Otitis Media (Ear Infection)
What is otitis media?
Otitis media is an infection or inflammation of the middle ear. This inflammation often begins when infections that cause sore throats, colds, or other respiratory or breathing problems spread to the middle ear. These can be viral or bacterial infections. Seventy-five percent of children experience at least one episode of otitis media by their third birthday. Almost half of these children will have three or more ear infections during their first 3 years. It is estimated that medical costs and lost wages because of otitis media amount to $5 billion* a year in the United States. Although otitis media is primarily a disease of infants and young children, it can also affect adults.
*Gates GA. Cost-effectiveness considerations in otitis media treatment. Otolaryngol Head Neck Sur. April 1996. 114 (4): 525-530.
How do we hear?
The ear consists of three major parts: the outer ear, the middle ear, and the inner ear. The outer ear includes the pinna--the visible part of the ear--and the ear canal. The outer ear extends to the tympanic membrane or eardrum,
|Image of the inner ear
which separates the outer ear from the middle ear. The middle ear is an air-filled space that is located behind the eardrum. The middle ear contains three tiny bones, the malleus, incus, and stapes, which transmit sound from the eardrum to the inner ear. The inner ear contains the hearing and balance organs. The cochlea contains the hearing organ which converts sound into electrical signals which are associated with the origin of impulses carried by nerves to the brain where their meanings are appreciated.
Why are more children affected by otitis media than adults?
There are many reasons why children are more likely to suffer from otitis media than adults. First, children have more trouble fighting infections. This is because their immune systems are still developing. Another reason has to do with the child's eustachian tube. The eustachian tube is a small passageway that connects the upper part of the throat to the middle ear. It is shorter and straighter in the child than in the adult. It can contribute to otitis media in several ways.
The eustachian tube is usually closed but opens regularly to ventilate or replenish the air in the middle ear. This tube also equalizes middle ear air pressure in response to air pressure changes in the environment. However, a eustachian tube that is blocked by swelling of its lining or plugged with mucus from a cold or for some other reason cannot open to ventilate the middle ear. The lack of ventilation may allow fluid from the tissue that lines the middle ear to accumulate. If the eustachian tube remains plugged, the fluid cannot drain and begins to collect in the normally air-filled middle ear.
One more factor that makes children more susceptible to otitis media is that adenoids in children are larger than they are in adults. Adenoids are composed largely of cells (lymphocytes) that help fight infections. They are positioned in the back of the upper part of the throat near the eustachian tubes. Enlarged adenoids can, because of their size, interfere with the eustachian tube opening. In addition, adenoids may themselves become infected, and the infection may spread into the eustachian tubes.
Bacteria reach the middle ear through the lining or the passageway of the eustachian tube and can then produce infection, which causes swelling of the lining of the middle ear, blocking of the eustachian tube, and migration of white cells from the bloodstream to help fight the infection. In this process the white cells accumulate, often killing bacteria and dying themselves, leading to the formation of pus, a thick yellowish-white fluid in the middle ear. As the fluid increases, the child may have trouble hearing because the eardrum and middle ear bones are unable to move as freely as they should. As the infection worsens, many children also experience severe ear pain. Too much fluid in the ear can put pressure on the eardrum and eventually tear it.
Reprinted with the permission of the National Institute of Mental Health. © 2008 NIMH.
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