Otitis Media

Milind Kirtane*, Nikita Malhotra**
What is the Treatment of Otitis Media?
Medical treatment
Prompt treatment of middle ear infections with antibiotics is vital to prevent complications. Amoxicillin or amoxicillin-clavulanate are the recommended antibiotics. Trimethoprim-sulfamethoxazole is useful for people allergic to penicillin. In resistant cases, newer generation cephalosporins are recommended. Oral antibiotics can be given for five to seven days in children over two years old. A full ten-day course of antibiotics, however, should still probably be used for very young children and for those with complications.

Analgesics (pain relievers) may be given to reduce the discomfort. Antihistamines, decongestants and steroids have not been proven to work in children for the treatment of otitis media.

Surgical treatment
Once the infection clears, fluid may remain in the middle ear. This situation is termed serous otitis media or otitis media with effusion. Middle ear fluid that is not infected may disappear after several weeks; alternatively, it may persist for several months. If the fluid persists for more than three months and is associated with a loss of hearing, the insertion of a tympanostomy tube is suggested.

A procedure called myringotomy is performed where a tiny incision is made in the child's eardrum and fluid in the middle ear is gently sucked out. A small metal or plastic tympanostomy tube is then placed through the eardrum to prevent the myringotomy from closing and to help clear the middle ear fluid. This procedure is done under general anaesthesia. Once the fluid is evacuated from the middle ear, the child's hearing often returns to normal. The tubes cannot be seen or felt while in place. Most types of tympanostomy tubes usually stay in place for six to twelve months and fall out spontaneously once the incision heals.

Tympanostomy tubes play an important role in keeping the ear healthy. They help prevent the buildup of middle ear fluid and thus reduce the rate of middle ear infection. They also allow the middle ear pressure to equilibrate with the atmospheric pressure and thus optimize hearing. Some children may need to have the operation repeated if the fluid re-accumulates after the tube comes out. While the tubes are in place, water should be kept out of the ears. It is recommended that a child with tubes wear special ear-plugs while swimming or bathing so that water does not enter the middle ear.

Additional treatment strategies for otitis media
If the child has enlarged or infected adenoids, the otolaryngologist may recommend an adenoidectomy at the same time that the tubes are inserted.

Children in group care settings as well as children who are exposed to cigarette smoke are more prone to middle ear infections. Infants who nurse from a bottle also appear to develop otitis media more frequently. Thus, when bottle feeding your child, hold his or her head above the stomach level during feeding. This can help keep the Eustachian tubes from getting blocked. The best hope for avoiding ear infections is the development of vaccines against the bacteria that most often cause otitis media. At present, they are still in the experimental stage.

Otitis Media Otitis Media 02/28/2001
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