Acute otitis media is characterized by inflammation of the middle ear, where fluid accumulates along with symptoms of an ear infection, often causing pain or leading to a perforated eardrum with possible discharge. This condition is the most common diagnosis among unwell children in the United States, particularly affecting infants and preschool-aged children. Nearly all kids experience at least one episode before turning six.Children’s Eustachian tubes are shorter than those of adults, facilitating the easy entry of bacteria and viruses into the middle ear and resulting in acute otitis media. The bacteria Streptococcus pneumoniae and Hemophilus influenzae are responsible for approximately 85% of acute otitis media cases, with viruses accounting for the remaining 15%. Infants younger than six weeks often contract infections from different bacteria.Breastfeeding can help prevent otitis media by passing immunity from the mother to the child and promoting better Eustachian tube function compared to bottle-feeding. If bottle-feeding is necessary, holding the baby rather than allowing them to lie down with the bottle is recommended. It is also advised not to let a child take a bottle to bed, as this can increase the risk of both acute otitis media and tooth decay.Upper respiratory infections are a major risk factor for acute otitis media, so being in settings like daycare centers can lead to more frequent colds and ear infections. Exposure to irritants like tobacco smoke also raises the risk. Children with conditions such as cleft palate or Down syndrome are more prone to ear infections. Those who experience acute otitis media before six months of age are likely to have more frequent ear infections later.Young children with otitis media might be irritable or have trouble feeding or sleeping, while older kids often complain of ear pain and fullness. Fever can occur in children of any age. These symptoms are usually accompanied by signs of a cold, such as a runny nose or cough.The accumulation of pus in the middle ear can cause pain and temporary hearing loss due to reduced eardrum vibrations. In severe cases, the eardrum may rupture, allowing pus to drain into the ear canal. Typically, the eardrum heals with medical treatment.The standard treatment for acute otitis media involves antibiotics for 7 to 10 days. However, healthy children aged six months to two years and older, without severe symptoms or a confirmed diagnosis, might be monitored without antibiotics. About 10% of children don't respond to treatment within the first 48 hours. Even after treatment, 40% may retain some fluid in the middle ear, causing temporary hearing loss for up to three to six weeks, though the fluid usually resolves on its own.For children with recurrent otitis media, a tympanostomy tube may be surgically placed to help drain fluid. In cases of severe pain and a bulging eardrum, a myringotomy might be necessary to release pus, with the eardrum typically healing within a week.Acute otitis media itself is not contagious, though the preceding cold may be. A child with this condition can travel by airplane, but if the Eustachian tube is not working properly, pressure changes can cause discomfort. A child with a draining ear should avoid flying and swimming.
