Eric Murray – Ear infections – what to do?
October 12, 2009
As Drew watched his 3-year-old son crying and tugging at his ears, he thought back to his own childhood. It seemed he was always being taken to the doctor for an ear infection and then given antibiotic medication.
Now, as then, ear infections are a big problem for pre-school children. It’s the most common reason a child is taken to see a doctor. Now, as then, treatment of ear infections is a dilemma for both doctors and patients. Although they rarely develop into anything serious, ear infections usually lead to a lot of sleepless nights and suffering plus, in some cases, temporary hearing loss at a crucial time in a child’s language development.
The approach toward treating childhood ear infections has changed over the past several decades, however, with a move toward avoiding unnecessary use of antibiotics and surgery.
Based on growing concern about overuse of antibiotics, the American Pediatric Association in 2004 issued guidelines recommending an “observation option” for certain otherwise healthy children with uncomplicated ear infections. In such cases, antibiotics would be withheld for 48 to 72 hours to see if the condition improves on its own. In the majority of cases, it does.
A middle ear infection occurs when fluid builds up behind the ear drum, creating a breeding ground for bacteria. The infection then causes more fluid to accumulate, creating pressure, pain and difficulty hearing. An ear infection is not contagious although it usually follows a cold that is.
Children are more vulnerable than adults to ear infections because 1) their immune systems are still in a stage of development, 2) they have eustachian tubes that are shorter and in a position that is more horizontal than vertical and 3) their adenoids, located nearby, are larger than they are in adults and can become inflamed.
The eustachian tube is a narrow passage that connects the middle ear to the back of the throat behind the nose. When the eustachian tube becomes clogged, such as following a cold, fluid can build up in the middle ear, which is ordinarily filled with air.
As pus and other fluids accumulate, they push on the ear drum, causing pain. When a child tugs at his ear, it’s an attempt to relieve some of this pressure.
The pressure may increase, however, when the child lies down, chews or sucks on a pacifier or bottle. That’s why he’s irritable, eats less than normal and has trouble sleeping. Other symptoms include fever, nausea, vomiting and dizziness.
An ear infection is more than just an ear ache, and in rare instances it can lead to serious complications, particularly in children who have other medical conditions. A trip to the doctor is called for, and it’s understandable that parents expect a prescription for antibiotics.
What parents and children most want at that time is relief from pain, and it’s important for them to understand that antibiotics will have no effect on pain for at least 24 hours and minimal effect after that time. Antibiotic medication will not help a viral (as opposed to bacterial) infection. And it will not eliminate the fluid in the middle ear, which may linger for several weeks, with or without treatment.
Another major reason for the “wait and see” approach is that frequent use of antibiotics can lead to strains of antibiotic-resistant bacteria that can be increasingly difficult to treat. These resistant bacteria are more likely to occur in children who have had numerous ear infections treated with antibiotics.
Whether antibiotics are used or not, the child might be prescribed medication such as acetaminophen or ibuprofen to relieve the pain and fever.
Some youngsters are simply more prone than others to ear infections but parents can minimize a child’s risk by: preventing exposure to second-hand smoke; holding the baby at an angle when bottle feeding rather than allowing the child to lie down with the bottle; practicing good hand-washing hygiene in the household; and limiting a child’s exposure to large groups of children at times when upper respiratory infections are making the rounds.
In one study of children with viral upper respiratory tract infections – colds or flu – 61 percent eventually developed fluid in their middle ears, with or without infection. The best strategy for preventing ear infections in young children is clearly to reduce their exposure to colds and flu.