Otitis media is an inflammation in the middle ear (the area behind the eardrum) that is usually associated with a buildup of fluid. The fluid may or may not be infected. Symptoms, severity, frequency, and length of the condition vary. At one extreme is a single short period of thin, clear, non-infected fluid without any pain or fever but with a slight decrease in hearing ability. The other extreme is repeated bouts with infection, thick "glue-like" fluid, and possible complications such as permanent hearing loss. Fortunately, with early identification, serious medical complications can be controlled with medicine or surgery. However, there is one problem that nearly always occurs with all types of otitis media -- fluctuating hearing loss.
Otitis media occurs most frequently in children. In fact, it ranks second to the common cold as the most common health problem in preschool children. Fifty percent of children have had at least one episode by one year of age. Between one and three years, 35% will have had repeated episodes. For school children, an estimated 5 million school days are missed every year due to otitis media.
The Eustachian tube, a passage between the middle ear and the back of the throat, is smaller and more nearly horizontal in children than in adults. Therefore, it can be more easily blocked by conditions such as large adenoids and infections. Until the Eustachian tube changes in size and angle, children are more susceptible to otitis media.
Three tiny bones in the middle ear carry sound vibrations from the eardrum to the inner ear. When fluid is present, the vibrations are not transmitted efficiently and sound energy is lost. The result may be a mild or even a moderate hearing loss. Therefore, some speech sounds may be muffled or inaudible. Generally, this type of hearing loss is temporary. However, when otitis media occurs over and over again, damage to the eardrum, the bones of the ear, or even the hearing nerve can occur and cause permanent hearing loss.
Children learn speech and language from listening to other people talk. The first few years of life are especially critical for this development. If a hearing loss exists, a child does not get full benefit of language learning experiences. Consequently, critical delays in speech and language development may occur. Otitis media without infection presents a special problem because symptoms of pain and fever are usually not present. Therefore, weeks, and even months, can go by before parents suspect a problem. During this time, the child may miss out on hearing the speech and language needed for normal development.
Even if there is no pain or fever, there are other signs you can look for that may indicate chronic or recurring fluid in the ear: inattentiveness, wanting the television or radio louder than usual, misunderstanding directions, listlessness, unexplained irritability, pulling or scratching the ears.
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A physician should handle the medical treatment. Ear infections require immediate attention, most likely from a pediatrician or otolaryngologist (ear doctor). If your child has frequently recurring infections and/or chronic fluid in the middle ear, two additional specialists should be consulted: an audiologist and a speech-language pathologist. An audiologist's evaluation will assess the severity of any hearing loss, even in a very young or uncooperative child, and will indicate if a middle ear disorder is present. A speech-language pathologist measures your child's specific speech and language skills and can recommend and/or provide remedial programs when they are needed.
As a parent, you are the best person to look for signs that suggest poor hearing. The American Academy of Pediatrics recognizes this when it states, "Any child whose parent expresses concern about whether the child hears should be considered for referral for behavioral audiometry without delay." Parents should not be afraid to let their instincts guide them in requesting or independently arranging for further evaluation whenever they are concerned about their children's health or development.
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