Q: My 18-month old gets frequent painful ear infections. Why, and what can be done to prevent these?

An acute middle ear infection is referred to as an otitis media (OM). The middle ear, located immediately behind the eardrum, is the most commonly infected part of the ear in children between the ages of 6 to 24 months. By age 3, 75-90% of children have had an OM. In addition to ear ache, there may be an accompanying (high) fever, irritability, nasal discharge, sore throat, reduced appetite and lethargy. The majority of OM infections resolve without the need for antibiotics.

Causes of and risk factors for OM

The Eustachian tube connects the middle ear to the back of the nose. If this tube becomes blocked, the child becomes predisposed to OM. When a child has a cold, the bacteria or virus causing the cold may make their way into the middle ear via the Eustachian tube. This can result in a buildup of fluid and mucus behind the eardrum resulting in increased pressure and consequently pain.

Specific risk factors include:

• Age 6-24 months
• Upper respiratory tract infection
• Upper respiratory tract allergies
• Enlarged adenoids
• Anatomical defects of the upper respiratory tract & face
• Immunocompromised
• A family history of OM

When should a doctor be consulted?

In most instances, the OM spontaneously resolves in 2-3 days. However, in the following scenarios it is highly recommended that the child be seen by a doctor: :

• Child’s symptoms persistent or getting worse after two to three days
• Unrelenting pain
• Any type of discharge from the ear
• Child has an underlying medical condition – e.g. heart disease, sickle cell, cancer, on steroids, etc.

Treatment

Healthy children suffering with an OM the doctor may opt to treat the child’s primary symptom, pain. Paracetamol or ibuprofen is prescribed for such. An antibiotic may be given in cases where the child’s symptoms are persistent beyond 2-3 days.

In certain situations the doctor may decide to start an antibiotic immediately:

• If the child is 6 months or younger
• Underlying comorbidities
• Child presents with severe symptoms.

Prevention

It’s not possible to absolutely prevent OM, however, there are things that can be done to significantly reduce a child’s chances of developing it.

• Breastfed babies have a lower incidence of OM
• Not sending the child to a nursery or school before they are 24-36 months
• Controlling GERD and allergies in the child
• Limiting the use of pacifiers
• Reduce child’s exposure to secondhand smoke
• Steer clear of children and adults with colds
• Practice frequent hand washing of both the child and all those around the child
• Ensuring that your child is fully vaccinated against HIB, pneumococcus, diphtheria, pertussis, the seasonal flu
• Only feed the child when they are in an upright position
• Never let the child go to bed with a bottle
• Grommets (ventilation tubes) may be surgically inserted into the eardrum if infections are not responding to preventive measures. If these are not working, the child’s adenoids may be removed.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.