Sezatoare canadiana (87)

lorelaim spune:

Pe website-ul jurnalul.ro am gasit:
"ORL - Prea muciosi
10/11/2007 de Florin Condurateanu


Nasul produce in 24 de ore intre doi si patru litri de secretie, pe care ii inghitim si nu ii simtim. Informatie de knok-out. N-am banui ca nasul fabrica intre doua si patru sticle pline cu secretie, adica nu ne inchipuim ca suntem atat de muciosi. Si o alta veste. Urechea medie, cea de dincolo de timpan, unde se misca scarita, ciocanul si nicovala, functioneaza numai daca in aceasta cale a urechii exista aer. Orice imputinare a aerului in urechea medie duce la o proasta vibratie a timpanului si la miscari incorecte ale celor trei oscioare. Am reunit informatia despre nas si ureche tocmai fiindca intre aceste doua organe exista o stransa legatura. Legatura intre nas si ureche se face prin acel canal de 2-3 mm diametrul, cat o mina de pix, canal numit Trompa lui Eustachio. Prin acest tub se asigura aerul in urechea medie, o conditie esentiala ca sa auzim bine. Dupa ce a explicat acestea, conf. dr Codrut Sarafoleanu, seful clinicii ORL de la Spitalul "Sf. Maria", precizeaza ca orice inflamatie a mucoasei din Trompa lui Eustachio face sa nu se mai aeriseasca bine urechea medie si nici sa nu se mai evacueze secretii normale ale urechii. Otita este o inflamatie a mucoasei din Trompa lui Eustachio, dar si o blocare a acestei trompe cu secretii scurse din sinus in otitele seroase. Astuparea Trompei lui Eustachio mai poate sa se intample si cand vegetatiile (polipii) sunt prea mari. Ca atare, pentru a nu avea neplaceri, polipii mari trebuie scosi si otitele tratate in vederea aerisirii corecte a Trompei lui Eustachio."

Lorelai

http://home-and-garden.webshots.com/album/562645890MtEtoL

"Daca dragoste nu e... nimic nu e..."

Ica 1975 spune:

Mihaela, merci de info, eu sper sa fie 3 ani Unde as putea cauta pe internet? Ref la gradi, biroul coordonator, sau nu-stiu-cine altcineva, le da dreptul sa ceara plata acestor zile, desi mie imi pare anormal. Noi NU platim zilele somate si platite, insa platim daca plecam in vacanta sau cand n-o ducem si este deschisa gradi; asa am convenit cu doamna respectiva, noi insa suntem la 25$ nu la 7$.

Noi

Ce faci te si face.

Ica 1975 spune:

Lorelaim, abia acum am vazut postarea ta prompta ca de obicei

Noi

Ce faci te si face.

lorelaim spune:

Ica draga - cu multa placere! Am sa intru sa corectez postarea care are "semne" ciudate.
Uite aici inca un art (in engl) gasit la link-ul: http://preventdisease.com/diseases/ear_infections.html
care mi se pare f complet... dar si f lung :-)

"Ear Infections (Otitis Media) in Children

WHAT ARE EAR INFECTIONS (OTITIS MEDIA) IN CHILDREN?

The Ear

The ear is the organ of hearing and balance and is organized into external, middle, and internal areas.
The outer ear collects sound waves that are conducted through a canal (the entrance of which is called the external auditory meatus ) to the tympanic membrane , commonly called the eardrum.


The tympanic membrane is a tissue that is lined on the inside with mucus. Like a drum, it vibrates to the incoming sound waves, converting them into mechanical energy.


This energy resonates through the middle ear, a complex structure filled with air and composed of tiny bones that vibrate to the rhythm of the ear drum and pass the sound waves on to the inner ear.


The inner ear is filled with fluid. Here, hair-like structures stimulate nerves to convert the mechanical waves to electrochemical impulses that are carried by a network of nerve cells to the brain, which senses these impulses as sounds.


The inner ear also contains three semi-circular canals that function as the body's gyroscope, regulating balance.


An important structure in the ear is the Eustachian tube, which runs from the middle ear to the passages behind the nose and the upper part of the throat. This tube ventilates the ear and equalizes the air pressure in the middle ear to the outside air pressure. (Problems with this tube's function are primary factors in most cases of ear infection.)
Ear Infections (Otitis Media) in Children

Ear infections are often defined by whether they are acute (acute otitis media) or chronic (otitis media with effusion).

Acute Otitis Media (AOM). Acute otitis media (AOM) is an infection in the middle ear that causes an inflammation behind the tympanic membrane.
Often it develops during or after a cold or a flu.


Middle ear infections are extremely common in children but are infrequent in adults.


In children, ear infections often recur, particularly if they first develop in early infancy.
Otitis Media with Effusion (OME) . Otitis media with effusion (OME) occurs when an effusion (fluid) builds up in one or both middle ears. When this is chronic and severe the fluid is very sticky and is commonly called "glue ear.";
It is not painful and the only clue that it is present is a feeling of stuffiness in the ears, which can feel like "being under water.";


Children who are susceptible to OME can have frequent episodes for more than half of their first three years of life.


The episodes can last from weeks to months.
WHAT CAUSES MIDDLE EAR INFECTIONS (OTITIS MEDIA) IN CHILDREN?

Otitis media (middle ear infection) is most often the result of a combination of factors that increase susceptibility to infections by specific organisms in the middle ear.
Conditions that Predispose a Person to Ear Infections

Problems in the Eustachian Tube. Many bacteria thrive in the passages of the nose and throat. Most are benign and some are even important in preventing harmful bacteria from getting out of control. In addition, the body has a number of defenses that prevent the harmful bacteria from replicating and infecting deeper passages, such as those in the ear.

However, various factors can impair these defenses. Such factors may include, but are not limited to the following:
Viral infection.


Smoke particles.


Allergies, such as hay fever, that affect the nasal passages (allergic rhinitis).
In general, these or other irritants can produce the following conditions that lead to ear infection:
Irritation from viruses, smoke particles, or allergies can cause the membranes along the walls of the inner passages to become inflamed, swell, and obstruct the airways.


If this inflammation blocks the narrow Eustachian tube so that it can not drain the middle ear properly, fluid builds up.


This fluid can then become a reservoir and breeding ground for bacteria and subsequent infection.
The Eustachian tubes in all children are shorter and smaller than in adults and therefore more vulnerable to obstruction. Children with shorter-than-normal and relatively horizontal Eustachian tubes are at particular risk for recurrent infections.

Genetic Factors. Several studies suggest that multiple genetic factors may play a role in making a child susceptible to otitis media.
For example, genetic susceptibility to certain bacteria may result in development of persistent and recurrent 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.
Researchers are hoping that these findings may encourage primary care physicians to closely monitor children who are offspring or siblings of individuals with a history of unusually frequent or severe upper respiratory tract infections.
Infecting Agents

Bacteria. Certain bacteria are the primary causes of acute otitis media (AOM) and are detected in about 60% of cases. The bacteria most commonly causing ear infections are:
Streptococcus pneumoniae (also called the pneumococcus) is the most common bacterial cause of acute otitis media, causing about 50% to 80% of cases.


Haemophilus influenzae is the next most common culprit and is responsible for 20% to 30% of acute infections.


Moraxella catarrhalis is also a common infectious agent, responsible for 10% to 15% of infections.


Less common bacteria are Streptococcus pyogenes and Staphylococcus aureus .
Of note, about 15% of these bacteria are now believed to be resistant to the first-choice antibiotics.

Viruses. Studies have reported the presence of viruses in the middle ear fluid in about 40% of children with ear infections. While viruses are not usually a direct cause of otitis media, they may play an important role by causing inflammation in the nasal passages and impairing defense systems, such as cilia, in the ear.
Respiratory syncytial virus (RSV), a common virus responsible for upper and lower respiratory infections, and influenza viruses ("Flu";) are prime suspects in this process.


Rhinovirus, a cause of the common cold, has been found in between 1% and 8% of otitis media cases, and, in one study 74% of patients with rhinovirus caused colds had middle-ear pressure abnormalities.
Causes of Otitis Media with Effusion (OME)

In some cases, otitis media with effusion develops after an acute otitis media attack, although often the direct cause of OME is unknown.

It is not clear, for example, what role bacteria or other infectious agents play. Standard tests do not detect bacteria in 40% to 60% of cultures taken from fluid in OME-affected ears. (In one study, a sophisticated test found genetic evidence of Haemophilus influenza bacteria in about a third of specimens in which no bacteria were detected by standard culture techniques.)

Susceptibility to OME is almost always due to an abnormal or malfunctioning Eustachian tube that causes a negative pressure in the middle ear, which, in turn, allows fluid to leak in through capillaries.
Problems in the Eustachian tube can be due to viral infections, second-hand smoke, injury, or birth defects, such as cleft palate.


Rare genetic conditions, such as Kartagener's syndrome, in which the cilia (hair-like structures) in the ear are immobile and cause fluid build up, can contribute to OME.
WHO GETS EAR INFECTIONS?

General Risk Factors for Ear Infections

Acute ear infections are the most common reason for childhood visits to the doctor. About 62% of children can expect to have a least one attack of acute otitis media (AOM) in their first year and 80% will have had an infection by age three. And, the incidence of AOM has been rising over the past decades. One study reported a 44% increase in prevalence between 1981 and 1988, with infants particularly affected. In American children, otitis media is second in prevalence only to the common cold.

Gender and Age. Boys are more apt to have infections than girls are, and the risk is higher the younger the child:
About 17% of all children under two have recurrent ear infections (i.e., three or more episodes within a six-month period). The earlier a child has a first ear infection the more susceptible he or she is to recurrent episodes. The peak incidence occurs between seven and nine months of age.


As children grow, however, the structures in their ears enlarge and their immune systems become stronger. By 16 months the risk for recurrent infections is rapidly declining. Still, about two thirds of children have had at least one acute ear infection by the time they are three years old.


Half of the cases of otitis media with effusion (OME) appear to develop within the first year of life. In one study, 18% of healthy children between birth and age three had frequent recurrences of OME in one or both ears. (Because OME has fewer symptoms than acute otitis media, however, its prevalence among very young children is unclear.)


After age five, most children have outgrown their susceptibility to any ear infections.
Other General Risk Factors. The following children also have higher risks for ear infections.
Children with a family history of ear infections.


Children from lower socioeconomic groups.
Increased Co-Incidence in Other Airway Infections and Disorders

Increased diagnosis of other disorders and infections of the upper and lower airways, such as asthma, allergies, and sinusitis, have paralleled the rise in ear infections. For example, the same bacteria are often responsible for both ear infections and sinusitis. 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. These studies may have overestimated the extent of clinically important sinus disease, but none the less, the association is significant. Researchers are looking for common risk factors:
Day Care Center Attendance. 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, then, 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. For children who had the condition for a long time, however, neither day care attendance nor any other risk factor, including a history of upper respiratory tract infections or family history of OME, appeared to be relevant. Attendance in day care centers, then, may explain part, but not all, of the current increase in ear infections and other upper airway disorders.


Increase in Allergies. Some experts believe that the increase in allergies is also partially responsible for the higher number of ear infections, which is unlikely to be related to day care attendance. Studies indicate that 40% to 50% of children over three years old who have chronic otitis media also have allergic rhinitis (hay fever). Allergies are also associated with asthma and sinusitis.


The rise in the rate of otitis media, then, is probably due to a combination of factors that are also responsible for the increase in these other airway problems.
Other Medical Problems that Increase Risk

Gastroesophageal Reflux Disorder. Gastroesophageal reflux disorder (GERD), in which acid backs up into the esophagus, is a common cause of heartburn in adults. In infants, GERD may occur when muscles in the upper part of the stomach are still immature and force acid back up, causing persistent vomiting. Some research also suggests that GERD in infants may contribute to sinusitis and ear infections by triggering inflammation in these upper passages.

Other Medical Disorders. Other medical disorders, including Down's syndrome, cleft palate, and immunosuppressive disorders, such as HIV, increase the risk for ear infections.
Parental Behavior

The behavior of parents can increase a child's risk for otitis media.
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 a number of problems, among them hearing loss and OME.


Babies who are bottle-fed may have a higher risk for otitis media than do breast-fed babies because the mother's milk provides immune factors that help protect the child from infections. Researchers have reported that oligosaccarides, sugar compounds found in milk, may have properties that help fight otitis media by preventing S. pneumonia bacteria from binding to the cells lining the respiratory tract. Also, to be breast fed, infants are held in a position that allows the Eustachian tubes to function well. To improve protection for bottle-fed babies, mothers should not lay babies down with their bottle; they should hold the infants in the same way they would to breast-feed them.
Several studies have found that the use of pacifiers place children at even higher risk for ear infections. Sucking increases production of saliva, which is a vehicle for bacteria that can travel up the Eustachian tubes to the middle ear.


WHAT ARE THE SYMPTOMS OF EAR INFECTIONS IN CHILDREN?

Symptoms of Acute Otitis Media

Symptoms of acute otitis media usually develop suddenly and can include:
Pain or discomfort in the ear. (It is difficult to determine if a preverbal child or infant has an ear infection. Some children may indicate pain if they have trouble swallowing food and rejecting it. Some parents believe that tugging on the ear indicates an infection, but this gesture is more likely to indicate pain from teething.)


Coughing.


Nasal congestion.


Fever


Irritability.


Loss of appetite.


Vomiting.


Pus in the ear may cause hearing loss in some children.


If the ear infection is severe, the tympanic membrane may rupture causing the parent to notice pus draining from the ear. (This usually brings relief from pain.)
Fevers and colds often make children irritable and fussy, so it is difficult to determine if otitis media is present as well. In about a third of children with acute middle ear infection, symptoms are not apparent.
Symptoms of Otitis Media with Effusion

Otitis media with effusion (OME) often has no symptoms at all. Some hearing loss may occur, but it is often fluctuating and hard to detect even by observant parents. The only signal to a parent that the condition exists may be when a child complains of "plugged up" hearing. There are some indications that older children with OME may have difficulty targeting specific sounds in a noisy room. (In such cases, some parents or teachers may attribute their behavior to lack of attention or even to an attention deficit disorder.) OME is often diagnosed only during a regular pediatric visit.


HOW SERIOUS ARE EAR INFECTIONS IN CHILDREN?

Acute Otitis Media in Infancy

Any infant under three months old who shows signs of ear infection should be seen by a physician promptly, since acute otitis media in babies can sometimes be a sign of a more wide-spread infection, sometimes including meningitis.
Hearing Loss and Delayed Development

Evidence strongly suggests that severe cases of recurrent acute otitis media and persistent otitis media with effusion (OME) impair hearing. The effect of long-term hearing problems can have the following effects:
Learning Delays . Hearing loss in children slows down language development and reading skills. Children with even mild hearing loss may miss spoken words and have trouble making sense out of a conversation or a lesson in school.


Behavioral and Social Problems. Children with impaired hearing may appear to be distracted, inattentive, unintelligent, and may even be inaccurately diagnosed as having attention deficit hyperactivity disorder.


Impaired Balance. Some studies have indicated that children with chronic OME have problems with motor development and balance.


Speech Problems. A few small studies have found speech problems in some young children with OME, but in one study the effect was limited to a group of Native American children.
It is not clear how significant the long-term effects of OME-related hearing loss are on learning in children. Some studies have suggested a weak association between mild to moderate hearing impairment and later learning and verbal problems. Many of these studies suggest that the effect on learning is not significant, however. In addition, some indicate that the lower learning scores may actually be due to the fact that children with ear infections tend to be in lower socioeconomic groups and so have less home attention.

Considering the increased usage of medications for attention deficit disorder, the costs of special education, and the social burdens carried by children diagnosed with emotional and learning disabilities, more research is essential for clarifying the long-term effects of hearing loss from recurrent or chronic ear infections.
Physical and Structural Injury in the Face and Ears

Serious complications or permanent physical injuries from ear infections are very uncommon but may include the following:
Very rarely, a child may develop facial paralysis, which is temporary and relieved by drainage surgery.


In severe or recurrent otitis media, certain children may be at risk for structural damage in the ear.


Cysts in the ear known as cholesteatomas are an uncommon complication of recurrent or severe ear infections.


In rare cases, even after a mild infection, certain children, possibly because of immune abnormalities, develop calcification and hardening in the middle and, occasionally, in the inner ear.
Mastoiditis

Before the introduction of antibiotics, mastoiditis, an infection in the bones located in the skull, was a major and serious complication of otitis media. This condition is difficult to treat and requires intravenous antibiotics and drainage procedures. Surgery may be required. If pain and fever persist in spite of antibiotic treatment of otitis media, the physician should check for mastoiditis. Even without antibiotics this is a rare complication.


HOW ARE EAR INFECTIONS IN CHILDREN DIAGNOSED?

Many experts believe that ear infections in children are overdiagnosed and overtreated with antibiotics. Parents should question their physician closely if they recommend antibiotics and feel comfortable if antibiotics are not diagnosed.
Medical History

The physician should be sure to ask the parent for a history of any recent cold, flu, or other respiratory infections. If the child complains of pain or has other symptoms of otitis media, such as redness and inflammation, the physician should be sure to rule out any other causes of such symptoms. They may include, but are not limited to the following:
Dental problems (such as teething).


Infection in the outer ear. Symptoms include pain, redness, itching, and discharge. Infection in the outer ear, however, can be confirmed by wiggling the ears, which will produce pain. (This movement will have no significant effect if the infection is in the middle ear.)


Foreign objects in the ear. This can be dangerous and a physician should always check for this first when a small child indicates pain or problems in the ear.


Viral infection can produce redness and inflammation. Such infections, however, are not treatable with antibiotics and resolve on their own.


A parent's or child's attempts to remove earwax.


Intense crying can cause redness and inflammation in the ear.
Physical Examination

An ear examination should be part of any routine physical examination in children, particularly because the problem is so common and many children have no symptoms.
The physician first removes any ear wax (called cerumen) in order to get a clear view of the middle ear.


The physician employs a small flashlight-like instrument called an otoscope to view the ear directly. This is the most important diagnostic step. This instrument will reveal signs of acute otitis media, bulging eardrum, and blisters. The physician will also check color.


To determine ear infection the physician should always use a pneumatic otoscope. This device detects any reduction in eardrum motion. It has a rubber bulb attachment that the physician presses to push air into the ear. Pressing the bulb and observing the action of the air against the eardrum allows the physician to gauge the eardrum's mobility.


Some physicians may use tympanometry to evaluate the ear. In this case a small probe is held to the entrance of the ear canal and forms an airtight seal. While the air pressure is varied, a sound with a fixed tone is directed at the eardrum and its energy is measured. This device can detect fluid in the middle air and also obstruction in the Eustachian tube.


A procedure similar to tympanometry, called reflectometry, also measures reflected sound to detect fluid and obstruction but does not require an airtight seal at the canal.
It should be noted that neither tympanometry nor reflectometry are substitutes for the pneumatic otoscope, which allows a direct view of the middle ear. The physician will then assess the results of this examination to determine a diagnosis.
A normal eardrum is grayish-pink and translucent. An eardrum with acute otitis media is opaque and can be red, white, or yellowish. It is also less mobile.


If the eardrum is red and inflamed but mobile, the cause is more likely to be irritation rather than a bacterial infection.


If the eardrum is clear and translucent but is not mobile and if fluid is present, then otitis media with effusion (OME) is likely to be present.


A scarred, thick, or opaque eardrum may make it difficult for the physician to distinguish between acute otitis media and OME.
Tympanocentesis

On rare occasions the physician may need to draw fluid from the ear using a needle for identifying specific bacteria, a procedure called tympanocentesis. This procedure can also relieve severe ear pain. This is most often performed by ear, nose, and throat (ENT) specialists, and usually only in severe or recurrent cases. In most cases tympanocentesis is not necessary in order to obtain an accurate enough diagnosis for effective treatment.
Determining Hearing Problems

Hearing tests performed by an audiologist are usually recommended for children with persistent otitis media with effusion. A hearing loss below 20 decibels usually indicates problems.

Determining Impaired Hearing in Infants and Small Children. Unfortunately, it is very difficult to test children under two years old for hearing problems. One way to determine hearing problems in infants is to gauge the baby's language development:
At 4 four to 6 weeks most babies with normal hearing are making cooing sounds.


By around 5 months the child should be laughing out loud and making one-syllable sounds with both a vowel and consonant.


Between 6 and 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.


The baby speaks his or her first word usually by the end of the first year.
If a child's progress is significantly delayed beyond these times, a parent should suspect possible hearing problems.

Determining Impaired Hearing in Older Children. Hearing loss in older children may be detected by the following behaviors:
They may not respond to speech spoken beyond three feet away.


They may have difficulty following directions.


Their vocabulary may be limited.


They may have social and behavioral problems.
WHAT ARE THE MEASURES FOR PREVENTING A FIRST EAR INFECTION?

Breast-feeding

Breastfeeding offers protection against many early infections. If possible, new mothers should breast feed their infants for at least six months.
Pacifier Use

There is some evidence to suggest that use of pacifiers may increase risk of otitis media in children under three years old. Nevertheless, some physicians believe any association is exaggerated and that the comfort a child derives from sucking (either thumb, breast, or pacifier) is more important any presumed increase risk for ear infection.
Preventing and Treating Colds and Flus

The best way to prevent otitis media is to prevent a cold and influenza from developing in the first place and to treat them effectively when they do develop. Simple precautions for prevention of colds are eating plenty of fruits and vegetables, getting enough rest, and washing hands frequently.

Good Hygiene. Adults and children should wash their hands frequently. New antibacterial soaps add little protection and ordinary soap is sufficient. In fact, a recent study suggests that common liquid dishwashing soaps are up to 100 times more effective than antibacterial soaps in killing respiratory syncytial virus (RSV), which is known to cause pneumonia. Flus and colds are not spread by touching inanimate objects, such as subway poles or toilet seats. Bacteria do not thrive on such objects and of the organisms that do survive on inanimate objects, most are harmless.

Dietary Factors. One analysis of studies found that large doses of vitamin C reduced the duration of colds by 21%. Infants and children, however, should not take large doses of vitamins. Fresh, dark-colored fruits and vegetables are rich in antioxidants and other important food chemicals, and daily diets containing such foods are important and sufficient for nearly everyone.

Reducing Stress. Interestingly, giving children affection and helping them relax could help prevent colds. One study found that the more social interactions a person has the less likely they are to have a cold, possibly because stress hormones, which suppress the immune system, are reduced.

Alternative Cold Remedies. Alternative agents, such as zinc and echinacea, are sold as remedies for prevention or reduction of cold symptoms. There is no strong evidence to support the claims for either of these substances and their side effects are also not fully known. [For more information see Report #94, Colds and Influenza (the Flu) .]
Avoiding Exposure to Cigarette Smoke

Parents or others should not smoke around children. Several studies have found that children who live with smokers have a significant risk for ear infections. One study even suggested that the more the mother smoked the higher the risk.


WHAT ARE THE HOME REMEDIES USED FOR EAR INFECTIONS IN CHILDREN?

Treatments for ear infections cost the country between three and four billion dollars each year, and evidence is mounting that many of these treatments, particularly heavy antibiotic use and surgical procedures, may be unnecessary.
Watchful Waiting

Careful 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.
In one 2000 study, 240 children under age 2 who were diagnosed with acute otitis media were treated with watchful waiting. After four days, only 3% of the children required treatment with antibiotics, while the infection cleared in the other 97%.
Children, however, must be monitored carefully.
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.
Natural Remedies

Before antibiotics, parents used home remedies to treat the pain of ear infections. Now, with current concern over antibiotic overuse, many of these remedies are back in favor.
Depending on regional cultures, parents may have pressed a warm water bottle or warm bag of salt against the ear. Such old-fashioned remedies may still help to ease ear pain.


Drops of tea tree oil may be beneficial. This herbal treatment has mild anti-bacterial properties, but it may irritate the skin.
Valsalva's Maneuver. 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. It may also be useful for unplugging ears during air travel descent as well. It works as follows:
The child takes a deep breath and closes the mouth.


He or she then blows the nose gently while, at the same time, pinching it firmly shut.


The parent should be sure to instruct the child not to blow too hard or the ear drum could be harmed.
This technique should not be used if an infection is present.
Pain-Relievers

A number of pain relievers are available to help relieve symptoms.
Either acetaminophen (eg, Tylenol) or ibuprofen (eg, 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.


Eardrops containing benzocaine, glycerin, and antipyrine (Auralgan) are also available by prescription. In one study Auralgan provided effective short-acting pain relief and helped children endure ear discomfort until an oral pain reliever took effect. Parents should check with a physician before using them. Eardrops could cause damage in children who have a ruptured eardrum. This might be indicated by fluid drainage from the ear canal.
Note: Aspirin and aspirin-containing products are not recommended for children or adolescents. Reports of Reye's Syndrome, a very serious condition, have been associated with aspirin use in children who have chicken pox or flu.
Cold and Allergy Remedies

Many non-prescription products are available that combine antihistamines, decongestants, and other ingredients, and some are advertised as cold remedies for children. Researchers have found little or no benefits for acute otitis media or for otitis media with effusion using decongestants, antihistamines, or combination products, which include Dimetapp, Sudafed Severe Cold Formula, Vicks DayQuil, and Triaminic, among many others. Experts strongly recommend that in any case children not be given any of these remedies unless under a physician's direction.

Precautions when Swimming

Swimming can pose specific risks for children with current ear infections or previous surgery. Water pollutants or chemicals may exacerbate the infection, and underwater swimming causes pressure changes that can cause pain. The following precautions should be taken:
Children with ruptured acute otitis media (drainage from ear canal) should not go swimming until their infections are completely cured.


Children with AOM that is not ruptured should not dive or swim underwater.


Children with implanted ear tubes should use earplugs or cotton balls coated in petroleum jelly when swimming to prevent infection.


WHEN AND HOW ARE ANTIBIOTICS OR OTHER DRUGS USED IN ACUTE OTITIS MEDIA?

Controversy over the Use of Antibiotics for Acute Otitis Media

Antibiotics have been the mainstay treatments of acute otitis media. Prescriptions for this condition doubled between 1980 and 1992 from 12 million to 24 million. In one region of the US more than 70% of children received antibiotics before they were seven months old, and the most common reason for these medications was otitis media. Of major concern is a worldwide increase of common bacterial strains that have become resistant to many standard antibiotics. [ See Box Warnings on Antibiotic Over-Use and Resistant Bacteria.]

Many American physicians feel pressured by patients and families into prescribing antibiotics when the patients do not really need them. Data indicate, however, that far fewer children diagnosed with acute otitis media and prescribed antibiotics actually need them:
One Dutch study reported that only one in seven children under two years old with a first episode of acute otitis media derived significant benefits from antibiotic treatment. In the study, although antibiotics reduced fever faster in the children, it did not reduce the duration of pain or crying.


A review of 27 studies found that antibiotics benefited only 11% of children with otitis media and 17% of those with otitis media with effusion.


According to a major 2000 analysis, about two-thirds of children with uncomplicated ear infections recover in a day. And, 80% of children are cured within a week without antibiotics. (Antibiotics cure up to 95% of infections during the first week.)


In many Northern European countries, the antibiotic prescription rate for ear infection is much lower than in the US, and reports indicate that children with ear infections there do as well as their American counterparts.
One study conducted in the Netherlands, where fewer antibiotics are prescribed, did find a higher rate of mastoiditis (3.8/100,000 people per year) compared to the rate in many countries with high-prescription rates (1.2 to 2.0/100 000). (Mastoiditis, a bone infection in the skull, is a serious complication of otitis media.) However, the incidence of this complication was still very small in the Netherlands. Furthermore, in Norway and Denmark (where prescription rates are high) the incidence of mastoiditis was nearly the same as in the Netherlands.
Recommendations for Choosing Antibiotics for Acute Otitis Media

Unfortunately, there are no objective tests available to determine specifically which children with acute otitis media would benefit from antibiotics and which would not. Older children seem to do better without them than younger ones. Some experts recommend the following:
Parents should monitor the child for three days, using mild pain relievers and home remedies. (One physician expert said that he prescribes antibiotics during that time only if the child is in obvious, severe pain and the eardrum is red and bulging.)


If symptoms resolve, no antibiotics are necessary.


If symptoms persist, antibiotics should be taken.
One British study reported that only 24% of children who followed these guidelines needed antibiotics. And, compared to other groups who were all given immediate antibiotics, there were no differences in missed school days or child distress. The antibiotic group also had much higher rates of diarrhea. Unfortunately, given even a remote possibility of serious complications, including mastoiditis and negative effects on learning from hearing loss due to recurrent infections, most physicians and parents are very reluctant to abandon the standard use of antibiotics.

Still many experts believe that ear infections in children are overdiagnosed and overtreated with antibiotics. The bottom line is that parents should question their physician closely if they recommend antibiotics and feel comfortable if antibiotics are not diagnosed.
Antibiotic Courses for Single-Episodes of AOM

A number of antibiotics are available for treating ear infections. [ See Box Antibiotic Choices for Treating Otitis Media.]

If a child needs antibiotics the following are some recommendations for duration of regimens.
A full ten to fourteen day course of antibiotics is typically used for very young children and for those with complications such as a perforated ear drum, facial abnormalities, or impaired immune systems.


An oral antibiotic may be given for five to seven days in children over two years old who start to improve within 72 hours and who have no risk factors for complications.


Parents should be sure their child completes the drug regimen. Not completing it is a major factor in the growth of bacterial strains that are resistant to antibiotics.
Effectiveness and Follow up Procedures

Earaches usually resolve within 8 to 24 hours after taking an antibiotic, although about 10% of children who are treated do not respond. Failure may be due to the following or other causes:
In many cases in which the response to an antibiotic is incomplete, a virus is often present.


In other cases, the bacteria may be resistant to the antibiotic.
In some children, fluid will remain in the middle ear for weeks or months, even after the infection has resolved. During that period, children may have some hearing problems, but eventually the fluid almost always drains away.

Follow-up may involve the following steps:
If the infection clears up with a single regimen in children less than 15 months old or in children with risk factors for reinfection, an examination should be scheduled two to three weeks after therapy.


If the infection clears up with a single regimen in older children with no specific risk factors, they should be reexamined three to six weeks after treatment.


If signs of infection are still present (eg, pus is still present in the ear) within 48 hours of taking the last antibiotic dose, the child should be re-examined. (Parents are excellent judges of whether their child's condition has cleared up.)


In cases where complications are suspected, an ear, nose, and throat specialist (an otolaryngologist) may perform a tympanocentesis or myringotomy, procedures in which fluid is drawn from the ear and examined for specific organisms. But this is reserved for severe cases and is usually preformed by a specialist.
Treatment of Persistent or Recurrent Acute Otitis Media

For persistent or recurrent acute otitis media a number of options are available.
Watchful waiting.


Second-line and other powerful antibiotics. [ See Box Antibiotic Choices for Treating Otitis Media.]


Tympanostomy. This is a surgical procedure that implants tubes to drain fluid and prevent build-up and infection [ see What Are the Surgical Procedures for Ear Infections?].


ANTIBIOTIC CHOICES FOR TREATING ACUTE OTITIS MEDIA

Standard Antibiotics for Acute Otitis Media (AOM)

While many different antibiotics may be used to effectively treat otitis media, the physician needs to balance effectiveness, safety, and convenience, as well as try to minimize the emergence of resistance. To this end the CDC has made very clear recommendations about first and second line treatments

First Line of Therapy. . Of note, about 15% of the bacteria that cause ear infections are now believed to be resistant to the first-choice antibiotics. This means that only about half of children will respond to a given antibiotic.
The most widely prescribed antibiotic for acute otitis media is amoxicillin (Amoxil, Polymox, Trimox, Wymox, or any generic formulation). This oral penicillin is both inexpensive and highly effective against the S. pneumoniae bacteria. Unfortunately, bacterial resistance to amoxicillin has increased significantly. A 2000 study, in fact, reported that 24% of S. pneumonia strains in the US were resistant to penicillin. And resistant infections reached 32% in children under five. Amoxicillin is also not as effective against H. influenzae . In areas where bacterial-resistance to antibiotics is high, some physicians recommend high-dose amoxicillin.


Ofloxacin (Floxin), an antibiotic available in ear drops is now recommended as first-line therapy for children with AOM who also have perforated ear drums or implanted tympanostomy tubes. Ofloxacin is known as a fluoroquinolone (also simply called quinolone) and is proving to be very effective and safe for these children. (It should be noted that drops are effective only in these cases.) Another quinolone, ciprofloxacin, is also available in eardrop form outside the US.
Second-Line Therapy. If treatment fails after 72 hours, for recurrent or persistent acute otitis media, or if the patient has had other antibiotics within the past month then the following are recommended:
Amoxicillin/clavulanate combination (Augmentin). This agent is known as an augmented penicillin, which works against a wide spectrum of bacteria.


Certain second- or third-generation oral cephalosporin antibiotics may also be good second-line options. Of these Cefuroxime (Ceftin) and cefpodoxime (Vantin) has the best record to date among the cephalosporins for coverage against bacteria that infect the upper respiratory tract. (Their safety and effectiveness in infants under six months old are not proven.)


Ceftriaxone (Rocephin), an injectable cephalosporin, is also an option. Administering it in a single injection may be sufficient for some children, although a 2001 study reported that a three-day regimen was more effective for children with non-responsive otitis media.
Antibiotics for Other Circumstances

More powerful and expensive antibiotics are available for other circumstances, including the following:
For children who are allergic to penicillin, cephalosporins, of both. (These antibiotics belong to a class beta lactam antibiotics. A person who is allergic to penicillin has a 5% to 14% chance of being allergic to a cephalosporin.)


For children who do not respond to these agents other options are available For children with persistent or recurrent episodes of acute otitis media.
These antibiotics are usually very expensive, however, and are not commonly used. They include the following:
Trimethoprim-sulfamethoxazole (Bactrim, Cotrim, Septra) or a combination of erythromycin and sulfisoxazole (Eryzole, Pediazole) are useful for people allergic to penicillin. It should not be used in patients whose infections occurred after dental work or in patients allergic to sulfa drugs. Allergic reactions can be very serious. Bacterial resistance to these agents has increased dramatically, however, and failure rates are high in certain regions. An oral solution (Primsol) uses trimethoprim alone. It poses less risk for an allergic reaction than the combination and yet is still effective.


Macrolides are other agents sometimes used as an alternative. They include erythromycin, azithromycin (Zithromax), clarithromycin (Biaxin), and roxithromycin (Rulid). These antibiotics are effective against S. pneumoniae and M catarrhalis , but there is increasing bacterial resistance to these agents. They are not effective against H. influenzae . Azithromycin only needs to be taken for five days. Shorter regimens are being investigated. In one study comparing Zithromax to Augmentin, the five day regimen of azithromycin (Zithromax) was less effective than Augmentin. In another study, however, a one dose regimen was as effective as Augmentin. More research is needed.
Side Effects of Antibiotics

The most common side effects of nearly all antibiotics are gastrointestinal problems, including cramps, nausea, vomiting, and diarrhea.


Allergic reactions can also occur with all antibiotics but are most common with medications derived from penicillin or sulfa. These reactions can range from mild skin rashes to rare but severe, even life-threatening anaphylactic shock.


Some drugs, including certain over-the-counter medications, interact with antibiotics; patients should report to the physician all medications they are taking.



Warnings on Antibiotic Over-Use and Resistant Bacteria

Over-prescription of Antibiotics for Colds and Flus. Each year in the United States, 160 million prescriptions are written for antibiotics, equal to about 25,000 tons of these drugs. About half are used for patients and half animal, fish, and other agricultural uses.

Virtually no antibiotics for colds are necessary, even with persistent cough and thick, green mucus, unless there is evidence of an accompanying infection. In one disturbing study, antibiotics were prescribed for nearly half of children who went to the doctor for a common cold. And experts estimate that, outside the hospital setting, only half of the antibiotics currently being prescribed for sore throat and 20% of prescriptions for persistent coughing are necessary.

Antibiotics may be required for upper respiratory tract infections only under certain situations, such as the following:
In patients, particularly small children or the elderly, who have medical conditions that put them at high risk for complications from such infections.


In strep throat (which is caused by the Streptococcal bacteria). (Strep throat makes up only about 12% of all sore throat cases.)


In some cases of an accompanying sinusitis, ear, or other bacterial infection. [See the Reports Ear Infections (Otitis Media) in Children and Sinusitis.]
Resistant Bacterial. Prescribing antibiotics to so many people who do not require antibiotics is raising great concern among health professionals because of emerging strains of bacteria that are no longer eliminated using many standard antibiotics. Although new powerful antibiotics continue to be designed, they are expensive and are also prone to resistance eventually.

High-Risk Areas. The prevalence of such antibiotic-resistant bacteria has dramatically increased worldwide. A 2000 study reported that 24% of Streptococcus pneumoniae strains are resistant to penicillin in the US. In general, regions and institutions with the highest rate of resistance are those in which antibiotics are heavily prescribed. In America, for instance, Georgia and Tennessee have the highest resistance to penicillin. 1

At-Risk Patients. As of yet, the average person is not endangered by this problem. Patients at greater risk for developing an infection resistant to common antibiotics are those with following conditions:
Being very old or very young.


Being exposed to patients with drug-resistant infection.


Hospitalization in intensive care.


Having had an invasive procedure.


Having had a hospital stay.


Having had prior and prolonged antibiotic therapy, particularly within the past four to six weeks.


The presence of a wound.


Having intravenous lines, catheters, or tubes down the throat.


Being immunosuppressed.
Positive News. There are some signs of hope:

The Centers for Disease Control and Prevention (CDC) is reporting a decline in antibiotic prescriptions since the early 1990s. And, countries that have reduced their dependence on penicillin are reporting a parallel decline in bacteria resistant to the antibiotic.

Innovative approaches are being investigated. One involves creating antibiotics that have the capacity to either self-destruct or regenerate themselves.

Greater emphasis is being placed on development of vaccines and expanding immunization programs to prevent infections in the first place.

What Patients and Parents Can Do.
For colds and mild flu, use remedies to relieve symptoms. Realize that antibiotics will not shorten the course of a viral infection.


Don't pressure a physicians into prescribing an antibiotic if it is clearly inappropriate. The physician very often will give in. It is important for patients and parents to understand that although antibiotics may bring a sense of security, they provide no significant benefit for a person with viral infection, and overuse can contribute to the growing problem of resistant bacteria.


If an antibiotic is prescribed, take the full course.




WHAT ARE THE GUIDELINES FOR TREATING OTITIS MEDIA WITH EFFUSION (OME)

Expert guidelines for children ages one to three with otitis media with effusion (OME) are the following:
Watchful Waiting during the First Three Months

The child is typically monitored for the first three months and not given an antibiotic. Some studies have reported that OME resolved without any treatment during this period in the following:
About two thirds of all children whose OME developed without a previous ear infection.


In 90% of children whose OME had immediately followed an episode of acute otitis media.
Drugs that thin the mucus, known as mucolytics, may have some benefit. Some of these agents contain guaifenesin and are commonly available (Robitussin, Scot-Tussin Expectorant). More research is needed to confirm whether they are helpful for OME.
Antibiotics at the End of Three Months

Antibiotics (usually given for 14 to 21 days) are prescribed after or during the three months under the following circumstances:
The condition persists after three months.


The child is suffering.


Hearing loss occurs. (A hearing test should be conducted if the condition persists for over three months, whether antibiotics have been given or not.)
[See Box Antibiotic Choices for Treating Otitis Media.]
Treatment Failure at Six Weeks

If OME persists for six weeks in spite of antibiotic therapies, the following options may be considered:
Antibiotics are continued and stopped when the condition has cleared.


Antibiotics are continued long-term even after the condition has cleared in high-risk children to prevent a recurrence of OME. (A number of studies indicate that antibiotic treatment is not very effective in preventing relapse, however. In fact, one study found no difference at all in persistent OME between treated and untreated children, and some experts believe that antibiotics are not useful at all for this condition.)


A combination of corticosteroids (commonly called steroids) and antibiotics may be more effective than antibiotics alone. The steroid's contribution is to reduce inflammation, which may improve fluid clearance in the middle ear. Corticosteroids have no effect on infection and, in fact, suppress the immune system, so antibiotics are also used. At this time expert groups still do not recommend oral corticosteroids at all for OME because of potentially severe side effects. They can be particularly dangerous for children who have not yet had chicken pox, particularly if they have been exposed within the month.


Surgery (tube insertion) is usually recommended if OME is still present and there is evidence of hearing loss of over 20 decibels. As with antibiotics, however, some experts believe it is overused for otitis media. [ See What Are the Surgical Procedures for Ear Infections?]
WHAT ARE THE SURGICAL PROCEDURES FOR EAR INFECTIONS?

Myringotomy and Standard Tympanostomy

General Guidelines. Surgery to drain the ear drum ( myringotomy) with or without implanted ventilation tubes to drain the fluid ( tympanostomy) is the basic surgical procedure for otitis media. It is the second most frequently performed procedure for children under two (circumcision is first). In 1996 tubes were placed in the ears of one out of every 110 American children. And, an estimated 280,000 children younger than three years of age underwent the operation. It is usually performed in children with recurrent acute otitis media or otitis media with effusion (OME) under they following circumstances:
They have not responded to aggressive antibiotic treatment or antibiotic treatment is not warranted.


They have evidence of fluid in the ear for more than four months and have experienced hearing difficulties.
Controversies Concerning Surgery. Surgery is as controversial as antibiotic treatment, however.

Arguments supporting tubal procedures are based on the following observations, among others:
Hearing is almost always restored following tympanostomy.


One 2000 study indicated that the operation significantly improves many aspects of a child's quality of life, including emotional distress, impaired hearing and speech, and limitations in activity.
The following are studies suggesting that surgery offers few benefits for many children on whom it is performed:
A 1994 study indicated that a quarter of all tube insertion procedures was not appropriate, and in 30% of procedures the risks were as great as the benefits. The study was done, however, to assess medical procedures for insurance reimbursement and a number of surgeons have questioned it.


Important studies in 2000 and 2001 suggested that the procedures in very young children (one and two years old) who had persistent otitis media offered no advantages for language development by the time the child reached the age of three.
Myringotomy. Myringotomy is used to drain the fluid. It may be used as a single procedure in unresponsive acute otitis media or used in combination with tympanostomy. It involves the following steps.
The surgeon makes a very small incision in the eardrum.


Fluid is sucked out using a vacuum-like device.


The fluid is usually examined for identifying specific bacteria


The eardrum heals in about a week.
Myringotomy and Tympanostomy. If otitis media with effusion persists in spite of drug therapy or if it is caused by structural or inborn problems, a tympanostomy is also performed. It involves the following:
A general anesthetic is required but children typically recover completely within a few hours.


Myringotomy is performed.


After myringotomy, the physician inserts a tube to allow continuous drainage of the fluid from the middle ear.


It is a simple procedure, and the child almost never has to spend the night in the hospital.


Some children report almost no discomfort after surgery and find acetaminophen (Tylenol) sufficient for any pain. About half of children, however, require codeine or more powerful pain relievers. One study found that lidocaine eardrops were effective in relieving pain and stress after the procedure.
Complications. Complications of the operation are very uncommon:
General anesthetic poses risks, although rare, for allergic reactions or other side effects.


Persistent ear drum perforation is the most common serious complication, but it too is rare.


Scarring can also occur, particularly in children who require more than one procedure, but it almost never affects hearing.


Small keratin (skin cell) containing cysts called cholesteatomas develop around the tube site in over 1% of patients. This raises some concern about the long-term safety of the procedure, although other studies have indicated that this complication is rare. More studies are needed.


Sometimes the tubes become blocked from sticky secretions or clotted blood after the operation. If the secretions are purulent (pus-filled) from infection, treatment with antibiotic ear drops, such as ofloxacin or ciprofloxacin, may be very effective.
Success Rates. Hearing is almost always restored following tympanostomy. Failure to achieve normal or near-normal hearing is usually due to complicated conditions, such as preexisting ear problems or persistent OME in children who have had previous multiple tympanostomies. In one ten year study, hearing loss was still present in 12.5% of people who had had surgery, although in half of these individuals, hearing loss was very mild (loss was below 20 decibels). Persistent fluid was the main reason for continued impaired hearing. Only 1.9% of hearing loss cases could be attributed to complications of the operation itself.

Precautions. While the tubes are in place, children may take the following precautions:
Many doctors feel that children should use earplugs when swimming as long as the tubes are in place in order to prevent infection. (Cotton balls coated with petroleum jelly are effective alternatives to ear plugs.)


Children may shower without earplugs.
Some physicians feel that as long as the child does not dive or swim underwater, earplugs may not be necessary, but parents should consult their own child's doctor on this subject.

Follow-Up. After surgery, the children may experience the following course.
Eventually, the tubes fall out as the hole in the eardrum closes. This may happen between several months to over a year. This is painless and the patient and parents may not even be aware that the tubes are out.


The operation may need to be repeated, occasionally several times, if, after the tubes fall out, the effusion and hearing loss still persist.


Antibiotics are often prescribed after surgery to prevent such recurrence.
Laser Tympanostomy

A new tympanostomy technique uses a laser, which creates a tiny hole and allows the fluid to drain immediately. No tubes are inserted and the child does not need general anesthesia. One 1999 study reported that within one week of laser-assisted surgery, 100% of children with acute otitis media were symptom free. After three months, only 8% had repeat infections (compared to an average of 47% when treated with antibiotics). Of those children with OME, 65% were fluid-free after three months.
Adenoidectomy

Adenoids are collections of spongy lymph tissue in the back of the throat. Removal of the adenoids, called adenoidectomy, is sometimes considered if they are overly enlarged and interfere with Eustachian tube function. In such cases, the procedure might follow myringotomy and tympanostomy. Removing tonsils at the same time as adenoids ( adenotonsillectomy) does not appear to add any value to the procedure, and it increases the chance of bleeding (which ranges from 0.5% to 4%). One 2001 study did report that either adenoidectomy or adenotonsillectomy at the time of tympanostomy substantially reduced hospitalizations related to otitis media among children two years of age or older. It is commonly held, however, that, except for special circumstances, adenoidectomy should not be conducted on children under four. More research is needed to confirm any benefits in this group.
Functional Jaw Orthopedics

Functional jaw orthopedics are experimental dental treatments that use appliances to stimulate muscles in the tongue, lips, and cheek. The devices are not supported by the teeth, but directly by the soft tissues in the mouth in order to make changes in bone and teeth. Some experts hope that this experimental approach may benefit a number of conditions now treated medically, including otitis media.


WHAT ARE THE GUIDELINES FOR PREVENTING RECURRENT ACUTE OTITIS MEDIA

Antibiotics

Antibiotics have been used for prevention of acute otitis media in children under the following circumstances:
If the child has had three or more separate ear infections every six months.


If the child has had four or more ear infections within a year.
Almost all physicians are moving away from this practice, however, because of concerns about resistance and questions on their value. The following are some observations on this issue:
Most recurring ear infections stop completely in children older than 16 months whether or not they were given preventive antibiotics. For this reason, some experts recommend that preventive therapy is not warranted at all in children over 16 months.


Although one large study reported that preventive antibiotics decreased the frequency of new episodes of acute otitis media by 44%, some experts believe that this figure does not represent a significant drop in the actual number of episodes.


One study reported that amoxicillin was no more effective in preventing recurrent ear infections than a placebo (so-called sugar pills).


In Finland, where very few children are treated with antibiotics for otitis media, a long term study found that after an initial diagnosis of recurrent acute otitis media, only 12% had three or more episodes afterward and only 4% developed otitis media with effusion. All the other children had only two or less attacks after the diagnosis.
Specific Antibiotic Choices. When preventive antibiotics are prescribed, the following may be used:
One or two daily doses of amoxicillin or sulfisoxazole (Gantrisin).


Azithromycin (Zithromax) may be an effective alternative for children who are allergic to penicillin, who live in regions with high rates of bacteria resistant to penicillin, or who have family conditions in which complying to a daily regimen is difficult. A single weekly dose may be sufficient.
Timing and Duration. Physician opinion varies as to the best timing and duration for taking preventive antibiotics. The following are some options:
Prescribed for a consistent three- to six-month period following the last acute episode.


Prescribed only in winter and spring when the risk for respiratory infections is high.
Prescribed at the onset of any respiratory infection.
Vaccines

Children who are susceptible to recurrent ear infections should probably be given vaccinations against influenza viruses and pneumococci.

Viral Influenza Vaccines. Vaccines are designed to recognize foreign agents (called antigens) in the body and to attack them. Vaccines against influenza currently employ inactivated (not live) viruses to produce an immune response that will then attack the active virus. Vaccines are given by injection in the fall, usually between October and December. A live but weakened intranasal vaccine (FluMist) should be available soon. It is engineered to grow only in the cooler temperatures of the nasal passages, not in the warmer lungs and lower airways. The vaccine boosts the specific immune factors in the mucous membranes of the nose that fight off the actual viral infections. It is employed using a nasal spray and in one study provided protection against the flu in up to 93% of children.

The following children over six months should be vaccinated against influenza:
Any child with a condition that requires regular medical care.


Any child who has been hospitalized for a serious illness (particularly lung, kidney, diabetes, sickle-cell, or immune deficiencies.)


Children who are receiving long-term aspirin therapy should also be immunized against the flu because they are at higher risk for Reye's syndrome, a life-threatening disease, if they get the flu.
Possible negative responses include the following:
Newer vaccines contain very little egg protein, but an allergic reaction still may occur in people with strong allergies to eggs.


Almost a third of people who receive the influenza vaccine develop redness or soreness at the injection site for one or two days afterward.


Other side effects include mild fatigue and muscle aches and pains; they tend to occur between six and 12 hours after the vaccination and last up to two days. It should be noted that these symptoms are not influenza itself but an immune response to the virus proteins in the vaccine. Anyone with a fever, however, should not be vaccinated until the ailment has subsided.


Some studies have reported more severe asthma symptoms in children with the lung condition. A 2000 study of asthmatic children, however, reported no increased risk. In fact, there was some indication that the vaccination helped reduce asthma attacks over time. More research is needed to confirm or refute these results.
Pneumococcal Vaccines. A recently approved pneumococcal vaccine (Prevenar or PCV7) could potentially prevent over a million cases of ear infections each year as well as serious infections, such as pneumonia, in American children. The vaccine is now recommended for all children up to age two and certain high-risk children up to age five, such as those at risk for meningitis or widespread infection. It should be noted that protection is not 100%, but the vaccine is still effective in many children. Protection lasts for over six years in most people. In one study, a similar vaccine under investigation protected not only children in day care from serious respiratory infections, but their younger unvaccinated siblings had fewer infections as well.
Experimental Agents

Interfering Bacteria. Researchers have observed that the noses and throats of children who are prone to ear infections harbor smaller numbers of the "friendly" bacteria that help prevent overproduction of the harmful bacteria, than children without frequent infection. An interesting study in Sweden employed a nasal spray containing harmless bacteria called alpha-streptococcal, which are normally found in the throat and competes for space with harmful bacteria. In the study, the bacteria helped to protect against recurrent otitis media in susceptible children. This is very promising because it could significantly reduce antibiotic use; more research is warranted.

Antiviral Agents. In one study, when the anti-viral drug, zanamivir (Relenza), was administered in the nasal passages of adults with influenza, middle-ear abnormalities were reduced from 73% to 32%. This drug is available for children greater than seven years old for treatment of influenza, but no research has determined it value for preventing or treating otitis media in children.

Xylitol. Studies are reporting that children who chew gum or swallow a syrup containing xylitol, a sugar alcohol, experience significantly fewer ear infections. Chewing gum was more effective than the syrup. Xylitol is produced naturally in birch, strawberries, and raspberries. It has properties that fight Streptococcal pneumonia bacteria. Although in one study, xylitol did not reduce bacteria in the nose and throat, it did prevent ear infection. Some health providers report that even children one and a half years old can learn to chew and not swallow gum. The gum is not widely available in the US, however, and studies have not tested children between six and 18 months, the highest-risk age group for otitis media. This is an area for further research.
"

Lorelai

http://home-and-garden.webshots.com/album/562645890MtEtoL

"Daca dragoste nu e... nimic nu e..."

lorelaim spune:

Si ultimul link unde eu am gasit info interesanta despre Otita medie este: http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/otitis_media.jsp
Bineintzeles ca mai sunt si multe altele - dar acestea mi-au "picat" mie in fatza ochilor si le-am consid bune de citit la momentul respectiv (apoi le-am salvat la Favorite).
Multzumesc bunului Dumnezeu - Gabisor a reusit sa scape pana acum fara otite... dar... nu stim niciodata ce ne asteapta.
Inca odata va doresc MULTA-MULTA sanatate si o seara faina!
Maine o sa incerc sa pun ceva poze cu iarna de la noi, cu zapada care a acoperit crocusii, cu fulguiala nebuna de azi dupa-masa... si poate si cu "bradutzul" cu puisori si oua de Pasti :-)


Lorelai

http://home-and-garden.webshots.com/album/562645890MtEtoL

"Daca dragoste nu e... nimic nu e..."

oanagabriela spune:

In sfirsit am reparat calculatorul si am recuperat pozele de la intilnire. Nu sint multe, ca eu sint mai "jenata" de felul meu si parca nu-mi venea sa va fotografiez tot timpul. Dar sint (zic eu) reusite. Oricum Nelia are 2 poze superbe...

http://picasaweb.google.com/Antonia13052000/2008IntilnireCuFeteleDC8Martie

Daca cineva nu este OK cu poze publice, le retrag si le trimit pe PM. Dati-mi de stire.

Donia spune:

Oana, foarte faine sunt pozele! Ma bucur sa vad iarasi fetze cunoscute si nickuri cunoscute :)

Cricor, Roxanei i-a cazut primul dinte (incisiv central jos) dupa 6 ani si jumatate, acum vreo... 2 luni? Intre timp i-a crescut unul nou (si stramb) si altul nu i-a mai cazut. I se mai clatina unul acum, dar va mai dura ceva pana o sa-i cada.
Dentistul mi-a spus ca sunt variatii foarte mari, la unii cad foarte repede, la altii foarte tarziu... imi dadea exemplul unei fetite de 9 ani careia de abia acum ii cresc incisivii centrali de sus... nimic iesit din comun, spunea el.
A, uitasem, Roxanei i-a aparut primul dintisor de lapte cand avea 4 luni si 10 zile, toata lumea spunea ca o sa schimbe dintii repede... cand colo e penultima din clasa careia i-a cazut dintele.
Si legat de sigilare, ca se discuta, el i-a sigilat deja Roxanei maselele definitive (patru bucati) iesite de vreo jumatate de an.

Ana, sanatate lui Tudor! Macar zilele astea sunteti acasa sa-l oblojesti.
Si Cristinel are ceva, inca nu m-am dumirit ce, noaptea plange si e suparat, ziua e veselut si cu febra... mai asteptam sa vedem in ce se tranforma, ca nu prea sunt in mood pentru mers la urgente...

---

Copiii se nasc perfecti - rolul parintelui e sa nu strice ceea ce Dumnezeu sau natura a creat.

lorelaim spune:

Oana - super pozele! Pacat ca nu au fost facute publice si celelalte si eu nu le-am putut vedea... Mi-ar fii fost drag sa va "cunosc" virtual macar :-)
La noi "it feels like" -8/-9! N-a fost asa de frig toata iarna! Saracile floricele! Crunt... cred ca cele care au fost "curajoase" si au iesit mai repejor... acum sunt inghetzate :-(
MULTA-MULTA sanatate si o sambata faina va doresc!

Lorelai

http://home-and-garden.webshots.com/album/562645890MtEtoL

"Daca dragoste nu e... nimic nu e..."

carmen77 spune:

Haha, Lorelai, tot Montrealul e campion .. aici sunt - 10 si feels like - 19 ... welcome spring! Macar nu au iesit florile pe aici ... eu cre ca zic saru-mana daca om avea iarba in mai macar ...


POZE NOI

Carmen si Matei Gabriel + Marc

lorelaim spune:

Carmen :-) - daca vrei cu-adevarat... potzi! sa ai iarna si pana in mai :-) iar daca cumva da coltzul ierbii pan' atunci... in Nunavut inca ar mai fii o sperantza de zapada ;-)
Apropo Carmen - te-am "descoperit"! http://www.desprecopii.com/POZECONCURS/folderview.asp?folder=clipe%20de%20viata%202007&page=30 poza "noi2.jpg" pe randul al 2-lea
si te-am si deconspirat! haha! nu zici nimic? nu ne spui si noua ca participi la concurs?
un weekend fain va doresc in continuare! ma duc sa mai tandalesc (ma uit la tembelizor ca-s programe tare faine... ba o mumie Inca pe National Geographic, ba o vidra pe Viasat Nature)... ca ouale doar le fierb si pun niste stickers... fripturica de pasare o bag deseara la cuptor... iar prajiturica (foietaj) e in conge (cumparata de gata :-P) - doar trebuie maine s-o azvarl si pe ea in cuptor :-)

Lorelai

http://home-and-garden.webshots.com/album/562645890MtEtoL

"Daca dragoste nu e... nimic nu e..."