Baby Has an Ear Infection
Now Ear This
Antibiotic Balancing Act continued...
Concern about antibiotic overuse and the development of drug-resistant bacterial strains, has prompted doctors to look more carefully at ear infection symptoms before prescribing antibiotics. If a baby has acute otitis media, not the less-serious OME, the doctor is likely to prescribe a stronger dose of amoxicillin twice a day rather than the traditional three weaker doses, says Magit. Other, more powerful, antibiotics are reserved for harder-to-treat cases, particularly in children under 2.
Doctors are also now less likely to offer prophylactic therapy -- taking a low-dose antibiotic for several months to prevent recurring ear infections -- particularly during the winter cold season.
"People are shying away from using [antibiotics prophylactically] because of the concerns about resistance," says Dr. Magit. "It works, but you're giving a child a lot of antibiotics to prevent one ear infection."
Those Pesky, Recurring Cases
So what do you do if your baby has repeated ear infections or ones that don't respond to treatment? If a child has persistent fluid buildup, lasting more than a few months, more than three ear infections in six months, or more than four in a year, your pediatrician may suggest other options.
Persistent fluid buildup prevents the eardrum from moving back and forth properly and can cause hearing difficulties. Although hearing loss typically isn't permanent, it still may be a problem for young children who are just learning language.
When antibiotics aren't enough, the most common recommendation is an outpatient surgical procedure in which small tubes, called tympanostomy tubes, are inserted through the eardrum to promote drainage. In most cases, this helps reduce the number and severity of infections.
"I warn families that it's not 100% ," says Park. "It results in a 50-60% reduction in the number of infections, but by reducing the number, it also reduces the need for antibiotics. And the tubes are very effective in preventing fluid from reaccumulating and thus, optimizing hearing."
Most tubes fall out by themselves in 6 to 18 months, as the hole closes. However, in about 1% of cases, the hole may not close on its own, requiring another surgical procedure to patch it.
A new surgical technique that uses a laser to make a hole in the eardrum doesn't require a general anesthetic, but the technique is controversial because it only lasts several weeks and may have to be repeated.
"It may be beneficial for the child who has had one ear infection where the fluid hasn't cleared and you need to have that opening last longer than a couple of days," says Magit. "But in the child who's had recurrent problems, it may not be as helpful."
And some children react adversely to the procedure, which is done in a doctor's office. "Even though they numb up the ear, it does make a loud noise, or the child may still feel pressure or even some discomfort," says Park.
Some parents claim they've found relief going the nontraditional route. Although there have been few large-scale studies and most traditional doctors remain doubtful, one study published in the Journal of Clinical Chiropractic Pediatrics showed that 80% of the 400 children in New Rochelle, N.Y., who received regular gentle adjustments to their cervical vertebrae or skull didn't have another ear infection within a six-month period.