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Otitis Media (Ear Infection)

What is otitis media?

Otitis media is an infection or inflammation of the middle ear. This inflammation often begins when infections that cause sore throats, colds, or other respiratory or breathing problems spread to the middle ear. These can be viral or bacterial infections. Seventy-five percent of children experience at least one episode of otitis media by their third birthday. Almost half of these children will have three or more ear infections during their first 3 years. It is estimated that medical costs and lost wages because of otitis media amount to $5 billion* a year in the United States. Although otitis media is primarily a disease of infants and young children, it can also affect adults.

*Gates GA. Cost-effectiveness considerations in otitis media treatment. Otolaryngol Head Neck Sur. April 1996. 114 (4): 525-530.

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How do we hear?

The ear consists of three major parts: the outer ear, the middle ear, and the inner ear. The outer ear includes the pinna--the visible part of the ear--and the ear canal. The outer ear extends to the tympanic membrane or eardrum,

Image of the inner ear
Image of the inner ear
larger image
which separates the outer ear from the middle ear. The middle ear is an air-filled space that is located behind the eardrum. The middle ear contains three tiny bones, the malleus, incus, and stapes, which transmit sound from the eardrum to the inner ear. The inner ear contains the hearing and balance organs. The cochlea contains the hearing organ which converts sound into electrical signals which are associated with the origin of impulses carried by nerves to the brain where their meanings are appreciated.  

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Why are more children affected by otitis media than adults?

There are many reasons why children are more likely to suffer from otitis media than adults. First, children have more trouble fighting infections. This is because their immune systems are still developing. Another reason has to do with the child's eustachian tube. The eustachian tube is a small passageway that connects the upper part of the throat to the middle ear. It is shorter and straighter in the child than in the adult. It can contribute to otitis media in several ways.

The eustachian tube is usually closed but opens regularly to ventilate or replenish the air in the middle ear. This tube also equalizes middle ear air pressure in response to air pressure changes in the environment. However, a eustachian tube that is blocked by swelling of its lining or plugged with mucus from a cold or for some other reason cannot open to ventilate the middle ear. The lack of ventilation may allow fluid from the tissue that lines the middle ear to accumulate. If the eustachian tube remains plugged, the fluid cannot drain and begins to collect in the normally air-filled middle ear.

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What are the effects of otitis media?

Otitis media not only causes severe pain but may result in serious complications if it is not treated. An untreated infection can travel from the middle ear to the nearby parts of the head, including the brain. Although the hearing loss caused by otitis media is usually temporary, untreated otitis media may lead to permanent hearing impairment. Persistent fluid in the middle ear and chronic otitis media can reduce a child's hearing at a time that is critical for speech and language development. Children who have early hearing impairment from frequent ear infections are likely to have speech and language disabilities.

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How can someone tell if a child has otitis media?

Otitis media is often difficult to detect because most children affected by this disorder do not yet have sufficient speech and language skills to tell someone what is bothering them. Common signs to look for are

  • unusual irritability
  • difficulty sleeping
  • tugging or pulling at one or both ears
  • fever
  • fluid draining from the ear
  • loss of balance
  • unresponsiveness to quiet sounds or other signs of hearing difficulty such as sitting too close to the television or being inattentive

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Can anything be done to prevent otitis media?

Specific prevention strategies applicable to all infants and children such as immunization against viral respiratory infections or specifically against the bacteria that cause otitis media are not currently available. Nevertheless, it is known that children who are cared for in group settings, as well as children who live with adults who smoke cigarettes, have more ear infections. Therefore, a child who is prone to otitis media should avoid contact with sick playmates and environmental tobacco smoke. Infants who nurse from a bottle while lying down also appear to develop otitis media more frequently. Children who have been breast-fed often have fewer episodes of otitis media.

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How does a child's physician diagnose otitis media?

The simplest way to detect an active infection in the middle ear is to look in the child's ear with an otoscope, a lightinstrument that allows the physician to examine the outer earand the eardrum. Inflammation of the eardrum indicates aninfection. There are several ways that a physician checks for middle ear fluid.

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How is otitis media treated?

Many physicians recommend the use of an antibiotic (a drug that kills bacteria) when there is an active middle ear infection. If a child is experiencing pain, the physician may also recommend a pain reliever. Following the physician's instructions is very important. Once started, the antibiotic should be taken until it is finished. Most physicians will have the child return for a followup examination to see if the infection has cleared.

Hearing should be fully restored once the fluid is removed. Some children may need to have the operation again if the otitis media returns after the tubes come out. While the tubes are in place, water should be kept out of the ears. Many physicians recommend that a child with tubes wear special ear plugs while swimming or bathing so that water does not enter the middle ear.

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