Acute Otitis Media

Acute otitis media (AOM) is a painful type of ear infection. It occurs when the area behind the eardrum called the middle ear becomes inflamed and infected.

The following behaviors in children often mean they have AOM:

• fits of fussiness and intense crying (in infants)
• clutching the ear while wincing in pain (in toddlers)
• complaining about a pain in the ear (in older children)

SYMPTOMS

What Are the Symptoms of Acute Otitis Media?

Infants and children may have one or more of the following symptoms:

• crying
• irritability
• sleeplessness
• pulling on the ears
• ear pain
• a headache
• neck pain
• a feeling of fullness in the ear
• fluid drainage from the ear
• a fever
• vomiting
• diarrhea
• irritability
• a lack of balance
• hearing loss

CAUSES

What Causes Acute Otitis Media?

The eustachian tube is the tube that runs from the middle of the ear to the back of the throat. An AOM occurs when your child’s eustachian tube becomes swollen or blocked and traps fluid in the middle ear. The trapped fluid can become infected. In young children, the eustachian tube is shorter and more horizontal than it is in older children and adults. This makes it more likely to become infected.

The eustachian tube can become swollen or blocked for several reasons:

• allergies
• a cold
• the flu
• a sinus infection
• infected or enlarged adenoids
• cigarette smoke
• drinking while laying down (in infants)

Who Is at Risk for Acute Otitis Media?

The risk factors for AOM include:

• being between 6 and 36 months old
• using a pacifier
• attending daycare
• being bottle fed instead of breastfed (in infants)
• drinking while laying down (in infants)
• being exposed to cigarette smoke
• being exposed to high levels of air pollution
• experiencing changes in altitude
• experiencing changes in climate
• being in a cold climate
• having had a recent cold, flu, sinus, or ear infection

Genetics also plays a role in increasing your child’s risk of AOM.

DIAGNOSIS

How Is Acute Otitis Media Diagnosed?

Your child’s doctor may use one or more of the following methods to diagnose AOM:

Otoscope

Your child’s doctor uses an instrument called an otoscope to look into your child’s ear and detect:

• redness
• swelling
• blood
• pus
• air bubbles
• fluid in the middle ear
• perforation of the eardrum

Tympanometry

During a tympanometry test, your child’s doctor uses a small instrument to measure the air pressure in your child’s ear and determine if the eardrum is ruptured.

Reflectometry

During a reflectometry test, your child’s doctor uses a small instrument that makes a sound near your child’s ear. Your child’s doctor can determine if there’s fluid in the ear by listening to the sound reflected back from their ear.

Hearing Test

Your doctor may perform a hearing test to determine if your child is experiencing hearing loss.

TREATMENTS

How Is Acute Otitis Media Treated?

The majority of AOM infections resolve without antibiotic treatment. Home treatment and pain medications are usually recommended before antibiotics are tried to avoid the overuse of antibiotics and reduce the risk of adverse reactions from antibiotics. Treatments for AOM include:

Home Care

Your doctor may suggest the following home care treatments to relieve your child’s pain while waiting for the AOM infection to go away:

• applying a warm, moist washcloth over the infected ear
• using over-the-counter (OTC) ear drops for pain relief
• taking OTC pain relievers such as ibuprofen (Advil, Motrin) and acetaminophen (Tylenol)

Medication

Your doctor may also prescribe eardrops for pain relief and other pain relievers. Your doctor may prescribe antibiotics if your symptoms don’t go away after a few days of home treatment.

Surgery

Your doctor may recommend surgery if your child’s infection doesn’t respond to treatment or if your child has recurrent ear infections. Surgery options for AOM include:

Adenoid Removal

Your child’s doctor may recommend that your child’s adenoids be surgically removed if they’re enlarged or infected and your child has recurrent ear infections.

Ear Tubes

Your doctor may suggest a surgical procedure to insert tiny tubes in your child’s ear. The tubes allow air and fluid to drain from the middle ear.

What Is the Long-Term Outlook?

AOM infections generally get better without any complications, but the infection may occur again. Your child may also experience temporary hearing loss for a short time. But your child’s hearing should return quickly after treatment. Sometimes, AOM infections can cause:

• recurrent ear infections
• enlarged adenoids
• enlarged tonsils
• a ruptured eardrum
• a cholesteatoma, which is a growth in the middle ear
• speech delays (in children who have recurrent otitis media infections)

In rare cases, an infection in the mastoid bone in the skull (mastoiditis) or an infection in the brain (meningitis) can occur.

PREVENTION

How to Prevent Acute Otitis Media

You can reduce the chances of your child having AOM by doing the following:

• wash hands and toys frequently to reduce your chances of getting a cold or other respiratory infection
• avoid cigarette smoke
• get seasonal flu shots and pneumococcal vaccines
• breastfeed infants instead of bottle feeding them if possible
• avoid giving your infant a pacifier.

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Acoustic Neuroma

Acoustic neuromas are noncancerous tumors. They grow on the nerve that connects the brain and ear. Since these tumors are benign, they don’t spread to other body parts. Still, they can grow large enough to damage important nerves.

According to the Acoustic Neuroma Association, acoustic neuromas appear in 1 out of every 50,000 people.

RISK FACTORS

Who Is at Risk?

The only known risk factor for acoustic neuroma is having a parent with the genetic disorder neurofibromatosis 2 (NF2). Most of these tumors appear spontaneously. They occur in people with no family history of the disease.

Scientists still don’t understand why some people get these tumors. Some risk factors might include:

• loud noises
• a parathyroid neuroma, which is a benign tumor of the thyroid
• exposure to low levels of radiation during childhood.

Acoustic Neuroma Symptoms

Small neuromas rarely have symptoms. Symptoms typically appear only when the tumor gets large enough to press on surrounding nerves. One of the most common symptoms is a gradual loss of hearing on one side of the head. This hearing loss usually happens slowly over time, but it can also start very suddenly. Vertigo, or dizziness, and ringing in the ears are common. These tumors can also cause facial numbness, weakness, and problems with balance.

Some less common symptoms include:

• headache
• problems with vision
• difficulty understanding speech
• pain in the face or ear
• numbness in the face or ear
• fatigue

DIAGNOSIS

Diagnosis of Acoustic Neuroma

If you experience hearing loss or other neurologic symptoms, it is important to keep track of them. This can help your doctor diagnose your problem.

Your doctor will want a detailed history of your symptoms. If you have a neuroma, you’ll probably need a hearing test. You may need other tests as well:

• Brain stem auditory evoked response tests can check both neurological and hearing function.
• Electronystagmography detects changes in eye movement that may be caused by inner ear problems.
• MRIs and CT scans can give your doctor an image of the inside of your head.

Treatment of Acoustic Neuroma

Your age, general health, and tumor size will all affect your treatment.

Treatment isn’t always necessary. If you have a small acoustic neuroma, your doctor may just monitor its growth with regular MRIs. On the other hand, a lack of treatment can sometimes lead to a buildup of fluid within the brain. This life-threatening condition is called hydrocephalus.

If you have a relatively small tumor, your doctor may try to stop its growth. This is done with stereotactic radiosurgery. In this procedure, radiation is applied to a small, specific area of your head. It’s not invasive, but it’s very slow. It can take months or years to get rid of a tumor. For that reason, this procedure is usually only used for very small tumors. It can also be used when surgery is too risky or if residual tumors remain after surgery.

Surgery may be necessary if your tumor is very large or growing quickly. You may also need surgery if your tumor is starting to approach a vital part of the brain. During surgery, the tumor can be removed either through the skull or through the ear itself. Recovery time ranges from a few days to several weeks.

This surgery can have many complications and risks. These include:

• complete loss of hearing
• weakened facial muscles
• ringing in the ears
• cerebrospinal fluid leaking from the incision
• problems with balance
• persistent headaches

It’s important to talk to your doctor as soon as you start experiencing neuroma symptoms. That’s the only way to preserve your hearing. Once lost, hearing won’t return after treatment.

According to the Acoustic Neuroma Association, acoustic neuromas appear in one out of every 50,000 people.

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