The Truth About Ear Infections By Dr. Ayodeji Otegbeye in Orlando, FL
6 Common Myths Every Parent Should Know.
Ear infections are one of the most common infections that we treat here at Night Lite Pediatrics. But because ear infections are more common in children than adults, we often come across parents that are misinformed about the symptoms, treatments, and severity of an ear infection. So, we wanted to debunk six common myths regarding this topic with hopes that it will help bring some clarity the next time your little one has ear pain.
MYTH 1: All Children or Adolescents with Middle Ear Fluid Need To Be Treated With Antibiotics
Acute otitis media – AOM refers to acute infection of middle ear fluid; whereas, Middle ear effusion (MEE) or Otitis media with effusion (OME) refers to fluid in the middle ear cavity, which can happen after AOM or if there is dysfunction of the Eustachian tubes. Middle Ear Effusion occurs in both otitis media with effusion and AOM. MEE can be seen after antibiotic treatment of AOM, but it is not an indication for repeat antibiotic treatment unless it gets infected again.
The importance of accurately diagnosing AOM cannot be overstated. Accurate diagnosis ensures appropriate treatment for children with AOM, which requires antibiotic therapy, while avoiding antibiotics in children with OME, where antibiotics are unnecessary. Ultimately, accurate diagnosis prevents overuse of antibiotics, which can lead to the development of resistant organisms.
MYTH 2: Children and Adolescents with confirmed Acute Otitis Media (Ear Infection) Must Be Treated With Antibiotics.
Roughly 80 percent of children with acute ear infections get better without antibiotic treatment. Also, studies show delaying antibiotic treatment with watchful waiting does not increase the likelihood of developing a severe illness.
The clinician should either prescribe antibiotic therapy or offer observation with close follow-up based on joint decision-making with the parent(s)/caregiver for unilateral AOM in children six months to 23 months of age. During observation, steps must be put in place to ensure follow-up and to begin antibiotic therapy if the child worsens or fails to improve within 48 to 72 hours of ongoing symptoms.
Gathering as much info on the tempo, severity, and duration of illness is also essential because a progressively or severely ill child is more likely to have a bacterial process that may not resolve right away.
Starting an antibiotic is reasonable if your child is:
- Six months or younger and has a diagnosis of certain or suspected acute infection.
- Between the ages of six months and two years and has severe symptoms with a diagnosis of certain or suspected acute infection.
- Between the ages of two and twelve years and has severe symptoms with a diagnosis of certain acute infection.
- Severe symptoms defined as moderate or severe otalgia for at least 48 hours or temperature 39°C [102.2°F] or higher).
Myth 3: My Child’s Ear Infection Should Always Be Treated With Amoxicillin?
Here are some reasons to go with something different or stronger than Amoxicillin:
- If the fever and fussiness are not improving after 48-72 hours of an antibiotic, your child may need a stronger one.
- If amoxicillin has not worked two or three times in the past, then it’s OK to start with a stronger antibiotic for future infection.
- If your child has taken amoxicillin in the past 4 to 6 weeks, and then develops another ear infection, chances are that this infection is resistant and needs a stronger antibiotic
- If your child is allergic to amoxicillin
- If there is accompanying pink eye with discharge which increases the likelihood of bacteria (Non-Typeable Hemophilus influenza) which is commonly resistant to Amoxicillin.
MYTH 4: Most Ear Aches (Otalgia) Are Due To Middle Ear Infection:
Symptoms such as ear tugging or ear pain (otalgia), while often helpful in nonverbal children, may also indicate middle ear fluid without infection. Other symptoms such as irritation of or blisters on the eardrum may be due to a viral infection (Myringitis).
Eustachian Tube (ET) dysfunction with decreased hearing is common in children with Allergic Rhinitis, Enlarged Adenoids especially after a plane ride or referred pain from a dental or throat problem.
Ear Pain as a symptom should be distinguished from pain in the external canal due to otitis externa which results in pain on movement of the earlobe and inflammation of the ear canal usually without any systemic symptoms such as fever.
MYTH 5: Are Children’s Ear Infections Ever Serious?
ANSWER: Yes, But Rarely
A severe or untreated infection can rupture your child’s eardrum. Ruptures don’t happen very often and heal quickly. Repeated ear infections or chronic MEE (middle ear fluid for months even without infection) can sometimes cause hearing loss and scarring. In rare cases, untreated ear infections lead to mastoiditis (a skull infection behind the ear) or meningitis.
It is advised to follow up with your child’s doctor to make sure the infection has cleared up and that the eardrum is healing well.
MYTH 6: There Is No Way To Prevent Ear Infections- It Is One Of Those Common Things Every Kid Gets
Breastfeeding until at least 6 months is recommended to help prevent acute ear infections. Parents should also avoid “bottle propping” and eliminate your child’s exposure to secondhand smoke.