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Everything You Wanted To Know About Ear Infections – Part 2

February 25, 2013

iTriage
Recently we covered the nuts and bolts of why kids get ear infections. In this installment of our series, we’ll take a look at treatment and prevention of this common condition.
The first question to consider is whether we need to treat at all.
Antibiotics have been around for 78 years. In the thousands of years prior to 1935, children recovered from ear infections just fine without the aid of any medication.
How can this be? Well, as it turns out, the human immune system is quite capable of eradicating bacterial invaders in the middle ear space.
Another point to consider: A hefty number of middle ear infections are caused by viruses. You’ll recall that antibiotics kill bacteria, not viruses. So for many kids, an antibiotic isn’t going to help.
And finally, the over-use of antibiotics, especially in an infection that would resolve on its own or one that is caused by a virus, may result in the growth and spread of hard-to-kill drug-resistant bacteria.
So why use an antibiotic at all?
Left to themselves, many bacterial ear infections will result in so much pus and pressure in the middle ear space that the ear drum ruptures, allowing pus to spill out the external ear canal. This actually sounds worse than it is. In most cases, the “rupture” is a tiny pinhole that scars over without lasting effect. But if that happens multiple times, the ear drum can become stiff, resulting in hearing loss.
Prolonged and recurrent bacterial infections may also damage the three little bones in the middle ear space, which also results in hearing loss. Another possibility is the spread of infection to the nearby mastoid bone of the skull or even to the brain itself, causing meningitis or encephalitis.
Fortunately, these serious complications of ear infections are rare… but they are possible.
And so we find ourselves in the position of not wanting to over-treat or under-treat. To this end, most of us take a middle road. If the symptoms seem mild, we encourage parents to wait a few days to see if the infection will resolve on its own. However, if the symptoms are severe or the infected child is very young or has an underlying medical condition, we prescribe an antibiotic.
Where do ear tubes fit into the picture?
When ear infections become a recurrent problem, a surgeon can insert a small plastic tube through the ear drum. This provides an exit route for bacteria. Instead of becoming trapped, the microbes can move through the tube, into the external ear canal, and become skin bacteria.
How about preventing ear infections in the first place? That’s a more difficult task. As we discussed in our previous installment, ear infections are caused by a combination of ear anatomy, mouth bacteria, and viral upper respiratory infections. You can’t alter the first two. You can the third, but it means taking your child out of daycare, preschool, or any other place where kids and viruses hang out.

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