OverviewOtitis media (OM) is inflammation and effusion (fluid, referred to as OME) in the middle ear. It is the second most frequent medical diagnosis for persons of all ages in the United States, and the most frequent medical diagnosis for children under the age of 15 (Schappert, 1992). In 1990, the number of doctor office visits for treatment of OM among children up to age 2 years was 102.1 visits per 100 children per year; for children between 2 and 5 years, the rate was 47.8 visits per 100 children and was 18.2 visits per 100 children between 6 and 10 years old.The middle ear includes the inner surface of the eardrum and three bony ossicles, known as the hammer (malleus), anvil (incus), and stirrup (stapes). The ear funnels sound waves to the eardrum that vibrates as the waves strike its outer surface. The middle ear ossicles vibrate in response to the ear drum vibrations. Their movements pass vibrations to the inner ear, where sense receptors transmit messages to the brain through the acoustic or auditory nerve. The inner ear is connected to the mouth by the eustachian tube and to the outside of the body by the external auditory canal. Inflammation can extend to the eustachian tube and mastoid (the part of the skull just behind the ear). Hearing can be adversely affected by reduced flexibility of the eardrum, reduced mobility of the ossicles, or damage to the ossicles.OM tends to be more prevalent in the winter months when there are increased numbers of upper respiratory (head, nose, throat, and sinus) infections. When the eustachian tube becomes blocked by infection, secretions from the middle ear are prevented from draining, resulting in a negative pressure in the middle ear space. The negative pressure increases the aspiration of secretions from the nose and mouth, resulting in bacterial infections of the middle ear. Young children have shorter and more horizontally placed eustachian tubes than do older children and adults. This results in poorer drainage when they have a cold and the tendency to develop more serious dysfunction of the auditory tube and more frequent infections (Berman & Schmitt, 1995). Additional causes of earaches that are not attributable to OM might include mumps, toothache, external ear infections, and temporomandibular joint dysfunction (Berman & Schmitt, 1995). Environmental risk factors that appear related to increased inci-494