By Judy Rupp, columnist
Enid News and Eagle
Katie had a busy schedule at work and was hurrying to get her 2-year-old packed and ready for day care. But he hadn’t slept well and was fussing and difficult this morning. When he started tugging at his ear, she knew the signs. She checked his temperature, and, yes, he had a fever. “No day care today,” she sighed. “And another missed day of work.”
Ear infections are all too common among young children, and they create a great deal of pressure and stress for young parents and, sometimes, their doctors.
Doctors know that most ear infections get better on their own in a day or two and that prescribing antibiotics is often unnecessary and maybe unwise. Katie, however, wants a quick solution so that she does not have to miss another day or two of work.
Unlike a cold, which is nearly always a viral infection, an ear infection is usually bacterial. It occurs when fluid builds up behind the ear drum, often as a follow-up to a cold, the flu or a nasal allergy. When the eustachian tubes, which run from each middle ear to the back of the throat, become congested, conditions become ripe for an infection.
Anyone can get an ear infection, but they are most common in children, in part because children have narrow eustachian passageways. They also have less developed immune systems and are frequently in a day care or school environment around other contagious children.
Symptoms in a young child are pretty easy to spot: waking up in the night, crying, fussiness, tugging at the ears and a fever.
A doctor will use a lighted instrument known as an otoscope to examine the ear drum. If it’s red and bulging, it’s probably because of an ear infection. If a diagnosis is still uncertain, a pneumatic otoscope or tympanometry may be used to measure the flexibility of the ear drum.
When the diagnosis is reasonably clear, treatment usually involves an antibiotic such as amoxicillin, plus a pain reliever such as acetaminophen or ibuprofen. Aspirin should not be given to children under age 18 because of the risk of Reye’s syndrome.
When the diagnosis is uncertain, particularly for children age 2 and over, 2013 guidelines of the American Academy of Pediatrics encourage doctors to wait and monitor — starting antibiotic therapy only if symptoms fail to improve after 48 to 72 hours. Overuse and misuse of antibiotics can lead to the development of resistant strains of bacteria. When an antibiotic is prescribed, it’s important that the child take the full course as prescribed, even though symptoms will undoubtedly improve rather quickly.
More typically, uncertainty about the course of treatment occurs not with the first ear infection but with subsequent ones, and repeat ear infections are very common among pre-schoolers. When a child has five or six ear infections a year, the doctor may begin to wonder if another approach may be needed.
When fluid remains behind the ear for an extended time or recurs again and again, the diagnosis is chronic otitis media with effusion. So even if the child has no infection, the risk of one is high in this congested environment. And hearing is impaired, which, in turn, can affect language development and learning.
If there is a smoker in the house, it’s a good idea to take this smoke out of the house. Doctors also recommend that children not be put to bed with a bottle.
If these preventive measures don’t help, the doctor may ask the parents to consider other approaches such as removal of the tonsils and adenoids and/or insertion of tubes to allow draining of fluid from the middle ear.
Used for several decades to treat repeat ear infections, the appropriateness of these surgical approaches has been called into question. One long-term study of children with persistent ear infections followed until they were 9 to 11 years old found that children who had ear tubes inserted promptly did not necessarily show a better developmental outcome, as expected.
Doctors and parents must make a decision based on how long the effusion has existed, the severity of the hearing loss and the individual child’s language and speech development. In many cases, referral to an otolaryngology specialist may be recommended.
Measures that can be taken to reduce the risk of recurrent ear infections include yearly flu shots; immunization with the pneumococcal conjugate vaccine (PCV13); frequent hand washing; avoidance of tobacco smoke; and reduced exposure to other children with respiratory infections.
Anything that protects your child from colds and other respiratory infections will also reduce his or her risk of ear infections.
Rupp is a certified information and referral specialist on aging for NODA Area Agency on Aging. Contact her at 237-2236