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Ear Infections A to Z by Robert Rabinowitz, M.D.
The middle ear is a small air-filled cavity in the skull that is situated between the eardrum, or tympanic membrane, and the inner ear. Sound waves enter the auditory canal and strike the eardrum. The vibration these sound waves produce is transmitted through the middle ear with the aid of three bones. The vibration stimulates the auditory nerve in the ear and the brain interprets the resulting impulse as sound. The eustachian tube connects the middle ear with the back of the nose in the area of the adenoids. If the eustachian tube is functioning properly, air can get into the middle ear and small amounts of fluid, which are produced inside, can get out. In the case of a normal middle ear, sound is easily transmitted to the auditory nerve. Malfunction of this all-important structure, called eustachian tube dysfunction, is the cause of essentially all cases of otitis media. Congestion from all causes, but especially from upper respiratory viral infection, sometimes results in eustachian tube dysfunction and consequently, otitis media. This is especially true in children between the ages of 6 months and 2 years. Exposure to cigarette smoke and close contact with other children, such as occurs in daycare, also increase a child’s risk of developing ear infections. Conversely, breastfeeding offers some protection and can decrease risk of ear infections. When the eustachian tube is damaged, the middle ear becomes a fluid-filled rather than an air-filled cavity. The abnormal, fluid-filled middle ear is fertile ground for bacterial growth. Bacterial infection complicates the problem of fluid in the middle ear. Fever, hearing loss and pain may herald the onset of otitis media. Treatment for Otitis Media Bacterial infections are generally treated with antibiotics; otitis media is no exception. Antibiotics are the mainstay of our treatment plan. However, we have learned that due to repeated and excessive use of antibiotics, some bacteria develop resistance. The emergence of drug resistant bacteria is a dangerous situation. Because of this threatened resistance, the practice of using antibiotics to try to prevent otitis media has fallen into disfavor. Also important to consider when discussing antibiotic use are allergic reactions and other side effects. Studies have repeatedly shown that antihistamines and decongestants are of no value in treating otitis media. They also play no role in the treatment or prevention of ear infections. The proper medical approach to otitis media involves the judicious use of antibiotics followed by a great deal of watchful waiting. Follow-up is essential to be certain the middle ear has returned to normal and that hearing has not been affected. Looking to the future, there is a brand new vaccine, called the pneumococcal vaccine, which may help to prevent some middle ear infections. Surgical Treatment for Otitis Media The great majority of children with middle ear infections recover fully. However, some young children seem to get otitis media with every cold. Even more worrisome are children who continue to have fluid in their middle ear in between infections. These children, due to ongoing eustachian tube dysfunction, also have prolonged periods of hearing loss and another approach may be necessary for them. Various surgical procedures have been used to treat middle ear infections and to try and prevent the accumulation of fluid. Myringotomy is a procedure in which the physician cuts an opening in the eardrum to allow fluid to drain out. New techniques using lasers allow this procedure to be done without anesthesia. For the past 30 years physicians have been using pressure equilibration tubes (ear tubes) placed in the openings created by myringotomy to keep the tympanic membrane open and draining. The hope is that the ear tubes will prevent the recurrence of fluid and infection. Ear tube placement is not without potential problems. Anesthesia is required, which always carries some risk. Also, once operated upon, the eardrum may scar, the tubes may be rejected and even need replacement and infections may recur despite functioning tubes. The benefits of ear tubes may be very short lived. Ongoing studies are attempting to clarify the relationship of otitis media to language development, learning and social and emotional development. The results of these studies will help guide us in the selection of children who will benefit from more aggressive treatment. We still have a great deal to learn about this most common childhood illness. [ top ] |
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Otitis Media (middle ear infection) is, after the common cold, the most common infection in children and responsible for more than 25 million physician visits each year. In order to understand otitis media, it is necessary to review the structure and function of the middle ear. 
