Middle Ear Infections in Children

Abstract

pediatrician John C. Bolton recalls tales of home remedies for earache. I lived in the South, people said the best thing to do was to press a hot water bottle against the offending ear and hope it would get better, he says. My wife, who comes from New England, says a warm bag of salt against the ear was the preferred treatment around there. With the advent of antibiotics and precision surgical instruments, treatments for painful infection of the middle ear, or otitis media, have become more sophisticated than hot water bottles and salt. Yet over the last few years, opinions on how best to cure such infections have generated high-decibel controversy. Otitis media ranks second only to the common cold as the most frequent illness among children in the United States. Because it can cause hearing loss if not treated properly, middle ear infection has attracted considerable attention from medical and other health care professionals. numbers tell the story. Nearly 70 percent of children born in the United States will develop otitis media by age 2. Most of them will outgrow their susceptibility to the infection by age 5, as the immune system and body develop. For other children over half of those who experience an initial infection it remains a continuing battle, recurring three or more times. Implanting tubes to drain the middle ear, a surgical procedure known as tympanostomy, is the most common surgery requiring a general anesthetic performed on children under age 2. In addition, otitis media accounts for at least 30 percent of visits to pediatricians each year and represents more than $3.5 billion in U.S. health care costs annually. The sheer number of children affected and the incredible amount of money spent for treatment demand that we take a serious look at what's going on, says Bolton, president of the Northern California chapter of the American Academy of Pediatrics. He treats hundreds of children for otitis media each year in his San Francisco practice. Otitis media develops when bacteria or viruses, usually associated with colds or sore throats, make their way up the Eustachian tube, from the upper part of the throat behind the nose to the middle ear. As a result of the infection, the eardrum can become swollen and inflamed, a condition called acute otitis media, which can lead to hearing loss and thus affect a child's learning and language skills. When fluid accumulates against the eardrum, either as a result of an acute infection or on its own, a second, more insidious type of otitis media may develop. Known as otitis media with effusion, this condition often shows no symptoms such as pain or fever. Parents of infants may not even know their child has fluid blocking the eardrum unless a doctor discovers it as part of a routine examination. Each type of otitis media is distinct from the other, although a number of physicians theorize that repeated bouts of acute otitis media may lead to effusion.