Middle Ear Infections : Treatments, Diagnosis

by Food and Drug Administration (FDA)

(Page 2 of 3)

Two Treatments

For now in the United States, antibiotics and tympanostomy tubes remain the most common and accepted tools for treating acute otitis media and otitis media with effusion.

Both approaches have benefits. Many oral antibiotics are inexpensive and can relieve a child's pain and fever from an acute ear infection in a few hours. For chronic fluid, tympanostomy tubes instantly drain the middle ear and restore hearing. According to the National Center for Health Statistics, there were about 670,000 surgeries in 1988 to insert ear tubes, making it the most common surgical procedure for children.

But there are drawbacks to both approaches as well. Antibiotics don't always work completely, leaving some infected fluid. Other times, the bacteria are resistant to the drug. Some researchers believe resistant bacteria are on the rise because our country overuses many antibiotics.

Antibiotics have side effects, too — the most troubling one being diarrhea. Others include thrush (an oral yeast infection) and vaginal yeast infections in girls.

If antibiotics are used, parents must be vigilant in giving each dose on time. Skipping or getting off schedule with doses will only make the infection worse, allowing bacteria that are resistant to the drug to grow.

"The child gets better, and the parents get lax," says Michael Blum, M.D, a medical officer at FDA. "If you skip a day here or there, there's more potential for resistant bacteria to develop."

When antibiotics fail, surgery is the next option. Most tympanostomies are done by ear, nose and throat specialists in an outpatient setting at a hospital. A general anesthesia is used for most children, not because it's very painful, but because the child needs to lie perfectly still.

During surgery, the physician cleans the ear canal, makes a small incision in the eardrum, suctions out the fluid behind it (a procedure called myringotomy), and places a tiny tube in the incision. The procedure is done under a microscope with an instrument that resembles a small pair of tweezers. It lasts about 15 to 30 minutes.

The AHCPR panel estimated the cost of tubes at about $2,174 (including a parent's lost time in work). Unfortunately, the tubes can easily fall out within weeks or months, and must be replaced. One-third of children with tubes have them replaced within five years of the first operation.

Other drawbacks of tubes include the risk of complications from anesthesia and the need for children to protect their ears with earplugs while swimming or bathing. It's a good idea to wait until autumn to put in tubes so that they won't interfere with beach and pool trips.

A child's hearing should always be tested before inserting tubes, the panel said. A loss of 20 decibels in each ear (as loud as a humming refrigerator) warrants treatment, the panel said. Although that's not a large hearing loss, experts are quick to point out that no one knows just how much loss might impede a child's language development.

Accurate Diagnosis

Before a child undergoes any treatment, it's crucial to get an accurate diagnosis, the panel advised.

A magnifying instrument called a pneumatic otoscope enables the doctor to see the eardrum while pumping a puff of air against it. If the eardrum is red and inflamed, it's probably infected. If it's not inflamed, but still doesn't move properly when the air hits it, it probably has uninfected fluid behind it.

"Many doctors do not use the pneumatic otoscope," says Cynthia Carney, a journalist and consumer representative on the AHCPR panel. "We say very clearly in the guidelines that that's the only way to be sure."

Many doctors either don't know how to use the pneumatic otoscope properly, or they can't get an accurate reading on a squirming, screaming 2-year-old. But experts say the results with a pneumatic otoscope are worth the extra time and effort.

The diagnosis can be confirmed by a specialist with another test called a tympanogram. Using a soft plug fitted snugly into the ear canal, the tympanometer emits a low noise and records how the eardrum reacts. If it doesn't move well, that's an indication that there's fluid behind the drum.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.