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EAR INFECTIONS   One of the commonest reasons I see a child for illness is because of ear pain. One out of two children has one or more ear infection by their first birthday. Two thirds of all children have an ear infection by three years of age. Nine out of ten children will have this illness by age nine. Otitis media is an infection of the middle ear. What is otitis media? When should you suspect it? How do you treat it? How can you prevent it? ear

Before we can understand why children get ear infections, you should understand the anatomy of the ear. As shown in the diagram, the ear has three parts. These parts are the external ear, the middle ear and the inner ear. The external ear goes from the outside up to the eardrum or tympanic membrane and includes the external ear canal. This part of the ear gets infected in the summer during swimming. Otitis externa or swimmer's ear occurs when infected water gets trapped in the canal. Germs grow and infect the external canal causing inflammation. This type of infection needs eardrops for treatment.

The middle ear lies behind the eardrum and contains three little bones. These bones transmit eardrum vibrations from the eardrum to the hearing organ located in the inner ear. Usually, this middle ear chamber is air filled to permit easy vibration of the three little bones. The eustachian tube is an open airway between the middle ear and the mouth. This tube drains fluid that may accumulate in the middle ear. Behind the middle ear is the inner ear. This is the location of the hearing organ (the cochlea) and the balance canals (the labyrinth). Sound vibrates the eardrum, which in turn vibrates the middle ear bones. These bones in turn vibrate nerve endings in the cochlea. Nerves carry the impulses from the cochlea to the brain.

Otitis media results from infection of fluid that has accumulated in the middle ear. A child's eustachian tube is shorter, narrower, and more horizontal than that of an adult. When your child has a cold or allergies, the mucous membranes become swollen. The nasopharynx, eustachian tube, and middle ear become inflamed and congested. This results in obstruction of the draining tube and fluid accumulates in the middle ear. Then, like the water in a stagnant pond, this fluid can become infected.

What are the symptoms of otitis media? Usually, it starts as an upper respiratory tract infection. Your child may complain of ear pain. He may have loss of appetite, or just lay around not wanting to do anything. He may have fever. Other signs may include headache, diarrhea, drainage from the ear, and a yellow or green nasal discharge. An infant may pull or rub the ear. He may be irritable, fussy, or whinny. He may be sucking at the bottle vigorously for a few seconds and suddenly pull away, crying out in pain. Infants also may seem more comfortable in an upright position and may cry out when placed in a prone position.

How is otitis media treated? Bacteria usually cause otitis media. We treat this infection with antibiotics. The type of antibiotic used usually depends on the age of your child, past infections and ease of giving the medicine. Pain relievers and decongestants are sometimes also used. It is important to give your child the full course of treatment. Your child may start to feel better after a day or two. If you stop the medication after just a few days, the germs may come back and the symptoms may soon return. It is also important to have the ear rechecked after you finish the medicine. Sometimes there is still an infection even though your child does not have symptoms. Some children get ear infections frequently. Often we must change the type of antibiotic we use before we get one that works. When the ear infections are recurrent, severe and long lasting we may decide on a minor surgical procedure called a myringotomy. The surgeon makes an incision in the eardrum and removes the fluid from the middle ear. He may then place a tiny ventilating tube, called a tympanotomy tube, in the eardrum. This allows the fluid to drain continuously from the middle ear. Another procedure is an adenoidectomy. This procedure removes the adenoids from around the opening of the eustachian tube. This lets the tube function more effectively.

Are there ways in preventing ear infections? At the first sign of a cold give your child an antihistamine and/or decongestants. Theoretically, this will dry your child out and prevent congestion of the eustachian tube. Never give a bottle when putting your child to bed. The milk or formula may flow from the mouth into the middle ear via the eustachian tube. Substitute a pacifier or sterile water.

Remember, although ear infections are common they are minor illnesses and I can easily treat it.

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