Ear Infections
Ear infection (acute otitis media) is a bacterial infection in the middle ear space (just behind the ear drum). This space is normally filled with air allowing the ear drum to vibrate normally to sound. Ear infections begin with fluid (also called effusion) in the middle ear space. This occurs when the natural connection (eustachian tube) between the middle ear and the throat doesn’t work to equalize the pressure in the middle ear and a vacuum develops. This occurs most often with colds or seasonal allergies.
If the fluid persists and bacteria happen to travel from the throat to the middle ear a bacterial infection can begin increasing the pressure in the ear, causing pain.
Ear infection is most likely when there are symptoms of a cold complicated by fever and ear pain. Ear pulling in the absence of nasal congestion, fever, or sleep disruption is unlikely to be an ear infection.
When to call
Ear infections can be distressing but are rarely a medical emergency. The initial goal is controlling the pain. Ibuprofen dosed correctly for age (see appendix for dosing) is very effective. Other measures that can also be helpful are warm heating pads or wash rags to the ear and side of head (not hot) or topical pain relieving drops. If these measures are not helpful than call your doctor for further advice regarding managing pain. Antibiotics will not provide immediate pain relief so using left over antibiotics or going to the emergency room when the pain is well controlled is NOT recommended.
Call immediately for
- Stiff neck (can’t bend chin to chest)
- Fever over 105°F
- Severe pain, not better 2 hours after the correct dose of pain medication.
Treatment
Ear infections are often caused by bacterial infected fluid build up in the middle ear (otitis media). In the past ear infections were always treated with antibiotics but there is a growing understanding that many milder ear infections resolve without needing antibiotics. This approach would more often be undertaken if the child is older than two years old, does not have a high fever, and symptoms have been going on for less than 48 hours. Prolonged symptoms, sleepless nights, and severe pain are reasons for treatment with an antibiotic.
Prevention
- Many factors contribute to ear infections including family history and environment. While we can’t do anything about our genetics the following have been shown to decrease risk for ear infections.
- Pneumococcal vaccine (Prevnar®) introduced in 2001 and given to all infants reduces the risk of ear infections since it vaccinates against the most common serotypes of the most common bacterial cause of ear infections
- Avoid exposure to cigarette smoke!
- Breast feed if possible
- No bottle propping
- Hold baby at 45 degree angle for feeding
- Try to avoid day care settings (especially with more than 12 kids which exposes children to more colds)
- Limit or eliminate pacifier use, especially after 12 months of age
Persistent Ear Infection
Treatment failure of an antibiotic is possible if no improvement in appearance of ear and the child continues to experience fever and ear pain after 72 hours of treatment. At that point a different antibiotic is considered in an attempt to better target potential resistant bacteria. With increasing problems with bacteria becoming resistant to common antibiotics careful antibiotic choices are needed. It is normal for the fluid to persist for 4 -- 6 weeks following an infection and a child may experience transient decreased hearing or ear tugging and poking on that side.
Recurrent Ear Infection
Repeated ear infections can be frustrating for children and families. While routine follow-ups after ear infection are not done be sure to discuss with your doctor if your child has had repeated infections so that a recheck can be scheduled and resolution can be documented.
Persistent (chronic) Ear Fluid
Effusion is the presence of fluid in the middle ear. It is always a part of any ear infection. If the fluid persists it can decrease a child’s hearing in the same way wearing ear plugs can. It does not cause permanent damage of any kind. Once the fluid resolves hearing returns to normal. Decisions about ear tubes are based on the age of the child, duration of ear fluid, and frequency of infections. With decreased hearing, a child’s language skills can become delayed but in almost every case children catch up once the fluid resolves (either on its own or with surgery). Many long term studies have been unable to show any developmental differences between children who had ear tubes placed or undertook a strategy of “watchful waiting”.
