WHAT IS AN EAR INFECTION?
There are two kinds of ear infections. Otitis Media is also known as a middle or inner ear infection. Otitis Externa is also known as an outer ear infection or a swimmers ear. A child with a Otitis Externa usually has a history of swimming or getting water in the ear and the ear hurts when pulled on or blown into, but usually does not have cold symptoms or a fever. This paper will primarily deal with inner ear infections.
HOW DOES AN EAR INFECTION START?
Most middle ear infections start with fluid building up in the middle ear space, either due to allergies, eustachian tube dysfunction or a viral or bacterial infection. Once this fluid builds up, the ear will feel full, you will have from a 5 to 20% high frequency hearing loss and the fluid makes you much more likely to get an middle ear infection. Bacteria enter the middle ear from the eustachian tube from the nasal passages and adenoid area. Once the bacteria start to grow in the middle ear fluid, then pressure builds up causing pain and chemicals are released which cause fever.
WHAT ARE THE CAUSES OF EAR INFECTIONS?
The actual organism that infects that ear are as follows and all numbers are approximate and constantly changing: 10 to 20% are caused by any one of hundreds of viruses. The rest are bacteria. 30% are Streptococcus pneumoniae (not the cause of strep throat), 25% Haemophilus influenzae ( not the "flu" and not the same one that your child had the Haemophilus influenza type B vaccine for), 15% Moraxella catarrhalis, 1-2% Staphylococcus aureus, and many rare others.
WHAT ARE THE SYMPTOMS OF A MIDDLE EAR INFECTION?
A child with Otitis Media usually has cold symptoms that are worse than usual, has a fever over 101, the ear hurts ( or the child is pulling on it) but not when pulled or blown in, and the child will be fussy. Children that are teething may have the same symptoms though ( pull on ears, colds symptoms, temp up to 102, drooling, fussy), but the pattern of fussiness can sometimes help you determine if your child has an ear infection or is just teething. Teething children are fussy, then well between fussy episodes, while children with ear infections are fussy continuously and get worse with time. Occasionally a child with a middle ear infection will only have severe ear pain and fever without cold symptoms. If you feel your child has an ear infection, then call the office to be seen within the next 12 to 24 hours. Ear infections alone are never an emergency and do not require a visit to the emergency room, except for extreme pain.
WHAT SHOULD HAPPEN NOW?
From the first dose of antibiotic, it takes about 12 to 24 hours to see any response at all. In fact, some children worsen slightly while waiting for the antibiotic to take effect. The fever may be up to 104 the first night, but will be gone within 3 to 4 days usually. Over the next 3 to 5 days, the cold symptoms slowly resolve. The cough that some children have may takes 3 to 7 days to turn dry and hacky and then take a another week or more to resolve. Most children are completely well by the 10th day of the antibiotic. If you don’t give the antiobiotic, most kids follow the same course, just get better a little slower.
HOW LONG IS MY CHILD CONTAGIOUS?
Bacterial ear infections are not contagious. About 10% of ear infections are viral and these are contagious, but most exposed children will not become ill or won’t get an ear infection.
WHAT ARE THE ANTIBIOTIC SIDE EFFECTS?
The most common of these is a mild diarrhea that starts a few days after starting the antibiotic and can also be reduced by taking your child off of milk or milk based formula and switching to Lactaid brand milk or Isomil-DF formula and by giving more fiber in the diet. There is some evidence that Lactobacillus Acidophilus (Lactinex) can speed the diarrhea recovery. This is a bacteria normally found is your gut. Taking this alternative medicine can restore the normal gut bacteria faster and possibly make the diarrhea go away quicker. There is no known harm from this particular alternative medicine. You can buy this at health food or drug stores, where they know it as acidophilus or lactinex granules. Take one capsule 3 times a day. Regardless of antibiotic use, about 10% of the time, the ear drum may burst allowing the pus in the inner ear to escape and the pain will resolve with this rupture. This is normal and will not usually result in any hearing loss. When a child's ear drum has ruptured, the pain will be gone and there may be a fluid leaking from that ear that looks like clear to cloudy yellow/green nasal discharge and it will smell foul. If this happens, simply clean out as much of the pus as possible, make your child comfortable and call the office the next morning. The most common complication is a short term hearing loss due to failure of the fluid to resolve or failure of the infection to respond to the antibiotic. About 10 to 15% of ear infections will result in fluid in the middle ear canal that lasts up to 2 months. Occasionally this fluid results in repeated infections or significant hearing loss. Occasionally the pressure in the middle ear builds up so much that it affects the balance mechanism, which is only millimeters away, and this causes dizziness. Liquid antibiotics degrade after 14-20 days and can be harmful, therefore never save left over antibiotics.
HOW CAN I HELP MY CHILD'S OTHER SYMPTOMS?
The fever and pain may be treated with acetaminophen (Tylenol) and/or ibuprofen (Motrin, Advil) as directed. The runny nose and congestion will be greatly helped by a vaporizer/humidifier, salt water nose drops and nasal suction (or blowing the nose). If instructed by your doctor, you may use Neosynephrine nose drops or an over the counter decongestant for the runny nose as directed. The cough will be helped by the vaporizer also, but you may add a cough medicine as directed if instructed to do so by your doctor. If the ear pain is severe, then give Tylenol and or ibuprofen, put a heating pad on that ear, have the child suck on a pacifier or chew gum (whichever is age appropriate, this will ease the pressure some) or place warmed sweet oil in the ear canal. Warmed sweet oil should be slightly warmer than body temperature, not hot and should not be used if there is no pain or if there is a drainage in the ear. There is a prescription pain medicine (Auralgan) we can place in the ear if the pain is severe, simply ask for a prescription for this if you think you will need it.
WHEN TO CALL THE DOCTOR
If your child's course of recovery does not follow that listed above, i.e., if the fever is not gone in 5 days, if there is no improvement by 48 hours, if your child worsens on treatment after the first day or looks seriously ill during the first 24 hours. Also call immediately if the ear appears to prop forward, the ear hurts when touched or the bumb behind the ear hurts when touched.
FOLLOW UP VISIT
A doctor always needs to see the ear drum in 10 to 21 days to be sure that the ear infection has resolved. You doctor will tailor the follow up visit to your child's situation. PLEASE MAKE SURE TO NOT MISS THE FOLLOWUP as it is more important than the treatment for preventing hearing loss.
