Acute otitis media is an infection of the middle ear and Eustachian tubes. It can occur at any age, but primarily affects children between the ages of six months and two years. The condition is very common: Thirty percent of all antibiotics given to children are prescribed for otitis media, and the incidence has been rising over the last 25 to 30 years.
The most common cause is an upper respiratory infection. As the Eustachian tubes of the middle ear become congested and obstructed, infection begins. Another cause is allergies, which can cause dysfunction of the Eustachian tubes.
The most common symptoms are fever, ear pain, ear discharge (called otorrhea), dizziness, and temporary hearing loss. Young children may become irritable, lethargic, or quiet. They may have a fever, decreased appetite, vomiting, or diarrhea.
In rare cases, the infection can spread from the inner ear to other areas, including the brain. Therefore, it is important to diagnose otitis media appropriately and treat it promptly.
Risk Factors
- Lack of breast-feeding: Breast-feeding for at least three months appears to lower the risk of otitis media.
- Male gender
- Age: Children younger than 10 years, and especially between the ages of six months and two years, are most commonly affected.
- Use of pacifiers and bottle-feeding
- Day care attendance
- Exposure to tobacco smoke and air pollution
- Hereditary factors
- Fall and winter months
Acute Otitis Media: Diagnosis and Treatment
Diagnosis
- In nearly all cases, a careful history and physical examination makes the diagnosis. The symptoms noted above will suggest to the doctor that otitis media is likely.
- The doctor will then look into the ear using a specialized microscope, called an otoscope. In patients with otitis media, the doctor will see redness and cloudiness of the ear drum (the tympanic membrane). Fluid may also appear in the ear. Rarely, a culture of the fluid is necessary to check for infection. This is usually only considered in cases of recurrent ear infections or severe disease.
Treatment
- Otitis media is treated with antibiotics, usually amoxicillin.
- For pain relief, non-steroidal anti-inflammatory drugs, acetaminophen, or ear drops can be used.
- In cases of recurrent ear infections, daily antibiotics and/or surgery may be necessary.
Acute Otitis Media: Nutritional Considerations
- Avoidance of allergenic foods: Up to 10 percent of all children are allergic to one or more foods. In particular, chronic cases of otitis media have been associated with food and environmental allergies, perhaps causing up to 40 percent of cases. Further, diets that eliminate suspected foods have resulted in significant improvements in otitis media and other conditions.
An important cause of food allergy is milk and dairy products. As a test, it is helpful to eliminate all milk and dairy products for one month or longer. If symptoms resolve, consider long-term avoidance. - Following a healthy diet: Some children with otitis media have low antioxidant levels, low zinc levels, and low iron levels. Although vitamin-mineral supplementation may be useful, a well-rounded, healthful diet usually provides all necessary nutrients and promotes healthy immune function.
Children should be encouraged to eat plenty of fruits, vegetables, and whole grains, and healthful snacks, such as homemade "smoothies" and dried fruits. - Breast-feeding: Most studies show that breast-feeding prevents allergies and many diseases of childhood. If formula must be used, choose a soy-based or amino acid-based formula, rather than a cow's milk formula.
