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The most common cause of earache in children is acute otitis media, which is caused by infection in the middle children are at risk because eustachian tubes, which connect the middle ear to the throat, are small and become obstructed easily. Acute otitis media is often part of a respiratory tract infection, such as the common cold. The infection causes inflammation that may block one of the eustachian tubes, causing a buildup in the middle ear that may get infected with bacteria.
The part of the ear that we can see is called the outer ear. It is connected to an external canal, which is then separated from the structures of the middle ear by a thin drum like membrane called the eardrum (tympanic membrane). The middle ear is filled with air and is connected to the back of the nose by a tube like canal called the eustachian tube. The other parts beyond the middle ear are the inner ear (cochlea, semicircular canal) and the auditory nerves (carries messages to the brain).
Otitis Media refers to an infection of the middle ear that normally follows the flu or a cold. OM can affect people at any age, but it is more common in children under the age 7.
About 1 in 5 children under age 4 has one episode of acute otitis media each year. the condition is more common in children whose parents smoke. It is also common in children of eskimo or native american descent and may run in families, suggesting a genetic factor. The condition is less common in children over the age of 8.
What are the sympotms?
Symptoms usually develop rapidly over several hours. a very young child may have difficulty locating the pain, and the only symptoms may be fever and vomiting. In older children, the symptoms may be more specific and include:
*20-40% of the cases of bacterial infections may have little or no symptoms.
*In infants, there is irritability, poor feeding, or loss of appetite may be the only symptoms for the first few months.
*In cases without bacterial infection, there may be a mild decrease in hearing or a feeling of heaviness in the ear.
*In most cases of acute OM there is:
flu, cold, sinus, throat, allergies, and earaches.
*The bone behind the ear (Mastoid bone) may hurt if it is pressed.
*Fever may or may not be present
*If the eardrum is punctured, fluid may leak out (otorrhea)
*Hearing loss and spread of the infection to other site (brain, facial nerves and mastoid bone) can occur
*Tugging or rubbing the painful ear.
*Temporary impaired hearing in the affected ear.
Left untreated, the eardrum may rupture, relieving the pain but causing a discharge of blood and pus. Recurrent infections in the middle ear may cause chronic secretory otitis media.
Conditions such as a Common Cold (caused by a virus), sinuses, throat infections, allergies to tree pollen, mold spores, and mites can irritate the eustachian (E) tube and weaken its normal defenses.
Once the defenses of the eustachian tube is compromised, it is prone to invasion by bacteria, which then climb up to the air filled middle ear chamber and cause an infection. This results in fluid build up, earaches, and other symptoms.
Bacteria responsible for OM are:
Haemophilus Influenza (20-25%)
Moraxella catarrhalis (10-15%)
Group A streptococci and Staphylococcus species (1-3%)
Up to 30% of cases of OM occur without any Bacterial infections
*Structural abnormalities of the ear or an E-tube present at birth
*Previous history of OM
*Family history of OM, especially in a sibling
*Second hand tobacco smoke
Method of Diagnosis::
Medical history and a physical examination is the first step
There may be facial pain (over the sinuses), nasal (nose) congestion, sore, red throat if allergies exist, or a sinus infection may be present.
There may be enlarged Lymph glands (pea size nodes) in the neck
The mastoid bone may hurt if doctor presses on it.
The doctor will use a special light (otoscope) to look into the ear canal, where he will see the ear drum bulging out (fluid behind it), moving poorly, or have a tear and the middle ear where fluid is leaking into the external canal.
The fluid that may have leaked out can be collected by a sterile cotton swab, and sent to the laboratory so they can identify the cause and type of the bacteria (takes 24-48 hours).
Hearing can be tested by a specialist called an audiologist.
*Males more than females
*Ear trauma or previous ear surgery
* Usually treated on an outpatient basis except for infants under 2 years of age with high fever.
*If not too sick, use Auralgan drops (eases the pain) and Tylenol (pain and fever) by mouth, and observe closely for the first 2-3 days.
*If symptoms persist for more than 48-72 hours, or the patient is sick, consider antibiotics.
*Antibiotics such as Amoxicillin are given by mouth for up to 10 days (or until the bacteria is identified).
*If there are 3 or more OM’s in 6 months, or 4 or more in one year, then antibiotics may be needed for up to 6 months.
*In cases where there is persistent fluid (Effusion) in the middle ear without bacteria (consider Allergy), antibiotics do not help, and Antihistamines (Claritin) or decongestants such as Entex can be tried.
*In allergic OM, where medications do not help, one may consider consulting with an allergy and Immunology doctor.
*In cases where middle ear effusion is present for more than 4 months in both ears, or more than 6 months in one ear, or, if hearing is affected (greater than 25 decibels), surgery may need to be done.
*Recurrent bacterial OM (more than 2-3) while on antibiotics may also benefit from surgery.
*An ENT (ears, nose, throat) doctor will perform all necessary surgeries.
*Surgeries include drainage of the middle ear fluid via a tiny tube (tympanostomy tube).
*The tube may be placed for days, weeks, months, or in some cases, permanently.
*A good diet that is full of vegetables, fruits, fish, and low in animal products (beef, pork, etc.) and fats may help to prevent future infections.
*Try breast-feeding your baby
*Stop smoking, especially around your children and animals.
What might be done?
You should consult you childâ€™s doctor if liquid is discharged from the ear or if the earache last more than a few hours. he or she will examine your childâ€™s ears and may blow air into the affected ear using a special instrument to check that the eardrum is moving normally. Acute otitis media can clear up without treatment; however, the doctor will probably prescribe antibiotics if he or she suspects that a bacterial infection is present. to relieve discomfort, acetaminophen may be recommended. After a few days, your doctor will reexamine you child.
Symptoms usually clear up in a few days with appropriate treatment. a ruptured eardrum should heal within a few weeks. In some children, hearing is affected for more than 3 months until the fluid in the ear disappears.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.