Ear infections are the most common clinical complain in the pediatrician office. Most cases are seen in children ages 6 month to 24 month of age. The prevalence of the ear infections decreases as the child matures and are infrequent in school-age children, adolescents, and adults.
The biggest culprit of ear infections is usually a common cold. To understand better how a common cold leads to an ear infection, let us go back to basic physiology. Our nose and throat connected with middle ear through the Eustachian tube. The Eustachian tube is positioned at the angle to prevent reflex of the secretions from the nose and throat getting into the middle ear.
The other responsibility of the Eustachian tube is to keep the air pressure inside the middle are same as outside. Normally middle ear compartment is filled with air only, but when patient has a cold it begins to accumulate fluid. During viral process an increase amount of mucus produced inside in the nose. The viral particles cause inflammation inside the nose and later in the Eustachian tube.
The obstruction of the Eustachian tube in turn causes poor ventilation and leads to the accumulation of secretions in the middle ear. This fluid is sterile, but nasal secretions are not and when the Eustachian tube temporarily relaxed virus particles/bacterial particles get in. Microbial growth inside the secretions in the middle ear, cause the clinical symptoms of the ear infection.
High prevalence of ear infections during infant period is partially caused by the horizontal anatomy of the Eustachian tube, which makes middle ear fluid flow more challenging. It further compromised if infant is bottle-fed vs breast-fed. During bottle-feeding, especially with non-ventilated bottles, a negative pressure gradient is formed that reduces Eustachian tube drainage and predisposes bottle-feed infants to ear infections. Thus, exclusive breastfeeding for the first 6 month after birth protects from ear infections.
In young children and infants, the presenting symptoms are rapid onset of fever, ear pain, or pulling or rubbing of the ear, irritability, decrease of sleep, no appetite or vomiting. On clinical exam, the clinician usually sees red, bulging ear drum.
The treatment varies on the severity of the infection and age. Pain is a common feather of ear infection and may be severe. Pain should be controlled by Infants/Children’s Ibuprofen or Acetaminophen regardless of whether or not patient is treated with antibiotics. A new concept of watchful observation for 48-72 hours vs. starting antibiotic right away has been recently recommended by American Academy of Pediatrics. Infants under age of 6 month of age, those with severe illness, and children younger than 2 years of age with bilateral ear infection are started on antibiotics immediately. If a child does not fall in one of the above category, he/she are observed for any worsening symptoms. All children are re-evaluated within 48-72 hours for worsening symptoms or no improvement. If a patient has been started on antibiotics and no improvement is seen, antibiotic might be changed to a different one. The length of a treatment with oral antibiotic is usually 10 days, although some studies suggest that shorter course is adequate in younger kids.
It is not uncommon to have fluid in the middle ear after ear infection. The fluid may reduce hearing until fluid resolves. The fluid usually spontaneously resolves by 3rd month. If it’s taking longer or causes language delay, physician may refer a patient to ENT specialist.
In my practice, I use following holistic approaches whether I am observing or treating infection with an antibiotic:
- Probiotic – since it is believed to reduce upper respiratory tract colonization with pathogenic bacteria and prevents diarrhea in children on antibiotics.
- Nasal saline wash with or without Xylitol. Xylitol is a natural sugar found in strawberries and raspberries. It is believed that it prevents S. pneumonia (which is one of the bacteria causing ear infection) from growing or attaching to the mucosa in the nose.
Thanks, as always!