American Medical Association Family Medical Guide - American Medical Association [193]
Some children have repeated ear infections, which, if left untreated, can lead to serious complications, such as hearing loss. Hearing loss that occurs early in childhood can have a significant impact on a child’s speech and language development.
Ear Infections
Infection or inflammation of the middle ear (a condition that doctors call otitis media) can occur in people of all ages but is most common in infants and young children. Otitis media can be either acute (short and severe) or chronic (long-lasting). If a child has three or more acute ear infections within 6 months, or four or more infections within 12 months, the condition is called recurrent acute otitis media.
Otitis media can result when fluid or mucus from a bacterial or viral infection of the nose and throat (such as a cold or flu) or an allergy causes the eustachian tube (the tube that connects the middle ear to the back of the nose and throat) to swell and to drain improperly. Exposure to secondhand smoke can increase the risk of inflammation and infection of the respiratory tract and problems with the eustachian tube in young children. In some children, the adenoids (lymph tissue that lies on each side of the back wall of the nose and the upper part of the throat) can become enlarged and can block drainage from the eustachian tube. If the eustachian tube is blocked, pus can build up in the middle ear, putting pressure on the eardrum and causing severe pain, hearing loss, and, possibly, a ruptured eardrum (see page 1022).
Ear infections and accumulation of middle ear fluid are more frequent in children than in adults because a child’s eustachian tubes are smaller and more horizontal than those of an adult, making it more difficult for infected fluid to drain. Children who have a family history of ear infections (who have a parent or siblings with ear infections), a weakened immune system, or some birth defects (such as Down syndrome; see page 955) that change the shape of the eustachian tubes are at increased risk of developing ear infections. For unknown reasons, otitis media is more common in boys than in girls.
Earache
If your young child has an earache, he or she may not be able to tell you it hurts. You should suspect an earache if you notice your child frequently pulling on his or her ear or being more fussy and irritable than usual.
Symptoms and Diagnosis
Symptoms of acute otitis media include fever and pressure, pain, or pus in the ear. Other symptoms may include drainage from the ear and hearing loss. A young child may be irritable and pull on the ear that hurts.
To diagnose acute otitis media, a doctor will take a detailed health history and examine the ear with a lighted viewing instrument called an otoscope. The doctor also may take a sample of fluid from the affected ear to check for bacteria.
Treatment
In many cases, an ear infection will go away on its own. However, a doctor may prescribe antibiotics (taken by mouth) to treat acute otitis media caused by bacteria. He or she may also recommend a pain reliever to treat the pain and fever. (Never give aspirin to a child under age 18 because of the risk of a life-threatening condition called Reye’s syndrome; see page 411.) The doctor may ask you to return to the office after about 2 weeks to make sure that the infection has cleared up.
In severe cases, the doctor may recommend a procedure called myringotomy, in which a surgeon makes a small incision in the eardrum, suctions out the fluid, and sometimes inserts tiny drainage tubes. Myringotomy usually is done as an outpatient procedure (with general anesthesia) but also can be done in the doctor’s office using laser surgery (without general anesthesia). Alternatively, a doctor can treat a persistent case of acute otitis media by suctioning fluid from the middle ear in an office procedure.
Prevention
The following steps can help reduce your child’s risk of developing ear infections: