Otitis Media Outlook

Otitis Media is classified as any inflammation of the middle ear characterized by the accumulation of infected fluid in the middle ear, bulging eardrum, and pain in the ear. Otitis Media, which is also known as a middle ear infection, is the second most common disease of childhood after upper respiratory infection (Otitis Media, 2017). The middle ear is a small space behind the eardrum that is supposed to be well ventilated by air. Air normally passes up from behind the nose, through the Eustachian tube in order to keep the middle ear dry and clean (“Understanding Ear Infections - the Basics”, n.d.). However, when there is not enough fresh air ventilating the middle ear causing the Eustachian tube to be clogged and blocked, it becomes damp, still and warm, which causes the infection.

Epidemiology of Otitis Media
It is much more common in children and infants because their Eustachian tube is often too soft and undeveloped so it has a harder time staying open. In children and infants, the tube is also shorter and has more of a horizontal orientation than adults, which causes reflux from the pharynx. The highest occurrence of the infection occurs in the first two years of life and about 90% of children will have a least one infection by age 6. It has been reported that there is a higher prevalence in boys than in girls. Moreover, while 50% of children aged 1 year are likely to have at least one episode of the disease, 1/3 of children will have at least 3 infections by age 3 and 90% of children will have at least 3 one infection by age 6. Otitis Media tends to affect children during winter months.
Types of Otitis Media
There are two main types of Otitis Media and two subtypes. The first type is Acute Otitis Media (AOM). AOM is the more serious and painful type. It has a rapid onset accompanied by one or multiple symptoms such as ear pain, ear discharge, fever, headache, irritability, loss of appetite, vomiting, diarrhea. The other type and the more common one in children is Otitis Media with Effusion (OME). OME is a collection of non-infected fluid in the middle ear with symptoms of hearing loss, tinnitus, vertigo and ear pain (Philadelphia, 2014). OME is usually a result of poor function of the Eustachian tube, which makes it the most common type that occurs in children aged 6 months to 3 years old. The third type of OM is Chronic Suppurative Otitis Media, which is a persistent ear infection that results in tearing or perforation of the eardrum. It is a chronic inflammation of the middle ear that persists for at least 6 weeks and is linked to otorrhea through a perforate TM, an indwelling tympanostomy tube, or surgical myringotomy. The last type is Adhesive OM, which occurs when a thin retracted eardrum becomes sucked into the middle ear space and gets stuck. This could happen during AOM or OME.
Risk Factors
There are a few risk factors that can increase the likelihood of someone getting Otitis Media. These risk factors include upper respiratory infections, allergies, craniofacial abnormalities such as cleft palate, Down’s syndrome and passive smoking.
Signs and Symptoms of Otitis Media
The most notable signs and symptoms of Otitis Media in infants and children are irritability, ear pain, fever, and changes in personality. However, the signs and symptoms of Otitis Media differ depending on the individual’s age. For neonates or infants, the most common signs include change in behavior, vomiting, irritability, decreased appetite, and tugging at ears. For children aged between 2 and 4 years, the common symptoms of Otitis Media include fever, difficulties in hearing, Otalgia, and changes in personality. For children aged 4 years or more, the symptoms include changes in personality and complains of ear pain.
When to go to a Doctor
Once these symptoms occur, there are certain things a parent should look out for to determine if and when medical attention should to be sought out. Fever is big indicator that it’s time to go to the doctors. For instance, if a child has a fever of 104, he/she must see a doctor. For children younger than 3 months, you should see a doctor if they have a fever of 100.4. A child should also be taken to a physician if he/she complains about pain that is not relieved from pain medication or if pus or blood is leaking from the child’s ear. In regards to adults if pain or fluids are coming out of the ear, they much see a doctor as soon as possible for diagnosis.
Diagnosis
It is critical for clinicians to distinguish between normal middle ear status from OME or AOM. OME does not benefit from antibiotic treatment, which implies that correct diagnosis is crucial. There are a few different ways to examine the ear in order to get a proper diagnosis. The most popular and standard technique for patients with suspected OM is a Pneumatic Otoscopy. It allows for a careful examination of the external ear and Tympanic membrane. Every examination should include an evaluation and description of the color, position, mobility and perforation of the tympanic membrane. In addition to examining the ear it is also important to examine the head and neck region of the patient. The alternative screening techniques for OM are Impedance Tympanometry and Acoustic Reflectometry. Impedance Tympanometry measures the change in acoustic impedance of the TM/middle ear system with air pressure changes in the external auditory canal. On the contrary, Acoustic reflectometry measures reflected sound from the TM; the louder the reflected sound, the greater the likelihood of an MEE. Once a diagnosis is made the physician can provide the most optional treatment for the patient.

Treatment of Otitis Media
Treatment for OME depends on many factors and is tailored for each child. In most cases the fluid in OME resolves on its own within 4 to 6 weeks so acute treatment is not needed. In regards to AOM, most cases improve spontaneously. For such cases that require treatment, antibiotics are usually the course of action. Amoxicillin is the antibiotic of choice and should be prescribed for bilateral or unilateral AOM in children aged at least 6 months with severe sign and symptoms. If an infection causes serious complications and fluid remains in the ear for a long time the most popular course of action is to do a myringotomy, which is an insertion of tubes in the ear in order to have a constant drainage system in place to drain out the pus or blood. When conducting drainage, the doctor creates a small hole in the eardrum so fluids such as water, blood, or pus can drain out, and also puts in tubes so it wont get back up again. The tube, which will usually fall out on its own in about 6-18 months, lets air flow through and keep the middle ear dry. These tubes also help with pain, improve hearing, and cut down the number of infections the child might have. Some home remedies that could be utilized in treatment of Otitis Media include keeping warm, gargling salt water to soothe a raw throat and clear the Eustachian tubes, and standing tall.
Possible Complications
It is important to start treatment as soon as possible so complications do not continue. It is very common to acquire a conductive hearing loss while having the infection. Some other complications that may occur with chronic OM include acute mastoids, chronic perforation of the tympanic membrane, tympanosclerosis, cholesteatoma, facial nerve paralysis, and cholesterol granuloma, which is a Benign cyst that can occur in the petrous apex, a part of the temporal bone of the skull that is next to the middle ear.
Tips for Reducing the Prevalence of the Condition Among Children
Since Otitis is so common in children, there are some tips on how to reduce the prevalence of infection. Breastfeeding is huge since it has been reported that babies who nurse for 12 months or more tend to have fewer infections. If breastfeeding isn’t an option, the child should be bottle-fed in an upright, sitting position. It is also very important to keep your child up to date with their immunizations. Don’t expose your baby to cigarette smoke and try to avoid other forms of air pollution. Additionally, if your baby is using a pacifier after 12 months old, the chance for ear infection increases, so it is extremely important to wean them off as early as possible. Lastly, clean your hands and your child’s hands often using soap and water to reduce the spread of germs.























References
“Otitis Media.” (2017, October 18). Medscape. Retrieved December 01, 2017, from https://emedicine.medscape.com/article/994656/overview?pa=e7%2BHyhjaKi5kXPCHgzrSWtOQ7XMaWaM%2BrHb%2FWZGFvTNuYgaWBD0SZJq9im84Wg%2BrHnIoM8a%2BOnfqLYTcSUU9MAf1%2FT5AOtgCo%2FGiWn3Mk%2BU%3D
Philadelphia, T. C. (2014, May 05). Otitis Media with Effusion (OME). Retrieved December 01, 2017, from http://www.chop.edu/conditions- diseases/otitis-media-effusion-ome
“Understanding Ear Infections -- the Basics.” (n.d.). WebMD Retrieved December 05, 2017, from https://www.webmd.com/cold-and-flu/ear-infection/understanding-otitis-media-basics#1