What is otitis media and ear infections?
Normally the ear is filled with air. When the middle ear air is replaced with fluid this condition is then known as otitis media with effusion. This is very common in children up to the age of 7 years old. The peak incidence of acute otitis media and effusions is between age 1 and 2 years old. Most children have at least one episode of otitis media or otitis media with effusion during the first year of life. The common terminology is described as below.
Acute otitis media (AOM): Acute inflammation of the middle ear content and eardrum. This is the condition where the eardrum is red inflamed and bulging. There may be some fluid present in the child’s ear and they often complain of severe ear pain, fever is common and general irritability. AOM is usually caused by bacteria (over 90% of cases). A smaller number of cases are due to some respiratory viruses. For this reason, the Acute Otitis Media does respond to antibiotics and analgesia (pain relief). In very young children especially under 2 years of age when AOM is diagnosed it is often treated with antibiotics for 10 days. In children older than 2 years old delayed antibiotic therapy is acceptable given that the large majority of these children improved with analgesia only within 48 hours. The current recommendation for treating AOM in children over 2 years old is to delay antibiotics by 48 hours and if there is no improvement start a course of antibiotics.
Following an Acute Otitis Media, fluid and signs of inflammation may remain for a number of weeks before normal appearance of the eardrum returns. During this period children may exhibit irritability, poor hearing and sleep disturbance. Persistent fluid and inflammation in the eardrum beyond 6 weeks may require a further course of antibiotics for 2 weeks. If inflammation and hearing loss persists beyond 3 months or there are multiple episodes of AOM spread over a 6 month period then there may be a case for surgical intervention. The current rule of thumb is children having 3 or more episodes of AOM in a period of 6 months or 6 episodes in 12 months should seek an ENT’s opinion. Apart from analgesic treatment other treatments such as decongestant therapy, antihistamine, oral steroids, inhaled steroids, mucolytic agent agents are not currently recommended.
