If you have a child, no doubt at one time or another, you have worried about whether or not your baby or child has an ear infection. Because of their anatomy, babies and young children are more prone to middle ear infections, which are infections in the middle ear cavity behind the tympanic membrane, as opposed to external ear infections which are infections of the canal which leads to the tympanic membrane.
Before the Hemophilus influenza or HIB vaccine and the Pneumococcal vaccine, PCV 13, middle ear infections were thought to lead to dangerous complications such as mastoiditis, an infection of the bone behind the ear or meningitis, an infection of the spinal fluid. Ear infections were treated aggressively with antibiotics to prevent these possible complications. Today with the newer vaccines against certain bacterial infections along with more research suggesting that most of these infections may be viral and not responsive to antibiotics, the thinking has changed in the treatment of otitis media.
For young infants under two years, an ear infection may be treated with an antibiotic for seven to ten days. For older children without severe pain and fever, watchful waiting may be the best course. Sometimes a doctor may give a parent a prescription for an antibiotic to be filled if the ear pain and/or fever do not resolve in a day or two. Data suggests that ibuprofen (Advil or Motrin if over 6 months) or acetaminophen (Tylenol) for fever and pain control can work effectively to eliminate pain and fever avoiding the need for antibiotics. A five day course of antibiotics may be prescribed for an older child as well. These guidelines are changing rapidly so be prepared to see more news on the ear infection front.
Myringotomy tubes are small ventilation tubes that are surgically inserted into the tympanic membrane by an ear, nose, and throat specialist. These tubes were once popular for children who had recurrent ear infections or persistent fluid following ear infections. We now know that the diminished hearing that can temporarily result from this fluid that can last six weeks or longer after a middle ear infection does not prevent normal speech acquisition. We also know that the tubes themselves can cause scarring of the tympanic membrane and require general anesthesia to be inserted. Most pediatricians prefer watchful waiting to surgery for persistent fluid. There are times, however, when tubes are indicated and can be helpful.
Stay tuned to this ever changing area of children’s health.
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