Otitis media (OM) is the medical name for an infection of the middle ear. While it affects people of all ages, it is far more common in young children; in fact, it is the number one reason that children under one year old are taken to the doctor.
Despite advances in drugs and other treatments, the percentage of children who develop otitis media has remained quite steady over time. About half of all infants will come down with an ear infection before their first birthday; and those who do will have an increased risk of further attacks, as well as a higher risk of developing repeated infections later in childhood.
From the point of view of keeping ears healthy and avoiding otitis media and other infections, breast-feeding is best for infants. Just as clearly, if parents cannot breast feed, it is critical to use feeding bottles that are designed to prevent nipple collapse and air bubble formation.
The disease is more common in boys than in girls; it is also more common in whites, in lower socioeconomic groups, in Native Americans (particularly in Alaska), and in children born with a cleft palate and other structural problems of the face or skull. OM is also somewhat seasonal, more likely to occur in early spring and winter.
When a child uses a typical feeding bottle, lack of ventilation or inadequate ventilation causes a vacuum to form, and this can cause problems inside the ear. It works like this: the non-vented bottle is simply a solid walled vessel with a nipple held in place with a cap. The cap holds the enlarged flange end, or base of the nipple, firmly against the top of the bottle forming a tight seal. This arrangement does not permit any air entry, resulting in the creation of a vacuum (negative presssure) during sucking. Fluid may only be removed by the infant in small amounts by overcoming the stiffness of the wall of the nipple or bottle.
The vacuum created by bottle-feeding can play havoc with the ear's inner auditory tube.
The vacuum created by bottle feeding can play havoc with the ear's inner auditory tube. Negative pressure generated in the mouth is transmitted up the tube and into the middle ear where, as a result, fluid can build up. The increased fluid can cause hearing difficulties and infections. Interestingly, none of this occurs with breast feeding, which does not create any kind of vacuum and which actually creates positive pressure within the ear.
Not only does negative middle ear pressure increase a child's risk for otitis media, but severe cases of otitis media can have even worse long-term consequences. Studies have shown a definite relationship between this kind of negative pressure in the ear and development of more serious ear disease. It may lead to a condition known as secretory otitis, which can cause permanent hearing loss, along with delayed speech development. It may also contribute to the development of other, irreversible kinds of middle ear disease (examples include atelectasis, adhesive otitis, and cholesteatoma).
If breast feeding is out of the question, parents should try to reduce the risk of vacuum and air bubble formation by using feeding bottles with continuous positive pressure at the nipple during the entire feeding cycle.
In response to this problem, the U.S. Centers for Disease Control (CDC) has given out new recommendations on how to treat otitis media more effectively with antibiotics. To paraphrase these recommendations, if the infant has not received antibiotics in the last month, it is recommended that the infant be started on usual-dose or high-dose amoxicillin. If the treatment is not working by day three, then the infant should be given high-dose amoxicillin-clavulanate (Augmentin®) or cefuroxime axetil (Ceftin®) or injections of ceftrianone.
For an infant who has received antibiotics in the last month, it is recommended that high-dose amoxicillin, high dose amoxicillin-clavulanate or cefuroxime axetil be started. If there is no improvement by day three, treatment options include injections of ceftrianone, clindamycin or tympanocentesis, which means using a needle to puncture the ear drum and remove trapped fluid. In both cases, infants are reexamined on days 10 to 28.
Whether, when and how to treat otitis media with antibiotics or other treatments are decisions that should be made in close consultation with your doctor. Parents can and should reduce their child's risk factors as discussed above but children who do come down with an ear infection should see a doctor immediately.