Acute otitis media (AOM) is the typical ear infection that presents with pain, fever, drainage, pulling of the ears and fussiness. Otitis media with effusion (OME), on the other hand, is the chronic fluid in the ears, and it often displays no symptoms aside from hearing loss.

Otitis media is evaluated by examining the ear with an otoscope (a magnifying-glass-like instrument) that painlessly puffs air to assess eardrum movement. A hearing test is also frequently performed.

Parents often ask if their child's ear problems are hereditary. While no specific gene for ear infections has been verified, many studies confirm affected children often have parents or siblings with similar difficulties. Additionally, genetic disorders such as Down syndrome and cleft palate predispose children to chronic ear infections.

Bacteria often cause AOM, but it may start as a viral infection, and about 70 percent resolve without treatment within 72 hours. Therefore, most doctors treat with antibiotics only when symptoms last longer than 48-72 hours in children 2 years old or older. Children under 2 or those with severe ear infections generally receive oral or injection antibiotics promptly.

Overuse or inappropriate use of antibiotics leads to the development of resistant bacteria. To combat this problem, the doctor may not prescribe antibiotics for every suspected ear infection or fluid problem without infection. Ear fluid after an infection is common and should eventually go away.

Tympanostomy tube insertion is recommended when acute ear infections do not respond to antibiotics, when a child suffers from repeated ear infections, when fluid lasts longer than three to four months or when decreased hearing is a concern. The insertion of tubes is an outpatient procedure done under general anesthesia. A small incision is made in the eardrum and a tube (tiny cylinder) is placed. Pain is minimal and children typically return to their normal state within a few hours. This artificial tube bypasses the non-functioning Eustachian tube, allowing fluid to exit and air to circulate inside the eardrum.

This procedure removes fluid, improves hearing and reduces the number of infections. It does not prevent all infections. The tube lasts anywhere from a few months to several years depending on the ear's growth. Parents should keep large amounts of soapy or dirty water from entering the ear. If children plan on diving into water 3 to 6 feet deep, ear plugs are recommended. Once the tubes fall out, the eardrum usually self repairs the remaining hole.

If the hole does not heal, another surgery may be necessary. This happens in less than 10 percent of children. Additional sets of tubes can be placed for continued chronic infections, sometimes with the removal of the adenoids. Scarring of the eardrum can occur with repeated infections or with repeated surgery, but usually does not result in long-term hearing problems.

Insertion of ear tubes is a common and safe procedure with minimal complications and is performed by an ear, nose and throat surgeon.

Babies at Risk

About 50 percent to 60 percent of children experience at least one acute ear infection by age 1, with a peak age of 6 months to 18 months.

WHAT CAUSES EAR INFECTIONS

Children are prone to developing ear infections because their Eustachian tubes (the ear's natural drainage and equalization tubes that empty at the back of the nose) are not mature in position and function.Additional known risk factors include: exposure to other sick individuals such as schoolmates or siblings, seasonal changes and passive exposure to cigarette smoke.

Although controversial, some studies suggest that using pacifiers increases the risk of ear infections.

REDUCING EAR INFECTIONS

Research suggests that breastfeeding reduces the incidence of ear infections during the first year. We are uncertain why, but some credit the transfer of immune factors, the more upright position of breastfeeding compared to bottle feeding or perhaps the decreased sucking pressure required for breastfeeding.

From The Charlotte Observer