Ear infections in childhood bring more children to the pediatrician's office than all other illnesses combined. Officially known as Otitis Media, ear infections can cause pain and fever and if untreated, in severe cases, hearing loss and middle ear damage. Together with the sleepless nights and days lost from school and work, it is no wonder that parents are so worried about this common childhood illness. The cause of ear infections is usually mechanical - young children have frequent colds and do not know how to keep their airways cleared (nose blowing is an older child accomplishment) so mucus remains inside the nose and in the sinuses and the Eustachian tube (the canal that connects the airways from the nose to the ear) and the virus or bacterial particles in the mucus multiply and inflame. Coupled with infant's natural facial architecture - small passages and sharp angles between nose, ears, and canals, the multiplying germ garden grows quickly so that a simple cold this morning can be tonight's screeching ear pain. In addition, bottle sucking (and perhaps pacifier use according to recent studies), increases the pressure and packs the mucus even deeper into the canal of the Eustachian tubes, increasing the likelihood of developing an ear infection. There is no doubt that children who live in homes with cigarette smoke are at greater risk for otitis because smoke diminishes the airways natural defenses against invasion by deadening the cilia that serve to evict the germs in smoke free children.

There are cases of otitis that are not associated with colds and these are often in children with already long histories of ear infections. This is because their canals are already damaged and narrowed by the old infections and it is easier for germs to multiply quickly even with minimal assistance by mucus presence. Often these children have fluid in the middle ears on a constant basis which acts as a nidus for germs to grow and therefore not only impedes clear hearing, but also acts to cause frequent relapses of otitis. This is known as serous otitis or otitis media with effusion. Some doctors treat this with daily doses of "prophylactic" antibiotics for very long periods, others recommend surgery for the placement of ventilation tubes in the middle ear (tympanostomy tubes), others recommend tincture of time and vigorous attention to nose clearing during cold season. There is no one method that always works and each child's situation must be dealt with as individually as possible, so don't apply the wisdom of your neighbor's doctor to your child's - it may not apply in the least to her case. Talk openly with your pediatrician about the various ways your child is suffering from otitis - irritability, lack of sleep, being off balance, even poor language development in the toddler period, are all reasons to discuss the alternatives with your doctors. Although ear infections are rarely associated with major complications, once upon a time it was the behind the scenes cause of severe infections of the mastoid (a vital internal part of the skull) and meningitis. Thankfully, antibiotics have mostly put an end to those nightmares. Still there is a lot of antibiotic use that might be avoided if children lived in smoke free environments, were moved off bottles earlier, were nursed in semi-upright position so that less milk would be sucked up into the canals, and less contact with children with colds could be accomplished. All of these are difficult to control in many children's lives so at least be aware that ear infections need attention and that if your child holds their ear and cries in the night, Tylenol is only enough until the morning. The pediatrician needs to see your child - he cannot "just prescribe something" over the phone. The good news is that ear infections usually significantly decrease in frequency after age 3 in most kids so this won't go on forever.

Description

Painful swelling and increased pressure in the middle ear caused by virus or bacteria. Common in young children and often associated with a cold.

Usual course

Most ear infections begin gradually with increasing irritability noted in the young child and sometimes the presence of a fever. Most children indicate the presence of pain in one or both ears and younger children may vomit or appear to be off balance from the middle ear dysfunction. If treated with antibiotics, in the case of bacterial infection, the pain and discomfort resolve usually within 2-3 days and can be hastened with the use of pain killers like acetaminophen or ibuprofen or with ear drops applied directly into the affected ear. In the case of viral infections, the key to recovery is decreasing pressure on the middle ear with decongestant medication and nasal clearance via steaming, gentle nose blowing, and saline nose drops in infants. These infections usually take longer to resolve but most are well within 5 days. If there is considerable congestion there is a great likelihood of recurrence and it is not unusual for a child to have several ear infections in the winter season.

How it is spread

Although ear infections are not themselves contagious, the passage of a cold from child to child will increase the chances of developing an ear infection greatly. Avoiding children with obvious cold symptoms if your child is particularly prone to ear infections is vital as is treating your child's cold symptoms early, before the ear infection sets in. Presence of tobacco smoke raises the incidence of ear infections 6 times, and bottle feeding, especially in a flat position increases risk as well. Children who are breast fed and live in smoke free environment and are fed in a semi-upright position generally suffer with fewer ear infections although most children eventually experience at least one episode. There is evidence that some children with allergies may benefit from decongestants and allergen avoidance since inflammation can be a contributor to the occurrence of middle ear infections by leading to swelling of the nasal and Eustachian passages. This allows normal bacteria in the airway to multiply abnormally and cause the development of symptoms.

Treatment

Bacterial ear infections are treated with antibiotics, usually for a ten day period although newer drugs that work in less time are now available for some situations. Virally caused infection will take longer to resolve and respond best to steaming, nasal clearing, and pain relief measures. Regardless of type, children with ear infections should sleep in a semi-upright position to decrease pressure in the middle ear and assist in recovery.

When to call the doctor

If your child has ear pain and you cannot ease the pain with simple measures such as decongesting (steaming) and nose clearing you might want to have the doctor take a look. Most ear infections are viral and do not require antibiotics and will improve slowly with time and resolution of the cold symptoms that caused it.