Young children are often brought into emergency rooms by parents distraught by their children's constant crying. Pediatricians however are not likely to prescribe antibiotics for 48-72hrs to see if the infection will resolve itself.

What is it?
Acute otitis media (AOM) is a painful infection of the middle ear, the portion of the ear behind the eardrum. (Another form of ear infection,  otitis  external  or swimmer's ear, is entirely different, and is not covered here.) AOM often follows a cold, sore throat, or other respiratory illness. Although it can affect adults, this occurs primarily in infants and young children

What Happens?
Children too young to explain their discomfort cry, fuss, and pull at their ears. They might also appear unresponsive because they can't hear well—fluid buildup in the middle ear prevents the eardrum and small bones in the ear from moving, causing temporary hearing loss.

Most hearing loss associated with AOM ends when the infection is treated. However, recurring ear infections and their accompanying short-term hearing losses may affect a child's speech and language development.

In addition, a complication called secretory otitis media (fluid build-up in the middle ear) may develop and cause continuous hearing loss for months. Other possible complications of AOM include mastoiditis (an infection of the bone behind the ear) and, occasionally, spinal meningitis.

Why does it happen?
When the Eustachian tube connecting the upper part of the throat to the middle ear is blocked by a cold's mucus and swelling, fluids pool behind the eardrum, providing an ideal place for bacteria to grow; an infection may set in, generating even more fluid. The pressure this exerts on the eardrum can be intensely painful. The eardrum turns red and bulges.

Should I see a doctor?
Any child who appears to have an ear infection should be seen by a physician. Without treatment, most middle ear infections resolve on their own, often through a harmless rupture of the eardrum.  Many pediatricians take a conservative approach, generally waiting 24 to 72 hours until they are certain an ear infection warrants antibiotics.

A review of 33 randomized trials involving 5,400 children concluded that antibiotics modestly improved the rate of recovery. An evaluation of six randomized, controlled studies concluded that early antibiotic use had only slight benefit, reducing pain and fever in a small percentage of children and helping to prevent the development of infection in the other ear, but not significantly speeding up recovery of hearing. Finally, children with recurrent ear infections do not appear to benefit from preventive antibiotic treatment.

Children who are prone to recurring bouts of otitis media or who have deficiencies in their immune system may be prescribed antibiotics or a tympanostomy tube by their doctor to prevent future infections. A tympanostomy tube is inserted into the ear during surgery to permit fluid to drain from the middle ear.
Multiple upper respiratory infections may lead to frequent acute otitis media. For this reason, exposure to large groups of children, such as in child care centers, results in more frequent colds and therefore more earaches. Environmental irritants, such as secondhand tobacco smoke, should also be avoided.

Some medical conditions are associated with frequent otitis media, specifically Down syndrome, cleft palate, and allergies. Certain groups of people are also more frequent sufferers of ear infections, particularly Native Americans. Males are also more commonly affected than females. Children who have acute otitis media when younger than 6 months may be more prone to frequent bouts of ear infection.

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