Ear infections are one of the most common illnesses for which children seek medical treatment. Two thirds of all children will suffer from at least one ear infection by the age of 3 years.
An ear infection, called otitis media, is infected fluid that collects in the middle ear, a cavity behind the eardrum. It is usually associated with pain as well as temporary hearing loss. The pain is frequently more intense when lying down. Fever may be present. Associated symptoms can be irritability, disturbed sleep, headache, nausea and poor balance.
At times, children have non-infected fluid behind the eardrum that is called a middle ear effusion. The fluid may occur with a cold. It can also be present for months after an ear infection has been treated. If bacteria grow in this effusion, it then becomes an ear infection.
The younger child is more prone to ear infections. This is partly based on the structure of the eustachian tube, which connects the middle ear to the throat. Compared to an adult, this tube is shorter and flatter. Its shape and position make it more difficult to drain the naturally produced middle ear secretions into the back of the throat. The eustachian tube also acts as a one way valve to prevent bacteria that line the nose and throat from backing up into the middle ear. It often does not work well in young children.
The common cold is a frequent setup for an ear infection. A major reason young children are more prone to ear infections is that they are more susceptible to common colds. They average 8 to 10 colds a year. Drinking a bottle while lying flat on the back, smoke exposure, allergies and reflux can make your child more prone to ear infections. Breast-feeding helps reduce ear infections.
In the past ear infections were routinely treated with an antibiotic. Research shows that the majority of ear infections will resolve by themselves without treatment and without complications. Antibiotic treatment is most often used to treat ear infections in children younger than two years old, severe ear infections in older children or those not clearing by themselves. Your doctor will decide when and which of the many antibiotics is the most appropriate. Follow-up visits may be recommended to determine if the ear infection has cleared.
Relief from Pain Caused by Ear Infections
Symptomatic relief for the pain associated with an ear infection can be achieved by raising the head of the bed and administering pain medicine such as acetaminophen or ibuprofen. Some pain relief may be achieved by altering the temperature of the ear. This is done by applying a warm water bottle or heating pad to the outside of the ear or by placing a few drops of cold water into the ear canal. Numbing ear drops may be prescribed.
Recurrent Ear Infections
Some children are very prone to ear infections. If your child has more than three infections in six months or four infections in a year, your child's doctor will discuss preventative options. Allergies can be a cause of recurrent ear infections and your child's doctor may want to begin allergy treatments or refer your child for a more formal allergy evaluation. Some children benefit from elimination of milk products from their diet.
Preventative antibiotics are occasionally prescribed to reduce the ear infection frequency. This is used infrequently because of the concerns that continuous use of antibiotics cause infecting bacteria to develop a resistance to the drug and makes future infections harder to treat.
Ventilation Tube Placement
Children who have frequent infections that cannot be controlled with medicines are candidates for a surgery called ventilation tube placement. These tubes are also used if chronic ear fluid is present for more than three months and is associated with significant hearing loss.
This surgery involves making a small cut in the eardrum, draining any fluid and then placing a plastic tube through the hole to keep it open. The tube will gradually fall out.
This type of surgery can drastically reduce the frequency of ear infection as well as restore the hearing loss that was caused by the middle ear fluid. Unfortunately, some children continue to have difficulty even after this type of surgery. If your child becomes a candidate for this procedure, the risks will be fully discussed. Other surgical procedures such as adenoidectomy may be recommended. The benefit of this remains controversial.
Preventing Ear Infections
- Exposure to cigarette smoke has been shown to dramatically increase the frequency of ear infections. If you smoke, try to quit. If you can't quit, eliminate smoke from the house by smoking outside or in only one room that is off limits to your child.
- Don't let your baby drink lying flat on the back. This may allow formula to enter the middle ear, making it a setup for infection.
- Breast-feeding has been shown to reduce the frequency of ear infections
- Limit exposure to germs by good hand washing at home and in the daycare setting