Cause, Diagnosis and Treatment of Ear Infections in Children

Middle ear infections, or acute otitis media are incredibly common in young children. Almost seventy five percent 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, Moraxella catarrhalis and viruses such as Influenza A, Respiratory syncitial virus and Parainfluenza virus.

Risk factors for AOM:

Certain factors predispose a child to acute otitis media. These factors include viral upper respiratory tract infections, passive exposure to tobacco smoke, day care (particularly at under 2 years of age), immunodeficiency, trisomy 21 (Down syndrome), hypothyroidism and cleft palate.

Protective factors for AOM:

Fortunately, breast feeding actually reduces the incidence of acute middle ear infections in infants.

Diagnosis of AOM:

Acute otitis media is frequently erroneously diagnosed. This is because the diagnosis is based on the physical exam and presenting complaints.
However, examining the inside of a 2 year old's ear is notoriously difficult. Additionally, redness is a common finding 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. He or she may also note that the affected tympanic membrane appears to be opaque, lacking its normal translucent quality.

Treatment of AOM:

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

First line antibiotic treatment- Amoxicillin.

Second line if Amoxicillin fails- Augmentin or Cefuroxime acetil.

Considerations in frequent Acute Otitis Media:

In children with more than 3 infections in 6 months or 4 infections in 1 year, tympanostomy tube placement or myringotomy may be necessary. Your doctor should refer you to an ENT physician for further evaluation.