 2006; 39(6): 1237-55.
7. Spector ND, Kelly SF. Medical home, obesity, acute otitis media, and otitis media with effusion. Current Opinion in Pediatrics. 2004; 16(6): 706-22.
8. Otitis media. In: Principles and Practice of Pediatric Infectious Diseases, 2nd ed. Long SS, Pickering LK, Prober CG, eds. New York: Churchill Livingstone, 2003.
9. American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004; 113(5): 1451-65.
10. American Academy of Pediatrics Subcommittee on Otitis Media with Effusion. Otitis media with effusion. Pediatrics. 2004; 113(5): 1412-29.
11. Therapeutic guidelines: Antibiotic, Version 13 [online]. Therapeutic Guidelines. 2006 [cited 27 June 2007]. Available from URL: http://www.tg.com.au
12. Uhari M, Mantysaari K, Niemela M. A meta-analytic review of the risk factors for acute otitis media. Clinical Infectious Diseases. 1996; 22(6): 1079-83.