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Otitis media in children

What is it?

  • Otitis (o-TI-tis) media is an infection (in-FECK-shun) of the middle ear (the space behind the eardrum). Children are most likely to get ear infections between the ages of three months and three years. Ear infections are most common during cold and flu season, usually in the winter and early spring months.
  • Your child may have an ear infection in one or both ears. He may have one or many repeated infections during his early childhood. Children with ear infections have a build-up of fluid and pressure in the middle ear. The middle ear may become infected by germs, which grow easily in the fluid trapped behind the eardrum. Antibiotic medicine may be used to treat your child's ear infection. Your child should feel better in two to three days after taking antibiotics. Always give your child antibiotics exactly as directed by his caregiver.

Causes:

  • Your child may get an ear infection when his eustachian (u-STAY-shun) tubes become swollen or blocked. Eustachian tubes are tiny tubes that connect the middle ear to the back of the nose and throat. Eustachian tubes drain fluid away from the middle ear. They keep fresh air flowing in and out of the ears and control air pressure in the middle ear. Fresh air and the right pressure are needed so that your child can hear properly.
  • When eustachian tubes become blocked, usually because of a cold or allergy, fluid cannot drain from the ear. Fluid that is trapped behind the eardrum is a perfect place for germs called bacteria (bak-TEER-e-uh) to grow. As the trapped fluid builds up, it puts increased pressure against the eardrum. If too much pressure builds up, the eardrum may break open. This is usually not a serious problem, because with time, the eardrum repairs itself.

Who is at high risk for getting ear infections?

  • Children who go to day care or school.
  • Children who live or play around people who smoke.
  • Children whose brother, sister, or parent has had problems with ear infections.
  • Babies who get their first ear infection before six months of age.
  • Children with problems with their face or head, such as those with cleft palate or Down syndrome.
  • Children who suck on pacifiers after ten months of age.
  • Children who drink bottles while lying flat.

Signs and Symptoms:

  • Fever.
  • Ear pain.
  • Fussier and more restless than normal.
  • Trouble sleeping.
  • Pus or yellowish fluid coming from the ear.
  • Trouble hearing. This may be caused by fluid build-up in the middle ear. Your child may not hear quiet noises that he normally hears in the room. He may seem like he is not paying attention to what you are saying. He may try to sit very close to the TV or ask to turn up his music so it is louder.
  • Ear tugging, pulling, or rubbing.
  • Will not eat or drink. Sucking, swallowing, and chewing can make the pain worse.
  • Dizziness or loss of balance.

Wellness Recommendations:

Following are things you can do to decrease the risk of your child getting an ear infection.

  • Breast feed. Your child may be less likely to get an ear infection if he is breast fed.
  • Do not give your baby a bottle while he is lying down. This can let liquid get into your baby's eustachian tube. This tube connects the middle ear to the back of the nose.
  • Do not use a pacifier. Pacifiers are associated with a higher risk of ear infections.
  • Keep your child away from people who smoke. Children who are around smokers are more likely to have ear infections.
  • Germs are easily and quickly spread in daycare centers. Keep your child away from sick playmates. Try to keep him home if there is a cold or other infection going around the daycare.
  • Some vitamins help the body fight infection. Make sure your child eats a good diet to include vitamins A, C, and E, and zinc. A daily multivitamin for children is good if he does not get enough vitamins and minerals in his food.

Medical Care:

  • Caregivers will use an otoscope to look inside your child's ears to see if he has an ear infection. A tympanogram may be done to see if your child's ears are infected. This test is done by putting an ear plug into his ears to see how the eardrum moves.
  • Antibiotic medicine may be needed to treat the infection. Acetaminophen or ibuprofen may help your child's fever and ear pain. A heating pad set on low and placed on the ear may also help the pain. Do not give aspirin to children under 18 years. This could cause Reye's syndrome which is a serious illness.
  • Caregivers may suggest that your child have tubes put in the ears if he has had frequent ear infections. The tubes let liquid drain from the ears. This may keep your child from having ear infections or a hearing loss. With time, the tube falls out and the eardrum heals on its own.
  • Prop your child's chest and head up with a pillow during sleep. This may decrease his ear pain.

Dietary Measures:

  • Decrease the sugar in your child's diet. He may be able to fight infection better with less sugar in his body.
  • You may want to give your child Xylitol sweetened chewing gum if he is old enough to chew gum. This gum may decrease ear infections.
  • Your child may have a food allergy that is causing ear infections. Keep a food diary to learn if a food triggers an infection, such as after eating sugar, dairy products, eggs, corn, soy, tomato, or peanuts.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Herbs:

  • Echinacea (Echinacea purpura) has been used for many years, but has not been studied in children who have otitis media.
  • Garlic (Allium sativum) has been used for many years, but has not been studied in children who have otitis media.
  • Goldenseal (Hydrastis canadensis) has been used for many years, but has not been studied in children who have otitis media.
  • St. John's wort (Hypericum perforatum) has been used for many years, but has not been studied in children who have otitis media.

Supplements:

  • Vitamin C has been used, but has not been studied in children who have otitis media.
  • Zinc has been used, but has not been studied in children who have otitis media.

Other ways of treating your symptoms:

Other ways to treat your symptoms are available to you.

Talk to your caregiver if:

  • You would like medicine to treat otitis media.
  • Your child's symptoms have not gone away or improved by these self-help measures.
  • Your child has a rash.
  • You have questions about what you have read in this document.

SEEK CARE IMMEDIATELY IF:

  • Your child has a high fever.
  • Your child is crying, fussy, and tugging at the ears after taking the medicine for 48 hours.
  • Your child is still not eating or drinking after 24 hours.
  • Your child is not thinking clearly.
  • Your child cannot stay awake.
  • Your child has a stiff neck.

Care Agreement:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care will be used to treat your child. You always have the right to refuse treatment.

References:

1. Bernstein JM: The role of IgE-mediated hypersensitivity in the development of otitis media with effusion. Otolaryngol Clin North Am 1992; 25(1):197-211.

2. Daly KA, Brown JE, Lindgren BR et al: Epidemiology of otitis media onset by six months of age. Pediatrics 1999 Jun; 103(6 Pt 1):1158-1166.

3. Duncan B, Ey J, Holberg CJ et al: Exclusive breast-feeding for at least 4 months protects against otitis media. Pediatrics 1993; 91(5):867-872.

4. Dybing E & Sanner T: Passive smoking, sudden infant death syndrome (SIDS) and childhood infections. Hum Exp Toxicol 1999; 18(4):202-205.

5. Host A: Mechanisms in adverse reactions to food: the ear. Allergy 1995; 50(20 Suppl):64-67.

6. Hurst DS: Allergy management of refractory serous otitis media. Otolaryngol Head Neck Surg 1990; 102(6):664-669.

7. Jackson JM & Mourino AP. Pacifier use and otitis media in infants twelve months of age or younger. Pediatr Dent 1999; 21:255-260.

8. Nsouli TM, Nsouli SM, Linde RE et al: Role of food allergy in serous otitis media. Ann Allerg 1994; 73:215-219.

9. Uhari M: Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ 1996; 313:1180-1184.


Last Updated: 4/4/2014

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