Now Ear This
Reviewed By Gary Vogin
Feb. 18, 2002 -- No matter how conscientious parents are, babies are likely to come down with colds during their first year, and colds often lead to ear infections.
"The signs and symptoms can be very general, so they need to be looked at, especially in really young children less than 2 months of age," says Anthony Magit, MD, associate clinical professor at the University of California, San Diego, and the Children's Hospital and Health Center. Left untreated, ear infections can lead to more serious problems, including meningitis and hearing loss.
The typical ear infection -- called otitis media -- occurs when a cold or allergy causes swelling of the baby's eustachian tube, causing blockage that allows bacteria to grow in the middle ear.. Otitis media is particularly common in babies because their immune systems are immature and their eustachian tubes may not effectively drain fluid from the middle ear.
There are two types of middle ear infections. Acute otitis media often causes pain, fever, and a bulging red eardrum. Otitis media with effusion (OME) occurs when the middle ear doesn't drain properly and fluid is trapped behind the eardrum. A child may not experience pain with OME. Both types of infection sometimes clear up without treatment.
The Latest in Ears
Because they're so run-of-the-mill, you may think you know all you need to know about ear infections. But treatment and prevention strategies have changed in the past year, so a refresher course may be in order. You should know that:
- There's now a vaccination for children under 2 to help ward off one of the most common bacterial causes of ear infections.
- Doctors are using antibiotics more conservatively in an effort to prevent drug resistance.
- There's a new laser surgery that might be worth considering in certain cases of recurring ear infections.
The newest weapon in the battle against otitis media is the pneumococcal vaccine. According to new American Academy of Pediatrics guidelines, all children under age 2 years should receive the vaccine, along with other recommended immunizations, at 2, 4, and 6 months and between 12 and 15 months.
"It's not 100 percent [effective], but it seems to result in about a 20% reduction in ear infections," says Albert Park, MD, assistant professor of pediatric otolaryngology at Loyola University Medical Center in Maywood, Ill. The vaccine is also recommended for children ages 2 to 5 who are at high risk for developing pneumococcal infections.
Antibiotic Balancing Act
If your child hasn't been vaccinated, or gets an infection anyway, your pediatrician will typically prescribe the antibiotic amoxicillin. The most acute symptoms should subside within 24 to 48 hours, but since the pain may continue for several days, acetaminophen and warm compresses may help relieve discomfort.
Make sure to administer the antibiotics for the prescribed time, or the infection might stick around, and your baby could need a new round of antibiotics, possibly a different kind, such as Ceclor, Augmentin, Ceftin, and Rocephin.
Concern about antibiotic overuse and the development of drug-resistant bacterial strains, has prompted doctors to look more carefully at ear infection symptoms before prescribing antibiotics. If a baby has acute otitis media, not the less-serious OME, the doctor is likely to prescribe a stronger dose of amoxicillin twice a day rather than the traditional three weaker doses, says Magit. Other, more powerful, antibiotics are reserved for harder-to-treat cases, particularly in children under 2.
Doctors are also now less likely to offer prophylactic therapy -- taking a low-dose antibiotic for several months to prevent recurring ear infections -- particularly during the winter cold season.
"People are shying away from using [antibiotics prophylactically] because of the concerns about resistance," says Dr. Magit. "It works, but you're giving a child a lot of antibiotics to prevent one ear infection."
Those Pesky, Recurring Cases
So what do you do if your baby has repeated ear infections or ones that don't respond to treatment? If a child has persistent fluid buildup, lasting more than a few months, more than three ear infections in six months, or more than four in a year, your pediatrician may suggest other options.
Persistent fluid buildup prevents the eardrum from moving back and forth properly and can cause hearing difficulties. Although hearing loss typically isn't permanent, it still may be a problem for young children who are just learning language.
When antibiotics aren't enough, the most common recommendation is an outpatient surgical procedure in which small tubes, called tympanostomy tubes, are inserted through the eardrum to promote drainage. In most cases, this helps reduce the number and severity of infections.
"I warn families that it's not 100% ," says Park. "It results in a 50-60% reduction in the number of infections, but by reducing the number, it also reduces the need for antibiotics. And the tubes are very effective in preventing fluid from reaccumulating and thus, optimizing hearing."
Most tubes fall out by themselves in 6 to 18 months, as the hole closes. However, in about 1% of cases, the hole may not close on its own, requiring another surgical procedure to patch it.
A new surgical technique that uses a laser to make a hole in the eardrum doesn't require a general anesthetic, but the technique is controversial because it only lasts several weeks and may have to be repeated.
"It may be beneficial for the child who has had one ear infection where the fluid hasn't cleared and you need to have that opening last longer than a couple of days," says Magit. "But in the child who's had recurrent problems, it may not be as helpful."
And some children react adversely to the procedure, which is done in a doctor's office. "Even though they numb up the ear, it does make a loud noise, or the child may still feel pressure or even some discomfort," says Park.
Some parents claim they've found relief going the nontraditional route. Although there have been few large-scale studies and most traditional doctors remain doubtful, one study published in the Journal of Clinical Chiropractic Pediatrics showed that 80% of the 400 children in New Rochelle, N.Y., who received regular gentle adjustments to their cervical vertebrae or skull didn't have another ear infection within a six-month period.
How to Avoid Infection in the First Place
"Parents frequently ask what they can do to reduce their child's risk of ear infection, and at the top of the list I'd put day care," says David Darrow, MD, associate professor of otolaryngology and pediatrics at Eastern Virginia Medical School in Norfolk, Va.
He means avoiding day care, which isn't practical for most parents. If it's a must, doctors suggest that you try to find a setting with no more than five or six children, to reduce your baby's risk of getting ear infections to about the same as that of a child who stays home.
Other measures that reduce ear infection risk:
- Breast-feeding boosts your baby's immune system and uses a swallowing mechanism that allows less milk to enter the eustachian tube. Also, breast milk is less irritating to middle-ear tissue.
- Not letting your baby drink from a bottle while lying down, which may allow small amounts of formula to enter the eustachian tube and cause blockage.
- Eliminating exposure to cigarette smoke.
Take heart -- there's usually an end in sight. The peak incidence for ear infections is usually around 6 to 18 months, says Park. Because the anatomy of the eustachian tube gradually becomes more like that of an adult, and infant immune systems mature, your child's ear troubles may be over by the time he hits age 3.
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