Otitis media is more commonly referred to as an ear infection. As most parents know, ear infections demand attention. Otitis media can be classified as acute otitis media or as otitis media with effusion meaning that there is an accumulation of fluids. Acute otitis media is characterized by rapid onset of symptoms, and episodes are more frequent in the first 3 years of life. Acute otitis media is the most frequent diagnosis in infants and children who visit physicians because of illness.(1) Acute otitis media occurs in adults, but with much less frequency. Otitis media with effusion differs from acute otitis media in that signs and symptoms of acute infection are absent.

The middle ear is best described as an air-filled cavity that begins at the eardrum, also referred to as the tympanic membrane, and extends to the upper throat behind the nose, an area called the nasopharynx. Connecting these two areas is the eustachian tube. Its primary functions are the regulation of atmospheric pressure between both sides of the tympanic membrane, protection from nasopharyngeal secretions, and draining secretions from the middle ear into the nasopharynx. In the adult, the eustachian tube lies at a 45° angle from the horizontal plane. In children that angle is only 10°. This may indeed help explain the increased rate of infection in infants and children, since the degree of this important angle may cause improper drainage.

Several risk factors contribute to the higher incidence and frequency of otitis media. These include the season of the year, certain malformations, environmental factors, and the age of the child when the first episode occurred.

There are basically two situations which may occur with middle ear disturbances. First, a pathogen, such as bacteria, may get into the middle ear and, as it reproduces, fluid is unable to drain due to swelling and inflammation. Potential causes of this may include head trauma from birth or from an accident, or eustachian tubes congested from allergies or colds.

Secondly, some experts feel that chronic ear complaints may be initiated by food or environmental allergies. Allergies could cause a fluid buildup in the ear, which may create pain or pressure in the child, but this is not an infection. However, this buildup can become a ripe medium for pathogen invasion. The biggest food culprits are wheat, corn, and dairy. Other common problem foods include soy, eggs, citrus, and peanut butter. The bacteriology of middle ear infections has changed very little since the mid-1970's with the exception of emergence of some strains of bacteria which seem to be resistant to antibiotics.