“I think if you have a very cooperative child who should probably be over the age of four, and you can afford this machine, I think it’s a good thing to try. I think it will be somewhat successful. However, I think the jury is still out and we need to see the long-term results. I don’t think it will be harmful to your child.”

– Dr. Julie Zweig, M.D., Ear, Nose and Throat Specialist

Acute otitis media, commonly called an ear infection, usually starts when germs that cause colds or sore throats (either bacterial or viral infections) spread to the middle ear. Once in the ear, the infection can cause a buildup of pus or fluid behind the eardrum. The pressure on the eardrum can lead to significant pain in some children.

Acute otitis media is an inflammation of the area behind the eardrum (tympanic membrane) in the chamber called the middle ear. Deep within the outer ear canal is the eardrum, which is a thin, transparent membrane that vibrates in response to sound waves. The middle ear contains air and sits behind the eardrum. When the eardrum vibrates, tiny bones within the middle ear transmit the sound signals to the inner ear, inside which nerves are stimulated to relay the sound signals to the brain. The eustachian tube, which connects the middle ear to the nose, normally ventilates and equalizes pressure to the middle ear. When your child’s ears “pop” when yawning or swallowing, the eustachian tube is adjusting the air pressure in the middle ear. Consider the following:

• Two out of three children under the age of 3 experience at least one episode of acute otitis media.
• Acute otitis media is the most common bacterial illness in children.
• Fifty percent of antibiotics for American preschoolers are prescribed for ear infections.

Acute otitis media is an infection that produces pus, fluid and inflammation within the middle ear. With proper medical treatment, the bacteria causing the infection can be killed. Antibiotics do not eliminate viral infections, however.

Older children often complain of ear pain, ear fullness or hearing loss. Younger children may demonstrate irritability, fussiness, or difficulty in sleeping, feeding or hearing. Fever may be present in a child of any age. These symptoms are frequently associated with signs of upper respiratory infection, such as a runny or stuffy nose or a cough. During the infection, there will usually be some temporary hearing loss. As fluid and pus disappear from the middle ear, however, hearing improves.

While the number of office visits for otitis media with effusion – middle ear fluid – have decreased over the past decade from 25 million in 1990 to just 16 million in 2000, the number of antibiotic prescriptions written for treatment has remained constant. At the same time, concerns about the rising rate of antibiotic – or antibacterial – use and resistance have emerged. Consider the following:

• Symptoms of acute otitis media include fever, ear pain or pulling at one or both ears, irritability, decreased appetite, and/or fluid coming from one or both ears.
• Children experiencing an earache or a sense of fullness in the ear, especially when combined with fever or a prior upper respiratory tract infection, should always be evaluated by a doctor.
• Ear infections are more common in children who live with someone who smokes.
• Studies have shown that up to 80 percent of acute ear infections will clear up on their own without medical treatment.
• Children whose ear infections are not treated immediately with antibiotics are not likely to develop a serious illness.

A temporary, mild hearing loss nearly always occurs with all types of otitis media. The symptoms, severity, frequency and duration of the condition vary. The American Speech-Language-Hearing Association (ASHA) puts it this way: “At one extreme is a single short period of thin, clear, non-infected fluid without any pain or fever but with a slight decrease in hearing ability. At the other extreme are repeated bouts with infection, thick ‘glue-like’ fluid and possible complications such as permanent hearing loss.” The children who experience thick “glue-like” fluid may also be at risk for persistent behavioral and developmental problems.

ASHA suggests parents watch for signs that may indicate chronic or recurring fluid in the ear, even if there is no pain or fever. Signs include:

• Inattentiveness
• Wanting the television or radio louder than usual
• Misunderstanding directions
• Listlessness
• Unexplained irritability
• Pulling or scratching at the ears

Check with your healthcare professional if you suspect your child has problems with chronic fluid in the ear.

American Speech-Language-Hearing Association
American Academy of Pediatrics
The Journal of the American Medical Association
KidsHealth
American Medical Association
National Center for Infectious Diseases

8 year-old Colleen
visits the doctor with an earache. “She has a very slight
middle ear infection,” says Dr. Michael Levine, a pediatrician
in metro-Atlanta. “So the question is whether we should even
treat it or not. And with something mild like this, I prefer not
to.”

Dr. Levine sends her home with no prescription for an antibiotic.
He tells her mother, “Wait it out and if she’s not
having severe pain, I wouldn’t do a thing. If it gets worse,
bring her back.”

New research in the journal of Pediatrics followed kids
with a mild ear infection. Both those who took the drugs and those
who did not, felt better within 10 days.

Dr. Levine says, “In most cases if it’s a mild ear
infection, if we watch and wait, the symptoms go away, the ear
infection goes away, and the child does not need antibiotics.”

Colleen’s mother says, “I agree with the doctor when
they are mild ear infections not to try to treat them with antibiotics.”

But not all parents are so willing to skip the prescription.
James Santivanez, an Atlanta area father says, “I would probably
go to another doctor, frankly.” Teri-Lynne Johansson says, “I’m
a working mom and I would really wish that they would give an antibiotic.”

“They are so programmed to have an antibiotic at the drop
of a hat,” says Dr. Levine. “We pediatricians in particular
are very nervous about this. We feel that antibiotics have been
over-prescribed for upper respiratory infections in general for
the past 20-30 years.”

Doctors say the more we use antibiotics, the more germs will
mutate….and become resistant to drugs. Dr. Levine says, “Then
when you get a serious infection it may be very, very difficult
to treat it.”

Mom Allison Marshall says, “I guess my thought on it is
you should just kind of save the antibiotics for something really
serious, like if the ear infection’s getting much worse.”

As for Colleen—she has no problem watching and waiting. “That’s
much better than medicine,” she says.

Dr. Levine says all kids with an earache should be checked by a doctor.
Those with a bad infection will need drugs immediately to prevent
complications like hearing loss. If you are told to watch and wait,
tell your doctor if the symptoms get worse.

Acute otitis media, commonly called an ear infection, usually starts
when germs that cause colds or sore throats (either bacterial or viral infections)
spread to the middle ear. Once in the ear, the infection can cause a buildup
of pus or fluid behind the eardrum. The pressure on the eardrum can lead to
significant pain in some children.

Acute otitis media is an inflammation of the area behind the eardrum
(tympanic membrane) in the chamber called the middle ear. Deep within
the outer ear canal is the eardrum, which is a thin, transparent
membrane that vibrates in response to sound waves. The middle ear
contains air and sits behind the eardrum. When the eardrum vibrates,
tiny bones within the middle ear transmit the sound signals to the
inner ear, inside which nerves are stimulated to relay the sound
signals to the brain. The eustachian tube, which connects the middle
ear to the nose, normally ventilates and equalizes pressure to the
middle ear. When your child’s ears “pop” when yawning or
swallowing, the eustachian tube is adjusting the air pressure in
the middle ear.

• Two out of three children under the age of 3 experience at least
  one episode of acute otitis media.
• Acute otitis media is the most common bacterial illness in children.
• Fifty percent of antibiotics for American preschoolers are prescribed
  for ear infections.

Acute otitis media is an infection that produces pus,
fluid and inflammation within the middle ear. With proper medical treatment,
the bacteria causing the infection can be killed. Antibiotics do not eliminate
viral infections, however.

Older children often complain of ear pain, ear fullness or hearing
loss. Younger children may demonstrate irritability, fussiness or
difficulty in sleeping, feeding or hearing. Fever may be present
in a child of any age. These symptoms are frequently associated with
signs of upper respiratory infection, such as a runny or stuffy nose
or a cough. During the infection, there will usually be some temporary
hearing loss. As fluid and pus disappear from the middle ear, however,
hearing improves.

While the number of office visits for otitis media with effusion – middle
ear fluid – have decreased over the past decade from 25 million
in 1990 to just 16 million in 2000, the number of antibiotic prescriptions
written for treatment has remained constant. At the same time, concerns
about the rising rate of antibiotic – or antibacterial – use
and resistance have emerged. Consider the following:

• Symptoms of acute otitis media include fever, ear pain or pulling
  at one or both ears, irritability, decreased appetite, and/or fluid
  coming from one or both ears.
• Children experiencing an earache or a sense of fullness in the
  ear, especially when combined with fever or a prior upper respiratory
  tract infection, should always be evaluated by a doctor.
• Ear infections are more common in children who live with someone
  who smokes.
• Studies have shown that up to 80 percent of acute ear infections
  will clear up on their own without medical treatment.
• Children whose ear infections are not treated immediately with
  antibiotics are not likely to develop a serious illness.

Ten-month-old Jahiem has had a runny nose, a cough and a fever. He has a cold. “OK, I’m going to listen to him and then look in his ears,” says Dr. Kathleen Nelson, emergency room pediatrician.

He’s not crazy about the stethoscope. He reacts with a look of confusion when he feels it on his back. But it’s the otoscope Dr. Nelson uses to look in his ear that causes Jahiem to cry loudly. Dr. Nelson has discovered the problem. “OK. Well, this side I think he’s got a big glob of was there, but he definitely has an ear infection on this (left) side.”

The infection had caused pus to build up inside his ear. “His eardrum was bulging and was immobile. When I tried to squeeze some air into my otoscope to see if the eardrum will flutter, which it does normally … I got no movement of the eardrum,” says Dr. Nelson.

Dr. Nelson says a cold often leads to an ear infection in young children. The reason: The tubes that drain fluid from the ear are underdeveloped and during a cold, glands swell and put pressure on the tubes, making it harder for the ears to drain. “That allows for fluid to build up in the middle ear, and it allows germs to grow there. It’s like a stagnant pond, and it’s a good culture media for bacteria,” says Dr. Nelson.

Today, doctors are less likely to use antibiotics to treat ear infections because so many germs have developed a resistance. But when the infection is bacterial and the child’s in pain, antibiotics can still work and work fast. “When we treat children with ear infections with antibiotics, they should respond within 48 to 72 hours with a decrease in the fever and really feeling much better,” says Dr. Nelson.

Acute otitis media, commonly called an ear infection, usually starts when germs that cause colds or sore throats (either bacterial or viral infections) spread to the middle ear. Once in the ear, the infection can cause a buildup of pus or fluid behind the eardrum. The pressure on the eardrum can lead to significant pain in some children.

Acute otitis media is an inflammation of the area behind the eardrum (tympanic membrane) in the chamber called the middle ear. Deep within the outer ear canal is the eardrum. The eardrum is a thin, transparent membrane that vibrates in response to sound waves. The middle ear contains air and sits behind the eardrum. When the eardrum vibrates, tiny bones within the middle ear transmit the sound signals to the inner ear. In the inner ear, nerves are stimulated to relay the sound signals to the brain. The eustachian tube, which connects the middle ear to the nose, normally ventilates and equalizes pressure to the middle ear. When your child’s ears “pop” when yawning or swallowing, the eustachian tube is adjusting the air pressure in the middle ear.

• Two out of three children under the age of 3 experience at least one episode of acute otitis media.
• Acute otitis media is the most common bacterial illness in children.
• Fifty percent of antibiotics for American preschoolers are prescribed for ear infections.

Acute otitis media is an infection that produces pus, fluid and inflammation within the middle ear. With proper medical treatment, the bacteria causing the infection can be killed. Antibiotics do not eliminate viral infections, however.

Older children often complain of ear pain, ear fullness or hearing loss. Younger children may demonstrate irritability, fussiness, or difficulty in sleeping, feeding or hearing. Fever may be present in a child of any age. These symptoms are frequently associated with signs of upper respiratory infection, such as a runny or stuffy nose or a cough. During the infection there will usually be some temporary hearing loss. As fluid and pus disappear from the middle ear, hearing improves.

While the number of office visits for otitis media with effusion – middle ear fluid – have decreased over the past decade from 25 million in 1990 to just 16 million in 2000, the number of antibiotic prescriptions written for treatment has remained constant. At the same time, concerns about the rising rate of antibiotic – or antibacterial – use and resistance have emerged.

• Symptoms of acute otitis media include fever, ear pain or pulling at one or both ears, irritability, decreased appetite, and/or fluid coming from one or both ears.
• Children experiencing an earache or a sense of fullness in the ear, especially when combined with fever or a prior upper respiratory tract infection, should always be evaluated by a doctor.
• Ear infections are more common in children who live with someone who smokes.
• Studies have shown that up to 80 percent of acute ear infections will clear up on their own without medical treatment.
• Children whose ear infections are not treated immediately with antibiotics are not likely to develop a serious illness.

American Academy of Pediatrics
JAMA Medical Library
KidsHealth.org