Ear Illness Common, Confusing

It's an experience that every parent dreads: watching helplessly as your young child tugs on her ears and shrieks in pain--common signs of ear infection, or otitis media.

Most parents have been through this experience because, by age 6, almost every child has had at least one middle ear infection (and about half of these children have had at least three episodes).

After colds, otitis media is the most common childhood illness, and it is the No. 1 problem treated by pediatricians, resulting in more than 24 million doctor visits every year in the U.S. Despite its common occurrence, there is still much confusion and some controversy surrounding its treatment. Much of this confusion exists because doctors use the term "otitis media" to describe two distinctly different middle ear problems that require different treatments.

Acute otitis media is used to describe patients who have fluid in the middle ear and clear signs of an actual bacterial or viral infection, such as redness and bulging of the eardrum, fever and pain.

Although the body's immune system may be able to overcome the infection by itself in some cases, without any medical treatment, there is a risk that the infection could permanently damage the ear, and the pain is usually too severe to ignore. In the U.S., the most widely accepted approach is to treat the infection with antibiotics as early as possible, using pain relievers if necessary. (In some countries, ear infections are left untreated for several days to see whether they will clear up without antibiotics.)

The term otitis media "with effusion" is used when there is fluid in the middle ear, but no signs or symptoms of infection. This type of fluid accumulation usually follows a case of acute otitis, but it may occur spontaneously.

Three months after an ear infection is treated successfully, about 50% of children will still have fluid behind their eardrum (but without any sign of active infection). By the end of a year, without any further treatment, the fluid will be gone in almost all of the children. For this reason, there is usually no need to treat this type of fluid accumulation with antibiotics. There is also no evidence that antihistamines and decongestants will clear the fluid more quickly. If fluid remains in the middle ear for long periods of time, it can interfere with hearing and language development. Therefore, a child with persistent effusion should be examined at regular intervals by a physician.

For parents, knowing how to prevent otitis media is important. Studies show that both forms occur more commonly in children who are bottle-fed (especially if the infant lies flat while feeding), who are exposed to second-hand cigarette smoke, and who attend group child-care facilities. If bottle-fed, the child should be in an inclined position while drinking. Children prone to frequent ear infections should avoid close contact with sick children, if possible. All children should be provided a completely smoke-free environment.

If a fluid effusion persists, parents need to watch for signs that it is interfering with the child's hearing. Does the child fail to respond to soft sounds or communication? Does she sit too close to the television set, seem unusually inattentive or frequently ask you to repeat what you said? Longstanding hearing problems can retard language development, especially if they occur very early in childhood.

Children should be examined by a physician if language is not developing normally or if any of the following signs or symptoms of acute otitis media are present: tugging on an ear and crying or complaining of pain around the ear, fever, fluid draining from the ear, unusual irritability or difficulty sleeping, or loss of balance. If you think your child may have a hearing problem, arrange for a hearing test, usually performed by an audiologist. No infant or child is too young to have his or her hearing tested if a problem is suspected.


Dr. Jonathan Fielding is the director of public health and the health officer for the Los Angeles County Department of Health Services. Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. They can be reached by e-mail at ourhealth@dhs.co.la.ca.us. Their column appears the second and fourth Mondays of the month.

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