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Author: admin | 16.12.2014 | Category: Ringing In The Ears Causes

The outer ear collects sound waves, which move through the ear canal to the tympanic membrane, commonly called the eardrum. The inner ear also contains three semi-circular canals that function as the body''s gyroscope, regulating balance. The Eustachian tube, an important structure in the ear, runs from the middle ear to the passages behind the nose and the upper part of the throat. In children, ear infections often recur, particularly if they first develop in early infancy. Children who are susceptible to OME can have frequent episodes for more than half of their first 3 years of life. Most episodes will resolve within 3 months, but 30 - 40% percent of children may have recurrent episodes. An important 2006 study indicated that chronic OME (both with and without effusion) may be caused by biofilms, which are slimy collections of antibiotic-resistant bacteria. The inner ear also contains three semi-circular canals that function as the body's gyroscope, regulating balance.
Most episodes will resolve within 3 months, but 30 - 40% of children may have recurrent episodes. Haemophilus influenzae, the next most common culprit, is responsible for 20 - 30% of acute infections.
However, other viruses, such as respiratory syncytial virus (RSV, a virus responsible for childhood respiratory infections) and influenza (flu), can be the actual causes of some ear infections. Otitis media with effusion (OME) may occur spontaneously following an episode of acute otitis media. The primary setting for ear infections is in a child''s Eustachian tube, which runs from the middle ear to the nose and upper throat. If a cold does occur, the virus can cause the membranes along the walls of the inner passages to swell and obstruct the airways. About 15% of AOM-causing bacteria are now believed to be resistant to the first-choice antibiotics.
Genetic susceptibility to certain bacteria may result in development of persistent and recurrent acute otitis media. Abnormalities in genes that affect the defense systems (cilia and mucus production) and the anatomy of the skull and passages would also increase the risk for ear infections. Abnormalities in genes that regulate a powerful immune factor called interleukin 1 have been identified in some patients with recurrent acute otitis media who did not have any allergic disorders. Researchers are hoping that these findings may encourage primary care doctors to closely monitor children who have a family history of unusually frequent or severe upper respiratory tract infections. The rise in ear infections has paralleled the increasing incidences of other upper and lower airway disorders such as asthma, allergies, and sinusitis. In 2006, the American Academy of Otolaryngology -- Head and Neck Surgery Foundation (AAO-HNSF) issued their first guidelines for management of AOE.
As children grow, however, the structures in their ears enlarge and their immune systems become stronger. Certain medical disorders, including Down syndrome, cleft palate, Kartagener syndrome, and immunosuppressive disorders, such as HIV, increase the risk for ear infections. Parents who smoke pose a significant risk for both otitis media with effusion (OME) and recurrent acute otitis media (AOM) in their children.
Pregnant women who drink alcohol put their babies at risk for birth defects that can cause hearing loss and OME, among other problems.
Several studies have found that the use of pacifiers place children at even higher risk for ear infections. If the ear infection is severe, the tympanic membrane may rupture, causing the parent to notice pus draining from the ear. Fevers and colds often make children irritable and fussy, so it is difficult to determine if acute otitis media is present as well. Evidence strongly suggests that severe cases of recurrent acute otitis media and persistent otitis media with effusion (OME) impair hearing. However, results from a 2007 New England Journal of Medicine study strongly indicate that chronic middle ear effusion poses no danger for developmental delays. Before the introduction of antibiotics, mastoiditis (an infection in the bones located in the skull), was a serious, albeit rare, complication of otitis media.
If pain and fever persist in spite of antibiotic treatment of otitis media, the doctor should check for mastoiditis. If an infection of the mastoid air cells cannot be controlled with antibiotics, surgery may be needed. While severe cases of recurrent acute otitis media or persistent otitis media with effusion (OME) are associated with impaired hearing for a period of time, the long-term consequences resulting from this hearing loss may not be significant in most children. Hearing loss in children may temporarily slow down language development and reading skills. Before the introduction of the conjugate pneumococcal vaccine, mastoiditis (an infection in the bones located in the skull), was a serious, albeit rare, complication of otitis media. The doctor first removes any ear wax (called cerumen) in order to get a clear view of the middle ear. The doctor uses a small flashlight-like instrument called an otoscope to view the ear directly.
An otoscope is a tool that shines a beam of light to help visualize and examine the condition of the ear canal and eardrum. Neither tympanometry nor reflectometry are substitutes for the pneumatic otoscope, which allows a direct view of the middle ear. AOM (fluid and infection) is often difficult to differentiate from OME (fluid without infection).
Parents can also use a sonar-like device, such as the EarCheck Monitor, to determine if there is fluid in their child's middle ear. On rare occasions the doctor may need to draw fluid from the ear using a needle for identifying specific bacteria, a procedure called tympanocentesis. Hearing tests performed by an audiologist are usually recommended for children with persistent otitis media with effusion. By around 5 months, infants should be laughing out loud and making one-syllable sounds with both a vowel and consonant. Between 6 - 8 months, babies should be able to make word-like sounds with more than one syllable. Usually starting around 7 months, and by 10 months, babies babble (making many word-like noises).
Around 10 months, babies can identify and use some term for a parent, such as dada, baba, or mama.
If a child's progress is significantly delayed beyond these times, a parent should suspect possible hearing problems. Parents can also use a sonar-like device, such as the EarCheck Monitor, to determine if there is fluid in their child''s middle ear. By around 5 months the child should be laughing out loud and making one-syllable sounds with both a vowel and consonant. Between 6 - 8 months, the infants should be able to make word-like sounds with more than one syllable. Usually starting around 7 months the baby babbles (makes many word-like noises) and should be doing this by 10 months. Around 10 months, the baby is able to identify and use some term for the parent, dada, baba, or mama.
If a child''s progress is significantly delayed beyond these times, a parent should suspect possible hearing problems. Preventing influenza (the "flu'') may prove to be a more important protective measure against ear infections than preventing bacterial infections. In general, experts recommend that the flu vaccine be given to all children over 6 months with a condition that requires regular medical care. Still, the pneumococcal vaccine does not completely protect against otitis media because other types of bacteria can cause the problem.
The recommended schedule of pneumococcal immunization is four doses, given at 2, 4, 6, and 12 - 15 months of age. In one 2005 study, 223 children with non-severe AOM were randomly prescribed either watchful waiting or immediate antibiotic treatment. Another 2005 study surveyed parents and doctors on their use and perceptions of watchful waiting.
In 2004, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) released updated guidelines for the management and diagnosis of acute otitis media. Children 6 months or older should be treated for pain within the first 24 hours with either acetaminophen or ibuprofen. An initial observation period of 48 - 72 hours is recommended for select children to determine if the infection will resolve on its own without antibiotic treatment.
For children aged 6 months - 2 years, criteria for recommending an observation period are an uncertain diagnosis of AOM and a determination that the AOM is not severe.
If antibiotics are needed, amoxicillin is recommended as first-line treatment (except in children who are allergic to penicillins).
The American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) released updated clinical practice guidelines for OME in 2004.
OME that is persistent or recurrent (even if there is no hearing loss) and may put the child at risk for developmental delays or structural damage to the ear. Adenoidectomy plus myringotomy, with or without tube insertion, is recommended as a repeat surgical procedure. Adenoidectomy is not recommended as an initial procedure unless some other condition (chronic sinusitis, nasal obstruction, adenoiditis) is present.
Until recently, nearly every American child with an ear infection who visited a doctor received antibiotics. If there is no improvement or symptoms worsen, parents can schedule an appointment with the child's doctor to determine if antibiotics are needed.
While children with non-severe AOM who are given antibiotics may recover slightly more quickly, they often have a high number of side effects and antibiotic-resistant bacterial strains. Preventive antibiotics (antibiotic prophylaxis) may be recommended for recurrent acute otitis media.
Tympanostomy (the insertion of tubes into the eardrum) is the first choice for surgical intervention.
In one 2000 study, 240 children under age 2 who were diagnosed with acute otitis media were treated with watchful waiting. High fever, severe pain, or other signs of complications should warrant immediate attention by a medical professional. Parents of infants should contact their doctor immediately if they have any fever, regardless other symptoms.
Depending on regional cultures, parents may have pressed a warm water bottle or warm bag of salt against the ear. Studies have reported that Otikon, an extract made of various plants, including garlic and St.
Herbal remedies are not standardized or regulated, and their quality and safety are largely unknown. The parent should be sure to instruct the child not to blow too hard or the eardrum could be harmed. Either acetaminophen (Tylenol) or ibuprofen (Advil) is the pain-reliever of choice in children.
Older children may be able to take prescription pain relievers that contain codeine if the pain is severe. Note: Aspirin and aspirin-containing products are not recommended for children or adolescents. Many non-prescription products are available that combine antihistamines, decongestants, and other ingredients, and some are advertised as cold remedies for children.
Swimming can pose specific risks for children with current ear infections or previous surgery. Children with ruptured acute otitis media (drainage from ear canal) should not go swimming until their infections are completely cured. Some doctors recommend that children with implanted ear tubes should use earplugs or cotton balls coated in petroleum jelly when swimming to prevent infection. Seek immediate medical attention for high fever, severe pain, or other signs of complications. Most children with uncomplicated acute otitis media (AOM) will recover fully without antibiotic therapy. The most common type of ear infections in children are those that occur in the middle ear (behind the eardrum), called otitis media. The ear is made up of three different parts – the outer ear, middle ear and inner ear. Ear infections can be hard to detect in young children because it is hard for them to report symptoms. Your child may tug or pull at their ears, be irritable, cry often or have trouble sleeping if they are suffering from an ear infection.
An ear infection can be diagnosed by using an otoscope, a small lighted tube used to view the eardrum.
There are specific recommendations and guidelines which should be followed to ensure appropriate treatment of your child. While some ear infections may resolve on their own within two or three days, some children may require antibiotics. The temporomandibular joint (TMJ) is the area right in front of the ear on either side of the head where the upper jaw (maxilla) and lower jaw (mandible) meet. The temporomandibular joints are very complex and are made up of muscles, tendons, a disc and bones.You have a temperomandibular joint on each side of your jaw (right and left side). Micro trauma is considered internal, such as grinding the teeth (bruxism) and clenching (jaw tightening).
TMJ pain can usually occur because of unbalanced activity, spasm, or overuse of the jaw muscles. Most patients are quite successful with conventional conservative therapy (such as resting the jaw or night guard).
We are a full service dental practice that specializes in relaxation and cosmetic dentistry services, dental implants, TMJ disorder treatment, periodontal disease treatment, teeth whitening, porcelain crowns and porcelain veneers, and other restorative dental care.
It is not uncommon for infants and toddlers to experience fluid in the middle ear or ear infections at some point during their early years.
The immature structure of a baby or toddler’s ear can make it more difficult for fluid to drain from the middle ear. This fluid does not always become the source of an actual infection, so the fluid can remain in the middle ear without causing the typical symptoms of an infection. Children first learn to speak by hearing, and the first three years of life are crucial to their language development skills. Ear infections in childhood are often more easily recognized and therefore more quickly treated, reducing long-term consequences on hearing and speech development. The first step is to have your child’s hearing tested and ears examined if you suspect fluid in the ear or another cause of hearing loss might be the cause of your child’s speech delays. Once the hearing issues have been diagnosed, work with your pediatrician to see what kinds of speech therapies can be helpful for your child. Nosolone-AQ nasal spray is indicated for the treatment of the nasal symptoms of seasonal and perennial allergic rhinitis in adults and children 12 years of age or older.
Ofloxacin otic is used to treat outer ear infections in adults and children, chronic (long-lasting) middle ear infections in adults and children with a perforated eardrum (a condition where the eardrum has a hole in it), and acute (suddenly occurring) middle ear infections in children with ear tubes. If you or your child is receiving SUPRAX® to treat an ear infection, your doctor probably made a diagnosis of acute otitis media, which is sometimes abbreviated as AOM. If your doctor prescribed SUPRAX®, he or she has made the diagnosis that this is a bacterial (not viral) infection.
Always complete the entire course of treatment unless told otherwise, and never share your medications with others. When incoming sound waves strike this membrane, it vibrates like a drum, and converts the sound waves into mechanical energy. Here, hair-like structures stimulate nerves to change sound waves into electrochemical impulses that are carried to the brain, which senses these impulses as sounds. An inflammation in the middle ear is known as "otitis media." AOM is a middle ear infection caused by bacteria that traveled to middle ear from fluid build-up in the Eustachian tube. This condition occurs when fluid, called an effusion, becomes trapped behind the eardrum in one or both ears, even when there is no infection. The middle ear is a complex structure filled with air that surrounds a chain of three tiny bones. This condition refers to persistent fluid behind the tympanic membrane without any infection present. For pain relief, over-the-counter remedies such as acetaminophen or nonsteroidal anti-inflammatory drugs (such as ibuprofen) usually help, but in severe cases opioid drugs may be prescribed. Viruses play an important role in many ear infections, and can set the scene for a bacterial infection. Nearly a third of infants and toddlers with upper respiratory infections go on to develop acute otitis media. Viruses can increase middle ear inflammation and interfere with antibiotics' efficacy in treating bacterial-causes ear infections.
Any medical or physical condition that reduces the ear's defense system can increase the risk for ear infections.
The Eustachian tube is shorter and smaller in children than adults, and therefore more vulnerable to blockage.
If this inflammation blocks the narrow Eustachian tube, the middle ear may not drain properly.
Allergens can also produce inflammation and blockage in the Eustachian tube, which creates an environment favorable to bacteria. Rhinovirus is a common virus which causes a cold, and plays a leading role in the development of ear infections. Several studies suggest that multiple genetic factors may make a child more susceptible to acute otitis media. Interleukin-1 plays a major role in producing inflammation in tissues and cells during heightened immune activity. Any medical or physical condition that reduces the ear''s defense system can increase the risk for ear infections.


Susceptibility to OME may also be due to an abnormal or malfunctioning Eustachian tube that causes a negative pressure in the middle ear, which allows fluid to leak in through capillaries. For example, the same bacteria are often responsible for both ear infections and sinusitis.
Although ear infections themselves are not contagious, the respiratory infections that precipitate them can pose a risk for children with close and frequent exposure to other children. Some experts believe that an increase in allergies is also partially responsible for the higher number of ear infections, which is unlikely to be related to day care attendance. About two-thirds of children will have a least one attack of AOM by age 3, and a third of these children will have at least 3 episodes.
The earlier a child has a first ear infection, the more susceptible they are to recurrent episodes (for instance, 3 or more episodes within a 6-month period). OME is very common in children aged 6 months to 4 years, with about 90% of children having OME at some point. Some doctors believe that an increase in allergies is also partially responsible for the higher number of ear infections. Although ear infections themselves are not contagious, the respiratory infections that often precede them can pose a risk for children with close and frequent exposure to other children. Several studies have found that the use of pacifiers place children at higher risk for ear infections. Risk FactorsAcute ear infections account for 15 - 30 million visits to the doctor each year in the U.S. The earlier a child has a first ear infection, the more susceptible he or she is to recurrent episodes (for instance, 3 or more episodes within a 6-month period).
OME is very common in children aged 6 months to 4 years with approximately 90% of children having OME at some point. The American Academy of Pediatrics recommends breastfeeding for at least the baby''s first 6 months.
Sucking increases production of saliva, which helps bacteria travel up the Eustachian tubes to the middle ear.
However, it is difficult to determine if an infant or child who hasn't yet learned to speak has an ear infection. Some hearing loss may occur, but it is often fluctuating and hard to detect, even by observant parents. In such cases, some parents or teachers may attribute their behavior to lack of attention or even to an attention deficit disorder.
However, it is difficult to determine if an infant or child who hasn''t yet learned to speak has an ear infection. Children with impaired hearing may appear to be distracted, inattentive, and unintelligent. Researchers evaluated children who had either prompt insertion of ear tubes to drain fluid when they were younger than age 3, or delayed insertion of tubes many months later. Certain children with severe or recurrent otitis media may be at risk for structural damage in the ear.
Cysts in the ear called cholesteatomas are an uncommon complication of recurrent or severe ear infections. In rare cases, even after a mild infection, some children develop calcification and hardening in the middle and, occasionally, in the inner ear. This condition is difficult to treat and requires intravenous antibiotics and drainage procedures. Some studies have indicated that children with chronic OME have problems with motor development and balance. However, uncomplicated chronic middle ear effusion generally poses no danger for developmental delays in otherwise healthy children. Certain children with severe or recurrent otitis media may be at risk for structural damage in the ear, including erosion of the ear canal. Inflammatory tissues in the ear called cholesteatomas are an uncommon complication of chronic or severe ear infections.
The condition is difficult to treat and requires intravenous antibiotics and drainage procedures.
Very rarely, a child with acute otitis media may develop facial paralysis, which is temporary and usually relieved by antibiotics or possibly drainage surgery.
An ear examination should be part of any routine physical examination in children, particularly because the problem is so common and may not cause symptoms. Examining the ear can reveal the cause of symptoms such as an earache, the ear feeling full, or hearing loss. In this case, a small probe is held to the entrance of the ear canal and forms an airtight seal. Symptoms may include fever, pulling on the ear, pain, irritability, or discharge (otorrhea) from the ear. It is important for a doctor to make this distinction as OME does not require antibiotic treatment.
EarCheck uses acoustic reflectometry technology, which bounces sound waves off the eardrum to assess mobility.
Unfortunately, it is very difficult to test children under 2 years old for hearing problems.
DiagnosisThe doctor should be sure to ask the parent if the child has had a recent cold, flu, or other respiratory infection. It can be used to detect fluid and obstruction, but does not require an airtight seal at the canal.
EarCheck employs acoustic reflectometry technology which bounces sound waves off the eardrum to assess mobility. Colds and flus are spread primarily when an infected person coughs or sneezes near someone else.
For example, studies report that children who are vaccinated against influenza experience 33 - 36% fewer ear infections during flu season than unvaccinated children. Children who are susceptible to recurrent ear infections should probably be given vaccinations against influenza viruses.
Newer vaccines contain very little egg protein, but an allergic reaction still may occur in people with strong allergies to eggs.
Up to two-thirds of people who receive the influenza vaccine develop redness or soreness at the injection site for 1 - 2 days afterward. Antibiotics have been used to prevent bacterial infections in children with recurrent ear infections (4 or more episodes a year). Daily diets should include foods such as fresh, dark-colored fruits and vegetables, which are rich in antioxidants and other important food chemicals that help boost the immune system.
Researchers are studying the possible protective value of certain strains of lactobacilli, bacteria found in the intestines. Xylitol, a sugar alcohol produced naturally in birch, strawberries, and raspberries, has properties that fight Streptococcal pneumonia bacteria. Several studies have found that children who live with smokers have a significant risk for ear infections. According to the American Academy of Pediatrics, exclusively breastfeeding for a baby’s first 6 months helps to prevent ear and other respiratory infections. Centers for Disease Control (CDC) recommend annual influenza vaccination for all children 6 months to 5 years of age. Antibiotics may occasionally be recommended to prevent bacterial infections in children with recurrent ear infections (4 or more episodes a year).
According to the American Academy of Pediatrics, exclusively breast-feeding for a baby’s first 6 months helps to prevent ear and other respiratory infections. The major debates rest on the use of antibiotics, surgery, and watchful waiting in both acute otitis media (AOM) and otitis media with effusion (OME).
The antibiotic group recovered more quickly, but had a high number of side effects and antibiotic-resistant bacterial strains.
Results indicated that although medical guidelines recommend watchful waiting, few doctors regularly practice it.
For children older than 2 years, the observation period criteria are non-severe symptoms or uncertain diagnosis.
Antibiotics and corticosteroids do not help and are not recommended for routine management of OME.
Approximately 20 - 50% of children who undergo this procedure may have OME relapse and require additional surgery. TreatmentMany of the treatments for ear infections, particularly antibiotic use and surgical procedures, are often unnecessary in many children.
Major studies now indicate that antibiotics are unnecessary in most cases of acute otitis media. The intense and widespread use of antibiotics has led to a serious global problem of bacterial resistance to common antibiotics. Studies have found that giving parents the option of delaying antibiotic treatment helps to reduce the unnecessary use of antibiotics without causing any health problems for the children.
Which children should be treated this way, as well as which antibiotics and for how long, have not been clearly determined. It is important for parents to recognize that persistent fluid behind the eardrum after treatment for acute otitis media does not indicate failed treatment. Adenoidectomy (removal of adenoids) plus myringotomy (removal of fluid), with or without tube insertion, is sometimes recommended as a repeat surgical procedure. Home RemediesCareful monitoring of the child''s condition (watchful waiting) along with home remedies and common over the counter cold medicines may be a viable alternative to antibiotic treatment for many children with a first episode of acute otitis media.
After 4 days, only 3% of the children required treatment with antibiotics, while the infection cleared in the other 97%. Now, with current concern over antibiotic overuse, many of these remedies are again popular.
John''s wort, is an effective anesthetic in treating the pain associated with ear infections. There is no evidence to indicate that these candles are safe or effective for treatment of AOM or other ear conditions.
Parents should never give their child herbal remedies, including oral remedies, without approval from a doctor. A simple technique called the Valsalva''s maneuver is useful in opening the Eustachian tubes and providing occasional relief from the chronic stuffy feeling accompanying otitis media with effusion. In one study, Auralgan provides effective short-acting pain relief and helps children endure ear discomfort until an oral pain reliever takes effect.
Reports of Reye syndrome, a very serious condition, have been associated with aspirin use in children who have chicken pox or flu. Researchers have found little or no benefits for acute otitis media or for otitis media with effusion using decongestants (either oral or nasal sprays or drops), antihistamines, or combination product.
Water pollutants or chemicals may exacerbate the infection, and underwater swimming causes pressure changes that can cause pain.
Home RemediesCareful monitoring of the child's condition (watchful waiting) along with home remedies may be a viable alternative to antibiotic treatment for many children with a first episode of acute otitis media. A simple technique called the Valsalva's maneuver is useful in opening the Eustachian tubes and providing occasional relief from the chronic stuffy feeling accompanying otitis media with effusion.
Auralgan provides short-acting pain relief and may help children endure ear discomfort until an oral pain reliever takes effect.
Reye syndrome, a very serious condition, is associated with aspirin use in children who have chickenpox or flu. When antibiotics are needed, a number of different classes are available for treating acute ear infections. Middle ear infections usually occur when the Eustachian tube, through which middle ear contents can drain, becomes inflamed, preventing drainage.
This is painless but often children find the experience of having their ears examined frightening. These children may require ear tubes (pressure equalization tubes – PET) to help the middle ear to heal and prevent future infections. Muscles attached to and surrounding the jaw joint control the position and movement of the jaw. Patients may complain that it is difficult to find a  comfortable bite or that the way their teeth fit together has changed.  Chewing on only one side of the jaw can lead to or be a result of TMJ  problems.
This continuous pounding on the temporomandibular joint can change the alignment of the teeth. This trauma can fracture the jawbone, cause dislocation of the TMJ, or cause damage to the cartilage disc of the joint. It is very common for people under stress to release this nervous energy by either consciously or unconsciously grinding  and clenching their teeth. About 80% of patients with a TMJ disorder complain of headache and about 40% report facial pain, and ear pain.
About one half of patients with a TMJ disorder notice ear pain and do not have any signs of ear infection.
Grinding, crunching, clicking, or popping sounds (medical term = crepitus) are common for patients with a TMJ disorder. If your symptoms persist, your doctor may recommend medications or a night guard to help keep you from grinding your teeth at night.
Dentist or doctor will recommend over the counter medications (like Aleve or Motrin), or prescription medications such as Dolobid are a first option to relieve pain. Antidepressants prescribed to be taken at bedtime have been successful in relieving TMJ pain in some patients. These types of drugs are sometimes used for a few days or weeks to help relieve pain caused by TMJ disorders. Injecting botulinum toxin (example Botox) into the jaw muscles may give relief to pain associated with TMJ disorders.
For patients who grind their teeth patients may gain from wearing a  firm custom made appliance. For patients whose main symptom is from stress or anxiety they may benefit from a visit to a psychotherapist.
The success of treatment depends on how severe the symptoms are and how well you comply with treatment. Marielaina Perrone's advanced training and years of experience translate into greater confidence and convenience for your entire family. However, long-term ear infections or fluid in the middle ear that may go untreated can cause speech delays that may require some form of speech therapy. Sometimes this fluid becomes infected, by either a virus or bacteria, and causes the tell-tale signs of a childhood ear infection: crying, pulling at the ears, general fussiness, fever, and difficulty sleeping. The signs of fluid in the middle ear can be as subtle as a slight loss of balance and changes in eating habits to hearing and speech related symptoms. During these years they are hearing sounds modeled for them, and while they might not be speaking in complete sentences, they are learning how to form the sounds needed for fluent speech.
You wouldn’t be the first parent, however, to not recognize the signs of uninfected fluid in the middle ear. Some children with poorly formed or matured ear structures benefit from having tiny tubes placed in their ears to drain the fluid. Some children who miss that critical window of speech development because they had temporary hearing loss benefit tremendously from working with an SLP to get caught up with developmental milestones. It is used to treat middle ear infections in children with ear tubes, as well as outer ear infections (also known as swimmer’s ear) in children and adults.
The ear infection is usually caused by bacteria or viruses that enter through the nose or the mouth and travel up the eustachian tube to reach the middle ear. IF THIS PRODUCT IS TO BE GIVEN TO PENICILLIN-SENSITIVE PATIENTS, CAUTION SHOULD BE EXERCISED BECAUSE CROSS HYPERSENSITIVITY AMONG β-LACTAM ANTIBIOTICS HAS BEEN CLEARLY DOCUMENTED AND MAY OCCUR IN UP TO 10% OF PATIENTS WITH A HISTORY OF PENICILLIN ALLERGY.
These bones vibrate to the rhythm of the eardrum and pass the sound waves on to the inner ear. The researchers suggest that ear tube insertion is the best treatment for children with chronic OME. It is called suppurative chronic otitis when there is persistent inflammation in the middle ear or mastoids, or chronic rupture of the eardrum with drainage. Rhinovirus is a common virus that causes a cold and plays a leading role in the development of ear infections. Children with shorter than normal and relatively horizontal Eustachian tubes are at particular risk for initial and recurrent infections.
CausesAcute otitis media (middle ear infection) is usually due to a combination of factors that increase susceptibility to infections by specific organisms in the middle ear. Abnormalities in interleukin production may possibly result in a persistent inflammatory response.
Problems in the Eustachian tube can be due to viral infections, second-hand smoke, injury, birth defects (such as cleft palate), or genetic diseases that affect the defense systems, such as Kartagener''s syndrome.
In one study, 38% of children with ear infections also had sinusitis, and other studies have reported that nearly half of children with OME have concurrent sinusitis.
Some experts believe that the increase in ear and other infections may be due to the higher attendance of very small children, including infants, in day care centers beginning in the 1970s.
Studies indicate that 40 - 50% of children over 3 years old who have chronic otitis media also have allergic rhinitis (hay fever). For pain relief, over-the-counter remedies such as acetaminophen or nonsteroidal anti-inflammatory drugs (such as ibuprofen) usually suffice, but in severe cases opioid drugs may be prescribed. Some research suggests that the increase in ear and other infections may be due to the increasing attendance of very small children, including infants, in day care centers. The American Academy of Pediatrics recommends breastfeeding for at least the baby's first 6 months. Eardrum abnormalities increased the more the child weighed, which might explain the association. The only sign to a parent that the condition exists may be when a child complains of "plugged up" hearing.
Children with even mild hearing loss may miss spoken words and have trouble making sense out of a conversation or a lesson in school. Some have even been inaccurately diagnosed as having attention deficit hyperactivity disorder. When the children were tested at ages 9 – 11, the researchers found no differences in speech and language, auditory processing, attention, behavior, social skills, and academic achievement.
PrognosisDoctors should carefully evaluate ear infections in infants fewer than 3 months old, and consider more serious infections, such as meningitis.


As the majority of chronic ear effusion cases eventually clear up on their own, many doctors recommend against placement of tympanostomy tubes for most children. Facial paralysis may also occur for patients with chronic otitis media and a cholesteatoma (tissue in the middle ear). Infection in the outer ear, however, can be confirmed by tugging the outer ear, which will produce pain.
A doctor should always check for this first when a small child indicates pain or problems in the ear.
While the air pressure is varied, a sound with a fixed tone is directed at the eardrum and its energy is measured.
In patients with OME, an air bubble may be visible and the eardrum is often cloudy and very immobile.
When fluid is present behind the middle ear (a symptom of AOM and OME), the eardrum will not be as mobile. This is most often performed by an ear, nose, and throat (ENT) specialist, and usually only in severe or recurrent cases.
If the child complains of pain or has other symptoms of otitis media, such as redness and inflammation, the doctor should rule out any other causes. Infection in the outer ear, however, can be confirmed by wiggling the ears, which will produce pain.
More than one study has reported that people with low stress who also have an active social life have fewer colds than people who have high stress levels or those who have low stress and few social connections.
The latest childhood immunization guidelines (released in 2007) recommend that all children ages 6 months – 5 years receive an annual flu vaccine. In fact, in 2003 the American Academy of Pediatrics (AAP) and the CDC encourages vaccination in all children, including healthy children, between 6 months and 2 years of age. One such drug, oseltamivir (Tamiflu), is approved for use in children age 1 year and older.
Studies suggest, however, that overall they only prevent 1 episode a year, and are not generally recommended for prevention, except for specific situations.
Studies have reported that children who chew gum or swallow a syrup containing xylitol experience fewer ear infections. Also, infants are held during breastfeeding in a position that allows the Eustachian tubes to function well.
Preventing influenza (the "flu') may be a more important protective measure against ear infections than preventing bacterial infections.
Also, infants are held during breast-feeding in a position that allows the Eustachian tubes to function well.
Most cases of acute otitis media do not require antibiotics, and the overuse of antibiotic prescriptions has increased the problem of antibiotic-resistant bacteria. Parents were equally satisfied with either treatment approach, and two-thirds of children in the watchful waiting group recovered without needing antibiotics.
Parents who had a higher educational level, more knowledge about antibiotics, and greater involvement in medical decisions were more likely to be satisfied with a watchful waiting recommendation.
Severe AOM symptoms include moderate to severe pain and a fever of at least 102.2A° Fahrenheit (39A° Celsius).
Between 80 - 90% of all children with uncomplicated ear infections recover within a week without antibiotics. Current guidelines released by the American Academy of Pediatrics and the American Academy of Family Physicians recommend an initial observation period of 48 - 72 hours for select children.
Unfortunately, surveys indicate that although medical guidelines recommend watchful waiting, few doctors regularly practice it. Antibiotics, decongestants, antihistamines and corticosteroids do not help and are not recommended for routine management of OME. Ear tube insertion may be recommended when fluid builds up behind your child's eardrum and does not go away after 4 months or longer. The American College of Chest Physicians recommends against the use of nonprescription cough and cold medicines in children age 14 years and younger.
Everything that can be done to distract the child from the exam will be done and usually this part of the exam only takes a few seconds. A single ear infection, however, may be observed or be treated with antibiotics depending on the case. When the muscles are relaxed and in balance and both jaw joints open and close comfortably, we are able to talk, chew, or yawn without discomfort or pain.
A problem with either one can lead to stiffness, headaches, ear pain, bite problems ( also called a malocclusion), clicking sounds, or locked jaws.
Teeth grinding as a habit can result in muscle spasm and inflammatory reactions, thus causing the initial pain. Pain in the TMJ can also occur following dental treatment whereby the joint is stretched open for extended periods of time. 50% of those patients will have resolution of their tinnitus after successful treatment of their TMJ disorder. Your dentist will conduct a careful patient history, dental examination, and take necessary x-rays to determine the cause of your symptoms. This night guard prevents your teeth from coming together in contact, and repositions teeth to decompress the jaw joint.
This would allow the patient to become self aware of stress triggers as well learning relaxation techniques to relieve stress. As always, it is best to maintain regular appointments to see your dentist and let them know if there any TMJ issues developing.
You’ll find complete dental expertise, utilizing the latest advancements in dentistry, all here under one roof.
Whether or not your child requires antibiotics to treat the ear infection depends on the source of the infection and your pediatrician’s recommendations. Because fluid in the middle ear that is not infected often causes no pain in children, the condition can go left undiagnosed and untreated for a long period of time, increasing the likelihood of more severe symptoms down the road.
Ear infections and excess fluid in the ears can result in hearing loss, even if it is temporary.
Many parents also find it helpful to work with an ENT – a doctor who specializes in the Ear, Nose, and Throat.
You can also help your child at home by speaking clearly, using precise language (perhaps single words for specific items), reducing background noise, and remembering that your child might be older now but needs some patience to recover that lost time in speech development. The incidence of gastrointestinal adverse reactions, including diarrhea and loose stools, in pediatric patients receiving suspension was comparable to the incidence seen in adult patients receiving tablets.
However, other studies indicate that watchful waiting is the best approach, as many cases of chronic OME eventually clear up on their own. CausesAcute otitis media (middle ear infection) is usually due to a combination of factors that increase susceptibility to bacterial and viral infections in the middle ear. An additional defense system in the airways, such as mucus, prevents the harmful bacteria from spreading and infecting deeper passages, such as those in the ear. The defense systems described above become inefficient, and the fluid becomes a breeding ground for bacteria and subsequent infection.
But other viruses, such as respiratory syncytial virus (RSV, a virus responsible for childhood respiratory infections) and influenza (flu), may be the actual causes of some ear infections. Inborn structural abnormalities, such as cleft palate, or genetic conditions, such as Kartagener''s syndrome in which the cilia (hair-like structures) in the ear are immobile and cause fluid build up, also increase the risk. Data indicate that nearly a third of infants and toddlers with upper respiratory infections go on to develop acute otitis media.
Research presented at a 2006 pediatric medicine meeting suggested that it may be wise to keep very young children (under 1 year old) out of day care to avoid exposure to the upper respiratory infections that can lead to ear infections.
The researchers also suggested that parents may be confusing their children''s fussiness due to the ear infection with hunger and, therefore, overfeeding them. Some parents believe that tugging on the ear indicates an infection, but this gesture is more likely to indicate pain from teething. Other symptoms can include loud talking, not responding to verbal commands, and turning up the television or radio.
PrognosisEar infections in infants less than 3 months old may indicate more serious infections, such as meningitis. As the majority of chronic ear effusion cases eventually clear up on their own, many experts now recommend against surgical intervention for most children. Pressing the bulb and observing the action of the air against the eardrum allows the doctor to gauge the eardrum's movement.
This device can detect fluid in the middle air and also obstruction in the Eustachian tube. A scarred, thick, or opaque eardrum may make it difficult for the doctor to distinguish between acute otitis media and OME. In most cases, tympanocentesis is not necessary in order to obtain an accurate enough diagnosis for effective treatment.
Pressing the bulb and observing the action of the air against the eardrum allows the doctor to gauge the eardrum''s movement. Antibodies to the influenza virus generally develop within 2 weeks of vaccination, and immunity peaks within 4 - 6 weeks, then gradually wanes. These symptoms are not influenza itself but an immune response to the virus proteins in the vaccine. Studies report significant reduction in symptoms and in the incidence of ear infections with this drug. It is included in the Recommended Childhood Immunization Schedule and is also specifically approved for preventing otitis media. In one study, milk containing the strain lactobacilli GG reduced respiratory infections in children who attended day care by 10 - 20%.
In addition, a 2006 study suggested that breastfeeding can help protect even those children who are genetically susceptible to ear infections. For example, studies report that children who are vaccinated against influenza experience a third fewer ear infections during flu season than unvaccinated children.
It is included in the Recommended Childhood Immunization Schedule and is specifically approved for preventing otitis media. Therefore, watchful waiting has become the preferred strategy for managing acute otitis media.
In a 2006 study of children with otitis media who were treated in emergency rooms, researchers found that giving parents the option of delaying antibiotic treatment helped to reduce the unnecessary use of antibiotics without causing any health problems for the children.
For one, the condition resolves without treatment in nearly all children, especially those whose OME followed an acute ear infection. In fact, a 2006 study suggested that antihistamines and decongestants may cause more harm than good by provoking side effects such as stomach upset and drowsiness.
Likewise, receiving antibiotics for an acute ear infection does not seem to prevent children from having fluid behind the ears after the infection is cleared up. Pain relief can initially be given with acetaminophen (Tylenol), ibuprofen (Advil), or topical benzocaine drops.
Between 20 - 50% of children who undergo this procedure may have OME relapse and need additional surgery).
Other antibiotics are available for children who are allergic to penicillin or who do not respond within 2 - 3 days. Your doctor can provide you with more information about PET placement and help determine if your child is a candidate. The temporomandibular joint functions to move the jaw, especially in biting and chewing, talking, and yawning. We can also feel the joint motion if we put a little finger against the inside front part of the ear canal. Changes in the normal stimuli or height of the teeth, misalignment of the teeth, and changes in the chewing muscles may cause temporomandibular joint changes.
Teeth grinding and clenching are habits that may be diagnosed in people who complain of pain in the temporomandibular joint or have facial pain that includes the muscles involved in chewing. Massage and heat application following your dental appointment can help relive the discomfort.
These symptoms are usually caused by Eustachian-tube dysfunction (structure responsible for the regulation of pressure in the middle ear).
Conventional treatment consists of a diet of soft foods along with warm compresses to settle down the tension of the muscles. Some at home treatments include OTC pain relief and warm compresses to alleviate the initial and immediate pain. Imagine you are walking around underwater and the sounds are all distorted – this is what the world might sound like to a child with fluid in her ears, and this problem can be amplified if there is pain associated with it. SUPRAX® is contraindicated in patients with known allergy to the cephalosporin group of antibiotics.
Otitis externa can also be precipitated by overly aggressively scratching or cleaning ears or when an object gets stuck in the ears.
The primary setting for middle ear infections is in a child's Eustachian tube, which runs from the middle ear to the nose and upper throat. Genetic conditions, such as Kartagener's syndrome in which the cilia (hair-like structures) in the ear are immobile and cause fluid build up, also increase the risk.
AOE can also be precipitated by overly aggressively scratching or cleaning ears or when an object gets stuck in the ears.
However, a causal relationship between allergies and ear infections has not been definitively established. But a reassuring 2002 study reported that only 4% of infants with an ear infection had a bacterial infection. Results indicate the likelihood of the presence of fluid and may help patients decide whether they need to contact their child's doctor. Results indicate the likelihood of the presence of fluid and may help patients decide whether they need to contact their child''s doctor.
In another study, when the antiviral drug, zanamivir (Relenza), was administered in the nasal passages of adults with influenza, middle ear abnormalities were reduced by more than half, to 32%. An important 2003 study indicated that these vaccinations could result in 1.7 million fewer office visits, 24% fewer procedures for tube implants, and significantly fewer antibiotic prescriptions. Another antiviral drug, zanamivir (Relenza), is available for children older than age 7 years . At present, there is no compelling evidence to indicate that allergy treatment can assist with OME management nor has a causal relationship between allergies and OME been established. Antihistamines and decongestants may cause more harm than good by provoking side effects such as stomach upset and drowsiness. But most children do not have long-term damage to their hearing or their ability to speak even when the fluid remains for many months.
If a patient is experiencing TMJ difficulty the simple act of opening and closing your mouth can cause considerable pain. Opening your mouth allows the rounded ends of the lower jaw (condyles) to glide along the joint socket of the temporal bone. These can include arthritis, trauma to the jaw, or muscle fatigue from clenching or grinding your teeth. Ear specialists are routinely called on to make the definitive diagnosis of a TMJ disorder.
It is believed that patients with TMJ syndromes have hyperactivity (muscle spasms) of the muscles responsible for regulating the opening and closing of the Eustachian tube. When problems exist and hearing loss for any reason occurs, there is an increased risk that a child will have a speech delay. The Eustachian tube is shorter and narrower in children than adults, and therefore more vulnerable to blockage. Children with Down syndrome or Fetal Alcohol Syndrome may also be at increased risk due to anatomical abnormalities. Viruses can increase middle ear inflammation and interfere with antibiotics’ efficacy in treating bacterial-causes ear infections. However, it is not recommended that children be treated with antibiotics based on the findings using this device.
Waterless hand cleaners that contain an alcohol-based gel are also effective for every day use and may even kill cold viruses. FluMist is made from a live but weakened influenza virus; flu shots use inactivated (not live) viruses. This drug is available for children older than 7 years for treatment of influenza, but no research has determined it value for preventing or treating otitis media in children.
They hope that this investigational vaccine may eventually help prevent middle ear infection caused by these organisms.
Waterless hand cleaners that contain an alcohol-based gel are also effective for everyday use and may even kill cold viruses. In general, regions and institutions with the highest rate of resistance are those in which antibiotics are the most heavily prescribed. TMJ disorders most commonly occur in women between the ages of 30 and 50, but can occur in teens after braces, and in both men and women at any age. Recent research suggests that for children ages 5 years and younger, vaccination with the live virus FluMist may provide better protection against influenza than inactivated virus flu shots. Children younger than 2 years old, and children younger than age 5 who have asthma or recurrent wheezing, should not receive FluMist. Even if OME lasts for longer than 3 months, the condition may resolve on its own and intervention may not be necessary. Even if OME lasts for longer than 3 months, the condition generally resolves on its own without any long term effects on language or development and intervention may not be necessary.
In such cases, alcohol-based rinses are needed.) Antibacterial soaps add little protection, particularly against viruses. The doctor will re-evaluate the child at periodic intervals to determine if there is risk for hearing loss. In fact, one study suggests that common liquid dish washing soaps are up to 100 times more effective than antibacterial soaps in killing respiratory syncytial virus (RSV), which is known to cause pneumonia and has been associated with ear infections. Wiping surfaces with a solution that contains 1 part bleach to 10 parts water is very effective in killing viruses.



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