Acute otitis media usually involves an infection of the middle ear, which contains the three smallest bones in the body. This infection is more common in children. In some cases, the only treatment required would be pain relief and close monitoring, but in many cases, there is a need for a course of antibiotics. Some children get recurrent ear infections, which can lead to hearing problems and other serious infections, even involving the brain.
— can present with ear pain especially on lying down
— others are seen tugging the ear
— excessive crying due to pain
— discharge from the ear
— excessive fussiness, reluctance to feed
— difficulty in hearing
What to do
If you suspect that your child may have a ear infection, then it’s time to visit your paediatrician:
Ear infections are usually caused by bacteria or viruses. Your child may have a cold or a fever, which causes congestion or swelling of the nasal passages and the Eustachian tube.
The Eustachian tube contains two tiny long tubes connecting the middle ear to the back of the throat, behind the nasal passages. Its role is to regulate the middle-ear pressure and to drain the secretions from the ear to the nose. When the Eustachian tube is blocked, the fluid does not drain from the middle ear, pressure builds up and you can develop symptoms of an ear infection.
Children are more prone to ear infections as the tubes get clogged and do not drain easily.
Adenoids are lymphoid tissue which are important for immune development. They are close to the opening of the Eustachian tube. So when the adenoids swell up due to allergy, it can block the opening of the Eustachian tube. This, in turn, can lead to ear infection. This phenomena is seen more commonly in children as adenoids are larger in children, especially in those under five years of age.
Kinds of Otitis media
Otitis media with effusion
Sometimes, the middle ear is filled with fluid. Usually there is no active infection and only fluid collects as there is dysfunction in the Eustachian tube.
Chronic Otitis media with effusion
In this condition, there is repeated collection of fluid and there is usually no evidence of either a bacterial or viral infection. As long as there is fluid, there is always a chance of repeated infections which can affect hearing.
Chronic Suppurative Otitis Media
Here, the infection is not completely clear despite antibiotics and can cause a hole in the ear drum.
Children who commonly get ear infection:
— The commonest age group is between six months and two years. This is because the Eustachian tube is narrow and their immune system is still in the developing phase.
— Children attending day care or in a group setting. Here, these children are more exposed to cold viruses
— Babies who bottle-feed, especially lying down are more prone to ear infections
— Exposure to cigarette smoke and air pollution
— In the West, fall and winter months see more ear infections
— Children who have cleft palate are also more prone to ear infections
Otitis media, especially if they are recurrent, can lead to complications:
— Mild hearing loss can be present when the baby has an ear infection because of fluid in the middle ear. This usually returns to normal once the infection settles down. In some cases, with recurrent infections the hearing loss can occasionally be permanent
— Children who develop hearing loss for long periods during the phase of speech and language development can develop speech delay
— Some children develop mastoiditis in which the ear infection can spread to the bone adjacent to the ear where pus accumulates. This can also spread to the brain, leading to meningitis
— Chronic Otitis Media can lead to a hole developing in the tympanic membrane, which can heal in most cases, but, occasionally, may need surgery to close the hole
— Breastfeed your baby as long as possible, at least till six months. Breast milk has antibodies that help in fighting infections
— Prevention of coughs and colds is easier said than done. Don’t be in a hurry to start group activities with other children too soon. And, if you do, then keep the numbers small. Get children to wash hands frequently and to cough and sneeze into their elbow. Get the vaccines such as the pneumococcal and haemophilus inflenzae vaccine and the flu vaccine for children under five years on time
— Make sure nobody smokes at home
— If your child bottle-feeds, make sure he is not lying down and feeding
Lastly, if your child has been on antibiotics, make sure it’s completely healed before you stop the antibiotics
Dr Saroja Balan is consultant neonatologist and paediatrician at Indraprastha Apollo Hospital. Her column appears every fortnight