The ear and infections
Next to the common cold, ear infections are the most commonly diagnosed childhood illness in the United States. More than 3 out of 4 kids have had at least one ear infection by the time they reach 3 years of age.
About Middle Ear Infections
Inflammation in the middle ear area is known as otitis media. When referring to an ear infection, doctors most likely mean "acute otitis media" rather than the common ear infection called swimmer's ear, or otitis externa.
Acute otitis media is the presence of fluid, typically pus, in the middle ear with symptoms of pain, redness of the eardrum, and possible fever.
Other forms of otitis media are either more chronic (fluid is in the middle ear for 6 or more weeks) or the fluid in the middle ear is temporary and not necessarily infected (called otitis media with effusion).
Causes / Kids develop ear infections more frequently in the first 2 to 4 years of life for several reasons:
Their eustachian tubes are shorter and more horizontal than those of adults, which allows bacteria and viruses to find their way into the middle ear more easily. Their tubes are also narrower and less stiff, which makes them more prone to blockage.
The adenoids, which are gland-like structures located in the back of the upper throat near the eustachian tubes, are large in children and can interfere with the opening of the eustachian tubes.
A number of other factors can contribute to kids getting ear infections, such as exposure to cigarette smoke, bottle-feeding, and day-care attendance.
Ear infections also occur more commonly in boys than girls, in kids whose families have a history of ear infections, and during the winter season when upper respiratory tract infections or colds are frequent.
Diagnosis and Treatment
A child who might have an ear infection should visit a doctor, who should be able to make a diagnosis by taking a medical history and doing a physical exam.To examine the ear, doctors use an otoscope, a small instrument similar to a flashlight, through which they can see the eardrum.
The fact that most ear infections can clear on their own has led a number of physician associations to recommend a "wait-and-see" approach, which involves giving the child pain relief without antibiotics for a few days.
Another important reason to consider this type of approach are the limitations of antibiotics, which:
Won't help an infection caused by a virus / won't eliminate middle ear fluid
may cause side effects / typically do not relieve pain in the first 24 hours and have only a minimal effect after that / Also, frequent use of antibiotics can lead to the development of antibiotic-resistant bacteria, which can be much more difficult to treat.
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What causes ear infections?
Ear infections are the second most commonly diagnosed illness in children in the United States (after the common cold). In fact, three out of four children have had an ear infection by the time they're 3 years old.
An ear infection is usually caused by bacteria, but a virus can also be the culprit. It happens when fluid builds up in the area behind your child's eardrum and then becomes infected. Normally any fluid that enters this area leaves pretty quickly through the Eustachian tube, which connects the middle ear to the back of the nose and throat. But if the Eustachian tube is blocked — as commonly happens during colds, sinus infections, even allergy season — it traps the fluid in the middle ear.
How will the doctor treat my child's ear infection?
It depends on his symptoms. The American Academy of Pediatrics (AAP) recommends that if your child is between 2 and 12 years of age he be given an antibiotic if he has severe symptoms and the doctor can diagnose AOM for certain. If the doctor is uncertain, or if your child doesn't have severe symptoms, the doctor may suggest observing your child for 48 to 72 hours to see if he gets better without an antibiotic. (Eighty percent of children with AOM get better without antibiotics.) "The sicker the child looks, the more you go the precaution route and prescribe an antibiotic right away," says Robert Ruben, an otolaryngologist (ear, nose, and throat doctor) at Montefiore Medical Center in New York.
If your preschooler does get a prescription, make sure you give him the entire course of antibiotics and follow up with an ear recheck a few weeks later so the doctor can gauge whether the medicine did its job.
Keep in mind that the antibiotic will not relieve your child's pain in the first 24 hours — in fact, it will only minimally affect it after that. What's more likely to help is the correct dose of acetaminophen or ibuprofen. (Never give your child aspirin as it makes him more susceptible to Reye's syndrome, a rare but potentially fatal disease.) Your preschooler may also be comforted by a warm compress held to his ear or ear drops. (Ask the doctor about the best drops to use.) It may also be helpful to elevate your child's head when he's lying down.
Whether or not you're treating your child with antibiotics, if he isn't getting better after a few days — if he still has a fever or any of the other symptoms he started out with or he's getting worse — call your doctor. She may want to switch antibiotics or start a course of antibiotics if you took the wait-and-see approach.
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