ASK THE DOCTOR: Treating ear infections
By DR. JIM MITTERANDO
The Patriot Ledger

Q. My doctor recently told me that my child's ear infections do not need to be treated with antibiotics. Do you agree?

A. More prescriptions are written for ear infections - over 30 million annually - than for any other medical condition.

While antibiotics are still the main treatment for ear infections in this country, parents and doctors are starting to think twice about this practice.

Increasing problems with antibiotic resistance as well as new studies showing that most ear infections improve without antibiotics are forcing American health care providers to reexamine their habit of prescribing antibiotics for ear infections.

Europeans have cut down their use of antibiotics resulting in decreased antibiotic resistance.
During the school year, most children who get ear infections first had a cold that caused nasal congestion and swelling of a passageway from the ear to the throat called the eustachian tube.

The eustachian tube normally allows air to flow behind the ear drum and equalize the pressure inside and outside the ear. When the tube becomes blocked, the ear drum is sucked inward, causing popping and pain in the ear similar to the sensation of descending on an airplane.

If the tube stays blocked, the space behind the ear drum (called the middle ear) can fill with fluid. This fluid can then become infected with bacteria or viruses, causing a middle ear infection.

This is in contrast to an outer ear infection also called "swimmer's ear" that is due to swimming pool water and inflammation in the ear canal outside the eardrum.
There are a lot of nerves in the ear, so any pressure or infection can cause quite a bit of pain. Most children, at some point, have ear aches. But interpreting pain in a child who is too young to talk can be a challenge; this often leads many parents to worry that their irritable, sleepless child may have an ear infection.

Fortunately, times are changing; parents do not need to rush their children to the doctor when they suspect an ear infection.

New studies reveal that most ear infections do not require antibiotics and will improve within three days with or without antibiotics.

Children who don't improve in three days should see their health care provider.

Children whose pain is not relieved with acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) can receive prescription pain medication including numbing, analgesic ear drops. Auralgan or Auroto ear drops contain benzocaine, which is similar to novocaine and is also found in the teething medications Orajel and Ambesol.

Analgesic ear drops do not contain antibiotics and do not speed recovery. They are simply used to give some pain relief, help the child sleep through the night and buy some time while the child recovers.

These ear drops should not be used with children who have "tubes" placed in their ear drums or who have drainage from their ears, which can be a sign of a ruptured ear drum that should be seen by a health care provider.

Codeine is also an effective pain reliever to help kids sleep through the night when Tylenol or Ibuprofen are not enough. Positioning the child upright may help with ear pain and congestion, as well as placing a warm (not hot), moist cloth or heating pad (on lowest setting) over the ear.

A child tugging on her ear does not mean she has an ear infection; often she may have ear pressure from a blocked eustachian tube.

Many children with colds and ear pain that I see in the office have ear drums that are sucked in from pressure rather than infection. Sometimes pinching the child's nose while he or she is crying may equalize the pressure behind the ear drum. Scuba divers use this technique frequently.

Antihistamines and decongestants do not help ear aches and should be avoided in children under the age of 5 because of potential side effects.

I believe that ear infections are commonly overdiagnosed. Often a child's ear can be a little red during a simple cold or when a child is crying. I often find that children seen in the emergency room are overdiagnosed with ear infections. In fact, children with ear infections do not need to go to the emergency room. Prompter treatment with an antibiotic will not help with the pain. Pain medications are the key to making a child comfortable.

Because most ear infections clear on their own, your health care provider may first recommend a "wait-and-see" approach.

In other cases, your doctor may opt to prescribe an antibiotic to treat the infection. If your child does not improve over the next three to four days call your health care provider.

With the "wait-and-see" approach, 20 to 30 percent of children with ear infections will require antibiotics; this approach reduces antibiotic use by 70 to 80 percent.

We need to lighten up on our antibiotic habit, or we risk antibiotic-resistant bacteria and the loss of cures for potentially life-threatening infections such as pneumonia.

This approach may not apply to children with frequent ear infections who may require preventative antibiotics or "tubes" to be surgically placed in the ear drums to drain fluid and equalize ear pressures.

Dr. Jim Mitterando is a family doctor at Health Care South/Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright The Patriot Ledger
Transmitted December 11, 2001