The most common bacterial illness in children accounting for millions of doctor visits each year is otitis media — a middle ear infection. Acute otitis media typically occurs during or after a cold, upper respiratory infection or bout with allergies when the Eustachian tube that connects the middle ear to the throat becomes swollen and traps fluid. The fluid can cultivate bacteria or viruses, causing an infection.
Is there any way to protect your child from this potentially painful illness? How do you know if treatment is needed? We spoke with Swedish Otolaryngologist Linnea Peterson, M.D. who helped us separate fact from fiction regarding middle ear infections.
There is no way to avoid repeated ear infections; they’re just a part of childhood.
- “Though it’s true that otitis media is one of the most common childhood ailments, parents can take steps to reduce their child’s risk,” says Dr. Peterson. “Consider breast feeding, as breast fed babies tend to have fewer infections. And, if your child does use a bottle, don’t let them fall asleep with it.” Certain vaccinations are also helpful in preventing ear infections. “The H. influenza vaccine, which is a routine childhood vaccination, is particularly beneficial,” explains Dr. Peterson. “The seasonal flu and pneumococcal vaccines may also provide protection.”
Some children are more susceptible to ear infections.
- “Children in general are more susceptible to ear infections than adults due to the size and position of their Eustachian tubes, and larger adenoids that affect the function of the tubes.” Dr. Peterson says. “Some children have an even greater chance of developing infections due to risk factors such as: exposure to smoke; exposure to viral infections in a group setting like daycare; and a family history of or genetic predisposition to ear infections.”
If there is no ear pain, my child probably doesn’t have an ear infection.
- Pain is the most common symptom of otitis media, but it’s not the only one. “Loss of appetite; trouble sleeping; a temperature up to 104°F; yellow, white or blood-tinged drainage that may have a bad odor; and difficulty hearing are also symptoms,” explains Dr. Peterson. If your child is not old enough to tell you their ear hurts, irritability or crying, especially during feeding, may indicate an infection. Difficulty hearing due to fluid usually subsides within three months when the fluid drains from the middle ear. Fluid that persists longer than three months is called serous otitis media and may have no apparent symptoms other than reduced hearing. “It’s important to recognize and monitor persistent fluid to avoid a prolonged period of hearing loss or damage to the eardrum,” Dr. Peterson advises.
Ear infections should be treated immediately with antibiotics.
- “For mild episodes of acute otitis media, many physicians are recommending ‘watchful waiting’ where parents are given a prescription and asked not to fill it unless symptoms are the same or worse after 48 to 72 hours,” describes Dr. Peterson. “Many infections will resolve on their own, and this approach, typically used in children older than age two, helps reduce unnecessary antibiotic use.” Dr. Peterson adds that symptoms can be alleviated with at-home treatments like warm compresses, acetaminophen or ibuprofen, and anesthetic ear drops. “If there are significant symptoms like pain or high fever, or early progression of the infection, antibiotics may be required,” says Dr. Peterson. “Untreated otitis media can cause complications, especially in children under age two.”
The decision to place ear tubes depends on the child and his or her unique situation.
“Pressure equalization tubes, commonly called ear tubes, do involve some risks and should be recommended only to appropriate patients,” explains Dr. Peterson. Risks of this surgical procedure, in which small plastic tubes are inserted into the eardrum to aerate the middle ear, include hearing loss and a hole that remains in the eardrum once the tubes fall out. The American Academy of Otolaryngology, American Academy of Pediatrics and American Academy of Family Physicians recommend one of the following conditions be present before ear tubes are considered:
- Fluid that persists four months with a documented hearing loss
- Persistent or recurrent otitis media in a patient with speech or other developmental delay
- Damage to the eardrum or middle ear due to infections or fluid
- Recurrent acute otitis media (three separate acute infections in six months or four in a year)
Though middle ear infections are often not serious, it’s a good idea to be familiar with the symptoms and aware of the possibility for complications. If your child exhibits symptoms of an infection, contact your pediatrician.