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The Ear Infection  
It's Back...Again!


HealthThere are few things more frustrating than having an infant or toddler in pain and incapable of telling you what hurts. Many parents have felt the frustration and helplessness of being unable to make things feel better. One of the most likely causes of childhood pain of this nature is acute otitis media or, the dreaded ear infection. The American Academy of Pediatrics states that nearly 90 percent of children between the ages of six months and four years will experience an ear infection. Although as a parent you may not know the specifics of the cause, you most likely do know the signs—tugging or pulling at the ear and inconsolable crying. You know something hurts but it takes minor detective work to uncover the root cause of the pain. Hopefully with a bit of background knowledge on the cause, symptoms, and treatment of ear infections you will be able to make the next occurrence a less painful one for your child.

According to the Mayo Clinic, our ears are composed of three parts; the outer, inner, and middle ear. The outer ear is the part which is most visible from either side of the head and includes the folds of skin and cartilage that form the ear and the ear canal that leads to the eardrum. The middle ear is a pea-sized chamber behind the eardrum that is normally filled with air. It also houses three tiny bones that send vibrations from sound from the eardrum to the inner ear. The inner ear is an area where nerve endings change the sound vibrations into signals that are sent to the brain via the auditory nerve. It is those signals that enable us to hear.

HealthNow that we have an idea of the mechanics of the ear and the hearing process, we can better understand what happens when an ear infection occurs. Normally air enters the middle ear through the eustachian tube, a narrow tube that connects the middle ear to the back of the nose and helps drain fluid from the ear. Ear infections typically start with an upper respiratory infection or a cold or may form from allergies. Both colds and allergies cause inflammation and swelling in the sinuses and eustachian tubes. Eustachian tubes in children are shorter and narrower than those in adults so it takes very little inflammation to block the tube entirely, thereby trapping fluid in the middle ear. The buildup of fluid in the middle ear causes discomfort and impairs the transmission of sound, diminishing the ability to hear. The environment of the inner ear is ideal for bacterial growth when fluid is present. When this fluid becomes infected, the condition is referred to as acute otitis media. Pressure from the infected fluid presses against the eardrum and causes the notorious pain associated with an ear infection.

Children whose ear infections clear up only to return again and again experience recurrent otitis media. The Mayo Clinic notes that doctors define recurrent as three or more ear infections within a six-month period or four infections within one year.

The National Institutes of Health identifies some of the possible symptoms of an ear infection as:

  • Irritability
  • Inconsolable crying
  • Fever
  • Trouble sleeping
  • Fullness in the ear
  • Feeling of general illness
  • Vomiting
  • Diarrhea
  • Hearing loss in the affected ear

The Mayo Clinic notes that although any child can get an ear infection, the following kids are more susceptible:

  • Boys
  • Infants and children under the age of two
  • Children whose siblings have a history of recurrent ear infections
  • Children with a family history of allergies, asthma, or eczema
  • Children with a cleft palate or Down syndrome
  • Children with weakened immune systems
  • American Indian, Alaskan Inuit, and Canadian Inuit children—possibly due to genetic factors that affect the shape of the auditory tube
  • Hispanic children

There are some additional risk factors that can be controlled by parents and may help reduce the risk of a child developing ear infections. Among the factors noted by both the Mayo Clinic and the National Institutes of Health are:

  • Protecting children from secondhand smoke. Children who live with a smoker are at a greater risk of developing ear infections and are more likely to have chronic ear infections. Don't smoke or allow others to smoke while your child is present.
  • Infants that are bottle- fed are more likely to develop ear infections than those who are breast-fed. Breast-fed infants benefit from natural immunity passed from the mother that helps fight ear infections. If bottle-feeding an infant, hold the baby upright during feeding and don't feed a child of any age from a bottle while the child is lying in bed. Drinking from a bottle while lying down can lead to blocked auditory tubes.
  • Babies who rely on pacifier use have a higher risk of developing ear infections (especially babies between six and twelve months). There is however no evidence linking thumb sucking to an increased risk of ear infection.
  • Most ear infections begin with an upper respiratory infection like a cold or the flu. Reduce your child's chances of catching a cold by teaching frequent hand washing and being selective about play partners during cold and flu season.
  • Allergies also lead to ear infections. Childhood allergies may be treated with medication that helps dry the fluid in the middle ear.
  • Children who get the recommended pneumococcal conjugate vaccine (usually recommended for children under the age of two) are less likely to have recurrent ear infections. Those who receive the flu vaccine are also at a reduced risk of developing an ear infection during flu season.
  • Reducing your child's exposure to other children during cold and flu season can also help reduce the likelihood of developing ear infections. Although this is difficult to achieve, choosing child care facilities with fewer children in attendance, or those with a strict policy on attendance while ill, may greatly reduce the ear infection risk to your child.

If your child does happen to develop an ear infection, you doctor may recommend a couple treatment options depending upon your child's age, the frequency, duration, and severity of the infection, other risk factors your child might have, and whether the infection affects your child's hearing. The American Academy of Pediatrics states that watching your child's symptoms for two or three days is a reasonable option for most children over six months of age. If symptoms haven't improved during that time, your doctor will want to recheck your child's ears and may prescribe an antibiotic at that time. Regarding antibiotic use, the Mayo Clinic notes that frequent use of antibiotics may make future infections more difficult to treat and may also increase the spread of drug-resistant bacteria in the general population. "Watchful waiting" has become a more standard method of treatment in recent years as opposed to automatic treatment with antibiotics.

Although it's natural to want a quick cure that will make your child feel better immediately, the Mayo Clinic states that 80 percent of acute ear infections usually clear up without the use of antibiotics. With "watchful waiting," pain relief will still be necessary and may include one or more of the following:

  • Over-the-counter pain relievers such as acetaminophen, ibuprofen, or naproxen sodium in infant or child concentrations or dosages. The Mayo Clinic notes that administering these pain relievers won't otherwise change the course of treatment your doctor would recommend. Use the correct dosage for your child's age and weight. Never give aspirin to children under the age of 19 as it has been shown to cause Reye's syndrome, a rare but potentially life-threatening condition.
  • Applying a warm, moist cloth to the ear may help relieve some of the ear pain and make your child more comfortable.
  • Ask your doctor about eardrops containing antipyrine or benzocaine that will help numb the ear. Such drops won't cure an infection but they may help ease the pain. The Mayo Clinic adds that you should not use eardrops if fluid is draining from your child's ear.

If your doctor prescribes an antibiotic to fight the infection, a 10-day treatment course is usually recommended for children five and under and a five-to-seven-day treatment course for those six years and older. When using antibiotics, the Mayo Clinic notes:

  • Finish all the medication. Follow your doctor's instructions and give the full course of antibiotics even if symptoms get better. If the full course of antibiotics is not given, the infection may not be completely cured and the risk of developing drug-resistant bacteria is increased.
  • Read all medication labels and follow the directions. If you don't understand the instructions or have questions, ask your doctor, nurse, or pharmacist.
  • Antibiotic use can result in side effects (which should be noted in materials you receive with the prescription). Some side effects include nausea and diarrhea. If you child develops a rash or has signs of an allergic reaction, contact your doctor immediately or take your child to the emergency room. Remember to notify your doctor of any other medications your child takes to avoid any unexpected drug interactions.

If a child has recurrent ear infections, your doctor may recommend surgery to insert ear tubes. This procedure helps drain the fluid from and ventilate the middle ear while also balancing the pressure between the outer and middle ear. Your family physician will decide whether ear tubes are right for your child given the child's history and response to treatments.

So when it comes to dealing with ear infections, you have plenty of company. Do what you can to reduce the risk factors for your child by reducing germ transmission during the cold season (hand washing, disinfecting communal toys, avoiding interaction with those who have a cold, etc.) and you may avoid the common occurrence of an ear infection. If you're not that lucky, follow your doctor's advice for treatment. It just may be the thing to make ear infections a thing of the past for your child.

As with any medical condition, consult with your family physician concerning any medical conditions and associated treatment plans.

Mayo Clinic—
National Institutes of Health—
American Academy of Pediatrics—

Articles are provided for the general interest of our readers. Gerber Life Insurance is not responsible for any content and recommends that you consult the appropriate professional with any questions or concerns you may have concerning any financial or health related issues.

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