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Ear Infections

by Sue Hubbard, M.D.

I keep referring to “sick season” and all of the colds we are seeing and with those nasty colds a child may develop a secondary ear infection.  Ear infections (acute otitis media) are most common in the first several years of a child’s life, especially between 6–12 months of age.

imagesBecause a young child’s eustachian tube is shorter and more horizontal they may be anatomically prone to more infections.  84% of children will have experienced at least one ear infection by the time they are 3 years of age.  The majority of these will occur in the winter!

During a viral upper respiratory infection there is inflammation of the nasopharynx and Eustachian tube.  The eustachian tube then does not drain the fluid from the middle ear and that leads to a fertile area for bacterial growth and the subsequent ear infection.

There are several different bacteria that are typically found if cultures of this middle ear fluid are done.  It is from studies that look at prevalence of bacteria within the middle ear that the choice of antibiotic is made. It is important for pediatricians to keep abreast of this information in order to prescribe the most effective antibiotic.

It is interesting that different bacteria may be more prevalent in one part of the country than another, and that drug resistance may also differ from region to region.

There are no definitive ‘signs’ that your young child has an ear infection. I hear comments like, ‘they pull on their ears’, or ‘they wake up in the middle of the night’, or they just ‘seem fussy’.  The only real way to tell if your baby has an ear infection is for the doctor to look in their ears and visualize the eardrum.

I must say that the majority of the time, there is not a ‘sign’ that your child’s ear is infected, and there are fortunately a lot of ‘false alarms’.

Conversely, there are occasions when a child is in the office for another reason, whether it is a check-up or another issue and they are found to have an ear infection. In those cases the parent will often comment, ‘what if I hadn’t known’ or ‘how would I have known?’.

There are often times that a baby or toddler may have an ear infection that is never discovered and they resolve on their own.  The incidence of this occurrence is obviously not known, but I personally know that I have seen plenty of these incidental infections that have resolved on their own.

A parent need not ‘feel guilty’ if their child is found to have an ear infection at a check up.  They have not sustained hearing damage or developmental damage or any of the other myriad of disorders that a parent need ‘feel guilty’ about.

The most frequent treatment for an ear infection is to put your child on an oral antibiotic.  70% of acute ear infections are due to a bacterial infection so, therefore an antibiotic is appropriate.

The first line antibiotic is typically amoxicillin (the good old ‘bubble gum’ medicine). If children have an unresolved infection or recurrent infections, second line antibiotics are used, such as Omnicef, Augmentin, or Zithromax.  For really difficult infections a child may receive an injection of Ceftriaxone.

There is not one way to treat an ear infection and different physicians prefer different antibiotics.

More about ear infections this week, there is a lot to cover.

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