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Ear Infections: Take A Look Inside

by Sue Hubbard, M.D.

More coughs and colds today in the office and a lot of emails with questions about ears infections.

earThere is really not a way to diagnose an ear infection without your doctor looking in your child’s ears. With that being said, once your child reaches about the age of 9 -12 months, and they have had several colds, you get an idea if your child seems to be ‘otitis prone’. In other words, do they get an ear infection with each cold or runny nose, or have you taken them in to the doctor and they always have clear ears.

Despite what ‘many mothers say’ not everyone gets an ear infection with a cold, and in fact, most children don’t.  Parents also want to ‘prevent’ an ear infection and studies continue to show that antihistamines and/or decongestants do not seem to have a role in preventing the development of an ear infection or in the treatment of otitis.  Antihistamines and decongestants also have side effects and are not recommended to use in children younger than 5-7 years.

Once your child is older and they may now be able to tell you that their ear hurts (typically 2 and older), they still need to have their ears looked at.

Ear pain (otalgia) is not always due to an infection of the middle ear.  There are many times that a child (or adult) will complain about their ears hurting, but they may have referred pain from a sore throat, or they may have fluid behind the ear drum (serous otitis) and feel as if their ears are full, but they are not infected.  I also see teens who complain of ear pain and may be grinding their teeth. All ears that HURT are NOT due to an infection.

A new approach to treating ear infections in a child over 2, who is not ‘otitis prone’ and does not appear to be terribly sick is to treat the painful ear with pain relieving ear drops and oral Tylenol or Motrin.  This is termed “watchful waiting”.

There have been several studies, in older children, to compare immediate versus delayed antibiotic treatment.  The studies to date have shown little difference in symptoms by watchful waiting and may indeed limit unnecessary antibiotics.  There is still the need for further research in this area, but I  must say, I have used this approach in a lot of children.

I will write the antibiotic prescription as well as a pain relieving ear drop and instruct a parent to wait a few days before filling the antibiotic. If their child is improving they will not need to even take an antibiotic. I really have had a lot of success with this approach, but only in older children, who do not seem to be very ill.  More to come on this issue.

One last point, I do not recommend that parent’s buy an otoscope to try and diagnose an ear infection at home.  Looking in ears (otoscopy) is one of the hardest things to learn during residency. It takes thousands of ears to be seen to become really proficient in examining an ear drum. It really is practice, practice, just like many other professions.

If you really think that your child’s ears are infected, you must let your pediatrician take a look. Surely we will have a better method someday??

That’s your daily dose. We’ll chat again soon.

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