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And should you treat them with antibiotics, pain relievers, or ear tubes? Understanding the causes and options makes managing this childhood problem easier.
Dr. Jennifer McLevy, a pediatric otolaryngologist with Le Bonheur Children’s Hospital, says there are several causes for ear infections, with structural issues often to blame. The narrow passageways or Eustachian tubes that connect the middle ear behind the eardrum to the back of the nose are narrower, shorter, and more horizontal in children than adults. When too narrow, fluid builds up behind the eardrum, causing an infection. Genetics can also play a role. “If a mother had a problem with ear infections in childhood, her children are more likely to have recurring ear infections as well.”
Other factors that lead to infection are being around other children at daycare, secondhand smoke, and “bottle propping.” Allergies, while not a direct cause, can also contribute, notes Dr. Betty Mirro of East Memphis Allergy and Asthma. “When patients have allergies, the swelling of the nasal airway may cause [the Eustachian tubes] to be swollen and not function properly. This may lead to accumulation of fluid in the ear.”
Symptoms. Frances Vigil, mother of five, recalls her oldest son’s first signs of trouble. “After about three infections, I could tell when he was working towards another one; he wouldn’t listen or respond when I talked to him.” Occurring both during and after an ear infection, hearing loss is usually temporary but may last several weeks.
Other symptoms include:
- Pain in the ear, with child tugging or pulling at the affected ear
- Unusual crying or irritability
- Loss of appetite
- Trouble sleeping
- Fever above 101.5
- Ear drainage
Treatment. With growing concern regarding antibiotic-resistant bacteria, or superbugs, many doctors are forgoing antibiotics as a first course of action. “In children older than ages 1 or 2 with a low-grade fever and pain that can be well controlled with Tylenol or Motrin, pediatricians may recommend observing for one or two days to see if symptoms improve,” advises McLevy. While it may seem unnatural to allow a child to ‘fight’ the infection without antibiotics, the American Academy of Pediatrics says approximately 80 percent of ear infections resolve on their own.
Exceptions may include:
- under age 1 unless low-grade fever or pain is controlled
- children 6 months to 2 years if symptoms are severe
- symptoms that don’t improve after 72 hours
- fever over 101.5
- uncontrolled pain/fever
- underlying conditions such as Down syndrome or immune disorders
- fluid lasting three months with hearing loss
If allergies are suspected of contributing to recurring infections, Mirro suggests ruling that out before self-medicating. “Seeing an allergist in this circumstance may prevent the use of medications that are not going to be helpful. If the patient does not have allergies, the use of antihistamines and nasal sprays, especially on a long-term basis, would not be of any use in the treatment/prevention of ear infections.”
McLevy says another option may be ear tubes if one of the following takes place: fluid persists for three months with hearing loss, six infections occur within a year, or four infections occur within six months. However, doctors often try to avoid tubes due to possible adverse effects from anesthesia, damage to the eardrum, or tubes falling out prematurely. Other treatment options include long-term, low-dose antibiotics or surgery to remove adenoids.