Diagnosis and treatment of ear infections in children

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The majority of toddlers and young kids will get an ear infection atleast once.  In fact, up to 75% of children will have at least three episodes of acute otitis media (AOM) by the age of two.

Causes of AOM:

Common pathogens of middle ear infection in children include S. pneumoniae, H. influenzae, and Moraxella catarrhalis. Many people don’t realize that ear infections are also often caused by viruses such as Influenza A, Respiratory syncitial virus and Parainfluenza virus.

Risk factors for AOM:

Certain factors predispose a child to acute otitis media. The risk factors for ear infections include viral upper respiratory tract infections, exposure to tobacco smoke in the home, day care (particularly in children under 2 years of age), immunodeficiency, trisomy 21 (Down syndrome), hypothyroidism and cleft palate.

Protective factors for AOM:

Fortunately, there is at least one factor that offers portection from middle ear nfections. Breast feeding significantly reduces the incidence of acute middle ear infections in infants.

Diagnosis of AOM:

Acute otitis media is frequently incorrectly diagnosed. This is because the diagnosis is based on the physical exam and presenting complaints.  But, examining the inside of a 2 year old’s ear is notoriously difficult. Additionally, eustachian tube redness is a common finding on physical exam with acute otitis media. However, ear redness may also be the result of vigorous crying.

Ideally, your physician will remove any earwax that impedes the view of the eardrum (also called the tympanic membrane). He or she will also test for decreased mobility of the eardrum with an insufflator bulb. The membrane may be bulging or retracted. Your doctor may also note that the affected tympanic membrane appears to be opaque, lacking its normal translucent quality.

Treatment of AOM:

Most cases of acute otits media resolve without any treatment at all. However, complications of middle ear infections include hearing loss so most physicians will treat AOM with antibiotics.

The first line antibiotic used to treat AOM is Amoxicillin.  The second line antibiotic used if Amoxicillin fails is the antibiotic Augmentin or Cefuroxime acetil.

Considerations in frequent Acute Otitis Media:

Children who get more than 3 infections in 6 months or 4 infections in one year may need to have tympanostomy tube placement.  On occasion myringotomy may be necessary. In the case of frequent ear infectins, your doctor should refer your child to an ENT physician for further evaluation.


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