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As printed in Hearing Health, volume 19:2,
Summer 2003
By Robert J. Ruben, M.D.
How many parents of young children know that antibiotics
are not required to treat every ear infection? Most
times, parents of sick children are looking for fast
relief of symptoms and see antibiotics as the answer.
Similarly, most parents do not understand that there
are two types of otitis media (infection of the middle
ear). With acute otitis media, the child typically has
a bulging red eardrum, fever and is sick. The other,
called otitis media with effusion, is when the child
has fluid behind the eardrum, may have hearing loss,
feeling of pressure in the ear and in the youngest,
some loss of balance – this is a very “quiet”
disease.
Acute otitis media and otitis media with effusion require
different treatments depending on a child’s age
and other health conditions.
| TREATMENT OF
ACUTE OTITIS MEDIA |
| Child Age |
Certain Diagnosis |
Uncertain Diagnosis |
| Under 6 mos. |
Antibiotics |
Antibiotics |
| 6 mos. to 2 yrs. |
Antibiotics |
Antibiotic if severe illness; Observe if non-severe
illness |
| 2 yrs. or older |
Antibiotic if severe illness; Observe if non-severe
illness |
Observe |
| Table based on New York State
Department of Health guidelines for treatment of
acute otitis media, www.health.state.ny.us/nysdoh. |
Widespread use of antibiotics to treat all forms of
otitis media over the past decades has resulted in the
emergence of many strains of bacteria that are antibiotic
resistant. These resistant bacteria cause serious infections
that are very difficult to care for. Additionally, many
children have become allergic to the antibiotics given
for otitis media and they now have a lifetime restriction
as to the type of antibiotic that can be used to fight
infection. These serious societal and individual problems
of reduced effectiveness of antibiotics caused by increased
resistance and allergy has led to a critical re-examination
of the care of otitis media.
Vaccines against some of the more common bacteria causing
acute otitis media have been developed and are now a
routine part of childcare. Medical societies and governmental
agencies have recommended guidelines to care for acute
otitis media.
There is a very special group of children in which
there appears to be a greatly increased risk of developing
meningitis from acute otitis media. These are children
who have a cochlear implant. According to the Centers
for Disease Control, children should be vaccinated before
receiving their implant with Prevnar®, Pneumovax®
23 or Pnu-Imune® 23 and the Haemophilus influenzae
type b conjugate (Hib) and maintained afterward. If
a child has already received an implant, he or she should
then be vaccinated. All episodes of acute otitis media
in children with cochlear implants should be treated
with an appropriate antibiotic and closely observed
for any sign of meningitis.
Otitis media with effusion is a very different condition
that will most often get better by itself. If it persists
for more than three months and is causing a problem,
including changes in the eardrum, a significant hearing
loss or association with a language delay, or is in
a child who may be more susceptible to hearing loss
from the fluid (e.g., a child with a sensorineural hearing
loss, language deficit or developmental delay), then
the most effective care is the surgical insertion of
a middle ear ventilating tube. An adenoidectomy, the
removal of tissue from the opening of the Eustachian
tube, may also be performed in conjunction with the
insertion of the ventilating tubes.
Robert J. Ruben, M.D., FACS, FAAP,
Distinguished University Professor at Albert Einstein
College of Medicine, is a leading specialist in pediatric
otolaryngology.
Related article:
Hearing Risks,
the Early Years
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