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All About Ear Infections

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WebMD Feature

Ear infection: The diagnosis strikes fear in the hearts of parents, who want to do what's best for their child but tend to get conflicting medical advice. What makes ear infections so troubling is not only the damage that repeated infections can cause, but also the danger of over-treating the infection: antibiotic resistance. What's a concerned parent to do? Here's what the experts know.

Usually Not a Cause for Alarm

Two-thirds of children have had an ear infection, also known as acute otitis media, before their first birthday. Young children are susceptible to these infections in part because their eustachian tube, which connects the middle ear to the throat and nose, is underdeveloped and lies at a horizontal angle (it becomes more angled with age), easily clogging with fluid. Also, young children's immune systems are still developing, putting them at high risk for upper respiratory infections, which can lead to ear infections.

Symptoms of an Ear Infection

  • Fever
  • Pain in the ear (babies rub or pull on their ears)
  • Vomiting and diarrhea (in infants only)
  • Difficulty hearing
  • Crying/pain when sucking
  • Loss of sleep or appetite

Treatments and Complications

In about half of all cases, an ear infection resolves itself without any need for medication. However, in the majority of cases children need an antibiotic, usually amoxicillin, for a course of 10 days. The drug starts to work within a day or so.

Sometimes the fluid in the middle ear doesn't drain, blocking the eardrum and causing temporary hearing loss, or otitis media with effusion. Again, this is not uncommon, and in many cases another round of amoxicillin or another type of antibiotic will do the trick.

Repeated ear infections can be a problem, since they're associated with extended temporary hearing loss. During the early years of childhood, proper hearing is essential to speech development. And if children have significant hearing loss for a long period of time, they may experience difficulties in language learning.

To Tube or Not to Tube

Traditionally, children who experience recurrent ear infections for three months or longer and have hearing loss are candidates for a myringotomy, a surgery in which tubes are inserted into the ear to keep the middle ear ventilated. However, in light of new studies, doctors are increasingly opting to forgo this surgery. A 1994 study found that in 23 percent of cases, tubes were medically unnecessary. In addition, a new study of 182 children, published in a recent issue of the medical journal Lancet, found that putting off surgery for up to nine months didn't hamper a toddler's long-term language abilities. If your doctor suggests a myringotomy, you might want a second opinion.

Danger of Misusing Antibiotics

Before considering a myringotomy, many doctors prescribe a long course of antibiotics as a preventive measure. This can reduce the number of infections a child gets, but it also promotes the spread of antibiotic-resistant bacteria. To help minimize the overuse of antibiotics, the American Academy of Pediatrics (AAP) advises that antibiotics be withheld if there's fluid but no sign of infection or fever.

Some pediatricians, however, will cave in to a parent's request to prescribe antibiotics even when they're not warranted, simply because the parent expects a prescription. It's important that you don't pressure your pediatrician to prescribe antibiotics if they're not necessary. If your doctor does prescribe antibiotics, it's vital that your child completes the entire course. Not finishing a round of antibiotics can set the stage for antibiotic resistance.

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