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Acute Otitis Media

Introduction

Otitis media can be subdivided into two general types, otitis media with effusion (OME, previously and often still referred to as serous otitis media or fluid in the ears) and acute otitis media (AOM, previously acute suppurative otitis media or ear infection).

Otitis media is the most common reason for childhood visits to the pediatrician and it is estimated that 80% of children will have at least one episode by age 5 years. Otitis media with effusion and acute otitis media result from poor Eustachian Tube (ET) function and general body immaturity of childhood. The Eustachian tube connects the back of the nose with the middle ear and is normally closed. This tube opens by the action of the muscles of chewing and swallowing and when we pop our ears with air descent or on an elevator. Normal ET function allows air to enter the middle ear space. The Eustachian tube most often becomes blocked in children in association with colds and sinus infections or due to infection or enlargement of the adenoids. The adenoids are like the tonsils but are located in the back of the nose.

What are the symptoms of otitis media with effusion (OME)?
The most common symptoms of OME are ear fullness and hearing loss. In many children, particularly younger children, OME may be asymptomatic.  In otherwise healthy children, with no speech or language delays, OME does not need to be actively treated. A course of oral antibiotics is sometimes prescribed even though OME does not present with the signs or symptoms of the acute infection of AOM (see below).

How is otitis media with effusion (OME) treated?
Ultimately, if middle ear fluid does not resolve, a myringotomy (hole in the ear drum) with insertion of a ventilation tube is indicated. This surgical procedure is usually performed under a light general anesthetic. A small incision is made in the tympanic membrane (myringotomy) and a ventilating tube is placed into the incision. Small ventilation tubes will usually remain in place and aerate the middle ear for six to nine months. Longer lasting tubes should be reserved for recurrent disease. Most authors agree that the adenoids should not be removed at initial myringotomy, but reserved for recurrent cases. Eighty five percent of children need tubes only once. The most common complication of myringotomy with tube insertion is infection and ear drainage, which occurs in approximately 10% of cases.

What are the symptoms of acute otitis media (AOM)?
Acute otitis media is an acute infection of the middle ear space. This may be viral or bacterial.  Often, in children, OME and AOM represent a continuum of disease.  Middle ear fluid gets repeatedly infected, with the fluid persists between acute infections. Acute ear infections in children cause fever, pain and sometimes ear drainage. Young children will sometimes run a high fever and have diarrhea, irritability and be generally sick.

How is acute otitis media (AOM) treated?
In May 2004, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) jointly issued a clinical practice guideline for children with AOM encouraging less use of antibiotics and greater use of pain killers. Children over the age of two years, who do not have a fever and have mild symptoms, can be treated with expectant observation and oral pain killers. Children below age two years should be treated with a ten day course of oral antibiotics.  Amoxicillin is the initial drug of choice, followed by augmentin and cefuroxime. Bacterial resistance has become an increasing problem.  Accordingly, myringotomy with ventilating tube insertion has become more common as a treatment of AOM.

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