Otitis Media

Incidence

Almost all children have acute OM at some time, but between 5% and 20% of children have chronic and recurrent OM with effusion. OM is most prevalent between the ages of 3 months and 3 years and is the most frequent reason for clinic visits in children younger than 15 years of age. Approximately 66% of children have at least one OM episode by the age of 3; 50% have two or more episodes of OM. The younger a child is when the first incidence of OM occurs, the more likely the child is to experience recurrent episodes. OM is fairly common during winter months because of the increased number of people suffering from colds and upper respiratory illnesses. Children with Down syndrome, cleft palate, or other craniofacial anomalies are particularly at risk for OM because of the structure of their eustachian tubes. Approximately 50% of all children with a cleft palate experience recurrent OM. Additional risk factors include family history, bottle-fed as an infant, exposure to second-hand cigarette smoke, pollution, high allergen levels, and day-care settings.

Diagnosis and Treatment

Diagnosis of OM can only be made by visual inspection of the ear by a medical professional. Treatment consists of a course of antibiotics, which generally relieves symptoms within 48 to 72 hours; approximately 50% cases clear up within 3 weeks. Persistent cases may require additional, extended medical treatments. A follow-up examination of the ear by a physician is necessary to confirm complete resolution of the condition and reduce OM recurrence. When OM is recurrent (i.e., three or more acute infections within 6 months), tubes may be surgically inserted into the ear to facilitate fluid drainage and avoid accumulation. The tubes typically remain in place for 6 to 12 months. It is important to monitor treatment adherence to ensure the child's complete recovery. It is also recommended that any child having recurrent OM with effusion be assessed by an audiologist and a speech pathologist. Additional [Page 364]suggestions for intervention include minimizing exposure to harmful environmental factors such as cigarette smoke, pollution, allergens, and situations in which there is an increased risk for illness or infection (e.g., day-care settings). Parents also should be instructed against bottle-feeding while the child is lying down. Medical personnel may also wish to disseminate preventative care information such as advocating the use of ear plugs while swimming.

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