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Earth Day Fun Facts

partysugar — Sun, 22 Apr 2007 00:01:11 -0700

I know some of you secretly love reading my fun facts as much as I do writing them (and acting like a know it all at parties telling people them), so I thought I'd give you a double dosing this week. I believe more and more importance should be placed on Earth Day every year so it's totally worthy of its own set of fabulous fun facts. Did you know that in some elementary schools, after Halloween and Christmas, Earth Day is the third largest celebrated holiday? Or how about that it is now observed in 175 countries and is the largest secular modern day holiday in the world? For more fun facts and to learn how much energy you save when you recycle one aluminum can, read more

Recycling one aluminum can saves enough energy to watch a TV for three hours - it's equivalent to half a gallon of gasoline.
Earth Day is a relatively new holiday and was first celebrated on April 22 in 1970. More than 20 million Americans participated in this first Earth Day celebration
Earth Day was founded by a senator of Wisconsin and the day is credited for creating the environmentalism movement.
April 22 is the first official day of Spring in the Northern hemisphere and of Fall in the Southern hemisphere and was chosen to be Earth Day for this reason.

Never underestimate the importance of recycling: if every newspaper was recycled, we could save about 250,000,000 trees each year. Unfortunately only 27% of all American newspapers are recycled.
More than 20,000,000 Hershey's Kisses are wrapped each day, using 133 square miles of tinfoil. All that foil is recyclable, but not many people realize it.
Only 11% of the earth's surface is used to grow food.
The world's first national park was started in 1872 at Yellowstone National Park in the US.

The first major international conference on environmental issues was held in Sweden in 1972 and was sponsored by the United Nations.
The first wildlife refuge was formed on Pelican Island Florida in 1903.
The patron Saint of ecologists is St. Francis and the first proclamation of Earth Day was made by the mayor of San Francisco in 1970.
A highlight of the annual Earth Day ceremony at the United Nations is the ringing of the Peace Bell that was given to the UN by Japan. It is made from coins given by school children to further peace on our planet.

Happy Earth Day!

Celebrate the Day With an Earth Day Quiz

YumSugar — Tue, 22 Apr 2008 01:01:33 -0700

Happy Earth Day! Whether you plant a garden, or whip up an eco-friendly meal, I hope you have a good one. To celebrate the day, I thought I'd see how much you know about Earth Day. Ready for our fun facts quiz? You can use these little tidbits to impress folks at your next party! Ready? Get started!
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Take the quiz

Want To Look Like Madonna, or at Least Have Skin Like Her?

BellaSugarUK — Mon, 16 Nov 2009 06:10:00 -0800

Just like our bodies need oxygen to be healthy, our skin does too. Enter Michelle Peck, facialist to Madonna, Gwyneth, Jennifer Lopez, Molly Sims, Justin Timberlake and Eva Longoria (just to drop a few names). She started off as a masseuse, however, her career really began to take off when she connected with skincare brand Intraceuticals and began putting her own healing touch on their oxygen treatment called Intraceuticals Infusion.

Those who have experienced Michelle's work, just can't stay away, and I can understand why. After speaking with her at length, not only did I find her to be open, kind and warm, but she is also overflowing with depth, compassion and perspective. Her time spent with famous faces (ehem, she's been on two world tours with Madonna where she gave her a treatment before every single show) has not jaded her one bit. In fact, she is more concerned with the Earth, the human spirit and her charity of choice, Raising Malawi, than with outer beauty.

To learn about the technology behind Intraceuticals treatments, where you can get them in the UK, plus for more about my exclusive interview with Michelle, just read more.

Intraceuticals came to the US about six years ago from Australia and is now available in over 35 countries. Michelle decided to come on board with them and eventually become their spokesperson because she saw something unique in their technology. Never before has there been a brand that combines 95% hyaluronic acid (the connective tissue that keeps skin lubricated and cushioned aka, young looking) mixed with hyperbaric pressure (oxygen under pressure) and 5% of vitamins A, C, E, aloe vera and green tea extract.

Keep in mind that plumping products/treatments like restylane and juvederm are forms of hyaluronic acid, but, you need to inject them into the skin because of the large-sized molecules. However, combined with the hyperbaric pressure, the Intraceuticals molecules are small enough to be driven into the skin with a machine that looks like an airbrush gun.

The entire treatment takes about an hour and are recommended to be done in a series of six every seven to ten days. After that, monthly maintenance is suggested. Sessions with Michelle are £325 each, but can go as low as £150 with other estheticians. Celebrities are so passionate about these treatments because there's no redness afterward, so you can put makeup on within 15 minutes. The end results are instant, but long term results are even better as it helps to minimize pores, tighten, firm, and hydrates the skin at the deepest level. Hey, if Madonna has been a fan for over four and a half years, there must be something to this! And if you want what Madge is having, ask for the Rejuvenation Treatment.

You must travel so much for work, how do you keep your skin looking good? I love serums because they penetrate deeper into my skin than creams.
What's your advice for keeping your skin young and healty? I'm big on staying out of the sun. Some of the most damaged skin I've seen in the world is sun damaged skin. I also use my treatment on the hands, necks and chest.
What's your favourite product? The Opulence Line Wand is great for under eye circles, and the Clarity Line Wand helps dry out blemishes really well.
What other skin care products does Madonna use? Atoxlelene Wand, Eye Gel and Blue Hydration Gel (which is rich in hyaluronic acid). The products support the treatments, but they aren't meant to replace your favourite product line. You can use whatever products you like in addition to ours.
What's your philosophy on beauty? Beauty truly comes from within. I'm very involved in Madonna's charity, Raising Malawi and have been to Malawi often. I find that helping others brings you personal happiness and inner beauty.

Where To Find Intraceuticals Treatments in London:
Although it's not the same as meeting Michelle in person, you can get Intraceuticals treatments at Beauty Works West, Fabiola Face Spa (on the King's Road), The Chelsea Day Spa.

Simply click here for other locations in the UK, and, check out these more budget friendly places for oxygen facials.

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PetSugar Street Team: True Blue Super Fresh Shampoo

PetSugar — Mon, 04 May 2009 06:56:34 -0700

Good thing there are plenty of other dog owners in the office, otherwise North would have a serious case of dandruff! I've been wanting to test out all the shampoos I've had stashed in my desk for a while now, but if I bathe my pup too often, his skin gets flaky and dry. Thankfully, Samson was good and stinky (and needed to be fresh and clean for our Dog Day on the Bay) when I asked LilPeaPod to test out True Blue's Super Fresh Grapefruit and Chamomile Shampoo ($13).

I liked the fact that True Blue was not only detergent-free, but is never tested on animals, is hypoallergenic, and is even safe for the earth - right down to the biodegradable bottle. What did our tester like about this shampoo, besides the fact that it smells divine? Find out if it's anything to bark about, and check out Samson's coat in a before and after when you read more.

LilPeaPod says:
At first sniff, True Blue smells like something out of a fresh botanical garden, but it doesn't overpower your nose. Good thing, since Samson isn't into all that flowery stuff - he prefers grass and dirt over roses and lilies. Getting the shampoo out of the bottle was easy enough (there's nothing worse than straining with wet hands to squeeze product onto your slippery and anxious dog), and it lathered up quite nicely.

With some dog shampoos, I've found that I have to put a ton on him to feel like I'm getting enough lather and coverage, but True Blue went the distance. It even rinsed off really quickly, just like the bottle promised. Plus, it didn't leave a film on his coat, and after he dried off he was silky and shiny, and didn't smell like a wet dog! Fancy that.

Geeks We Love: Kevin Hall of Dvice

GeekSugar — Tue, 10 Feb 2009 13:25:24 -0800

I check in daily with Dvice, not only because of its gadget coverage, but also because of its sweet sci-fi influence. So just in case you aren't familiar (and if not, why?), let me introduce you to one of Dvice's endearingly geeky contributors - and one of this year's Geeks We Love - Kevin Hall. Recent Brooklyn transplant, this geek hottie has traveled the world, seen (almost) everything, and can still say that robots are his favorite thing . . . ever.

GS: Pretend I'm a total stranger (and let's be honest, I pretty much am), and tell me a little about yourself.
KH: Well, I'm a 24-year-old freelancer living in Brooklyn, NY. I'm a transplant, though - I was born in La Jolla, CA, and have lived in Indonesia, Pennsylvania, London, and Texas. After graduating from college, I knew I wanted to write and heard NYC is the place to do it, so I moved here. I was lucky enough to get a shot at blogging for Gizmodo, then started writing for DVICE, and editing a SCI-FI channel blog called Visions For Tomorrow. That's all rather boring stuff, I suppose. What else? My favorite color is orange, I love eating at all of New York's fine burger spots, and I'm probably more into robots than anyone made of flesh should be. Seriously, if technology made it possible to implant my brain into a robotic shell, I'd totally do it.

To see how Kevin appreciates old(er) school technology, what gadget is on his hot list, and why I'd go on a Valentine's date with him any day of the week, just read more.

GS: Are you strictly a gadget type of guy, or are you also a sci-fi nerd and/or gaming geek?
KH: All three, I'd say, though mostly a sci-fi and gaming geek. I love gadgets, but I don't camp in lines for the latest thing. In fact, I've got a fat, old Samsung clamshell for a cell that's maybe 4- or 5-years-old now, and the same 3.2-megapixel Sony Cyber-shot that I had in high school. And when it comes to science fiction, all of my favorite shows have come and gone - Star Trek: TNG, Space Above and Beyond, Cowboy Bebop, Futurama, and Firefly. I do enjoy the new Battlestar Galactica, of course, and I still love Star Wars, despite my love of Star Trek. If it's in space, I'll probably love it. I read more sci-fi than I watch.

Oh, how I love video games. I'd say the titles that define my tastes would be Deus Ex, Myth, Shadow of the Colossus, Halo, Tribes, Guardian Heroes (for the Saturn), Everquest, Anarchy Online, EVE - now that I've started, I really could go on forever. The last game I played was Gears of Wars 2, and that was about 20 minutes ago. And now it's five a.m., so yeah, you can see how I enjoy my gaming!

GS: Do you remember your very first gadget? Mine was a pager. No, really.
KH: I think my first gadget was probably a Game Boy. Growing up overseas, most of the games we had access to were pirated cartridges titled something like "99 games in one," but each one would just have maybe five or 10 ripoffs of Mario and Pac Man and stuff like that. I think I've actually owned almost every iteration of the Game Boy, from the old beloved brick to the niche-y Micro. I guess I'm slowing down in my old age, though, as I didn't run out to replace my first-gen DS with a Lite.

GS: What gadget are you lusting over right now?
KH: Boring answer, I know, but the iPhone. I'm really impressed by it, especially now that the App Store has been blown wide open. I'm not hardcore enough to want a Blackberry, and I hate cellphones too much to be interested by anything else on the market. The iPhone seems to be a good blend of functional phone and handheld computer, and that really appeals to me.

GS: Dvice is a Sci-Fi owned blog, so you must get cool insider scoops, right? You know how Battlestar Galactica ends, don't you?! Tell me! Tell me now!
KH: We get our tie-ins and exclusive content, sure, but I can't say much more than that. The last thing I want is one of the Sci-Fi Channel's Terminators to return from the future and kill me in the middle of this interview.

GS: What would a geeky-cool guy like you want to do for your lady friend on Valentine's Day? Take us through your perfect date.
KH: Well, we'd start out by taking a newly constructed hover train from New York to Germany (yeah, doesn't exist, just roll with it - I love trains), and hit up this restaurant called Baggers, which has fully automated service. Then we'd fly over to Russia and hitch a ride up to the International Space Station for a flashlight-lit (I imagine candles would be dangerous) dessert in zero-gee and some stargazing. I think the brilliance of the Earth from orbit would make a pretty romantic backdrop, so we'd probably ride around for a full orbit, uh, "playing video games," and then it's back to Earth for us. Or - for a creepy alternate ending - she could reveal that she's actually a robot from an alien world and I'd follow her home. Or we could just go to Tokyo - it's my favorite place to visit and it's about as close as you can get to living in the future.

Ear infections

FitSugar — Wed, 08 Oct 2008 17:35:31 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Highlights

Ear Infections

Middle ear (otitis media) infections are very common in young children. They include:

Acute otitis media (AOM) is an inflammation caused by bacteria that travel to the middle ear from fluid trapped in the Eustachian tube. Children with AOM exhibit signs of an ear infection including pain, fever, and tugging at the ear.
Otitis media with effusion (OME) refers to fluid that accumulates in the middle ear without obvious signs of infection. OME usually produces no symptoms, but some children will have difficulty hearing or complain of “plugged up” ears.

Prevention

Preventing colds and influenza (“flu”) is the best way to prevent ear infections. Make sure children wash their hands frequently and receive an influenza vaccine annually. The pneumococcal vaccine is also very helpful for preventing ear infections.

Treatment

Most ear infections resolve without antibiotic treatment.
For most children with AOM, doctors recommend waiting 48 - 72 hours before prescribing antibiotics. However, children younger than 6 months should receive immediate antibiotic treatment. Parents can give children 6 months and older ibuprofen or acetaminophen to help relieve pain.
Antibiotics are not helpful for most cases of OME. Doctors usually monitor children with OME for 3 months to see if their condition improves. Some children with hearing loss and developmental problems may eventually need surgery. Inserting tubes into the ear drum (tympanostomy) is the usual surgery for this problem.

Introduction

The ear is the organ of hearing and balance. It has three parts: the outer, middle, and inner ear.

The outer ear collects sound waves, which move through the ear canal to the tympanic membrane, commonly called the eardrum.
The tympanic membrane, or ear drum, is lined with mucus. When incoming sound waves strike this membrane, it vibrates like a drum, and converts the sound waves into mechanical energy.
This energy echoes through the middle ear. The middle ear is a complex structure filled with air and made of tiny bones. These bones vibrate to the rhythm of the eardrum and pass the sound waves on to the inner ear.
The inner ear is filled with fluid. Here, hair-like structures stimulate nerves to change sound waves into electrochemical impulses that are carried 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.
The Eustachian tube, an important structure in the ear, runs from the middle ear to the passages behind the nose and the upper part of the throat. This tube helps equalizes the air pressure in the middle ear to the outside air pressure. Problems here are primary factors in most cases of ear infection.

The ear consists of external, middle, and inner structures. The eardrum and the three tiny bones conduct sound from the eardrum to the cochlea.

Acute Otitis Media (AOM). An inflammation in the middle ear is known as "otitis media." AOM is a middle ear infection caused by bacteria that traveled to middle ear from fluid build-up in the Eustachian tube. AOM may develop during or after a cold or the flu.

Middle ear infections are extremely common in children, but they are infrequent in adults.
In children, ear infections often recur, particularly if they first develop in early infancy.

Otitis Media with Effusion (OME). This condition occurs when fluid, called an effusion, becomes trapped behind the eardrum in one or both ears, even when there is no infection. In chronic and severe cases, the fluid is very sticky and is commonly called "glue ear."

It is usually not painful. Sometimes the only clue that it is present is a feeling of stuffiness in the ears, which can feel like "being under water."
It may impair children's hearing.
Children who are susceptible to OME can have frequent episodes for more than half of their first 3 years of life.
Most episodes will resolve within 3 months, but 30 - 40% of children may have recurrent episodes. Only 5 - 10% of episodes last longer than 1 year.

Chronic Otitis Media. This condition refers to persistent fluid behind the tympanic membrane without any infection present. It is called suppurative chronic otitis when there is persistent inflammation in the middle ear or mastoids, or chronic rupture of the eardrum with drainage.

Swimmer’s Ear (Acute Otitis Externa). Acute otitis externa (AOE) is an inflammation or infection of the outer ear and ear canal. It can be triggered by water that gets trapped in the ear. The trapped water can cause bacteria to breed. AOE can also be precipitated by overly aggressively scratching or cleaning ears or when an object gets stuck in the ears.

In 2006, the American Academy of Otolaryngology -- Head and Neck Surgery Foundation (AAO-HNSF) issued their first guidelines for management of AOE. A key recommendation is that AOE should be treated with topical (not oral) antibiotics. For pain relief, over-the-counter remedies such as acetaminophen or nonsteroidal anti-inflammatory drugs (such as ibuprofen) usually help, but in severe cases opioid drugs may be prescribed. With eardrops, most cases of AOE will clear up within 2 - 3 days.

Causes

Bacteria. Certain bacteria are the primary causes of acute otitis media (AOM). They are detected in about 60% of cases. The bacteria most commonly causing ear infections are:

Streptococcus pneumoniae (also called S. pneumoniae or pneumococcus) is the most common bacterial cause of acute otitis media, causing about 40 - 80% of cases in the U.S.
Haemophilus influenzae, the next most common culprit, is responsible for 20 - 30% of acute infections.
Moraxellacatarrhalis is responsible for 10 - 20% of infections.
Other bacteria include Streptococcus pyogenes and Staphylococcus aureus.

Viruses. Rhinovirus is a common virus that causes a cold and plays a leading role in the development of ear infections. It is not the direct infecting organism, however. But other viruses, such as respiratory syncytial virus (RSV, a virus responsible for childhood respiratory infections) and influenza (flu), may be the actual causes of some ear infections. Increasing evidence suggests that both viruses and bacteria play a role in ear infections. Viruses can increase middle ear inflammation and interfere with antibiotics’ efficacy in treating bacterial-causes ear infections. HIV or other immunocompromised states also increase the risk for ear infections.

Acute otitis media (middle ear infection) is usually due to a combination of factors that increase susceptibility to infections by specific organisms in the middle ear. The infection typically evolves as follows:

The primary setting for ear infections is in a child's Eustachian tube, which runs from the middle ear to the nose and upper throat. The Eustachian tube is shorter and smaller in children than adults, and therefore more vulnerable to blockage. It is also more horizontal in younger children and therefore does not drain as well.
Changes in middle ear pressure occur in about two-thirds of children with colds. Colds and respiratory infections are caused by viruses, such as the rhinovirus. Viruses play an important role in many ear infections, and can set the scene for a bacterial infection.
However, many bacteria normally thrive in the passages of the nose and throat. Most are not harmful. In fact, some can even block harmful bacteria from getting out of control. An additional defense system in the airways, such as mucus, prevents the harmful bacteria from spreading and infecting deeper passages, such as those in the ear.
If a cold does occur, the virus can cause the membranes along the walls of the inner passages to swell and obstruct the airways. If this inflammation blocks the narrow Eustachian tube, the middle ear may not drain properly. Fluid builds up. The defense systems described above become inefficient, and the fluid becomes a breeding ground for bacteria and subsequent infection.

Respiratory viruses may also contribute directly to the infection. Allergens can also produce inflammation and blockage in the Eustachian tube, which creates an environment favorable to bacteria.

The rise in ear infections has paralleled the increasing incidences of other upper and lower airway disorders such as asthma, allergies, and sinusitis. 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. Data indicate that nearly a third of infants and toddlers with upper respiratory infections go on to develop acute otitis media.

Medical or Physical Conditions that Affect the Middle Ear. Any medical or physical condition that reduces the ear's defense system can increase the risk for ear infections. Children with shorter than normal and relatively horizontal Eustachian tubes are at particular risk for initial and recurrent infections. Inborn structural abnormalities, such as cleft palate, increase risk. Genetic conditions, such as Kartagener's syndrome in which the cilia (hair-like structures) in the ear are immobile and cause fluid build up, also increase the risk. Children with Down syndrome or Fetal Alcohol Syndrome may also be at increased risk due to anatomical abnormalities.

Otitis media with effusion (OME) may occur spontaneously following an episode of acute otitis media. Susceptibility to OME may also be due to an abnormal or malfunctioning Eustachian tube that causes a negative pressure in the middle ear, which allows fluid to leak in through capillaries.

Risk Factors

Acute ear infections account for 15 - 30 million visits to the doctor each year in the U.S. In fact, ear infections are the most common reason why an American child sees the doctor. Furthermore, the rate of acute otitis media has been rising over the past decades.

Acute Otitis Media (AOM). About two-thirds of children will have a least one attack of AOM by age 3, and a third of these children will have at least 3 episodes. Boys are more likely to have infections than girls.

AOM generally affects children ages 6 - 18 months. The earlier a child has a first ear infection, the more susceptible they are to recurrent episodes (for instance, 3 or more episodes within a 6-month period).

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. After age 5, most children have outgrown their susceptibility to any ear infections.

Otitis Media with Effusion. OME is very common in children aged 6 months to 4 years, with about 90% of children having OME at some point. More than 50% of children have OME before the age of 1, and more than 60% by age 2.

Ear infections are more likely to occur in the fall and winter. The following conditions also put children at higher risk for ear infection:

Allergies. Some experts believe that an 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 - 50% of children over 3 years old who have chronic otitis media also have allergic rhinitis (hay fever). Allergies can cause inflammation in the airways, which may contribute to ear infections. Allergies are also associated with asthma and sinusitis. However, a causal relationship between allergies and ear infections has not been definitively established.
Enrollment in day care. 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 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.
Exposure to second-had cigarette smoke. Parents who smoke pose a significant risk for both otitis media with effusion (OME) and recurrent acute otitis media (AOM) in their children. (Passive smoking does not appear to be a cause of initial ear infections, however.)
Being bottle-fed as infants. Babies who are bottle-fed may have a higher risk for otitis media than breastfed babies. The American Academy of Pediatrics recommends breastfeeding for at least the baby's first 6 months.
Pacifier use. Several studies have found that the use of pacifiers place children at even higher risk for ear infections. Sucking increases production of saliva, which helps bacteria travel up the Eustachian tubes to the middle ear.
Obesity. Obesity has been associated with the occurrence of OME.
Having siblings with recurrent ear infections.
Anatomical abnormalities of upper airways.

Symptoms

Symptoms of acute otitis media usually develop suddenly and can include:

Pain or discomfort in the ear. However, it is difficult to determine if an infant or child who hasn't yet learned to speak 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
Sleeplessness
Loss of appetite
Vomiting
Diarrhea
Listlessness

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

Fevers and colds often make children irritable and fussy, so it is difficult to determine if acute otitis media is present as well. Symptoms are not apparent in about a third of children with acute middle ear infection.

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 sign to a parent that the condition exists may be when a child complains of "plugged up" hearing. Other symptoms can include loud talking, not responding to verbal commands, and turning up the television or radio.

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 during a regular pediatric visit.

Prognosis

Doctors should carefully evaluate ear infections in infants fewer than 3 months old, and consider more serious infections, such as meningitis.

While severe cases of recurrent acute otitis media or persistent otitis media with effusion (OME) are associated with impaired hearing for a period of time, the long-term consequences resulting from this hearing loss may not be significant in most children.

Hearing loss in children may temporarily slow down language development and reading skills. However, results from a high quality study strongly indicate that uncomplicated chronic middle ear effusion poses no danger for developmental delays. Researchers evaluated children who had either prompt insertion of ear tubes to drain fluid when they were younger than age 3, or delayed insertion of tubes many months later. When the children were tested at ages 9 - 11, researchers found no differences in speech and language, auditory processing, attention, behavior, social skills, and academic achievement. As the majority of chronic ear effusion cases eventually clear up on their own, many experts now recommend against surgical intervention for most children.

Occasionally, patients with chronic otitis media develop involvement of the inner ear. In these situations hearing loss can potentially be permanent. Most of these patients will also have problems with vertigo.

Serious complications or permanent physical injuries from ear infections are very uncommon, but may include:

Structural damage. Certain children with severe or recurrent otitis media may be at risk for structural damage in the ear, including erosion of the ear canal.
Cholesteatomas. Cysts in the ear called cholesteatomas are an uncommon complication of recurrent or severe ear infections.
Calcifications. In rare cases, even after a mild infection, some children develop calcification and hardening in the middle and, occasionally, in the inner ear. This may be due to immune abnormalities.

Before the introduction of antibiotics, mastoiditis (an infection in the bones located in the skull), was a serious, albeit rare, complication of otitis media. This condition is difficult to treat and requires intravenous antibiotics and drainage procedures. Surgery may be necessary.

If pain and fever persist in spite of antibiotic treatment of otitis media, the doctor should check for mastoiditis. Most cases of mastoiditis are generally not associated with ear infections.

If an infection of the mastoid air cells cannot be controlled with antibiotics, surgery may be needed.

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

Facial Paralysis. Very rarely, a child with acute otitis media may develop facial paralysis, which is temporary and usually relieved by antibiotics or possibly drainage surgery. Facial paralysis may also occur for patients with chronic otitis media and a cholesteatoma (cyst in the middle ear). Surgery is often necessary to correct this condition.

Diagnosis

The doctor should be sure to ask the parent if the child has had a recent cold, flu, or other respiratory infection. If the child complains of pain or has other symptoms of otitis media, such as redness and inflammation, the doctor should rule out any other causes. These may include, but are not limited to, the following:

Otitis media with effusion. OME is commonly confused with acute otitis media. It must be ruled out because it does not respond to antibiotics.
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. A doctor 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.

Instruments Used for Examining the Ear. An ear examination should be part of any routine physical examination in children, particularly because the problem is so common and may not cause symptoms.

The doctor first removes any ear wax (called cerumen) in order to get a clear view of the middle ear.
The doctor uses a small flashlight-like instrument called an otoscope to view the ear directly. This is the most important diagnostic step. The otoscope can reveal signs of acute otitis media, bulging eardrum, and blisters.

An otoscope is a tool that shines a beam of light to help visualize and examine the condition of the ear canal and eardrum. Examining the ear can reveal the cause of symptoms such as an earache, the ear feeling full, or hearing loss.

To determine an ear infection, the doctor should always use a pneumatic otoscope. This device detects any reduction in eardrum motion. It has a rubber bulb attachment that the doctor presses to push air into the ear. Pressing the bulb and observing the action of the air against the eardrum allows the doctor to gauge the eardrum's movement.
Some doctors 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. It can detect fluid and obstruction, but does not require an airtight seal at the canal.

Neither tympanometry nor reflectometry are substitutes for the pneumatic otoscope, which allows a direct view of the middle ear.

Findings Indicating AOM or OME. A diagnosis of AOM requires all three of the following criteria:

History of recent sudden symptoms. Symptoms may include fever, pulling on the ear, pain, irritability, or discharge (otorrhea) from the ear.
Presence of fluid in the middle ear. This may be indicated by fullness or bulging of the eardrum or limited mobility.
Signs and symptoms of inflammation. These may include redness of the eardrum as well as assessment of the child's discomfort. Ear pain that is severe enough to interfere with sleep may indicate inflammation.

AOM (fluid and infection) is often difficult to differentiate from OME (fluid without infection). It is important for a doctor to make this distinction as OME does not require antibiotic treatment. In patients with OME, an air bubble may be visible and the eardrum is often cloudy and very immobile. A scarred, thick, or opaque eardrum may make it difficult for the doctor to distinguish between acute otitis media and OME.

Parents can also use a sonar-like device, such as the EarCheck Monitor, to determine if there is fluid in their child's middle ear. EarCheck uses acoustic reflectometry technology, which bounces sound waves off the eardrum to assess mobility. When fluid is present behind the middle ear (a symptom of AOM and OME), the eardrum will not be as mobile. The device works like an ear thermometer and is painless. Results indicate the likelihood of the presence of fluid and may help patients decide whether they need to contact their child's doctor. However, it is not recommended that children be treated with antibiotics based on the findings using this device.

On rare occasions the doctor 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 an ear, nose, and throat (ENT) specialist, 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.

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 2 years old for hearing problems. One way to determine hearing problems in infants is to gauge the baby's language development:

At 4 - 6 weeks most babies with normal hearing make cooing sounds.
By around 5 months, infants should be laughing out loud and making one-syllable sounds with both a vowel and consonant.
Between 6 - 8 months, babies should be able to make word-like sounds with more than one syllable.
Usually starting around 7 months, and by 10 months, babies babble (making many word-like noises).
Around 10 months, babies can identify and use some term for a parent, such as dada, baba, or mama.
Babies speak their first word usually by the end of their 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 3 feet away.
They may have difficulty following directions.
Their vocabulary may be limited.
They may have social and behavioral problems.

Prevention

The best way to prevent ear infections is to prevent colds and flu.

Good Hygiene. Colds and flus are spread primarily when an infected person coughs or sneezes near someone else. A very common method for transmitting a cold is by shaking hands. Everyone should always wash their hands before eating and after going outside. Ordinary soap is sufficient. Waterless hand cleaners that contain an alcohol-based gel are also effective for everyday use and may even kill cold viruses. (They are less effective, however, if extreme hygiene is required. In such cases, alcohol-based rinses are needed.) Antibacterial soaps add little protection, particularly against viruses. In fact, one study suggests that common liquid dish washing soaps are up to 100 times more effective than antibacterial soaps in killing respiratory syncytial virus (RSV), which is known to cause pneumonia and has been associated with ear infections. Wiping surfaces with a solution that contains 1 part bleach to 10 parts water is very effective in killing viruses.

The American Academy of Pediatrics (AAP) and the U.S. Centers for Disease Control (CDC) recommend annual influenza vaccination for all children 6 months to 5 years of age. Preventing influenza (the "flu') may be a more important protective measure against ear infections than preventing bacterial infections. For example, studies report that children who are vaccinated against influenza experience a third fewer ear infections during flu season than unvaccinated children.

Flu Vaccines. Flu vaccines produce an immune response that attacks the active virus. Vaccines are typically given by injection, usually between October and December. Antibodies to the influenza virus generally develop within 2 weeks of vaccination, and immunity peaks within 4 - 6 weeks, then gradually wanes. An intranasal vaccine called FluMist is approved for children ages 2 years and older. FluMist is made from a live but weakened influenza virus; flu shots use inactivated (not live) viruses. Children younger than 2 years old, and children younger than age 5 who have asthma or recurrent wheezing, should not receive FluMist.

Possible side effects include:

Allergic Reaction. Newer vaccines contain very little egg protein, but an allergic reaction still may occur in people with strong allergies to eggs.
Soreness at the Injection Site. Up to two-thirds of people who receive the influenza vaccine develop redness or soreness at the injection site for 1 - 2 days afterward.
Flu-like Symptoms. Other side effects include mild fatigue and muscle aches and pains. They tend to occur between 6 - 12 hours after the vaccination and last up to 2 days. 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.

Antiviral Drugs. Antiviral drugs are available to treat influenza. One such drug, oseltamivir (Tamiflu), is approved for use in children age 1 year and older. Studies report significant reduction in symptoms and in the incidence of ear infections with this drug. In another study, when the antiviral drug, zanamivir (Relenza), was administered in the nasal passages of adults with influenza, middle ear abnormalities were reduced by more than half, to 32%. This drug is available for children older than 7 years for treatment of influenza, but no research has determined its value for preventing or treating otitis media in children.

[For more information, see In-Depth Report #94: Colds and influenza.]

Preventive Antibiotics. Antibiotics have been used to prevent bacterial infections in children with recurrent ear infections (4 or more episodes a year). Studies suggest, however, that overall they only prevent 1 episode a year, and are not generally recommended for prevention, except for specific situations.

Pneumococcal Vaccine. The pneumococcal conjugate vaccine (PCV) protects against S. pneumoniae (also called pneumococcal) bacteria in children, the most common cause of middle ear infections, pneumonia, and other respiratory infections. It is included in the Recommended Childhood Immunization Schedule and is specifically approved for preventing otitis media. High quality evidence indicates these vaccinations could result in over 1.5 million fewer office visits, over 20% fewer procedures for tube implants, and significantly fewer antibiotic prescriptions. The recommended schedule of pneumococcal immunization is four doses, given at 2, 4, 6, and 12 - 15 months of age.

Still, the pneumococcal vaccine does not completely protect against otitis media. The current pneumococcal vaccine does not protect against all subtypes of S. pneumoniae. Also, other types of bacteria can cause the problem. Scientists are working on developing a new type of pneumococcal vaccine that combines S. pneumoniae and H. influenzae strains that are not influenced by the currently available H. influenzae vaccine. Researchers hope this investigational vaccine may eventually help prevent middle ear infection caused by these organisms.

Healthy Diet. Daily diets should include foods such as fresh, dark-colored fruits and vegetables, which are rich in antioxidants and other important food chemicals that help boost the immune system.

Probiotics ("Good" Bacteria). Researchers are studying the possible protective value of certain strains of lactobacilli, bacteria found in the intestines. Some of these strains, particularly acidophilus, are used to make yogurt. Studies have been mixed on probiotics’ benefits for preventing ear infections.

Xylitol. Xylitol, a sugar alcohol produced naturally in birch, strawberries, and raspberries, has properties that fight Streptococcal pneumonia bacteria. A few studies have reported that children who chew gum or swallow a syrup containing xylitol experience fewer ear infections, but other studies have not shown that xylitol is helpful.

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.

Breastfeeding offers protection against many early infections, including ear infections. Mother's milk provides immune factors that help protect the child from infections. Also, infants are held during breast-feeding in a position that allows the Eustachian tubes to function well. In addition, a 2006 study suggested that breastfeeding can help protect even those children who are genetically susceptible to ear infections.

If possible, new mothers should breast-feed their infants for at least 4 - 6 months. According to the American Academy of Pediatrics, exclusively breast-feeding for a baby’s first 6 months helps to prevent ear and other respiratory infections. For bottle-fed babies, to improve protection mothers should not lay babies down with their bottle; they should hold the infants in the same way they would to breast-feed them.

Treatment

Treatments for ear infections cost the U.S. $3 - 4 billion each year, and many of these treatments, particularly heavy antibiotic use and surgical procedures, are often unnecessary in many children.

Experts continue to argue about the best approach for treating ear infections. The major debates rest on the use of antibiotics, surgery, and watchful waiting in both acute otitis media (AOM) and otitis media with effusion (OME).

Until recently, nearly every American child with an ear infection who visited a doctor received antibiotics. In one region of the U.S., more than 70% of children received antibiotics before they were 7 months old, and the most common reason for these medications was acute otitis media.

Major studies now indicate that antibiotics are unnecessary in most cases of acute otitis media. Between 80 - 90% of all children with uncomplicated ear infections recover within a week without antibiotics. Likewise, receiving antibiotics for an acute ear infection does not seem to prevent children from having fluid behind the ears after the infection is cleared up. Antibiotics are rarely recommended for otitis media with effusion.

Antibiotic Resistance. The intense and widespread use of antibiotics is leading to a serious global problem of bacterial resistance to common antibiotics. In the U.S., nearly a quarter of S. pneumoniae are currently resistant to at least three antibiotics. High rates of resistance strains are even being observed in infants. In general, regions and institutions with the highest rate of resistance are those in which antibiotics are the most heavily prescribed.

Watchful Waiting for AOM. Because of the high rate of antibiotic resistance, and the fact that non-severe AOM usually resolves on its own without antibiotics, many pediatric guidelines recommend a “watchful waiting” period before antibiotics are prescribed. Current guidelines released by the American Academy of Pediatrics and the American Academy of Family Physicians recommend an initial observation period of 48 - 72 hours for select children. Pain relief can initially be given with acetaminophen (Tylenol), ibuprofen (Advil), or topical benzocaine drops.

If there is no improvement or symptoms worsen, parents can schedule an appointment with the child's doctor to determine if antibiotics are needed. (Parents should contact the doctor within the first 24 hours if their child is 6 months or younger and has fever or other severe symptoms.) Another option is to ask the doctor for a Safety Net Antibiotic Prescription (SNAP) that can be filled if symptoms do not improve within 48 - 72 hours

While children with non-severe AOM given antibiotics may recover slightly more quickly, they often have a high number of side effects and antibiotic-resistant bacterial strains. Studies have found that giving parents the option of delaying antibiotic treatment helps to reduce the unnecessary use of antibiotics without causing any health problems for the children. Unfortunately, surveys indicate that although medical guidelines recommend watchful waiting, few doctors regularly practice it.

The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) guidelines and recent evidence support the following recommendations:

Accurate diagnosis of AOM including differentiation from OME.
Children fewer than 6 months of age should receive immediate antibiotic treatment.
Children 6 months or older should be treated for pain within the first 24 hours with either acetaminophen or ibuprofen.
An initial observation period of 48 - 72 hours is recommended for select children to determine if the infection will resolve on its own without antibiotic treatment. (Most children do improve within 72 hours.)
For children aged 6 months - 2 years, criteria for recommending an observation period are an uncertain diagnosis of AOM and a determination that the AOM is not severe. For children older than 2 years, the observation period criteria are non-severe symptoms or uncertain diagnosis. Severe AOM symptoms include moderate to severe pain and a fever of at least 102.2° F (39° C).
Antibiotic prophylaxis may be recommended for recurrent acute otitis media. Which children should be treated this way, as well as which antibiotics and for how long, have not been clearly determined.

The American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) released updated clinical practice guidelines for OME in 2004. These guidelines include the following treatment recommendations:

Watchful Waiting for OME. The child is typically monitored for the first 3 months. Antibiotics are not helpful for most patients with OME. For one, the condition resolves without treatment in nearly all children, especially those whose OME followed an acute ear infection. About 75 - 90% of OME cases that result from AOM resolve within 3 months. If OME last longer than 3 months, a hearing test should be conducted. Even if OME lasts for longer than 3 months, the condition generally resolves on its own without any long term effects on language or development and intervention may not be necessary. The doctor will re-evaluate the child at periodic intervals to determine if there is risk for hearing loss.

Drug Treatment. It is important for parents to recognize that persistent fluid behind the eardrum after treatment for acute otitis media does not indicate failed treatment. Antibiotics, decongestants, antihistamines and corticosteroids do not help and are not recommended for routine management of OME. These drugs are not effective for OME, either when used alone or in combination. Antihistamines and decongestants may cause more harm than good by provoking side effects such as stomach upset and drowsiness. At present, there is no compelling evidence to indicate that allergy treatment can assist with OME management nor has a causal relationship between allergies and OME been established.

Surgery. The decision to pursue surgery must be determined on an individual basis. Children with OME lasting longer than 4 months may be considered candidates for surgery if they have:

Hearing loss greater than 40 dB
Hearing loss between 21 - 39 dB (Children in this group may be observed or considered for surgery)
Hearing loss of 20 dB or less, when speech, language, or developmental problems are observed
OME and structural damage to the ear canal, eardrum, or middle ear

Tympanostomy (the insertion of tubes into the eardrum) is the first choice for surgical intervention. Adenoidectomy (removal of adenoids) plus myringotomy (removal of fluid), with or without tube insertion, is sometimes recommended as a repeat surgical procedure. (Myringotomy alone is not recommended for OME treatment. Between 20 - 50% of children who undergo this procedure may have OME relapse and need additional surgery). Tube insertion may be advised for children younger than 4 years of age. Adenoidectomy is not recommended as an initial procedure unless some other condition (chronic sinusitis, nasal obstruction, adenoiditis) is present.

Tonsillectomy (removal of tonsils) is not recommended for OME treatment.

Home Remedies

Careful monitoring of the child's condition (watchful waiting) along with home remedies may be a viable alternative to antibiotic treatment for many children with a first episode of acute otitis media. However, in some situations parents should contact their medical professional immediately:

Seek immediate medical attention for high fever, severe pain, or other signs of complications.
Parents of infants should contact their doctor immediately if they have any fever, regardless other symptoms.

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 again popular.

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.
Due to the high risk of burns, ear candles should not be used to remove wax from ears. There is no evidence to indicate that these candles are safe or effective for treatment of AOM or other ear conditions.

Herbal remedies are not standardized or regulated, and their quality and safety are largely unknown. Parents should never give their child herbal remedies, including oral remedies, without approval from a doctor.

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.
The child 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 eardrum could be harmed.

Do not use this technique if an infection is present.

A number of pain relievers are available to help relieve symptoms.

Either acetaminophen (Tylenol) or ibuprofen (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 anesthetics (Auralgan) are also available by prescription. Auralgan provides short-acting pain relief and may help children endure ear discomfort until an oral pain reliever takes effect. Parents should check with a doctor 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 syndrome, a very serious condition, have been associated with aspirin use in children who have chicken pox or flu.

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 (either oral or nasal sprays or drops), antihistamines, or combination product. Their use is not recommended for AOM or OME. Recent research has questioned the general safety of these products and they are currently banned for use in children under age 2 years.

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.
Some doctors recommend that children with implanted ear tubes should use earplugs or cotton balls coated in petroleum jelly when swimming to prevent infection. Others say earplugs are only necessary if the child will be diving underwater. Parents should consult their child's doctor.

Medications

When antibiotics are needed, a number of different classes are available for treating acute ear infections. Amoxicillin is a penicillin antibiotic and the drug of first choice. Other antibiotics are available for children who are allergic to penicillin or who do not respond within 2 - 3 days.

Duration. If a child needs antibiotics for acute otitis media, experts recommend they be taken for the following periods of time:

A 10-day course of antibiotics is usually recommended for children younger than 6 years of age, and for those with severe AOM.
Antibiotic therapy for 5 - 7 days is recommended for children 6 years of age or older with mild-to-moderate symptoms.

Parents should be sure their child finishes the entire course of therapy. Failure to finish is a major factor in the growth of bacterial strains that are resistant to antibiotics.

What to Expect. Earaches usually resolve within 24 hours after taking an antibiotic, although about 10% of children who are treated do not respond. This may occur when a virus is present or if the bacteria causing the ear infection is resistant to the prescribed antibiotic. A different antibiotic may be needed.

In some children whose treatment is successful, fluid will still 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. Antibiotics should not be used to treat residual fluid.

Follow-Up. Your child should return to the doctor's office:

Two to 3 weeks after therapy, if initial therapy cleared up the infection and the child is less than 15 months old, or has risk factors for reinfection
Three to 6 weeks after treatment, if initial therapy cleared up the infection and the child is older than 15 months old and has no specific risk factors
Within 48 hours of taking the last antibiotic dose if signs of infection are still present (for example, there is still pus in the ear)

When suspecting complications, consult with an ear, nose, and throat specialist (otolaryngologist) . This specialist 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.

The selection of an antibiotic is determined in part by the severity of the child's condition as well as a history of response/non-response to antibiotic therapy. Treatment decisions take into account whether the child's condition is severe or non-severe.

Amoxicillin is generally recommended for first-line treatment of AOM. The combination drug amoxicillin-clavunate is prescribed for patients who have severe pain or a fever higher than 102.2° F(39° C). Other drug classes may be prescribed if a child is allergic to penicillin or does not respond to the initial therapy.

The following treatment guidelines provide general recommendations based on the severity of a child's AOM.

First-line treatment for non-severe AOM:

Amoxicillin 80 - 90 mg/kg per day orally. Amoxicillin is a penicillin antibiotic.

If the patient has an allergy or a history of non-response to penicillin drugs, one of the following antibiotics may be prescribed:

Azithromycin or clarithromycin. These drugs are in the macrolide class and are administered orally.
Cefdinir, cefuroxime, or cefpodoxime. These drugs, classified as cephalosporins, are taken by mouth. They may cause reactions in penicillin-allergic patients.

If the patient does not respond to amoxicillin or alternative antibiotic drugs after 48 - 72 hours, one of the following drugs may be prescribed:

Amoxicillin-clavulanate, clindamycin, or ceftriaxone. Ceftriaxone is injected intramuscularly. The other two drugs are administered orally. Each of these drugs is a different type of antibiotic. Amoxicillin-clavulanate (Augmentin) is classified as a penicillin; ceftriaxone (Rocephin) is a cephalosporin; clindamycin (Cleocin) is a lincosamide.

First-line treatment for severe AOM:

Amoxicillin-clavulanate (Augmentin). This antibiotic is known as an augmented penicillin. It works against a wide spectrum of bacteria and is administered orally.

Second-line treatment for severe AOM:

Ceftriaxone. Ceftriaxone (Rocephin) is an injectable cephalosporin that may be prescribed as an alternative to amoxicillin-clavulanate, especially for children who have vomiting or other conditions that hamper oral administration.
Tympanocentesis or clindamycin. Patients with severe AOM who have failed to respond to amoxicillin-clavulanate after 48 - 72 hours may require the withdrawal of fluid from the ear (tympanocentesis) in order to identify the bacterial strain causing the infection. If tympanocentesis cannot be performed, clindamycin may be prescribed orally to treat penicillin-resistant pathogens that have not responded to prior drug therapy.

The most common side effects of nearly all antibiotics are gastrointestinal problems, including cramps, nausea, vomiting, and diarrhea. This can be a significant problem in infants and small children. One study reported that giving such children a soy-based formula that contained fiber (Isomil DF) was helpful in reducing these side effects.
Amoxicillin use during infancy may lead to enamel defects and discolorations of permanent teeth.
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. Parents should tell the doctor about all medications their children are taking.

Surgery

A tympanostomy involves the insertion of tubes to allow fluid to drain from the middle ear. The procedure involves:

A general anesthetic (asleep, no pain). Children typically recover completely within a few hours.
Myringotomy (removal of fluid) is performed first.
After myringotomy, the doctor inserts a tube to allow continuous drainage of the fluid from the middle ear.

Click the icon to see an illustrated series detailing ear tube insertion.

Postoperative Effects. Tympanostomy is a simple procedure, and the child almost never has to spend the night in the hospital. Acetaminophen (Tylenol) or ibuprofen (Advil) is sufficient for any postoperative pain in most children. Some children, however, may need codeine or other powerful pain relievers.

Generally, the tubes stay in the eardrum for at least several months before coming out on their own. On rare occasions, they will need to be surgically removed.

Complications. Otorrhea, drainage of secretion from the ear, is the most common complication after surgery and can be persistent in some children. It is usually treated with antibiotic eardrops. One study suggests that wearing earplugs may help the problem.

More serious complications from the operation are very uncommon, but may include:

General anesthetic risks. Rarely, allergic reactions or other complications, such as throat spasm or obstruction, may occur. The risk is highest in children who have other medical conditions, most commonly upper respiratory infections, lung disease, or GERD. Anesthetic-related risks are nearly always easily treated.
Tube blockage. Sometimes the tubes become blocked from sticky secretions or clotted blood after the operation.
Persistent eardrum perforation. This condition occurs when the eardrum does not close after the tubes have come out. It is the most common serious complication, but it is very rare.
Scarring can also occur, particularly in children who need more than one procedure, but it almost never affects hearing.
Small keratin (skin cell) containing cysts called cholesteatomas develop around the tube site in around 1% of patients.

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. Persistent fluid is the main reason for continued impaired hearing. Only a small percentage of hearing loss cases can be attributed to complications of the operation itself.

Earplugs as a Precaution. Many doctors feel that children should use earplugs when swimming while the tubes are in place in order to prevent infection. Others feel that as long as the child does not dive or swim underwater, earplugs may not be necessary. Parents should talk to their child's doctor about this subject. Cotton balls coated with petroleum jelly are effective alternatives to ear plugs. Children do not need to wear earplugs while showering.

Follow-Up. Eventually, the tubes fall out as the hole in the eardrum closes. This may happen after several months or more than a year later. It is painless. In fact, the patient and parents may not even be aware that the tubes are out.

About 20 - 50% of children may have OME relapse and need additional surgery that involves adenoidectomy and myringotomy. Tube reinsertion may be recommended for children younger than 4 years of age.

Myringotomy is used to drain the fluid and may be used (with or without ear tube insertion) in combination with adenoidectomy as a repeat surgical procedure if initial tympanostomy is not successful. It is not effective as a sole surgical procedure. Myringotomy 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.

Adenoids are collections of spongy lymph tissue in the back of the throat, similar to the tonsils. Removal of the adenoids, called adenoidectomy, is usually only considered for OME if a pre-existing condition exists such as chronic sinusitis, nasal obstruction, or chronic adenoiditis (inflammation of the adenoids). Unless these conditions exist, adenoidectomy is not recommended for treatment of OME.

Adenoidectomy plus myringotomy (removal of fluid) may be performed if an initial tympanostomy (tube insertion) procedure is unsuccessful in resolving OME. This combination procedure works best in children ages 4 years or older. Tube insertion is recommended for children under 4 years of age. It is not necessary to perform an adenoidectomy along with tube insertion for children under 4 years of age.

Click the icon to see an image of the adenoids.

Laser-assisted myringotomy is a technique that is being investigated as an alternative to conventional tympanostomy and myringotomy. At present, there is not enough evidence to say whether it is as good as ear tubes, the standard procedure. Some clinical trials have suggested that the success rate for laser-assisted myringotomy is half that of standard tympanostomy/myringotomy. Many insurance companies consider laser-assisted myringotomy to be an investigational procedure and will not pay for it.

Resources

www.nidcd.nih.gov -- National Institute on Deafness and Other Communication Disorders
www.aap.org -- American Academy of Pediatrics
www.entnet.org -- American Academy of Otolaryngology, Head and Neck Surgery

References

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Review Date:
2/19/2008
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Interview With Celebrity Apprentice's Annie Duke, Part I

SavvySugar — Thu, 26 Feb 2009 07:15:16 -0800

The second season of The Celebrity Apprentice premieres this Sunday and the previews have made me excited to watch. It's a diverse crowd of candidates this year, and I was lucky to chat with Annie Duke of professional poker fame. She's a sharp, funny, mother-of-four, and for a highly successful woman who has coached other celebrities like Matt Damon and Ben Affleck on their poker games, she is incredibly down to earth.

Annie said that she had huge hesitations about saying yes to the show because she never had interest putting herself out there on national TV more than she already does, but once she found out that she could raise money for charity by playing a game, she couldn't say no. As the co-founder of Ante Up For Africa she said, "Here’s a chance, because people know who I am, to do something really good. Not just for my charity but for other people’s charities. Every week of that show, some charity is going to benefit. I just thought it would be a really cool thing to be a part of. I would have been more enthusiastic had I known that in advance, but I’m really glad that I did it."

To see some of Annie's responses to a couple of Savvy questions and learn what Donald Trump is looking for, read more.

SavvySugar: Did your ability to read people come into play?

Annie Duke: The structure of the game is really interesting. On a game like Survivor, your teammates vote, on Dancing With the Stars, America votes. In this situation it’s one guy. You don’t have to worry so much about whether or not your teammates like you because in the end it just matters if Trump is pissed off at you. It’s a game of competence. In Survivor, it’s important you don’t appear too competent. But on The Celebrity Apprentice it's extremely important you appear competent for two reasons: Number one, Trump needs to think you’re competent, and number two, if your team wins you don’t face the board room and no one on your team wants to face elimination. It’s a very unusual game because you don’t have to hide your competence, in fact you have to show it off. After I found out I'd be on the show, I watched the entire first season - I didn’t just watch it, I paused and went backward and forward, analyzed everything. Watched how the challenges went, what part of the challenges tended to get you on the chopping block. If you do too much or not enough, it can get you there. I watched how bad it was not to defer to your project manager. I really strategically analyzed the first season and I was extremely regretful I hadn’t watched it because it’s an extremely interesting show - because it’s a show about competence.

SavvySugar: What else is Trump looking for?

Annie Duke: Controversy. But if you're controversial for no apparent reason you’re not going to win the game. Omarosa is a good example – all she did was pick fights with people and that was a good strategy to get her to the middle of the game. Take someone like Piers, he was controversial because he was direct and spoke his mind, but he backed it up every time. And that’s the better kind of controversy. If you’re a quiet little mouse, you’re going to be in big trouble on that show. Trump likes fireworks. He eggs people on. I saw situations in the first season where it seemed obvious that one person was wrong, like when Omarosa reamed at Piers the whole day talking about his kids and talking about what kind of father he was. That was a situation when there was one person clearly in the right and one clearly in the wrong. I was impressed that he kept his cool, but when they went into the boardroom Trump was like, 'Why are you such a jerk Piers?'. He certainly knows what makes good TV.

Check out what Annie had to say about the other candidates and her feelings about the show's March 1 premiere in tomorrow's post on SavvySugar. For more information on Annie Duke, check out her website.

Photo courtesy of Charles William Bush

Jeff: "Nothing Is Too Surprising on the Show"

partysugar — Fri, 30 Jan 2009 08:00:12 -0800

On Top Chef, Jeff seemed like a pretty strong competitor. However, I wasn't surprised to watch Padma ask the blond to pack his knives and go. I spoke with Jeff yesterday, and he's still incredibly disappointed by his dismissal from the show. He spoke candidly about his relationship with Fabio and openly expressed his opinion of Toby Young. To find out what the chef, who's currently working at the Ritz Carlton in South Beach, had to say, read more.

On his elimination: Everyone is a little upset when they get kicked off. Watching it was just a reminder. It's definitely something I will remember for awhile.

I wouldn't change my cooking style, but I was pretty let down. I thought I would have at least made it to the finale. It was really hard. You're cooking, you're stressed out. You're away from home not using your own toothbrush. You're always on your feet. You're out of your element, then before you know it, you got kicked off before you were ready to go.

On Fabio's dish: I thought Fabio was going to go. I was surprised. The judges kept saying to him: You overcooked this. You over dressed that. Scott said something about cheddar cheese not working with the dish. There were four main points that they didn't like about Fabio's dish. They didn't really even critique my dish. They never said, "oh it had too much salt, or tasted to sweet." They said, "you gave me a watered down version of ceviche." I didn't even use water in the dish, so I didn't know how to take the response. I guess I thought I was going to scoot behind that one. There was a little feeling in the back of my throat that I might go home, but it was small.

On competing against the All-Stars from previous seasons: It was different. Nothing is too surprising on the show. They could tell you to run off into the forest and hunt a unicorn and cook it on a grill. And we would do it. It was good to work with them. It was fun to meet the people from the old show.

On the judges: I liked Toby Young. I thought he was very intelligent. I did some research on him after the show. He's a very smart guy. He pulled out the drama and had big character. He had some important, witty things to say. He's definitely quick. There was plenty of people who didn't like him. They were scared of him. He made a lot of harsh comments that those chefs will carry around for awhile. Tom and Gail give critiques: too much salt, did you taste this/not taste this? Toby is good TV. The things he said are funny - unless you are on the other end of it. Padma is very intelligent. She has a great palate. She serves her purpose. She always liked my food: the spices and different elements I brought to the table, the fact that I cook globally, that I do a lot of different cuisines.

On Fabio: Fabio is a good friend of mine. I just saw him recently. He's a good guy. He's hilarious. He just finished a book and so did I. He's been helping me with that, to get it to a publisher. He was a great roommate. Did you know he cuts his own hair?

On who should win: I think everyone has the potential to win. Hosea and I became good friends. Hosea is the underdog. He's lost his focus and I am pulling for him. I hope he gets his head back in the game. No one can be underestimated. Everyone is definitely talented.

On his future: I just bought a house. I'm cooking at the Ritz Carlton. Hopefully the book will do well. It's called The Natural Course. It comes out this June. It's about cooking with organics. Taking what the earth gives you to make food. There is a lot on savory sorbets. I plan on staying here and cooking. I'm not going to try and open my own restaurant right now. It's not the day. Today isn't the day. Miami just had a lot of new restaurants open. The economy isn't good. Maybe 4 to 5 years down the line. I definitely want to do TV again. I'm happy right now, but if something comes along, who knows?

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Victoria Beckham Smiles and Gets Tons of Celebrity Praise

Molly — Fri, 05 Dec 2008 08:30:00 -0800

Victoria Beckham is taking the world by storm, again. Her new dress line sold out before it even hit the racks and, lucky her, she needs no model or celebrity face other than herself to sell her sexy, sultry, sophisticated brand. This time she's posing on the cover of Harper's Bazaar talking in her usual down to earth way and earning some awesome compliments from Heidi Klum to Marc Jacobs and more. Here are highlights:

On her persona: "I go into hair and makeup, and I turn into 'Victoria Beckham.' I'll try on all my dresses, and I'll pick out a handbag, and I'll put on the shades. I instantly turn into this person, and it sort of feels like a character. And there are so many pictures of it. . . But it's a true character because it's still me. . . If I go to the supermarket looking like sh*t, that affects my work. I am selling an image. Plus, I have fun with it."
On posing: "I have started smiling. I've mastered this smirk; it's a smile that isn't a smile. . . I used to get so nervous, and when I got on the red carpet, I'd freeze up. I've had so many things said about me over the years, like a public bullying. . . The older you get, the more comfortable you become with yourself, and you accept what you have physically. Also, the fact that my business is doing very well" - she smiles - "makes me feel a little more confident, too."
On having another baby: "I'm such a girl's girl. I walk into my closet and go, 'Crikey!' To one day hand that down to another girl ..." But no, she is not pregnant. "You get a little water retention; it's not news. Me, Katie [Holmes], Eva [Longoria], and Kate [Beckinsale] always joke about how one of us is allegedly pregnant, but no, we're just a little bloated today! None of us is pregnant."

To see what she has to say about her engagement to David and feelings about the paparazzi just read more.

On her engagement: "It was a really happy time. We've had a lot of ups and a lot of downs. We've been married for nine years. I love him more now than when I first met him." She pauses. "Back then, there was a certain innocence. I look back and think if only I knew then what I know now. I've toughened up a lot."
On the paparazzi: "I don't complain about paparazzi because I've put myself in that position, and so has David. But I always say to the boys, someone is going to take your picture because you're handsome or you're smart or because you're so good at soccer. But every now and again, Romeo might pick up one of David's cameras and say, 'Victoria, Victoria, over here!' And his attitude is sort of angry."

View 5 Photos ›

Image credit: Peter Lindbergh for Harper’s Bazaar

Do Brunettes Make Better Wives?

BellaSugar — Mon, 03 Nov 2008 07:00:51 -0800

How about blondes - do they make better girlfriends? Well, yes and yes. At least that's what the results of a new survey say. According to British hairstylist Andrew Collinge, whose company polled 3,000 men, "When it comes to marriage, men seem to opt for brunettes as they see them as more dependable and down-to-earth."

We've all heard the expression that blondes have more fun, and in this case, that means more dates, but does it also mean a walk down the aisle? Survey says. . . no. In fact, more than half of the blokes said that brunettes were marriage material due their dependable and sensible natures.

Let's get real, though: This type of thinking is antiquated. We all know it's really what's on the inside that matters (at least that's what mama always said). And as Collinge so wisely advises, "At the end of the day, men marry a person, not just a head of hair." I've got to agree with that - so what's with these surveys in the first place? For another viewpoint, check out BellaSugarUK's take.
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