Health Leader, Mommy, My Ear Hurts

STORY BY

Jaqueline Preston

It's an all-too-familiar wake-up call. It's 2 a.m. and your toddler is miserable, crying and tugging on his ear. You touch his forehead and he feels feverish. Chances are he's got an ear infection, right?

But, before you call your pediatrician and request the usual prescription, be warned. You might not get that antibiotic you're expecting.

Health experts from the American Academy of Family Physicians and the American Academy of Pediatrics recently released new guidelines in a revolutionary move to change the way physicians treat fussy, young patients with acute otitis media , better known as the dreaded middle ear infection.

Less is more

"With increased resistance to commonly prescribed antibiotics for ear infections, we're seeing many patients who aren't responding to the treatment," says Lisa deYbarrondo, MD, assistant professor of emergency medicine at The University of Texas Medical School at Houston. "For children at risk for bacterial ear infections with a high resistance to antibiotics— such as kids in day care— a higher dose of amoxicillin is usually prescribed. The question is 'do they really need it?'"

The joint committee, who drafted the guidelines, calls it a "societal trade-off," adding that antibiotics should be reserved for more serious ear infections with unusually high fever.

DeYbarrondo, who used to see her young patients only in a clinical setting, now works full-time in the emergency room, treating her cranky, young patients on the spot. She is encouraged by the new guidelines.

"When I followed up patients in the clinic, I noticed that some bacterial ear infections tended to be resistant to common antibiotics," deYbarrondo says. "Plus, so many children get antibiotics for something as simple as a viral throat, upper respiratory infection or allergies. They simply don't need the antibiotics."

Wait and see

Does all this mean that parents should just do some watchful waiting?

Yes, says deYbarrondo, who is a parent herself. Nearly 90 percent of all children get an ear infection during their young lives. Nearly one-third of all ear infections are viral, which don't respond to antibiotics, anyway. She says many ear infections, including bacterial ones clear up on their own.

Breastfeeding can prevent ear infections but genetic factors can also play a role. Boys are more prone to developing ear infections. "Even though I breastfed my son, he ended up with eight ear infections. He had them all the time," she explains. "Yet, my daughters rarely had them," deYbarrondo adds.

Plumbing and gravity

Ear infections are often a simple plumbing problem. Young children's eustachian tubes won't drain the middle ear readily. And drainage problems occur usually when the young patient also has a cold or other upper respiratory infection. If an ear infection is going to arrive, it's usually going to flare up after about the third day of an upper respiratory illness.

"Because of the swelling in the nasal passages during some upper respiratory infections, inflammation prevents drainage of the middle ear, which creates a nice, fertile growing ground for bacteria," the pediatrician explains.

The tubes become a highway for virus and bacteria to make their way to the middle ear.

Ear infections are also a structural design issue. "The tubes are more horizontal, less diagonal in children under the age of two, which means they don't drain properly," deYbarrondo says. "By the time a child reaches 24 months, ear infections lessen because they are in a more diagonal position."

Home Care Dos and Don'ts

Since ear infections can be quite uncomfortable, pain relievers such as acetaminophen, ibuprofen and home remedies like a warm washcloth placed over the ear can ease the pain.

Be sure not to put drops in the ear, like sweet oil, deYbarrondo warns, because they can obscure or cloud the eardrum, making it difficult for the doctor to get a good look. They can also cause irritation.

And, best to hold off on Q-Tips: it just impacts the wax, and pushes it farther down. "Besides, wax is a good thing-it protects against swimmer's ear ( otitis externa ) and keeps the canal's natural acidity in balance, which prevents bacterial growth," de Ybarrondo says.

Infants who lie down while drinking from a bottle rather than propped up in Mother's arms are more prone to fluid backing up in the tubes. De Ybarrondo strongly discourages parents from leaving a baby alone with a baby bottle under any circumstances. And she reminds parents to hold their babies at some incline when feeding them, to let gravity do its work by letting fluid run downhill.

Secondhand smoke leaves its mark on the ears, as well. Children who live in homes where parents smoke are at risk for ear infection because the irritating smoke causes chronic inflammation of the eustachian tube.

If your child is in day care, please keep in mind that the more youngsters your child is exposed to, the more viral illnesses they will meet. "This is no reflection on the day care. No matter how many times the adults wash their hands between diapering or feeding, odds are still high that viruses are being passed around on toys and tabletops," de Ybarrondo says.

Just because it's green doesn't mean...

And when parents see the "green goo" coming out of children's noses, it doesn't mean that a bacterial ear infection is necessarily around the corner. Nor does the color green mean that their child's cold looks "bacterial." Colds are, after all, viral.

Green or yellowish mucus "does not equal a sinus infection," deYbarrondo says and it is common— or even more common— in the beginning stages of a viral illnesses.

Bacteria are the culprit of most ear infections in children and are generally caused by pneumococcus, the same bug that causes pneumonia. Fortunately, 50 to 60 percent clear up without antibiotics. Most kids will respond positively to ear infections, thanks to their immune systems.

But my child still hurts - now what?

Okay, your child's pediatrician prescribed an antibiotic, but it's not working. It happens sometimes. If your child still has fever or ear pain for more than 48 hours, it's time to call back the pediatrician. Your child may need a different antibiotic.

"If your child is still screaming, has a high fever or if the area behind the ear is swollen, these are possible signs of something more serious," deYbarrondo warns. If the ear moves forward and the area behind the ear is swollen, red and painful, "these are signs of mastoiditis -a true emergency. This is an infection of the bone adjacent to the middle ear that could lead to a serious brain infection or meningitis."

The good news is most ear infections that develop in children are fairly minor, deYbarrondo says. "Knowing this ought to help you and your child sleep better."