Patient Relief During The Wait
A child with an ear infection can be miserable, from general fussiness to trouble eating and sleeping. During the wait-and-see period, garlic mullein oil is a good option for treating discomfort as long as the eardrum is not ruptured. This more natural treatment has been shown to alleviate ear infection pain as well as an anesthetic drop . In addition, garlic has some antibacterial, antiviral, and antifungal properties to help fight the infection itself.
When fighting any infection, small doses of vitamin C, echinacea, and elderberry can also be beneficial , as all of these support the immune system. One of my favorite superfoods, cod liver oil, is full of vitamins A and D and long-chain omega-3 fats, which are extra important when the immune system is hard at work.
The Role Of Eustachian Tubes
The eustachian tubes connect the middle ear to the back of the throat. The ends of these tubes open and close to regulate air pressure in the middle ear, resupply air to this area, and drain normal secretions.
A respiratory infection or allergy can block the eustachian tubes, causing a buildup of fluids in the middle ear. Infection can occur if this fluid becomes infected bacterially.
The eustachian tubes of young children are smaller and more horizontal than in older children and adults. This means that fluid is more likely to collect in the tubes rather than drain away, increasing the risk of an ear infection.
Ear Infections: If Not Antibiotics Then What
Your 3-year-old was up half the night crying because of pain in one ear. Hes still tugging on it this morning, but he doesnt have a fever. If youre like most parents, your first instinct will be to take him to the doctor, pronto. Youll ask for a course of antibiotics to make the ear infection go away quickly. After all, its tough to see him feeling uncomfortable. And youd dearly like to avoid more missed days at child care and at work.
Ear infections are common in children. Signs and symptoms include pain in one or both ears , pulling of the ear, difficulty sleeping, difficulty hearing, fever, and vomiting.
Parents often ask for antibiotics to treat ear infections. But these drugs arent always the right choice.
Nipunie S. Rajapakse, M.D., M.P.H., a pediatric infectious diseases specialist at Mayo Clinic in Rochester, Minnesota, says, Ear infections can be caused by both viruses and bacteria. Some of the common cold viruses can cause inflammation of the middle ear.
Up to 80% of ear infections in children get better on their own without drugs. A big reason: Infections caused by viruses have to run their course and dont respond to antibiotics.
Children younger than 2 years old are more likely to be prescribed antibiotics for their ear infections. A wait-and-see approach is generally advised for kids with a temperature less than 102.2 F who are:
Nipunie S. Rajapakse, M.D., M.P.H.
Jason H. Homme, M.D.
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Childhood Ear Infections Explained
Ear infections happen when there is inflammation usually from trapped bacteriain the middle ear, the part of the ear connects to the back of the nose and throat. The most common type of ear infection is otitis media, which results when fluid builds up behind the eardrum and parts of the middle ear become infected and swollen.
If your child has a sore throat, cold, or an upper respiratory infection, bacteria can spread to the middle ear through the eustachian tubes . In response to the infection, fluid builds up behind the eardrum.
Children are more likely to suffer from ear infections than adults for two reasons:
- Their immune systems are underdeveloped and less equipped to fight off infections.
- Their eustachian tubes are smaller and more horizontal, which makes it more difficult for fluid to drain out of the ear.
“In some cases, fluid remains trapped in the middle ear for a long time, or returns repeatedly, even when there’s no infection,” Tunkel explains.
Lets Review The Current Guideline
The American Academy of Pediatrics updated their recommendations for treatingchildhood ear infections in 2013. The current guideline, based on clinical studies and expertopinion, states that a full ten days of antibiotics may not be necessary for children over twoyears of age with non-severe ear infections. For these kids, five to seven days of antibiotics maybe enough. However, children over two years of age with a severe ear infection and kids with another bacterialinfection at the same time as the ear infection may still requirethe full ten days of antibiotics.
While antibiotics are great for fighting certain infections, they can also kill your bodys normal,good bacteria and contribute to the development of resistant bacteria, which means aparticular antibiotic is less likely to work the next time you need it. Antibiotics may cause sideeffects and increase the cost of fighting an infection. When an antibiotic is given for a shorterduration, your child is less likely to experience these negative effects.
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Home Remedies For Toddler Ear Infections
Ear infections are common in children. Five out of six children will have at least one ear infection by the time they are three years old, and ear infections are the most common reason for childhood doctor’s visits.
Common signs of ear infections in children include:
- Trouble hearing or responding to sounds
- Clumsiness/problems with balance
- Fluid draining from the ear
Because of concerns surrounding antibiotic resistance, many doctors are avoiding prescribing antibiotics for ear infections unless absolutely necessary.
Treatment is usually more focused on pain relief, which can be managed effectively at home in most cases.
FatCamera / Getty Images
When Else Are Antibiotics Needed
Antibiotics can be the right treatment for kids who get a lot of ear infections. Their doctors might prescribe daily antibiotics to help prevent future infections. And younger children or those with more severe illness may need antibiotics right from the start.
The “wait-and-see” approach also might not apply to children with other concerns, such as cleft palate, genetic conditions such as Down syndrome, or other illnesses such as immune system disorders.
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Symptoms Of An Ear Infection
If you think your child has an ear infection, see your pediatrician. They can make an accurate diagnosis, look for complications, and prescribe the appropriate medications, if needed. Keep in mind treatment for an acute ear infection is not always needed.
A telltale sign of an ear infection is a bulging tympanic membrane , as visualized by your doctor with an otoscope , and ear pain. Older children may also experience hearing loss.
In younger children and infants, the symptoms of an ear infection may include:
- tugging on the ears, ear pain, especially when lying down
- fever over 100 degrees F
- dizziness or loss of balance
- fluid draining from ear
- children who have cleft palates
- a recent ear infection
- lack of access to medical care
Ear infections are not contagious. However, colds are contagious and may spread through a daycare center or school and increase the risk of getting an ear infection.
Drainage of green or yellow fluid out of the ear may indicate that there is a ruptured eardrum.
What Are The Advantages Of Ototopical Antibiotics
Administration of antibiotics directly in the ear has several advantages over systemic delivery including the following:
- Topical antibiotic solutions contain vastly greater concentration of antibiotic than the medications administered orally, or even intravenously. The high antibiotic concentration, delivered directly at the site of the infection, is much more effective in killing the bacteria. It also reduces the possibility for development of antibiotic-resistant bacterial strains.
- The lowest level of drug concentration that can prevent bacterial growth is known as minimum inhibitory concentration . Some drug-resistant bacteria have a high MIC, but ototopical antibiotics far exceed the MIC required for destroying even highly resistant bacteria.
Absence of systemic effects
- The absence of systemic effects with topical administration eliminates the risk of systemic antibiotic side effects. The normal beneficial bacteria that live in the respiratory and gastrointestinal tracts are unaffected. Absence of systemic antibiotics also prevents the natural selection and proliferation of drug-resistant bacteria.
Alteration of microenvironment
- Ototopical antibiotics are generally less expensive than comparable systemic medications.
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What Is A Sinus Infection
The sinuses are cavities in the head that are filled with air. These air-filled pockets are lined with a very thin layer of mucus that functions to collect particles from the air that are breathed in, such as dust, germs, or other particles.
Very small hair-like projections function to sweep the mucus, along with any particles trapped inside of the mucus. The germ- or dirt-filled mucus then slides down the back of the throat and into the stomach where stomach acid works to kill any germs.
When a sinus infection occurs, this natural process involving mucus flow is blocked.
When To See A Doctor
Ear infections can go away on their own in many cases, so a minor earache may not be a worry.
A doctor should typically be seen if symptoms have not improved within 3 days. If new symptoms occur, such as a fever or loss of balance, a doctor should be seen immediately.
Any sign of discharge coming from the ear would also require a visit to the doctor.
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Antibiotics Provide Limited Benefit For Ear Infection
Ear infections are not always caused by bacteria. Research estimates that ear infections have bacterial origin in 51 to 78 percent of cases. This means that 22 to 49 percent of cases are due to other causes, such as viruses or even food sensitivities. When an ear infection is caused by a virus or food sensitivity, antibiotics will not help.
Research suggests that over time, without treatment, 80 percent of ear infections clear on their own.
A recent review analyzed a large collection of trials about antibiotics and ear infections. Two main types of studies were looked at: those that compared antibiotic treatment to placebo treatment and those that compared immediate antibiotic treatment to an expectant watchfulness, or watch and wait, approach. In the watch-and-wait treatment, antibiotics were only given if symptoms and pain persisted or got worse after three to seven days.
In comparing antibiotic treatment to placebo, antibiotic prescription did slightly reduce pain at various follow-up times up to two weeks following the start of treatment. Instances of ruptured eardrums and infection of the originally unaffected ear were also decreased mildly in the antibiotic group compared to placebo. However, 20 percent fewer children had recurrent ear infections in the placebo group. Perhaps a less damaged gut flora better protected the placebo-group children from subsequent infections.
Does your child need antibiotics for an ear infection?
Can I Buy Antibiotics
No, in the UK they are only available from your chemist, with a doctors prescription. In some other parts of the world they are available over the counter. However, to reduce the problem of resistance due to inappropriate use of antibiotics, it is best to always obtain medical advice before buying antibiotics.
How Do Ear Infections Happen
A middle ear infection usually happens because of swelling in one or both of the eustachian tubes . The tubes let mucus drain from the middle ear into the throat.
A cold, throat infection, acid reflux, or allergies can make the eustachian tubes swell. This blocks the mucus from draining. Then, or grow in the mucus and make pus, which builds up in the middle ear.
When doctors refer to an ear infection, they usually mean otitis media rather than swimmer’s ear . Otitis media with effusion is when noninfected fluid builds up in the ear. It might not cause symptoms, but in some kids, the fluid creates a sensation of ear fullness or “popping.”
The Best Antibiotics For Ear Infections
The 2004 American Academy of Pediatrics guidelines for the treatment of ear infections includes specific recommendation for which antibiotics should be used in different situations. Most ear infections do not need antibiotics at all.
If antibiotics are used, high-dose amoxicillin is the best choice for most children along with treatment for their ear pain. If the child is allergic to amoxicillin, then Ceftin, Omnicef, or Vantin are the preferred choices. If the child is also allergic to all four of these, then Zithromax or Biaxin are the recommended alternatives. If the child with the ear infection has a fever over 102.2 F or is severely ill, then the best starting antibiotic is usually Augmentin. If the child is allergic to Augmentin, then 1 to 3 injections of Rocephin is usually the best choice.
Whatever the initial antibiotic, it should be changed if there is not clear improvement within 48 to 72 hours. High-dose Augmentin is usually the best follow-up choice. If the fever is still over 102.2, the child is severely ill, or allergic to Augmentin, then three days of Rocephin injections are recommended. If the child is allergic to Rocephin, then clindamycin is the antibiotic of choice. These guidelines can help many children avoid unnecessary rounds of ineffective antibiotics.
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What Are Complications Of Sinus Infection Or Sinusitis
While serious complications do not occur frequently, it is possible for a sinus infection to cause a direct extension of infection into the brain through a sinus wall, creating a life-threatening emergency .
In addition, other adjacent structures can become infected and develop problems, such as osteomyelitis of bones in the skull and infection around the eye . Rarely, these infections may cause death. The most susceptible individuals to complications are patients with suppressed immune systems, diabetes, and relatively rarely from multiple trauma injuries that may occur in natural disasters.
But Will It Still Work
In most cases, yes! Thats why the guidelines for treating ear infections changed in 2013.However, each childs situation is unique, and your familys medical provider is the best personto decide how long your child should take an antibiotic for an ear infection. On the other hand, ifyour child is over the age of two and has a non-severe ear infection, it makes sense to ask yourprovider about the possibility of a shorter course of treatment.
As always, talk to your doctor if you have other questions or concerns, and always follow thedirections on your childs medication.
You can read the full AAP clinical practice guideline for treating ear infections here.
If you are a medical provider, please consider taking our 5-minute survey.
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Why Do Kids Get Ear Infections
Kids get ear infections more than adults do for several reasons:
- Their shorter, more horizontal eustachian tubes let bacteria and viruses find their way into the middle ear more easily. The tubes are also narrower, so more likely to get blocked.
- Their adenoids, gland-like structures at the back of the throat, are larger and can interfere with the opening of the eustachian tubes.
Other things that can put kids at risk include secondhand smoke, bottle-feeding, and being around other kids in childcare. Ear infections are more common in boys than girls.
Ear infections are not contagious, but the colds that sometimes cause them can be. Infections are common during winter weather, when many people get upper respiratory tract infections or colds .
Why Do Children Get Many More Ear Infections Than Adults Will My Child Always Get Ear Infections
Children are more likely than adults to get ear infections for these reasons:
- The eustachian tubes in young children are shorter and more horizontal. This shape encourages fluid to gather behind the eardrum.
- The immune system of children, which in the bodys infection-fighting system, is still developing.
- The adenoids in children are relatively larger than they are in adults. The adenoids are the small pads of tissue above the throat and behind the nose and near the eustachian tubes. As they swell to fight infection, they may block the normal ear drainage from the eustachian tube into the throat. This blockage of fluid can lead to a middle ear infection.
Most children stop getting ear infections by age 8.
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Preventing Recurring Ear Infections
To help prevent any infection, a healthy body including a healthy gut is optimal. If breastfeeding is possible, it is one of the best preventative options, since it helps line the gut with beneficial bacteria. Introducing formula in the first six months of life is associated with more ear infections in early childhood . For kids of all ages, feeding them other prebiotics and probiotics, first in very small doses, will also improve gut health over time.
Another way to boost health is removing toxins from the childs diet, including processed foods, refined grains and sugars, industrial seed oils, and pesticide residues. If these recommendations sound familiar, it is because they are some of the first steps toward a Paleo diet and lifestyle, which can have a profound impact on overall well-being. Often children with food allergies are more susceptible to ear infections , perhaps because the immune system is already overly activated and cannot properly fight additional infections. Removing common allergens such as gluten, soy, dairy, and peanuts from the childs diet also may help.
Xylitol, a sugar alcohol, in a nasal spray can help ward off infections of the ear, nose, and throat . This compound acts to break down the tough buildup of bacteria, called biofilm, that can stagnate in the nasal passageways. If you have a patient prone to chronic ear infections, a regimen of xylitol nasal spray, such as Xlear Nasal Spray, is worth exploring .