Otitis media is an inflammation of the middle ear, marked by the buildup of infected fluid, ear pain, and sometimes drainage into the ear canal if the eardrum is perforated. It is the most common diagnosis among sick children in the U.S., particularly affecting infants and preschoolers. Nearly every child experiences at least one episode of otitis media by the age of six. Children's Eustachian tubes are shorter than those of adults, which makes it easier for bacteria and other pathogens to reach the middle ear, leading to infections. About 85% of acute otitis media cases are caused by bacteria such as Streptococcus pneumoniae and Haemophilus influenzae, while viruses account for the remaining 15%. Infants younger than six weeks may experience infections from different bacteria.Bottle-feeding can contribute to the risk of otitis media, whereas breastfeeding provides temporary maternal immunity that helps prevent the condition. Some researchers suggest that breastfeeding positions are more favorable for Eustachian tube function compared to bottle-feeding, although this has not been conclusively proven. If bottle-feeding is necessary, it's recommended to hold the baby upright rather than allowing them to lie down with the bottle. Babies should not be put to bed with a bottle, as milk residue in the mouth can lead to tooth decay.Exposure to upper respiratory infections, common in child-care settings, increases the likelihood of acute otitis media. Environmental irritants, such as tobacco smoke, also elevate the risk. Children with conditions like cleft palate or Down syndrome are more prone to ear infections. Those who have their first bout of acute otitis media before six months of age are likely to experience more frequent infections later on.Young children with otitis media may become irritable, have difficulty feeding or sleeping, while older children might complain of ear pain and fullness. Fever can occur at any age. These symptoms are often accompanied by a runny nose or cough. The accumulation of pus in the middle ear causes pain and can temporarily impair hearing by affecting eardrum vibrations. Severe infections can cause the eardrum to rupture, allowing pus to drain into the ear canal. Medical treatment typically heals the eardrum.Treatment for acute otitis media typically involves a 7-10 day course of antibiotics. About 10% of children do not respond to treatment within the first two days. Even after treatment, 40% of children may have residual fluid in the middle ear, which can temporarily affect hearing for 3-6 weeks. The fluid usually resolves on its own. Children with recurrent otitis media may need a tympanostomy tube inserted to allow fluid drainage. If a child has a bulging eardrum and severe pain, a myringotomy might be performed to release the pus; the eardrum generally heals within a week.Acute otitis media is not contagious, though the preceding cold might be. Children with otitis media can fly, but pressure changes during flights may cause discomfort if the Eustachian tube isn't functioning well. Children with draining ears should avoid flying and swimming.
