Patient Education - Otitis Media
Otitis Media
Otitis Media is one of the most common conditions for which children require medical treatment. This condition also affects adults, but to a much lesser degree. Otitis media can be subdivided into several conditions:
Acute Otitis Media
Acute Otitis Media (AOM) is what is commonly called an ear infection. It is the collection of fluid behind the eardrum that has become infected by bacteria. Common symptoms include: pain, fever, fussiness, and hearing loss. Severe infections can cause rupture of the eardrum resulting in drainage from the ear canal. Infections often respond well to oral antibiotics. Patients who have had multiple episodes of AOM are often candidates for ear tube placement. This procedure drastically reduces the severity and frequency of infections. Infections can still occur after placement of ear tubes, but are much less painful, and can be easily treated with placement of antibiotic ear drops directly into the ear canal.
Serous Otitis Media
Serous Otitis Media (SOM) is more commonly known as “ear fluid.” This condition is often a sequelae of AOM. After an infection is treated, non-infected fluid can persist behind the eardrum. Often there is hearing loss as a result of the fluid. Patients may feel a pressure in the ear, but usually no pain. Fluid that persists for longer than 3 months is often treated with placement of ear tubes. It is important to identify this condition in children as hearing loss can sometimes result in speech delay.
Chronic Otitis Media
Chronic Otitis Media is a condition that more commonly affects adults. It is the result of a persistent low grade infection behind the eardrum as well as the bone behind the ear known as the mastoid. This condition can present as chronic drainage from the ear or as a hole in the eardrum with frequent episodes of drainage. This condition is often the result of poor Eustachian tube function. Temporary treatment often involves oral antibiotics or topical antibiotics in the form of ear drops. However, definitive treatment often involves surgery to remove the infection and repair the eardrum known as tympanomastoidectomy.
Eustachian Tube Dysfunction
The Eustachian Tube is a structure that connects the small space behind our eardrum (called the middle ear space) to the back of our nose. Negative pressure, or a vacuum, is constantly forming in the middle ear space. Every time we chew, move our jaw, or swallow, the Eustachian tube should open allowing air to enter the middle ear space and equalize this pressure. If this tube does not function properly, pressure, and sometimes fluid, can build behind the eardrum. This can result in ear pain, pressure, fullness, or even infection. Infants and children are more prone to ear fluid and infections, because the Eustachian tube does not properly develop until after age 4. In adults, ETD may be a result of improper development, or from an upper respiratory tract infection. Non-surgical treatment for ETD often involves the use of a prescription nasal spray and the daily use of a technique known as valsalva.
Otitis media, or infection of the middle ear, is common in young children and affects millions
annually.
It occurs in approximately 80% of all children.
Otitis media is generally a bacterial infection which often requires antibiotic treatment. The infections commonly
occur after a child experiences a cold or flu. Most infections are successfully treated with antibiotics. Unfortunately,
when otitis media occurs too often or when antibiotics fail, hearing loss can occur, as well as speech and
language delays. These problems often can impair a child’s learning ability and cause developmental delays.
Fortunately, most ear infections can be successfully diagnosed and treated effectively, while reducing the chances
for complications and long-term hearing damage.
Although serious complications such as mastoiditis (infection of the bone housing the ear structures) and
meningitis occur rarely, it is important that otitis media be treated thoroughly to prevent other complications.
treatment
Medical treatments of otitis media include different kinds of antibiotics for varying lengths of time.
When infections become problematic or recur too often, children may be referred to a specialist known as
an otolaryngologist. Evaluation of your child should include an accurate hearing test, called an audiogram,
performed by a certified audiologist. Hearing can be tested in children of any age, using a number of
advanced techniques and equipment.
pe tubes
When ear infections occur too frequently or are never completely resolved, we may recommend the
placement of ventilating tubes in children. Ventilating tubes, often known as PE tubes (pressure-equalization),
are placed in children under a brief general anesthetic. The tubes usually fall out by themselves within
a year or two and require routine check-ups to ensure proper function.
after surgery
Pain if any, is usually controlled with Tylenol™.
Topical antibiotic ear drops, if needed, will be prescribed during the first week after surgery.
Bathing generally does not require ear plugs. Your surgeon will instruct you specifically if you
should take any precautions.
A post-operative visit should be scheduled within 10-14 days with your surgeon.
long-term care of tubes
Swimming in fresh water (lakes, ponds or oceans) should be avoided because of higher
concentrations of bacteria. Ear plugs should be used and can be custom-fit by our audiologists.
Regular 6 month physician examinations are necessary to ensure that no problems or
complications occur with tubes.
We welcome any questions or concerns that you may have and look forward to providing you
and your child with the best care possible.
frequently asked questions
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Is surgery safe?
Surgery itself is very safe and has been used for over forty years. Anesthesia is also very safe. Problems
with anesthesia are extremely rare in healthy children. The risk from anesthesia and surgery is reported
to be less than 1:100,000 patients—rarer than being struck by lightning or winning the lottery.
Is there any pain after tubes?
Virtually no pain is experienced after the procedure. Children can be fussy after surgery,
but often do not need any pain medicine.
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What is expected after surgery?
There may be temporary drainage from the ears, as the infection drains. Ear drops, if necessary,
will be prescribed to eliminate infection.
Is there any permanent damage from the tubes?
Generally, ear drums heal without any problems. If PE tubes are left in for more than 2-3 years,
permanent perforations can occur. Routine follow-ups are necessary to ensure that tubes do not
stay in longer than necessary.
What can happen if tubes are not placed?
Ear infections left untreated can often be more damaging than any surgery. Complications can
occur, resulting in speech and language delay, rupturing of the ear drum, and scarring from too
many ear infections and occasionally, hearing loss which may be permanent.
Is there any role for removing the adenoids?
Adenoidectomy has been shown to eliminate the need for repeated PE tubes. This is usually
recommended only if a second set of PE tubes are needed or if the adenoids are enlarged.
Are there any other alternatives other than surgery?
Usually when surgery is recommended, there is no further indication for more antibiotics.
To our knowledge, no alternative medicine has been proven to cure chronic otitis media.
A second medical opinion, however, is always an option.
