Be careful when treating ear infections

Monday, Jan. 5, 2009 1:05 AM

Ear infections are the most common condition for which children are prescribed antibiotics in the United States.

Yet for many of these infections, antibiotics are not the solution. More importantly, the overuse of antibiotics for conditions such as ear infections is driving the national epidemic of antibiotic-resistant bacteria.

Most parents have endured long nights with their infants and toddlers with fever, irritability and crying. Usually, there is not much sleep to go around for the child or the parent. For the most common illnesses, it is tempting to want something - anything - to fix the problem.

Each year, millions of parents bring their children to the doctor's office the morning after such a night hoping the magic bullet, the antibiotic, will be just the solution. Perhaps the child has been tugging at his or her ears or "seems to have an earache."

The most common symptoms of an ear infection are ear pain, fever, fussiness, ear drainage, poor appetite and sleeplessness. Yet many of these symptoms are present with common viral respiratory illnesses, as well.

Nevertheless, ear infections are common among children. Even more common is a condition in which fluid is present in the middle ear cavity. This condition, known as "otitis media with effusion," affects more than 90 percent of preschool-aged children at least once.

Many ear infections start out as a plumbing problem. A viral illness causes enlargement of tonsils and adenoids near the middle ear tube. Also known as the eustacian tube, this is a pipe that drains fluid from the normally air-filled middle ear. When the tube is blocked, fluid accumulates in the middle ear cavity and causes pain. In addition, if bacteria are trapped in the fluid, infection can result.

In May 2004, after many years of controversy about the treatment of ear infections, the American Academy of Family Practice and the American Academy of Pediatrics reviewed all the medical evidence to date about the issue and released the first-ever national guideline about the diagnosis and treatment of ear infections.

Among the recommendations in this guideline is the importance of pain medication in the management of discomfort related to ear infections.

For certain low-risk children with ear infections, a period of observation without antibiotics up to 48 or 72 hours is recommended. The determination of risk is based upon characteristics such as the child's age, severity of symptoms and findings on physical examination.

The guideline includes recommendations about the prevention of ear infections, which has been demonstrated through reduced exposure to second-hand cigarette smoke and through routine immunization including annual influenza vaccination.

Dr. Matthew A. Clark is a
board-certified physician in internal medicine and pediatrics practicing at the Southern Ute Health Center in Ignacio.