By Douglas Denham, DO – Medical Director, Clinical Trials of Texas
SAN ANTONIO - Otitis Media, commonly referred to as an ear infection, is a condition affecting the middle ear and is most commonly seen in children. Ear infections are the most common cause for childhood visits to the physician’s office with nearly 16 million visits per year. There are two main types of otitis media, Otitis Media with Effusion (OME) and Acute Otitis Media (AOM).
OME is the presence of fluid in the middle ear without signs or symptoms of infection. This effusion is usually caused when the Eustachian tube becomes blocked and fluid becomes trapped in the middle ear.
AOM is defined as an infection of the middle ear with sudden onset, the presence of middle ear effusion and signs of middle ear infection. Nearly 66% of all American children have at least one episode of AOM prior to 1 year of age, and 80% have had one by age 3.
The proper method of treatment of AOM is debated within the medical community. Because of growing antibiotic resistance in common bacteria, many physicians do not recommend antibiotics for patients without fever. Instead, they recommend close observation for worsening of symptoms. For patients whose symptoms worsen or do not show improvement within 48-72 hours, the initiation of appropriate antibiotics is then recommended. For patients initially treated with antibiotics, reassessment and change in antibiotics is recommended in patients demonstrating no improvement or worsening in symptoms in 48-72 hours. Complications of chronic middle ear infections are recurrent infections, conductive hearing loss, language delay, behavioral problems and poor academic performance.
Indications for more aggressive treatment of chronic ear infections are recurrent episodes of AOM despite preventative antibiotic treatment, persistent OME (middle ear fluid duration considered excessive) and injury to the ear structure. This should prompt referral to an Ear, Nose and Throat doctor (ENT doctor) for evaluation for tympanostomy tube placement (small plastic tubes). Tympanostomy tubes are inserted through the ear drum into the middle ear space and allow for the drainage of effusions and the relief of middle ear pressure. These tubes tend to fall out in the following months and the ear drum will then heal. In some cases there may be scarring to the ear drum, but generally there is little to no hearing loss. Follow up with the ENT doctor for recurrent infections or drainage is important.
Fortunately, most cases of AOM will improve with treatment. Prevention of further episodes is important. Things that you can do to protect your child are:
- Prevent upper respiratory infections by altering amount of time child spends in daycare situations, if possible.
- Breast feeding for the first six months after birth has been found to help decrease incidence of AOM.
- Do not “prop bottles.”
- Stop pacifier use after the first six months of age.
- Limit the child’s exposure to cigarette smoke in the home and other places.
Discuss your concerns with your primary care provider and together come up with a plan to protect your child’s health.
Clinical Trials of Texas is currently conducting a study for children with ear tubes and ear discharge. To learn more about how your child may be eligible to participate in this study, visit our website at SAresearch.com, or call (210) 949-0122. Compensation for time and travel is available to qualified participants.