Otitis Media

Case Presentation

JoAnn was at work when she received a call from the day care where Michael, her five month-old son, was being watched. The child care provider told JoAnn that Michael had been fussy that morning, napped only a short while, refused his bottle, and was running a temperature of 101°F. JoAnn told the day care provider that she would be right over to pick up Michael. She called her pediatrician’s office and scheduled an appointment for that afternoon.

The pediatrician inspected Michael’s ears and informed JoAnn that Michael had a middle ear infection. She asked JoAnn if Michael had been coughing a lot and if he recently had a cold or runny nose. She also asked if Michael was breast-fed or bottle-fed and if there was anyone in their household who smoked. JoAnn told the doctor that Michael’s nose had been draining quite a bit lately, that he was bottle-fed, and that neither she nor her husband smoked. The doctor wrote a prescription for antibiotics and instructed JoAnn to give Michael a non-prescription childrens’ pain medication. An appointment was made for a recheck in two weeks.

Case Background

A middle ear infection, or otitis media, is most often of bacterial origin and commonly follows an upper respiratory infection. The bacteria usually enter the middle ear via the surface of the auditory tube mucus membrane. Inflammation of the tissues in the middle ear results from the infection. The auditory tube becomes swollen or clogged, and pus accumulates in the tympanic cavity of the middle ear as white blood cells rush to the site.

Otitis media can affect anyone, but is most common in young children, with 75% of children experiencing at least one episode by their third birthday. Children are more likely to suffer from otitis media than adults because their immune systems are immature, and their auditory tubes are shorter and straighter than those of adults. Children that attend large day cares, are bottle-fed, and are exposed to cigarette smoke are more likely to experience otitis media.

Symptoms in young children include severe earache, fever, nausea, vomiting, and diarrhea. Rupturing of the tympanic membrane, or eardrum, can also occur but is uncommon. If the condition is very persistent, generally seen as lasting for three months, an operation called a myringotomy can be performed. This operation involves the insertion of a ventilation tube in the tympanic membrane of an infected ear.