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Middle ear infection - otitis media

Middle ear infections - also known as otitis media - are one of the most common illnesses affecting infants and young children. Most children have at least one ear infection by age 3. By age 7, almost all children have had an ear infection.

Ear infections usually start with a cold, which can cause fluid to build up behind a child's eardrum. The fluid itself isn't necessarily a problem. But it's an ideal breeding ground for bacteria or viruses that cause infection.

An acutely infected ear is very painful. But interpreting pain in a child who may be too young to communicate verbally can be a challenge. Signs other than pain may be more apparent. A child with an ear infection may also have a fever and be irritable or listless. Difficulty sleeping is common.

Treatment

Doctors treat ear infections in a number of ways. What's best for your child depends on many factors, including:

• The diagnosis

• Any additional medical concerns

• How often your child has ear infections

• How long your child has had this ear infection

• Your child's age

• Whether the infection affects your child's hearing

The options for treatment include a wait-and-see approach and a variety of medical treatments:

• Wait-and-see approach. It's difficult for parents to see their children in pain. And most parents would do anything to help their child feel better. But it may be in your child's best interest to focus first on pain relief and to reserve antibiotics for persistent infections. That's because most ear infections clear on their own in just a few days.

• In addition, antibiotics won't help an infection caused by a virus. They also won't eliminate middle ear fluid. Furthermore, antibiotics may cause side effects such as nausea, diarrhea, rashes and allergic reactions. And frequent use of antibiotics can create strains of antibiotic-resistant bacteria. This can make it much more difficult to treat serious infections in the future.

• If you do decide to hold off on antibiotics, watch your child for any sign of increased pain or hearing loss and ask your doctor for advice on pain relief.

• Antibiotic therapy. If your doctor is concerned that your child's ear is infected, he or she may recommend using an antibiotic. When the medication is effective, your child should start feeling better in a few days. But even if your child's symptoms improve, continue giving the medicine for the full length of the prescription, which can vary from 5 to 10 days depending on the regimen. Stopping medication too soon could allow the infection to come back. It also contributes to the development of antibiotic-resistant strains of bacteria.

• Most children may have fluid in their ears for as long as 2 months after an infection has cleared up. This shouldn't be a problem unless it affects hearing.

• Preventive antibiotics. If your child has recurrent ear infections — three or more ear infections in a 6-month period, or four a year — your doctor might suggest a low-dose antibiotic for a few weeks or months as a preventive measure. Antibiotics won't clear fluid from the middle ear, but they may help prevent bacteria from growing. Antibiotics won't prevent viral infections. On the other hand, because many bacteria are resistant to antibiotics, your child could develop an infection even while taking medication. In addition, the longer your child takes antibiotics, the greater is his or her chance of having side effects such as diarrhea, rashes and allergic reactions. Giving children antibiotics as a preventive measure is an increasingly controversial decision. Be sure you discuss the risks and benefits to your child with your child's doctor.

• Drainage tubes. If middle ear fluid is affecting your child's hearing, or recurrent ear infections don't respond to antibiotics, your doctor may suggest insertion of a small drainage tube through your child's eardrum. This helps drain the fluid and equalize the pressure between the middle ear and outer ear. Your child's hearing should improve immediately. As your child's eardrum grows, the tube is eventually pushed out and the drainage hole heals.

This surgical procedure (myringotomy) requires general anesthesia. About 25 percent of children continue to have problems and need surgery to insert a second set of tubes. A few children require even a third set.

If your child has drainage tubes, your doctor may caution against swimming, which can increase the risk of ear infections.

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