Ear Infections in Children

The average child consumes an astounding three month's worth of antibiotics of otitis media (ear infections) in the first two years of life. The treatment of otitis media is having a huge effect on both our environment and on each child who receives more than 30 million courses of antibiotics given for ear infections every year.

The overall incidence of resistant bacteria is skyrocketing, particularly in children who have been previously treated.

Wouldn't it be wonderful if there were a way to cut the incidence of antibiotic use for otitis media? There is!

Over-diagnosed condition

The first way is for physicians to be more accurate in diagnosis. Acute otitis media is over-diagnosed in 40 to 80 percent of patients. Why? It is tempting for the office or emergency room physician to have an easy answer for a fussy child with an exhausted parent. If a crying child with a respiratory infection has a low-grade fever, he or she will almost invariably have some abnormality in the examination of the eardrum, due to either the crying itself, or some middle ear fluid, neither of which is actually an ear infection.

Tympanometry can be a useful help in diagnosing an ear infection. Your pediatrician might have a tympanometer in the office. It painlessly uses air pressure to distinguish a normal ear from a fluid-filled ear and from an acute infection.

Cause and Prevention

• Otitis media is a disease of infancy. Children will have fewer problems after three years old.
• Breast-feeding works. It reduces the number of ear infections in infants.
• Daycare multiplies exposure to respiratory bugs. Children in large daycare programs will have more infections than children in small groups.
• Secondary smoke in the home causes irritation of the respiratory tract in household contacts. Children exposed to smoke have more episodes of otitis media than children not exposed.
• Antibiotics are not needed for middle ear fluid if there is no infection. Fluid persists in the middle ear for weeks or months after acute otitis media. This is expected and is not helped by more antibiotic.
• Underlying allergies can lead to recurrent ear infections. Your doctor might recommend removing the offending allergen or trying an anti-allergy medication.
• There is a correlation between pacifier use and incidence of ear infections. Avoid the use of a pacifier, prolonged sucking on a bottle, or even a sippy-cup. Always have the child sit upright when drinking rather than lying down.