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If your child has had to gulp more than one round of bubble-gum-tasting meds for his ear infections this year, read on: Our doc explains the myths and facts about your child's ears right now.
On the way to the pharmacy for the umpteenth time this year, have you wrestled with these thoughts? Wait a minute! My toddler is not the only child in a daycare setting. I keep a clean house … relatively. I don't smoke. My toddler is not "sickly." Then why does every sniffle seem to settle into a bacterial ear infection?
I promise you, you're not alone!
Peek around the waiting room and you'll likely run into other parents of feverish kidsholding their ears. Why?
- There were 16 million office visits for ear infections in the US in 2000. (Half of them were in my practice. Or so it seemed.)
- For every 10 pediatric office visits for ear infections, eight children left the office with an antibiotic prescription. (Not from my practice, I hope!)
- More than 75 percent of children have had at least one ear infection by their third birthday—and 70 percent of kids have had at least one course of antibiotics by their first birthday.
- The average preschooler carries around one to two pounds of bacteria (about five percent of his body weight!). These bacteria "learn" from antibiotic exposure and can become resistant. About 80 percent of children with otitis media (the medical lingo for ear infections) get better without antibiotics.
Know that many parents are in the same (albeit germ-laden) boat. Multiple ear infections (or recurrent otitis media) are common in the toddler age group for multiple reasons.
Ear Infection Factors
First is exposure. At the end of his second year, your toddler is creating an immunity repertoire. Just like he needs to build a workable vocabulary in advance of his first job interview, he needs also to build immunity to a number of different viruses and bacteria over the course of his infancy and toddlerhood. Think of this infection exposure as adding to his toddler germ resume. More infections mean better long-term immunity, but the price you pay is more otitis media in the meantime.
Second, your child's middle ear cavity is theperfect anatomic set-up for bacteria to brew. Looking down the ear canal is like looking into a cave. The far wall of the cave is a thin membrane of skin called the eardrum. Behind that translucent drum is the middle ear cavity. That is where all the ear infection "action" takes place.
So how do bacteria get in there and set up shop? It is not through the eardrum. There is a secret opening to the back of that cavity called the Eustachian tube. This tube connects the back of the throat to the back of the middle ear cavity. You have felt evidence of your own Eustachian tubes if you have ever driven up a steep hill or taken off in an airplane. The "popping" of your ears that you feel in these instances is your Eustachian tube equalizing pressure between your throat and your middle ear cavity. Bacteria can get up this tube, get in the middle ear cavity, and start to multiply. This is an ear infection.
Your toddler's middle ear cavity and Eustachian tubes are dysfunctional in a number of ways (keep reading) that make bacterial ear infections (usually a complication of a bad viral head cold) much more likely.
Third is family history. Did you have lots of infections as a child? Well, consider this one more thing you can take the blame for. Anatomy, like eye color, is inherited. Your toddler may not have gotten your blue eyes, but that upward slanted, slightly kinked, easily blocked Eustachian tube? That's all your doing.
Classic Symptoms of Ear Infections
Diagnosing an ear infection is not like a pregnancy test, either positive or negative. There is judgment and interpretation involved. So, too quick a trip to your doctor may lead to a well-meaning but ill-founded diagnosis and possibly an unnecessary course of antibiotics.
I look for these few key signs and symptoms in kids over six months of age:
- ongoing cold symptoms,
- pain,
- and disrupted nighttime sleep.
These are the classic signs that I find most helpful. A bulging eardrum on exam clinches the diagnosis. How about fever? Ear tugging? Red external ear? These are all notoriously useless or at least less useful. And if you've thought about purchasing an otoscope (the ear checker thingy the doctor uses), forget it. It only took me about 300 ear exams to really learn how to diagnose an ear infection. And after more than 10 years in practice, I still have occasional difficulty.
The docs will tell you that exposure, anatomy, and family history are important to your child's risk of developing an ear infection, but there are a few things that arenot important:
Bath water, for instance, cannot cause a middle ear infection in a normal ear. Water that goes in that cave of an ear canal has only one way to get out: the way it came in. And we know that bacteria get into the middle ear cavity via the back of the throat.
Failure to wear a hat or coat in colder weather does not cause ear infections. (Mom, are you reading this?) Again, it is caused by a viral infection that is complicated by bacteria creeping up the Eustachian tube. (And, Mom, throw out the going-outside-with-wet-hair theory as well. It's bunk.)
How about the way your child eats, sleeps, and fails to blow his nose? All are meaningless when looking at your child's risk of otitis media.
What your doctor does know is that the fewer antibiotics your child is exposed to, the better. Bacteria living in your child (good and bad bugs) are waiting to learn from experience. Multiple exposures to multiple antibiotics teach bacteria the concept of resistance. And they learn it quickly. The American Academy of Pediatrics (AAP) has guidelines for kids over six months of age which recommend holding off on antibiotic treatment for 48 to 72 hours if your child is reasonably comfortable. (Read more about this here.) The risk to your child (in withholding antibiotics) is low, while the benefits (in reducing your child's antibiotic exposure) are significant.
Your doctor will send you to a specialist (otorhinolaryngologist or ENT) if your child's ear infections are too frequent or if there is inadequate clearing of fluid within three months of an acute infection. If your child has Down syndrome, cleft palate, or immunodeficiency, a specialist may need to be involved, as well.
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