Please see updated post April 2019
Ear
infections are among the most frequent reasons for a visit to the
pediatricians office. It feels like I am long overdue for addressing
this issue in a blog post.
As opposed to
an otitis externa (also known as swimmer's ear) where the outside of
the ear is red and sore, an otitis media (a middle ear infection) is not
visible from the outside. One of the biggest challenges is knowing if
your child has an ear infection or not.
Technology is
changing, but at present, unless you actually have an instrument at
home you will likely need to bring your child in for an exam if you are
suspicious.
At the end of
this post is some information about CellScope, an app that gives you
the ability to check out your child's ears at home.
If they are
old enough, they may simply tell you that their ear hurts. Keep in mind
that some kids complain about fluid in the ear or pressure; it isn't
always an infection.
If they are
still young and non-verbal, they may be extra fussy (especially when
going to sleep) feverish or tugging at their ear. Many kids wake up more
than usual at night. Most of the time kids are congested. Sometimes
vomiting can be associated with ear infections.
Some kids
seem like their balance is off. Others seem like they are having trouble
hearing (I know, all of our kids can seem deaf when we are telling them
something they don't care to hear.)
Other kids
don't let you know at all. We have had patients in the office for a well
child exam and have been caught by surprise when a routine ear check
revealed a raging infection. I have also seen ear infections go from
'zero to sixty' in no time flat. A child with a perfectly normal ear
exam one day can have a horrible ear infection the next.
Most of the
time, an infection in the middle ear (the space behind the eardrum)
accompanies a common cold, the flu, or other types of respiratory
infections. This is because the middle ear is connected to the upper
respiratory tract by a tiny channel known as the eustachian tube. Germs
that are growing in the nose or sinus cavities can climb up the
eustachian tube and enter the middle ear. Children's eustachian tubes
are smaller and more level than those of an adult. This means it is
harder for them to drain well and easier to get blocked up with even
mild swelling. Because of these drainage issues, when kids are
congested, they also may have fluid in their ear (serous otitis). This
is why I am more suspicious about a possible ear infection in a child
who has a cold. What may start out as a virus can turn into something
bacterial. That fluid is the perfect medium for bacteria to grow. I
compare it to a stagnant pond just waiting for the mosquitoes to breed.
Kids with
chronic serous otitis who get one infection after another will usually
end up at the ENT doc who may put some tubes in the ear to help them
drain. Melissa Wilson, Doctor of Audiology at Sound Speech and Hearing,
adds that tubes are also put in to address the hearing loss that often
accompanies middle ear fluid. Fluid build-up often causes a hearing loss
on the order of 30-40 decibels. Average speech is about 60 decibels. So
having fluid is like listening with your fingers plugging up your ears.
Everything your child hears is muffled and over time, this can impact
their speech and language development, and for the school-aged children
this can cause issues with listening in the classroom and academics.
By the way,
when kids have goopy eyes, many times they also have an otitis, which is
why we may bring them in to check out the eyes and the ears rather than
just giving eye drops over the phone.
Just because
your child is tugging at their ear does not mean they have an infection.
Some kids do it as a habit when they are tired. Others do it when they
are teething (especially upper teeth.) It can be a clue though that is
worth paying attention to, especially if it accompanies any other
symptoms. I realized after the fact that I had ignored my daughter
Lauren's first ear infection for more than a week when she was fairly
young. Looking back at videos you can see the poor kid simply grabbing
at her ear constantly. This was long, long ago prior to my Noe Valley
Pediatrics job. I was working at UCSF with complicated surgical cases
and thoughts of an ear infection didn't even cross my mind.
If your child
is diagnosed with an ear infection, chances are we will give you a
prescription for antibiotics. If your child is miserable and feverish,
it makes sense to treat it. If the eardrum is bulging and looks like the
membrane may rupture, the doctor will advise you that you should
absolutely go ahead with the medication regardless of how your child is
acting.
On the other
hand, If it is not a severe infection and your child seems consolable,
we may suggest that it is perfectly fine to watch and see for a few
days. Many ear infections can indeed clear up on their own and of course
we all would like to avoid the use of antibiotics if we can.
Some of our
parents come in eager to treat even if it is mild and others want to
avoid antibiotics at all costs. It is hard finding the balance. We are
happy to work with folks who want to do the watching and waiting, but
sometimes it does involve multiple trips into the office while we can an
eye on things. My main agenda, aside from making the kids more
comfortable, is preventing an eardrum from rupturing. This does happen
and we can't always stop it, but it is worth trying. If you have an
eardrum that ruptures frequently it can cause scarring and this can lead
to hearing loss.
When there is
a ruptured eardrum, one common scenario is for a child to be quite
miserable and suddenly they are much happier. They also have lots of
yellow/orange stuff draining out of the ear. The good news is that the
pain of the pressure in there is gone, but the tympanic membrane is an
important protective barrier from the outside and it is no longer
intact. Therefore, if your child does have a ruptured membrane, they do
need to be seen and treated even though they are no longer quite as
miserable. If there is more than one rupture it is worthwhile getting
the hearing tested to make sure there is no lingering hearing loss after
the eardrum heals.
If you do opt
to treat, make sure that you finish the entire course of medication. I
suggest doing probiotics to protect the gut. Do not give them exactly in
conjunction with the antibiotics, rather try to space them in between
doses. Also please don't forget to brush those teeth. Liquid antibiotics
tend to be sticky and sweetened in order to make them more palatable.
It may take
the medication at least a couple of days or before you note a
significant improvement. If your child is still super fussy or feverish
after a full three days, let's take another look in there to make sure
the meds are working. Some kids who are having a really difficult time
may end up getting an antibiotic injection. These hurt a bit, but they
are usually quite effective.
With or
without the use of antibiotics there are several things you can do for
comfort. Tylenol and/ or Ibuprofen are useful. There are some
prescription ear drops that can numb the ear, but they have some contra
indications, so we don't often prescribe those here.
Warmth
usually feels good. Try a warm wet washcloth against the ear. You also
can put some rice in a sock and heat that up in a microwave. Some folks
swear by a warm hair dryer held about a foot away from the ear. Believe
it or not though, my favorite remedy is garlic oil.*
Check the ear
to make sure there is no reason to suspect a rupture. I don't like to
add any drops if I have any suspicion that the eardrum may not be
intact. If there is no odor or drainage (a little wax doesn't count)
garlic oil may be a good option. Saute some cloves of garlic into some
olive oil. Let the oil cool until it is warm/not hot. Take a cosmetic
square (these are the round or square cotton pads that often come in a
stack. I like them better than cotton balls for this.) Dip one half of
the pad into the oil, roll it up like a scroll and stick it in the ear.
Do this as often as your child will allow.If it is the middle of the
night and your child is screaming, you can try any of these.
*Anecdote: My
daughter Alana had her tonsils out a few years ago when she was in her
early twenties. She started communicating on message boards with random
folk from all over the world who were going through the same ordeal.
These strangers bonded over their misery and swapped suggestions for
comfort measures. At day three, many of them got earaches. I never paid
much attention to this in the past, but with such a wide body of folks
communicating, it seems clear that this was a common part of the post
tonsillectomy list of woes. I made some garlic oil for Alana and when
she put it in her ear she felt almost instant relief. She shared it
with the hundreds of new best friends and many of them tried it and
thanked her for the suggestion. So there you have it. Garlic oil gives
relief.
If you are
concerned about hearing loss, either from frequent infections or chronic
fluid, Sound Hearing and Speech in Potrero Hillis a great option for
getting checked out: (415) 580-7604 Sound Speech and Hearing Clinic
If you are
intrigued by new technology and are interested in the ability to check
your child's ears from home, check out cell scope!
www.cellscope.com
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