Ear Infections

CONFUSION ABOUT EAR INFECTIONS

Ear InfectionsPediatricians spend more time in the diagnosis and treatment of ear infections than almost all other ailments combined. Since the middle ear can’t be seen without instruments, the possibility of an ear infection lurks in the mind of every parent whose child is cranky or feverish, especially when no other cause is apparent. Some physicians respond to this ear anxiety by treating almost every sick child with antibiotics when the eardrum is just slightly inflamed. Yet studies in Europe show that most mildly infected ears resolve without treatment and, except for pain medications, often do not require antibiotics. In the United States, antibiotics are still used rather heavily and for long periods but there is a growing trend to treat for shorter periods, often less than five days, and to withhold antibiotics unless the ear appears severely infected. This seems to be a wise compromise and in the best interests of the patient.

Where in the world did you hear?

Always cover your child’s head in bad weather. Exposure causes ear infections.

Sound Advice:

If this, my mother’s advice, was heeded, we would also believe that getting our feet wet, exposing our ears to windy or wet weather or not wearing a hat are reasons ears get infected. Mom, sorry, you’re wrong! The middle ear is completely protected from the environment by the ear drum. Nothing, not even a roaring waterfall, can enter that cavity from the outside. As long as the ear drum is intact, ear infections don’t occur from exposure to the “elements.” Ear infections are an inside job! Germs invade the middle ear cavity only when mucus or swollen adenoids block the Eustachian tube. And that happens only as a result of a cold or allergies, not because of exposure to dampness or inclement weather. Going out without a hat will only result in a cold head, not an infected ear.

The Conclusion:

Not to worry. Ear infections are the result of germs, not foul weather or wet heads.

Where in the world did you hear?

Frequent ear infections will result in delayed speech development.

Sound Advice:

This simply is not true. Studies have shown that, despite recurrent ear infections and persistent fluid behind the drums (serous effusions) children will still develop normal speech and vocabularies. What really counts in developing speech skills is exposure to talkative and literate caretakers. But many parents (and some physicians) are quick to resort to the surgical insertion of ventilating tubes, myringotomy and tympanostomy, for recurrent ear infections or persistent fluid. This procedure, although considered minor surgery, isn’t without complications and should be used only as a last resort. Children commonly develop lots of ear infections in the first three years of life, most episodes being uncomplicated, resolving quickly, with or without antibiotics. Only when ear infections are associated with serious illness such as mastoiditis, frequent high fevers or failure to thrive does surgical intervention deserve consideration. Parents are often alarmed when, during the course of ear infections or serous effusion, tympanograms and/or audiograms are abnormal. These findings are temporary and all tests will revert to normal once the infection subsides and fluid is gone. It’s misleading to perform these tests when the eardrum still appears abnormal since the poor results are a foregone conclusion. Recurrent fluid behind the eardrum in a happy, thriving child is not a good reason to perform surgery, especially if medical treatment (nasal or oral steroids, anti-inflammatories) can reduce or resolve the fluid. It’s not a permanent condition and resolves over time, leaving no permanent damage. The good news is that almost every child past the age of four will have healthy ears regardless of his past history. Usually it’s in the best interest of the child to treat conservatively and wait for the better times to come.

The Conclusion:

Recurrent ear infections are common in many families and, unless accompanied by more serious illness, are harmless and don’t interfere with speech or long term health.

Where in the world did you hear?

Children who get a lot of ear infections have poor immunity.

Sound Advice:

It’s genetics, not immunity. Lots of parents have a history of childhood ear infections and, more times than not, their children will inherit this trait. Eustachian tubes, which connect the nose and the middle ear, are usually the problem, failing to keep germs out. Others may have inherited allergic traits: chronic nasal congestion and mucus blocking the tube. But age and growth usually come to the rescue and, after the age of four, most ear infections will be just a memory and these kids will be strong and healthy.

In the meantime, medical science has provided vaccines that are effective in reducing this misery. Foremost is the pneumococcal vaccine, given to all infants after two months of age, resulting in almost 20 percent fewer ear infections. Flu vaccine adds to that protection, protecting even further. Then there’s maintenance: keeping nasal mucus down to a minimum using nasal saline, nasal steroids, allergy treatment and anti-inflammatory drugs.

The Conclusion:

Children with frequent ear infections have normal immunity. As they grow older, the infections will stop. And, no, they don’t need additional vitamins.

Where in the world did you hear?

Children always run fever when their ears are infected.

Sound Advice:

Generally, this is not the case. Pediatricians often see children who have “red hot” ear infections but normal or only slight elevations of body temperature. Fever usually doesn’t come from the infected ear but rather from an accompanying illness such as a flu or other virus. In rare instances, illnesses such as mastoiditis or abscesses will cause fever, but these children appear severely ill. Needless to say, all children with fever should be evaluated by the doctor. Only careful examination will reveal the source of the illness.

The Conclusion:

Never assume that fever in a child is caused by an ear infection. Fever always should be investigated to determine the source.

Where in the world did you hear?

Cancel your flight reservation: you can’t fly if you have an infected ear!

Sound Advice:

Would you believe that the safest time to fly may be when both ears are infected or filled with fluid? Here’s the reason: normal eardrums stretch easily under pressure, sometimes causing pain, especially if there is nasal congestion blocking the Eustachian tubes. But it’s a different story when eardrums are infected and swollen. The sick eardrums are much less mobile and, guess what, cabin pressure rarely budges them. In a study performed on airline passengers with various ear problems, almost all discomfort occurred in those passengers whose ears were normal before boarding. Sick ears flew best!

Of course, it’s best to fly when changes in cabin air pressure are not felt at all. This happy situation occurs when the nasal passages are clear and the Eustachian tubes are open. This is important, since, in small children even a tiny amount of nasal congestion can result in a miserable plane flight. The remedy is a simple over the counter medicine called Neo-Synephrine nose drops or spray which comes in varying concentrations, from

⅛ to ½ percent. Babies less than twenty pounds need only ⅛  percent. Once boarding the aircraft, the neosynephrine should be gently sprayed into the child’s nostrils while the head is tilted down (one or two drops are fine) or dropped into the nostrils with the head tilted back. While taking off, try to get the child to suck or swallow some liquid, then relax and enjoy the flight. When the flight crew announces that the plane will shortly begin descent, repeat the entire procedure. It is especially important for the child to drink and swallow during descent since the increasing cabin pressure pushes on the eardrums and, unless the Eustachian tubes are clear, pain and crying can occur.

The Conclusion:

Don’t cancel your flight if your child has an infected ear. Take precautions to keep the Eustachian tube open and have a good trip.

Have any questions? Please contact Dr. Mesibov

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