After the common cold, ear infections rank high as a common illness in the infant and toddler population. The pneumococcal vaccine has reduced the number of ear infections we see, but ear infections are still a major diagnosis in our office. There are several different kinds of ear infections. In spite of the fact the ear has very small and delicate structures that get involved in ear infections, most cases resolve with no permanent damage. However, the longer an infection continues or the more often they happen, the more likely there can be permanent damage. Hearing is usually somewhat compromised during an ear infection.
"Ear infection" usually refers to a middle ear infection (otitis media). This includes the ear drum and the small bones in the middle ear. Ear infections are often associated with a cold or allergy that might make more mucus in the middle ear. Ear infections are not contagious, but the often associated cold can be passed from one child to another. Some people are prone to ear infections. Other people may go a life time without an ear infection. Ear infections are not made worse by wood heat or being in the cold or getting wet feet. Getting very tired and having irregular sleep, a poor diet and having a cold or respiratory allergy may make ear infections more likely.
There are several types of ear infections:
Acute Otitis Media - is a recent onset infection in a previously uninfected ear. This is the kind of infection most commonly associated with pain in the ear.
Recurrent Otitis Media - is acute otitis happening several times with resolution of the infection each time.
Chronic Otitis Media - is ongoing acute otitis that is untreated or unresponsive to treatment.
Otitis Media with Perforation- is acute otitis with a hole in the ear drum allowing mucus and puss to come out the ear canal.
Serous Otitis Media - is congestion of the middle ear with mucus without acute infection in the ear. This is often associated with hearing loss as long as the congestion is present.
These different types of middle ear inflammation require different treatments:
Acute otitis media is caused by a bacteria or a virus. The pneumococcal vaccine has reduced the number of acute otitis cases we see. Often cases will resolve with no treatment or only treatment for pain or fever. When redness and swelling of the middle ear is more severe or long lasting or recurrent, it is often desirable to treat the child with antibiotics. Amoxicillin is the drug usually used first as it has a low rate of serious side effects and it is usually effective. Sometimes however, the bacteria causing the infection may be resistant to ampicillin or other factors make it desirable to choose a second antibiotic. Second choice drugs are effective, some are more effective than ampicillin, but they have disadvantages in the form of more serious side effects more often and usually much higher expense.
Recurrent acute otitis often requires antibiotics also, but if the previous infection was within a month it is probably desirable to change the antibiotic. With recurrent otitis it is important to be sure the infection clears completely after treatment. Sometimes taking a six week course of low dose antibiotics will prevent the recurrence of ear infections.
Chronic otiti- may requires antibiotics, often times several courses of treatment. With chronic disease it is important for children to be checked to be sure the infection has cleared. Sometimes ventilation tubes (placed by surgery) in the ear will stop chronic or recurrent acute otitis media.
Otitis media with a perforation often requires not only antibiotics by mouth but often antibiotic drops to the eat too. Because the ear drum is broken, antibiotic drops may get into the middle ear directly and prevent the spread of infection to the external canal.
Serous otitis is detected by seeing fluid with infection or by tympanometry. It is often treated with decongestants, exercises to get the eustachian tube to open (swallowing with the nose plugged, blowing balloons by mouth or by nose, etc) and time. If serous otitis becomes chronic, and especially if it interferes significantly with hearing, often placing ventilation tubes in the ear drum is desirable.
Ear infections deserve close attention because they involve an important sensory organ and they are common and they have potential for doing permanent damage. When taking any antibiotic it is important to take the drug according to instructions for the full course of treatment. Stopping an antibiotic early may lead to a return of the infection or the more rapid development of resistant bacteria. Immunization with the pneumococcal vaccine (PCV - the pneumonia shot) may prevent SOME ear infections.
Ted Humphry, M.D.
(707) 822-2441
this information last updated 06/06