Otitis Media Health Article

Otitis media with effusion (OME)

For young children ages one to three years, most physicians prefer a conservative, or wait-and-see, approach, using antibiotics if the infection is persistent, the child is in pain, or there is evidence of hearing loss. Most cases of otitis media with effusion get better within three months without any treatment. If the child continues to have repeated episodes of OME, despite taking antibiotics, the physician may decide to try long-term, low-dose treatment with antibiotics, even after the condition has cleared. If OME persists for over three months, despite antibiotic treatment, the doctor may suggest a hearing test. If OME persists for more than four to six months, even if hearing tests are normal, the doctor may suggest surgery to drain the eardrum and implant ear tubes for continuous drainage.

Surgery

In some cases, a surgical perforation to drain pus from the middle ear may be performed. This procedure is called a myringotomy. The hole created by the myringotomy generally heals itself in about a week. In 2002 a new minimally invasive procedure was introduced that uses a laser to perform the myringotomy. It can be performed in the doctor's office and heals more rapidly than the standard myringotomy. In some cases, the physician may decide that the placement of tubes during the myringotomy is recommended. These small tubes are placed to aid in draining the fluid from the middle ear. They fall out on their own after a few months. The decision to place these tubes is based on the following criteria:

• presence of fluid in the ears for more than three or four months following an ear infection
• fluid in the ears and more than three months of hearing loss
• changes in the structure of the eardrum as a result of ear infections
• a delay in speaking
• repeated infections that do not improve with antibiotics over several months

Another type of surgery, called an adenoidectomy, removes the adenoids. Removing the adenoids has been shown to help some children with otitis media between the ages of four to eight. It is a procedure generally reserved for those children who have recurrent otitis media after myringotomy tubes are extruded.

Alternative treatment

Treatment guidelines from the American Academy of Pediatrics and the American Academy of Family Physicians in the early 2000s state that there is insufficient evidence to either support or discourage the use of alternative medicines for acute otitis media. Increasing numbers of parents and caregivers are using various forms of nonconventional treatment for their children. Treatments that have been used for AOM include homeopathy, acupuncture, herbal remedies, chiropractic treatments, and nutritional supplements. Although most treatments are harmless, some are not. Some can have a direct and dangerous effect, whereas others may interfere with the effects of conventional treatments. Parent should inform their doctor if they are using any alternative or unconventional methods to treat their child's otitis media.

Prognosis

The prognosis of acute otitis media is excellent. The duration is variable. There may be improvement within 48 hours even without any treatment. Treatment with antibiotics for a week to 10 days is usually effective.

Prevention

Breastfeeding helps to pass along immunities to a child that may prevent otitis media. The position the child is in while breastfeeding is better than the usual bottle-feeding position for optimal eustachian tube function. If a child must be bottle-fed, it is best to hold the infant rather than allow him or her to lie down with the bottle. Because multiple upper respiratory infections may increase the risk for acute otitis media, reducing the exposure to large groups of children, particularly in daycare centers, may reduce the incidence. Children should also be kept away from environmental irritants such as secondhand tobacco smoke.