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           Acute otitis media (acute middle ear infection)


What is acute otitis media?

• Acute otitis media (AOM), or acute middle ear infection, is the most common bacterial illness in children and the one most commonly treated with antibiotics.
  
  
• Over 5 million AOM cases occur annually in US children.
  
  
• It results when fluid is unable to drain well from the middle ear.  This results in the accumulation of fluid behind the eardrum which provides an environment for bacteria or viruses to grow.
  

A diagnosis of AOM requires:

• Recent, sudden onset of illness.
  
• The presence of middle ear fluid, or effusion.
  
• Signs or symptoms of middle ear inflammation (e.g., redness of the eardrum, pain, poor movement of the eardrum)

What are the other forms of otitis media?

Your doctor will try to tell between the different forms of otitis because not all forms of otitis need to be treated with antibiotics.

• Otitis media with effusion – fluid in the middle ear thats temporary and isnt necessarily infected. The child does not have pain or fever.
  
  
• Chronic otitis media – persistent perforation (breakage) of the ear drum for more than 3 months

What are some other causes of ear pain in a child?

• Teething
• Jaw or throat problems
• Colds
• Foreign body in the ear canal

What are the signs and symptoms of acute otitis media?

• Ear pain
• Pus in the ear canal
• Fever (in about 1/3 of cases)
• Irritability

What is the treatment for acute otitis media?

• AOM sometimes goes away on it’s own within 2 or 3 days, even without any specific treatment.
  
  
• In 2004, the American Academy of Pediatrics issued new guidelines for the diagnosis and management of AOM in healthy children without health conditions such as recurrent or chronic otitis media, Down syndrome, immune system disorders, or cochlear implants.
  
  
• The guideline attempt to minimize antibiotic side effects by giving parents of select children the option of fighting the infection on their own for 48-72 hours, then starting antibiotics if they do not improve.

  A summary of the guidelines follow:

1. Pain management

         - Acetaminophen (Tylenol) or ibuprofen (Motrin, Advil)

         - Antibiotics do not relieve pain in the first 24 hours, and have only a 
           small effect after that.

2.  When antibiotics should be prescribed:

• For certain or suspected AOM in all children age 6 months and younger regardless of severity of symptoms.
  
  
• For certain or suspected AOM in all children age 6 months to 2 years if symptoms are severe.
  
  
• For certain AOM in all children age 2 to 12 years with severe symptoms.
  
  
• So, observation is an option for suspected or non-severe AOM in many cases for children older than 6 months of age.
  
  
• Many different antibiotics may be used to treat AOM and it is up to the discretion of your doctor which is the most appropriate for your child.
  
  
• In some cases, a second course of therapy with a different antibiotic may be necessary if the bacteria was resistant to the first antibiotic.
  
  
• If your childs doctor decides to prescribe antibiotics, a 10-day course is usually recommended.

What are the harmful effects of antibiotics?

• Each course of antibiotic given to a child can make future infections more difficult to treat. The result is an increase in the use of a larger range of antibiotics which in general are more expensive.
  
  
• Resistant bacteria in a child can be passed to siblings, other family members and peers in daycare or school.
  
  
• In addition, the benefit of antibiotics for AOM is small on average, and must be balanced against potential harm of therapy. About 15 percent of children who take antibiotics suffer from diarrhea or vomiting and up to 5 percent have allergic reactions, which can be serious or life threatening.
   

Are there any complications from acute otitis media?

• Published reports in which children with acute otitis media are not placed on antibiotics
  have shown no increased rate of complications, provided that children are followed carefully and receive antibiotics if symptoms persist or worsen.
  
  
• In rare cases, acute otitis media could lead to meningitis or infection of the mastoid sinuses (behind the ears).

When should I call my pediatrician concerning ear pain in my child?

• It is best to call your pediatrician if your child has symptoms of an ear infection that are not improving, especially if fever is present.
  
  
• You should also call your doctor anytime your child’s ear pain is worsening or if your child looks very ill.

Can AOM be prevented?

Families can help to prevent AOM by reducing risk factors.

For babies and infants these include:

• breastfeeding for at least six months
• avoid feeding them while lying down
• eliminating exposure to tobacco smoke
• keep them up to date on vaccinations