The most commonly diagnosed bacterial infection in children under age seven
By: Ken Ripp, M.D.
If you're a parent, you've probably had to deal with this ailment at one time or another. It affects approximately 93 percent of children in the United States at least once, and three quarters of children have recurring problems. What is this widespread condition? Middle ear infections.
A middle ear infection typically occurs when the small tube that connects your ear to your throat becomes swollen and blocked. This tube is called the eustachian tube. An allergy or upper respiratory infection, such as the common cold, can cause the tube to swell and become blocked. When this happens, fluid from the cold that is inside your ear has nowhere to drain. This fluid sits in the ear and can become infected.
Babies and young children under the age of seven have an increased risk for ear infections because their eustachian tubes are shorter, smaller and more horizontal. Because of these factors, they get blocked more easily than those in older children and adults.
Ear pain is the most common symptom of ear infection. If your child is very young and not yet talking, you can look for signs of ear pain. These might include pulling or tugging at the ear, fussiness, crying that can't be comforted, lack of appetite, trouble sleeping and apparent discomfort when lying horizontally (ear pain often increases when you are lying down). Other symptoms include fever, ear drainage and a trouble hearing.
If you see a thick, yellow fluid coming from the ear, it probably means that the infection has caused the eardrum to rupture. While this sounds serious, it usually is not. Actually, when an eardrum bursts, the pain usually decreases dramatically. The hole in the eardrum typically heals on its own within a few weeks.
Not all ear pain is caused by an infection. At times, there may be a fluid build-up in the ear, but no infection. In addition, babies and young children can experience ear pain when they are teething or have a sore throat. Air pressure changes, a build-up of ear wax or an object in the ear can also cause discomfort.
It used to be that all ear infections were treated with antibiotics. That line of thinking has changed somewhat over the years, and while some doctors still use antibiotics as their first course of treatment, the American Academy of Pediatrics advises that 80 percent of ear infections in children can be treated successfully at home. Home treatment includes encouraging rest, using a non-prescription pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil), placing a warm wash cloth or heating pad on the ear, and sometimes, ear drops prescribed by a doctor to relieve pain.
If 80 percent of ear infections can be treated at home, that leaves 20 percent that will require antibiotic treatment along with a doctor's care. See your doctor if ear pain or other symptoms continue for 48 hours after home treatment begins, your child has a fever of 101 ºF or higher or your child is under two.
You may want to discuss the risks and side effects associated with using antibiotics to treat ear infections with your doctor. These are typically minor and can include diarrhea, upset stomach, rash and allergies. Perhaps the greatest risk with taking antibiotics is that chance of creating antibiotic-resistant bacteria. When this happens, bacteria change in such a way that the antibiotics are no longer effective in killing them, making infections much more difficult to treat.
Some children experience chronic ear infections. If your child has repeat ear infections (three or more in six months or four or more in a year) your health care professional may want to consider treatment to prevent future infections. One option involves surgery to insert tubes into the eardrum to allow for fluid drainage. The tubes keep fluid from building up and usually stay in place for six to 12 months when they fall out on their own. About 80 percent of children need no further treatment after tubes have been inserted.
Ear pain is no fun – for a parent or child. Just knowing that 93 percent of children experience an ear infection at least once makes the condition seem unavoidable. While ear infections are common in young children, they can be successfully treated at home 80 percent of the time. If pain and other symptoms continue after two days of home treatment, if your child is running a high fever (over 101 ºF) or if your child is under two, make an appointment to see your doctor.
Discuss the pros and cons of different treatment options with him or her, and together map out a plan for your child's recovery.
Dr. Ripp is a board certified family practice physician at Raiter Clinic.