A middle ear infection, also called otitis media, occurs when a virus or bacteria cause the area behind the eardrum to become inflamed. The condition is most common in children. Most middle ear infections occur during the winter and early spring. Often, middle ear infections go away without any medication. However, you should seek medical treatment if pain persists or you have a fever. This type of ear infection comes on quickly and is accompanied by swelling and redness in the ear behind and around the ear drum.
After an infection goes away, sometimes mucous and fluid will continue to build up in the middle ear. There are a number of reasons why children get middle ear infections. They often stem from a prior infection of the respiratory tract that spreads to the ears. When the tube that connects the middle ear to the pharynx eustachian tube is blocked, fluid will collect behind the eardrum.
Bacteria will often grow in the fluid, causing pain and infection. There are a variety of symptoms associated with middle ear infections.
Some of the most common are:. During the exam, your doctor will look at the outer ear and eardrum using a lighted instrument called an otoscope to check for redness, swelling, pus, and fluid. Your doctor might also conduct a test called tympanometry to determine whether the middle ear is working properly. Otitis media acute.
Merck Manual Professional Version. Accessed March 29, Lieberthal AS, et al. The diagnosis and management of acute otitis media. Kliegman RM, et al. Tonsils and adenoids. In: Nelson Textbook of Pediatrics. Philadelphia, Pa. Kaur R, et al. Epidemiology of acute otitis media in the postpneumococcal conjugate vaccine era. Otitis media. Lalwani AK. Accessed March 26, Otitis media secretory.
Ear tubes. Accessed March 18, Coleman A, et al. The unsolved problem of otitis media in indigenous populations: A systematic review of upper respiratory and middle ear microbiology in indigenous children with otitis media. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.
Tympanometry is a test that can be performed in most health care providers' offices to help determine how the middle ear is functioning. It does not tell if the child is hearing or not, but helps to detect any changes in pressure in the middle ear.
This is a difficult test to perform in younger children because the child needs to remain still and not cry, talk, or move. Specific treatment for otitis media will be determined by your child's health care provider based on the following:. If fluid remains in the ear s for longer than three months, and the infection continues to reoccur even with the use of antibiotics, your child's health care provider may suggest that small tubes be placed in the ear s.
This surgical procedure, called myringotomy, involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating.
The child's hearing is restored after the fluid is drained. The tubes usually fall out on their own after six to 12 months. Your child's surgeon may also recommend the removal of the adenoids lymph tissue located in the space above the soft roof of the mouth, also called the nasopharynx if they are infected.
Removal of the adenoids has shown to help some children with otitis media. Treatment will depend on the type of otitis media. Consult your child's health care provider regarding treatment options. In addition to the symptoms of an ear infection listed above, untreated ear infections can result in any or all of the following:. Tympanostomy tubes are appropriate for children six months to 12 years of age who have had bilateral OME for three months or longer with documented hearing difficulties, or for children with recurrent AOM who have evidence of middle ear effusion at the time of assessment for tube candidacy.
Tubes are not indicated in children with a single episode of OME of less than three months' duration, or in children with recurrent AOM who do not have middle ear effusion in either ear at the time of assessment for tube candidacy. Children with chronic OME who did not receive tubes should be reevaluated every three to six months until the effusion is no longer present, hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected.
Children with tympanostomy tubes who present with acute uncomplicated otorrhea should be treated with topical antibiotics and not oral antibiotics.
Routine, prophylactic water precautions such as ear plugs, headbands, or avoidance of swimming are not necessary for children with tympanostomy tubes. Young infants are at increased risk of severe sequelae from suppurative AOM. Middle ear pathogens found in neonates younger than two weeks include group B streptococcus, gram-negative enteric bacteria, and Chlamydia trachomatis. There is little published information to guide the management of otitis media in adults. Adults with new-onset unilateral, recurrent AOM greater than two episodes per year or persistent OME greater than six weeks should receive additional evaluation to rule out a serious underlying condition, such as mechanical obstruction, which in rare cases is caused by nasopharyngeal carcinoma.
Isolated AOM or transient OME may be caused by eustachian tube dysfunction from a viral upper respiratory tract infection; however, adults with recurrent AOM or persistent OME should be referred to an otolaryngologist. Data Sources: We reviewed the updated Agency for Healthcare Research and Quality Evidence Report on the management of acute otitis media, which included a systematic review of the literature through July We searched Medline for literature published since July 1, , using the keywords human, English language, guidelines, controlled trials, and cohort studies.
Searches were performed using the following terms: otitis media with effusion or serous effusion, recurrent otitis media, acute otitis media, otitis media infants 0—4 weeks, otitis media adults, otitis media and screening for speech delay, probiotic bacteria after antibiotics. Search dates: October and August 14, As part of the guideline development process, authors of this article, including representatives from primary and specialty care, convened to review current literature and make recommendations for diagnosis and treatment of otitis media and otitis media with effusion in primary care.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Address correspondence to Kathryn M. Medical Center Dr. Reprints are not available from the authors. Tos M. Epidemiology and natural history of secretory otitis. Am J Otol. University of Michigan Health System otitis media guideline. April Accessed May 16, Prevalence of antimicrobial-resistant pathogens in middle ear fluid.
Antimicrob Agents Chemother. Arrieta A, Singh J. Management of recurrent and persistent acute otitis media: new options with familiar antibiotics. Pediatr Infect Dis J. Community-wide vaccination with the heptavalent pneumococcal conjugate significantly alters the microbiology of acute otitis media. Acute otitis media due to penicillin-nonsusceptible Streptococcus pneumoniae before and after the introduction of the pneumococcal conjugate vaccine. Clin Infect Dis. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review.
Clinical epidemiology of otitis media. Management of acute otitis media: update. Otitis media with effusion. Pelton SI. Otoscopy for the diagnosis of otitis media. The predictive value of tympanometry in the diagnosis of middle ear effusion. Clin Otolayngol Allied Sci. Kimball S. Acoustic reflectometry: spectral gradient analysis for improved detection of middle ear effusion in children.
American Academy of Pediatrics. The assessment and management of acute pain in infants, children, and adolescents.
A randomized, double-blind, multi-centre controlled trial of ibuprofen versus acetaminophen and placebo for symptoms of acute otitis media in children. Fundam Clin Pharmacol. Efficacy of Auralgan for treating ear pain in children with acute otitis media.
Arch Pediatr Adolesc Med.
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