Children's Ear Infections - the Treatment Dilemma

If you're the parent of a child under the age of three, you may not be aware that your child has a greater than 75% risk of getting an ear infection. If you've had to deal with one or more of those infections, you're probably not only well aware of this statistic, but also interested in finding out how to lessen it - and how to best care for your child when he or she is sick.

You may also have many questions. For example, why do children get so many ear infections? Is there a way to treat them without using antibiotics? And is there a way to prevent them?

A brief explanation
Otitis media, the medical term, actually refers to an inflammation of the middle ear. The eustachian tubes, which connect the ear to the back of the nose, get swollen and blocked with fluid, and can't drain properly. This causes pain and may affect the child's hearing and balance.

Not all inflammation is due to infection. It is possible to have otitis media without having an infection. Even if infection is present, the cause may be either bacterial or viral. And experts say that most common cases of otitis media clear on their own in two to three days.

Why are ear infections so common in children?
Children are more prone to otitis media for a number of reasons. For one thing, their eustachian tubes are shorter, narrower, and more horizontal. This makes them less adept at their usual purpose - to drain fluid from the ear to the nasal passages. Also, the adenoids are larger, and can block the openings of the eustachian tubes.

There are other factors that make children more susceptible to ear infections. These include the following:
- exposure to secondhand cigarette smoke
- exposure to other sick children, as in a daycare situation
- drinking from a bottle in bed
- use of pacifiers
- prematurity

Ear infections are also more common in boys than in girls.

Treatment of otitis media
Standard treatment of middle ear infections and inflammation is with pain- and fever-reducers, like acetaminophen (i.e. Tylenol) and ibuprofen (Advil), and warm compresses on the ear. And doctors often prescribe antibiotics.

Problems with traditional antibiotic treatment
Children who get many ear infections could end up taking antibiotics almost continuously. In fact, some doctors prescribe them for prevention. In this case, the child would need to take the antibiotic every day.

Antibiotics were the "wonder drugs" of the mid-20th century. They've meant the difference between life and death for many people. But many people, including quite a few physicians, now feel that in the case of children with otitis media, antibiotics are over-prescribed, and may do more harm than good. For one thing, antibiotics taken internally - rather than through ear drops - will affect more than just the ear; if they're taken by mouth, they'll also kill off the bacteria in the intestinal tract - bacteria that are supposed to be there to help the person digest food. Even more importantly, the body can develop resistance to them, requiring the use of stronger versions every time another infection appears.

Physicians also point out that antibiotics aren't needed for every case of otitis media. Non-infectious cases, and infections caused by viruses, won't respond to antibiotics. The trouble is, it's almost impossible for a doctor to tell if an infection is viral or bacterial. Many times they'll prescribe antibiotics just "to be safe," when in reality these drugs won't help at all.

Considerations
Parents concerned about the use of antibiotics for frequent ear infections are speaking up, and are starting to affect their doctors' decisions about prescribing them. Generally, they feel that if the infection will clear up in a few days anyway, maybe they can help their child get through this time with over-the-counter pain- and fever-reducers, warm soaks, and some extra TLC. And the doctors are agreeing with them.

Doctors do say, though, that if parents opt to follow this course, they need to watch their child for signs of more serious problems. It's important to take the child to the doctor if any of the following occurs:
- Infections last longer than they should.
- The child has a very high fever, or has more than the usual symptoms of a ear infection.
- The child is having trouble hearing, or the infections are so frequent that the hearing problem is affecting speech development.

Preventing ear infections
Doctors say there are ways to help keep your child from getting ear infections, or at least from getting so many of them. Here are a few of their suggestions:
- Breast feed children for at least six months, so they can reap the benefits of the mother's immunity.
- Decrease the child's exposure to cigarette smoke and to other children who may be sick.
- Wash hands before and after caring for the child, whether or not they're sick.
- Keep the child's immunizations up to date. Some of those immunizations can help prevent the causes of some ear infections.

Final thoughts
Ear infections don't have to be a large problem in early childhood. In fact, for some children they don't have to be a problem at all. Informed parents can do a lot to keep their child healthy and free of infections - which will be good for both the child and for the parents' peace of mind.