Ear Infections (Otitis Media)
Most ear infections can be treated by a primary care physician. There are many antibiotics that are available for the treatment of this process. There are three common bacteria that cause most infections. This is why it is sometime necessary to use one antibiotic and then to switch to a second antibiotic. There are no studies that show that switching more than twice is likely to succeed in clearing up ear infections.
When infections become chronic, it is important to identify what could be causing the recurrent infections.
Causes of recurrent ear infections:
The immature eustachian tube
The size and shape of the eustachian tube is different and children than in adults. Children have smaller, floppier and flatter eustachian tubes. Some children inherit small or dysfunctional eustachian tubes from their parents. This account in part for the family tendency toward middle ear infections. As a child matures, the eustachian tube usually assumes a more adult shape and function. Certain racial characteristics may also play a role. Native Americans tend to have a higher rate of infection compared to African-Americans.
Infections and fluid collections are more common in children with cleft palate. This is due to the fact that the muscles that move the palate also open the eustachian tube. These muscles are deficient or abnormal in children with cleft palate. Most doctors recommend that treatment is more aggressive for children with cleft palates even after the cleft is repaired.
The oral cavity of the child is certainly not sterile. Many infections are passed through a variety of things that contact their oral space. Increasingly, individuals who are in large day care settings may experience a transmission of the infection from other individuals in the day care. Recently we have observed that many of the bacteria are resistant to a variety of drugs. Some of these new bacteria are not treatable by the usual antibiotics that have been used for years. Larger day cares with more children tend to have more frequent ear infections.
Allergic reactions in the nose and throat increase the mucous membrane swelling. This swelling may also affect the eustachian tubes function. This reaction may be acute, as in hayfever, or it may be chronic, as in many varieties of chronic sinusitis. It can be difficult to make a diagnosis of allergy in children.
The adenoids are located in the back of the throat in a space called the nasopharynx. In this area when the adenoids become enlarged they may functionally block the eustachian tube. Infections of the adenoids may contribute to or cause infections in the middle ear.
Researchers have found that children who are breast-fed tend to have lower rates of middle ear infections. It has been observed that the first six months of life are critical for this to be effective. Smaller families with fewer children tend to have fewer infections.
Without a doubt smokers kids have a higher rate of ear infections. In fact, if the primary caregiver (like a grandparent) is a smoker, the rate is also higher. If there is a smoker in the child’s home, the rate of infection increases. If smokers can avoid smoking around the children especially in closed spaces like cars, the child is likely to have fewer ear infections. Smoke is known to paralyze cilia in the throat and allow infections to spread.
Even after everything has been done to mitigate all causes of recurrent ear infections, surgery may be recommended if ear infections persist or long-term.
When infections allow fluid to stay in the ear for long periods of time doctors usually refer to this as otitis media with infusion (OME). Some doctors use an older term of serous otitis, purulent otitis, glue ear or suppurative otitis. No matter what the process is called, it requires a plan of treatment. The indications for surgery are not generally agreed upon. The agency for health-care policy review has guidelines. These guidelines recommend that children who have long-term infections lasting 4 months in duration are candidates for surgical intervention. Hearing loss > 20 decibels is also a criterion for intervention. Other factors may be considered by your doctor in deciding when to intervene surgically. A child who has had a perforation of the ear drum in the past or a complication of ear disease such as a seizure or facial weakness may be considered for earlier placement of PE tubes and/or adenoidectomy. Children who are behavior problems, have speech or language delays or have other serious medical conditions might require earlier referral to an ear specialist.