otitisAn INFLAMMATIONof the EAR, typically the
middle ear (otitis media) or the outer ear (otitis
externa). Otitis can affect the inner ear (otitis
interna), though more often doctors identify inner
ear problems as LABYRINTHITISand related condi-
tions. The most common cause of otitis is
INFECTION. Otitis media often follows a cold or
other upper respiratory infection. Otitis can be
acute (comes on suddenly) or chronic (lingers at a
subclinical level or recurs).
Otitis MediaOtitis media is one of the most frequent reasons
parents take their children to see the doctor.
Young children are particularly susceptible to otitis
media because the eustachian tubes are nearly
horizontal until the child’s facial structure begins
to elongate at about age six or seven. The change
in facial structure pulls the eustachian tubes into
more angled positions. The purpose of the
EUSTACHIAN TUBEis to maintain pressure equilib-
rium between the middle ear and the external
environment. Inequities in pressure allow fluid to
accumulate in the middle ear, which inflames the
tissues and provides fertile ground for bacterial
growth. The eustachian tubes in a child are also
prone to becoming congested, which can feed
fluid and BACTERIAinto the middle ear.
Symptoms of otitis media are primarily PAINand
FEVER. Very young children often tug at the
affected ear, are fussy and sleep fitfully, and may
not want to nurse or bottle-feed. Older children
can say that their ears hurt or may complain of
HEADACHE. When there is a ruptured eardrum,
there is usually pus-filled or blood-tinged drainage
from the ear. Pain lessens when the eardrum gives
way because this releases the pressure. It is not
possible for a parent to determine whether a child
has an ear infection; the doctor must examine the
ear with an otoscope. The doctor looks for signs of
effusion, the collection of fluid behind the TYM-
PANIC MEMBRANE(eardrum). When effusion is pres-
ent, the preferred treatment is an oral antibiotic
medication.
The American Academy of Pediatrics issued
treatment guidelines in 2004 that emphasize
selective use of ANTIBIOTIC MEDICATIONSfor acute
otitis media without effusion. Clinical research
studies have failed to conclusively demonstrate a
more rapid rate of recovery with antibiotics when
there is no effusion. The treatment guidelines
reflect the growing concern among health-care
providers that inappropriate antibiotic use is
responsible for an alarming increase in the strains
of bacteria that are resistant to antibiotics. The
guidelines suggest- focusing on pain relief by giving the child
appropriate doses of ibuprofen or acetamino-
phen - allowing 48 to 72 hours for the child’s natural
immune response to bring the infection and
inflammation under control - prescribing an antibiotic as the first line of
treatment only in children under six months of
age or who have a history of recurrent otitis
media - prescribing amoxicillin as the antibiotic of first
choice unless there is a clinical reason (such as
sensitivity or known resistance) to prescribe a
different antibiotic
Acute otitis media generally clears up in 10 to
14 days. Chronic or recurrent otitis media may
require a more extended course of antibiotic ther-
apy or MYRINGOTOMYwith placement of tympanos-
tomy tubes. Adenoidectomy (surgery to remove
the ADENOIDS) may be necessary when other meas-
ures fail to eradicate the infection. Many children
experience temporary HEARING LOSS with otitis
media. Repeated infections may cause permanent
hearing damage.
Otitis Externa
A common name for otitis externa is swimmer’s
ear. Infections of the outer ear are most common
in the summer months when water activities,
especially outdoors, are prevalent. Otitis externa
develops when water and bacteria become trapped
in the auditory canal. Sometimes excessive CERU-
MENproduction contributes to the situation. Treat-
ment depends on the cause of the inflammation
and irritation. Taking care to thoroughly dry the
auditory canals after bathing, showering, or swim-
ming can help prevent otitis externa.
See also ANTIBIOTIC RESISTANCE; OTORRHEA.40 The Ear, Nose, Mouth and Throat