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My last article, "Childhood Diseases – On a Mission to Educate: Tetanus" we learned that Tetanus is an acute, sometimes fatal, disease of the central nervous system, caused by the toxin of the tetanus bacterium which usually enters the body through an open wound. Because it can cause painful spasms and stiffness in the jaw muscles, it is sometimes referred to as Lockjaw. We also learned that Tetanus can be prevented from a vaccine which provides immunity against it. Today we will move onto another common childhood illness, Ear Infections.
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What Is an Ear Infection?
Ear infections, also called Otitis Media, are a common problem in children. According to Kids Health (http://kidshealth.org/en/parents/otitis-media.html) ear infections happen “when viruses or bacteria get into the middle ear, the space behind the eardrum.” When the child develops an ear infection (otitis media), the middle ear fills with pus which is an infected fluid. When this pus pushes on the eardrum, it can be very painful to the child.
)According to The New York Otolaryngology Group (http://www.nyogmd.com/hearing-balance-center/hearing-disorders/ear-infection-otitis-media) “ear infections are often the result of a cold, which spreads and settles in the middle ear, and can be the result of both bacteria and viruses. Fluid accumulates in the middle ear, causing inflammation and pressure. Ear infections can sometimes clear up on its own, but if symptoms persist for several days, see your doctor.” It should be noted that ear infections can be in one or both ears.
Also according to The New York Otolaryngology Group otitis media is the most common cause of hearing loss in children. Even though it primarily affects children, it can occasionally affect adults too. Adults can also develop hearing loss if there is prolonged ear infection without intervention.
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What Causes an Ear Infection?
As stated above, an ear infection can be caused by bacteria or a virus. When fluid builds up in the area behind the child’s eardrum, it becomes infected. According to Baby Center (https://www.babycenter.com/0_ear-infections-in-children_11425.bc) in most situations, any fluid that enters this area usually drains quickly through the Eustachian tubes which connect the middle ear to the back of the nose and throat. If the Eustachian tube is blocked (frequently occurs during colds, sinus infections, allergies) the fluid gets trapped in the middle ear.
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Baby Center stated that “Germs like to grow in dark, warm, wet places, so a fluid-filled middle ear is the perfect breeding ground. As the infection gets worse, the inflammation in and behind the eardrum also tends to worsen, making the condition more painful. Your child may also develop a fever as his body fights the infection.” They also stated that parents may use a Pacifier to quiet the infant but that this is not good because it increases the risk of middle ear infections in babies and toddlers. They actually referred to a study which showed that the incidence of ear infections was 33% lower in babies who didn’t use pacifiers.
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What Are the Risk Factors For Ear Infections?
According to Drugs.com (https://www.drugs.com/article/middle-ear-infections-children.html) there are many things that can cause the Eustachian Tubes to become swollen or blocked that can lead to ear infections. The following is a list of these causes:
- Allergies
- The common cold
- Excess mucus and saliva produced during teething
- Infected or overgrown adenoids
- Tobacco smoke or other irritants
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Also according to Drugs.com there are other factors that may increase the child’s chances of developing an ear infection:
- Age: acute otitis media peaks between 6 and 18 months of age
- Family history of acute otitis media
- Day care attendance
- Child not breastfed
- Drinking from bottle or sippy cup while lying on back
- Use of a pacifier
- A recent ear infection
- Lack of access to medical care
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Why Are Babies and Young Children More Prone For Ear Infections?
Babies and young children are more prone for ear infections because they have short, approximately ½ inch, horizontal Eustachian Tubes according to Baby Center. As the child grows to adulthood, the tubes triple in length and become more vertical, which allows the fluids to drain more easily so that the fluid doesn’t have the chance to build-up.
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What Are the Signs of Ear Infection In Babies and Young Children?
The primary sign that a child has an ear infection is a Yellowish or Clear Pus that drains from the ear. The reason for the drainage is due to the fluid build-up that puts so much pressure on the eardrum, causing it to perforate, allowing liquid to leak out. Fortunately the eardrum has the ability to heal itself after such a perforation after a period of time without any resulting long term effects.
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According to First Med– Urgent Care (http://firstmedok.com/2015/02/25/signs-of-ear-infections-for-children-and-adults/) the following are signs of ear infections for children:
- Ear pain, especially when lying down
- Tugging or pulling at an ear
- Difficulty sleeping
- Crying more than usual
- Acting more irritable than usual
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- Difficulty hearing or responding to sounds
- Loss of balance
- Fever of 100 F (38 C) or higher
- Drainage of fluid from the ear
- Headache
- Loss of appetite
Because signs and symptoms of an ear infection can indicate a number of conditions, it is recommended by First Med– Urgent Care to get an accurate diagnosis and prompt treatment. See the doctor or bring your child into an urgent care facility if symptoms last for more than a day, especially if ear pain is severe, the child is sleepless or irritable after a cold or you see the discharge of fluid, pus or blood from the ear.
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How Is Ear Infection Diagnosed?
Initially a complete medical history and physical examination of the child is completed by his/her physician. According to Stanford Children’s Health (http://www.stanfordchildrens.org/en/topic/default?id=otitis-media-middle-ear-infection-90-P02057) the doctor will use an Otoscope to inspect the outer ear and the eardrum. “The otoscope is a lighted instrument that allows the physician to see inside the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.” A Tympanometry test can also be performed to help gauge how the middle ear is functioning. It can allow the doctor to determine any changes in pressure in the middle ear. This is usually difficult to use with infants and very young children because it requires the child to be still.
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According to Mindful Family Medicine (http://mindfulfamilymedicine.com/are-antibiotics-necessary-for-ear-infection-treatment/) it is extremely important to “remember that not all ear pain is an ear infection. Pain can also be caused by teething, upper respiratory inflammation and infections, teeth grinding or jaw clenching or eardrum inflammation”. It also stated that a proper diagnosis is crucial when dealing with an ear infection. “A red eardrum alone is not enough to make the diagnosis. Proper diagnosis is made with a painful, red, bulging, or distorted eardrum that does not move when air is pumped into the ear canal.”
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Current Standards of Care For Ear Infection Treatment?
In the past, physicians have primarily prescribed antibiotics to treat ear infections. According to Healthline (https://www.healthline.com/health/childrens-health/remedies-for-baby-ear-infection#antibiotics3) it is now known that antibiotics are often not the best solution. A research review that was published in the Journal of the American Medical Association (https://jamanetwork.com/journals/jama/fullarticle/186896) found that “among average-risk children with ear infections, 80% recover in about 3 days without the use of antibiotics. They found that using antibiotics to treat an ear infection may cause the bacteria responsible for ear infections to become resistant to antibiotics. This makes it harder to treat your child’s infections in the future.”
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According to Baby Center in 2015 the American Academy of Pediatrics (AAP) recommend watching your child for 48 to 72 hours to see whether his/her condition improves without antibiotics. As noted by the above study, 80% of the children get better without antibiotics. Doctors today will now be more cautious in prescribing antibiotics, basing their decision on the child’s age, symptoms, and what is best for him/her. There will be some situations, however, where the physician will feel that it is necessary based on his/her examination of the child, to order antibiotics. In these cases, the parents must make sure that the entire course of antibiotics are given followed by a revisit to the doctor.
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Baby Centeralso stated that antibiotics will not relieve the pain the child feels in the first 24 hours. The doctor may recommend a correct dose of acetaminophen or Ibuprofen for the pain. Remember, don’t give your child aspirin as it makes the child more susceptible to Reye’s syndrome (rare but potentially fatal disorder).
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Sometimes the child will have recurrent and/or frequent ear infections during the year even if treatment was successful. According to Dr.Eisner Pediatrician (http://www.doceisner.com/ear-infections/) when the child has these repeated ear infections and/or fluid buildup, Myringotomy tubes may be the treatment of choice. This surgical intervention is performed by an ENT specialist.
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New Upcoming Advances In Ear Infection Treatment
In an article called ”An antibiotic gel could treat kids’ ear infections with one dose” found in STAT News (https://www.statnews.com/2016/09/14/ear-infection-treatment-kids/), scientists at Boston Children’s Hospital want to commercialize an antibiotic gel that slowly seeps through the intact eardrum. Right now they have only tested this gel on animals with positive results. According to STAT News this is a very important discovery because Otitis Media is the most common diagnosis in US children and using oral antibiotics can be hard on the kids, parents and on the child’s digestive system. Also using too much oral antibiotics can contribute to the child’s future development of antibiotic resistance. The gel requires only one application.
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Complications of Ear Infections
Most ear infections don’t cause any long-term problems but according to Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616) frequent or persistent infections & persistent fluid buildup can result in some serious complications:
- Impaired hearing. Mild hearing loss that comes and goes is fairly common with an ear infection, but it usually returns to what it was before the infection after the infection clears. Persistent infection or persistent fluids in the middle ear may result in more significant hearing loss. If there is some permanent damage to the eardrum or other middle ear structures, permanent hearing loss may occur.
- Speech or developmental delays. If hearing is temporarily or permanently impaired in infants and toddlers, they may experience delays in speech, social and developmental skills.
- Spread of infection. Untreated infections or infections that don't respond well to treatment can spread to nearby tissues. Infection of the mastoid, the bony protrusion behind the ear, is called mastoiditis. This infection can result in damage to the bone and the formation of pus-filled cysts. Rarely, serious middle ear infections spread to other tissues in the skull, including the brain or the membranes surrounding the brain (meningitis).
- Tearing of the eardrum. Most eardrum tears heal within 72 hours. In some cases, surgical repair is needed.
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Prevention of Ear Infections
The following information may be redundant but is an important set of information for parents to know. There are some ways to help reduce the risk of developing ear infections according to the Mayo Clinic:
- Prevent common colds and other illnesses. Teach your children to wash their hands frequently and thoroughly and to not share eating and drinking utensils. Teach your children to cough or sneeze into their arm crook. If possible, limit the time your child spends in group child care. A child care setting with fewer children may help. Try to keep your child home from child care or school when ill.
- Avoid secondhand smoke. Make sure that no one smokes in your home. Away from home, stay in smoke-free environments.
- Breast-feed your baby. If possible, breast-feed your baby for at least six months. Breast milk contains antibodies that may offer protection from ear infections.
- If you bottle-feed, hold your baby in an upright position. Avoid propping a bottle in your baby's mouth while he or she is lying down. Don’t put bottles in the crib with your baby.
- Talk to your doctor about vaccinations. Ask your doctor about what vaccinations are appropriate for your child. Seasonal flu shots, pneumococcal and other bacterial vaccines may help prevent ear infections.
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In conclusion Ear Infections, also known as Otitis Media, is a painful inflammation of the middle ear where there is decreased drainage from this area resulting in a buildup of fluid behind the ear drum. Young children are more prone for ear infections where the Eustachian tubes do not work properly due to colds, allergies, enlarged adenoids, or not being in a favorable angle to allow for drainage. The child develops ear pain and may have a fever, trouble eating, drinking or sleeping. If the ear drum ruptures, the child might feel dizzy, nauseated and complain of ringing/buzzing in the ear. It is important to have the child examined by his/her doctor for a proper diagnosis and intervention.
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I hope you learned something from this article about Ear Infections. There are many resources on the internet if you need more specific information. I will continue this series with another childhood disease post. I hope you will continue to join me in this quest to learn about these illnesses that children usually encounter when they are young. Thank-you for reading my article on Childhood Diseases – On a Mission to Educate: Ear Infections. If you would like to follow me, please check HERE
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