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Acute otitis media (AOM) is characterized by infection and inflammation of the middle ear space (the space behind the eardrum). Chronic otitis media with effusion (COME) is characterized by fluid in the middle ear space in the absence of signs and symptoms of acute inflammation, lasting for at least 3 months.
Acute otitis media (AOM) is generally characterized by the rapid onset of signs and symptoms of infection of the middle ear (fever, ear pain, pulling at ears, irritability) frequently in the setting of a cold. For AOM, looking at the ear drum (otoscopy) usually reveals an opaque or red ear drum that does not freely move with insufflation (blowing air into the ear canal).
A vaccine was introduced in the United States in 2000 against one of the most common bacteria to cause AOM, Streptococcus pneumoniae.
One of the tests that may be recommended for a child with COME is an audiogram or hearing test. Antihistamines and steroids have not been shown to be effective in treatment of acute or chronic otitis media and can have significant side-effects in children. There is some data to suggest that complimentary and alternative medicine (CAM) may be successful in some cases of acute otitis media such as osteopathic manipulation but more studies are needed to better assess the outcomes. Although the insertion of ear tubes is an extremely common and safe procedure with minimal complications, as with any surgery, complications may occur. Overall trends for treatment of both AOM and COME have been to try to avoid antibiotics in otherwise healthy children age 2 years and older, without other risks factors for eustachian tube dysfunction, who have only mild symptoms due to the high spontaneous resolution rates. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Ongoing Exposure to Noise on the JobLong-term exposure to continuous loud noise can cause lasting hearing loss. Michael Rothschild, MD, director, pediatric otolaryngology, Mount Sinai Medical Center, New York. National Institute on Deafness and Other Communication Disorders, National Institutes of Health. It is a commonly accepted fact that we are living in an increasingly noisy world and damage to hearing due to over exposure to noise is becoming more and more commonplace. Cleaning of the ear canal is therefore unnecessary—those who diligently clean their ears, or those of their children, with cotton buds, for example, hinder the migration of skin, predisposing to wax accumulation and otitis externa. Some people have nonmigratory skin of the external auditory meatus and are susceptible to episodes of otitis externa. In the past, skin grafts initially used for myringoplasty often failed or led to otitis externa, because skin taken from elsewhere on the body did not take on this migratory role.
Although wax normally does not accumulate because of meatal skin migration, it may impact and cause a hearing loss, which may necessitate syringing, or suction clearance. Syringing is not painful, therefore pain means either an error in technique or that there is an otitis externa or a perforation. Previous attempts to remove a piece of plastic wedge in the child's meatus have led to bleeding in the meatus. One must not persevere in attempts to remove an aural foreign body, particularly in a child, as a perforation is easily caused. The effusion may be thin (serous) or thick (mucoid), but usually not frankly purulent (containing bacteria). Some children are particularly susceptible to ear infections because of genetic, environmental or lifestyle factors, such as attending day care, secondhand tobacco smoke, or taking a bottle to bed. Rates of meningitis (infection of the lining of the brain), a serious complication of infection by this bacteria, and which was the most common cause of acquired deafness, have dramatically reduced since widespread use of the vaccine. This test is conducted by an audiologist or hearing specialist in a sound booth with headphones. Newer data suggests that children older than 2 years of age with mild symptoms may be initially observed without treatment and that a high percentage of these patients will have spontaneous resolution. If a child has been prescribed multiple courses of antibiotics for ear infections or there are concerns of possible hearing loss and language delay due to fluid build-up behind the ear drum, a child’s pediatrician may recommend evaluation by an otolaryngologist. Ear tubes are surgically inserted into the ear drum and can reduce a child’s risk for future ear infections and their associated problems. Occasionally, the tube will cause a small amount of scar tissue on the ear drum but this generally does not have any permanent effect on a child’s hearing.
Recent studies with long-term follow-up have not identified any significant permanent impact on speech or language development of children whether they were treated with early or delayed (greater than 9 months after initial diagnosis) placement of ear tubes. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions.
It is intended for general informational purposes only and does not address individual circumstances. This is where the hearing has become damaged as a result of hair cell damage in the nerve (known as the Cochlea) often caused by general wear and tear.
This happens when a problem occurs with either the ear drum, such as a perforation, or difficulty with the area between the ear drum and the nerve (known as the middle ear) such as pressure build up, Glue Ear or similar.
The meatus tends to become occluded with desquamated skin wax and debris, and periodic cleaning of the ear is necessary.

2.35c-f A dot of ink, if placed near the center of the drum (c), is found to lie near the margin of the drum after three weeks (d), and between 6-12 weeks the dot migrates outwards on the meatal skin (e, f) to emerge in wax at the orifice of the meatus. If there is a perforation, the ear should not be syringed; pain with vertigo may occur with subsequent otitis media and otorrhea, and a past history of discharge suggests a perforation. If immediate removal with a hook or syringe is not effective, the patient must be admitted for removal under general anesthetic with the help of the microscope. The effusion may be related to an earlier episode of AOM or may have developed spontaneously. Less common conditions that may predispose children to eustachian tube dysfunction and subsequent recurrent AOM or COME include Down syndrome, cleft palate, or gastroesophageal reflux disease (GERD). Although it is very uncommon for an ear infection to result in permanent hearing loss, recurrent AOM or COME may affect speech, hearing, balance, sleep and behavior.
The audiologist will be able to determine the level in decibels at which speech can be heard for each ear. First line treatment for acute otitis media in patients younger than 2 years of age or those with significant symptoms (ear pain, fever ≥39?) includes antibiotics.
This means a low dose of antibiotics is given every day during peak upper respiratory infection (URI)-season to try to prevent bacterial infection.
Ear tubes are small tubes made out of plastic, metal or Teflon that are placed through the eardrum to allow air into the middle ear. In some instances, such as when more than one tube insertion is necessary, the ear, nose, and throat doctor will recommend removal of a child's adenoid tissue, located in the upper airway behind the nose, at the same time that the ear tubes are placed. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.
It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health.
Typically, this type of hearing loss is apparent with 1 in 4 adults as we get older and will tend to effect high frequency sounds such as beginning and endings of words, female and children’s speech and certain types of music. With this type of loss, the nerve is working correctly but there is a problem with the sound getting to it. This type of hearing loss is certainly more rare and can sometimes require further investigation. The rather large syringe of old-fashioned appearance has changed little in the past 100 years, and remains a simple and effective treatment for wax impaction. Coughing (from the vagal reflex—the auricular branch of the vagus supplies the drum) or syncope may complicate syringing. It is often dangerous to use forceps to remove an aural foreign body, since the object easily slips from the jaws of the forceps to go deeper into the meatus. The insect was adherent to the tympanic membrane, giving a sensation of discomfort and a deceptive drum appearance on examination; this insect was removed with syringing. Children with environmental or food allergies are more susceptible and there does appear to be a protective effect from exclusive breast-feeding for the first 6 months of life.
Pain often goes away if this happens because there is no longer the build up of pressure behind the ear drum. This treatment is not felt to be effective for COME where fluid is already present in the middle ear space. The middle ear is the part of the ear located between the eardrum and hard bone surrounding the inner ear.
During the procedure, a small incision is made in the eardrum under a surgical microscope with a small knife. Adenoid tissue is part of the immune system but may also be a reservoir of bacteria that spreads to the middle ear through the eustachian tube (the tube that connects the ears to the nose). Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. It is important to remember, whatever the results of your hearing test show, we are usually able to help people regain the hearing they have not been enjoying, often for many years.
In this condition, desquamated epithelium accumulates and may form a large impacted mass in the meatus, causing erosion of the bony canal. The pinna is pulled outwards and backwards to straighten the meatus, and water at body temperature is irrigated along the posterior wall of the ear. A perforation, particularly in the presence of a thin drum may be caused by over-penetration of the syringe nozzle. If symptoms persist after several days of antibiotics, sometimes another antibiotic is needed.
The tubes are temporary and can last from 6 months to several years, depending on what type of tube is used. After the hole is made, the fluid behind the eardrum is removed and the ear tube is then placed in the hole. Adenoids are not necessary, and patients aren’t any more susceptible to infections if adenoids are surgically removed. During the procedure, any fluid behind the child’s ear drum is immediately drained, but the tubes also allow for continual drainage of fluid that is produced.

Antibiotic eardrops may be administered after the ear tube is placed and may be necessary for a few days. Research has shown that removing adenoid tissue at the same time as inserting a second set of ear tubes can reduce the risk of recurrent ear infections and the need for repeat surgery. To learn everything you need to know about hearing aids, read the eBook, Hearing Aids Inside Out.
If the audiogram demonstrates a significant hearing loss due to fluid in the middle ear, and this is felt to be affecting a child’s speech and language development, further evaluation by an otolaryngologist (ear, nose, and throat specialist) may be recommended. This prevents future build-up of fluid behind the ear drum while the tube is in place, thereby reducing the chance of developing persistent ear infections or having hearing loss and language delay from chronic fluid build-up behind the ear drum. After surgery, the child will be taken to the recovery room where he or she will be closely monitored. Injury or Pressure ChangesSevere head trauma can dislocate middle-ear bones or cause nerve damage, causing permanent hearing loss.
Another advantage of ear tubes is that if a child does develop an ear infection with ear tubes, often antibiotic ear drops can be used as first-line treatment without having to resort to antibiotics by mouth. Sudden changes in pressure -- from flying or scuba diving -- can lead to damage to the eardrum, middle ear, or inner ear and hearing loss. Conductive hearing losses due to middle ear fluid are generally correctable (by removing the fluid), whereas nerve hearing losses are often permanent and may require hearing aids for treatment. The ear drops can get directly to the infection without having to circulate through the body like oral (by mouth) antibiotics would. Also, because hearing loss caused by the presence of middle ear fluid is often resolved by surgery, some children complain that normal sounds seem too loud. In these instances, generally 2-3 years after the initial surgery, a separate trip to the operating room may be necessary to remove the ear tube and patch the ear drum. This happens less than 5% of the time with the more common types of tubes used, and up to three times as often with long-acting tubes which are more commonly used in children with other risk factors predisposing them to prolonged eustachian tube dysfunction. Some doctors also recommend covering the ears to avoid water exposure after ear tubes are placed. This can include cotton balls during bath time or ear plugs for swimming although studies have also shown that the risk of developing an ear infection with water exposure from baths or chlorinated pools is quite low. Chronic DiseaseCertain chronic diseases that are not directly related to the ear can cause hearing loss. Autoimmune diseases, such as rheumatoid arthritis, also can be linked to some forms of hearing loss. How You Hear -- Anatomy of the EarSound waves enter the outer ear and travel through the ear canal. This causes the eardrum and tiny bones, called the hammer and anvil, in the middle ear to vibrate. Then vibrations travel to the fluid in the cochlea where microscopic hairs send nerve signals to the brain so sound is understood. Tumors and GrowthsNoncancerous growths, including osteomas, exostoses, and benign polyps, can block the ear canal, causing hearing loss. Acoustic neuroma (an inner ear tumor shown here), grows on the hearing and balance nerve in the inner ear. The average decibel level at a rock show is 110, loud enough to cause permanent damage after just 15 minutes. Hearing damage can occur with extended exposure of any noise over 85 decibels. Headphones and EarbudsCan others hear the music and lyrics you’re listening to through earphones? Think you have an earwax blockage? Don't try removing the wax with a cotton-tipped swab or by inserting anything else into your ear canal. For more hearing loss information from WebMD, click "Next." Childhood IllnessMany childhood illnesses can cause hearing loss. Ear infections can cause the middle ear to fill with fluid and cause hearing loss that usually clears when the infection and fluid are gone. Diseases known to affect hearing in children include chickenpox, encephalitis, influenza, measles, meningitis, and mumps. Though congenital hearing loss often runs in families, it can occur with maternal diabetes or an infection when pregnant.
Hearing loss can also develop if a newborn is premature or from other causes such as trauma during birth resulting in the infant not getting enough oxygen.
Usually, age-related hearing loss is caused by the progressive loss of inner-ear hair cells.

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