Ear Infections in Children - Count to THREE; wait and see
When I turned on the news this morning, there were stories on two major stations about the "new" philosophy about NOT treating middle ear infections in children. This is not really new information, but maybe it will catch on this time. For decades, European physicians have not treated middle ear infections as aggressively and as early as we do in the U.S. Many European physicians wait a WEEK before writing that prescription for amoxicillin.
The nature course of untreated middle ear infections in generally-healthy children is that most, nearly ALL, will get better...on their own...without antibiotics...in a few days. So, why do most medical providers treat 'em all?
Some medical providers even treat children with antibiotics who MAY get an ear infection, but currently only has a cold. There seems to be a universal belief among medical providers that patients expect antibiotics and leave unsatisfied and upset if they don't get them. While this may be true for some patients; it is far from a universal assumption. The 2004 Otitis Media Guidelines by the American Academy of Pediatrics states that for initial, non-severe otitis media, withholding antibiotics is an option. Duh! Not treating has always been an option.
A study of patient satisfaction with their medical visit (Hamm, Journal of Family Practice 1996; 43-55), it was determined that satisfaction was predicted by two factors: (1) Time spent by the medical provider explaining the illness, and (2) the patient's understanding of the treatment choice. Satisfaction was NOT predicted by whether they received antibiotics or not.
Parents with a screaming child are not that enthusiastic about withholding antibiotics. It is going to take some extra appointment TIME for the medical provider to explain the rationale for not treating some of these infections, and to convince parents that this is the right way to go.
It is only when medical providers begin to treat patients as equals and encourage them to become partners in their own and family's care, will we get a handle on the astronomical use of antibiotics -- antibiotics for a medical condition that has been proven, beyond a shadow of a doubt, to be self-limiting in most cases.
Universal changes in medical philosophy rarely happen suddenly. That, too, takes time. Whether the American medical community can jump from the current indiscriminate use of antibiotics to waiting a week, like our European counterparts, is questionable. But, we can compromise. How about waiting three days before treating healthy children with an uncomplicated middle ear infection? Give our ancient and remarkable immune system a chance to work! Count to three; wait and see.
Efforts to reduce antibiotic use will have many benefits. First, it will reduce the cost of medical care. Second, it will reduce the creation of community "super-bugs" -- microorganisms that have rapidly become resistant or even immune to antibiotics. And, lastly, initially withholding antibiotics will help strengthen our immune systems. Immune systems only improve by overcoming a biological challenge.
It is has been said that what doesn't kill us will make us stronger. While we never want children dying or developing complications from middle ear infections again, the "watch and wait" method makes excellent biological sense. Human beings have been naturally fighting pathological microorganisms as long as we have shared this planet -- millions of years. Antibiotics have only been around since the late 1930s.
These watch and wait guidelines are not intended for every child. Babies under 3-6 months of age should be treated early, as well as children who are immunocompromised or have other serious heath issues. However, for the vast majority of kids, it is perfectly safe and reasonable to take a deep breath and count to three (days).
Remember that pain should always be addressed while you are waiting those three days to see if antibiotics are going to be needed. The relief of pain is really the child's primary goal, Withholding antibiotics does not mean you should withhold the treatment of pain. Ear infections hurt!
While acetaminophen (Tylenol) and ibuprofen (Motrin) may be all that is needed for most children, some ear pain may require a bit more. A codeine-containing prescription for a few days can be used. There are also benzocaine-containing ear drops that the medical provider can prescribe that are helpful. Finally, make sure that your children have been immunized against pneumococcal disease - a common cause of middle ear infections. Get the Prevnar vaccine.
Something has to be done, folks. Like global warming, we are already paying the economic and biological price of our frequent antibiotic use. Next time that your medical provider whips out that prescription pad, ask if it would be reasonable to wait a few days before starting an antibiotic. Your doctor may be pleasantly surprised, but I suspect he/she will be willing to work with you on this "new" concept.
Related Topics: Slime Behind Chronic Ear Infections?, Drug-Resistant Staph a Growing Concern
Technorati Tags: ear infection, antibiotic, MRSA, pediatrics
The nature course of untreated middle ear infections in generally-healthy children is that most, nearly ALL, will get better...on their own...without antibiotics...in a few days. So, why do most medical providers treat 'em all?
Some medical providers even treat children with antibiotics who MAY get an ear infection, but currently only has a cold. There seems to be a universal belief among medical providers that patients expect antibiotics and leave unsatisfied and upset if they don't get them. While this may be true for some patients; it is far from a universal assumption. The 2004 Otitis Media Guidelines by the American Academy of Pediatrics states that for initial, non-severe otitis media, withholding antibiotics is an option. Duh! Not treating has always been an option.
A study of patient satisfaction with their medical visit (Hamm, Journal of Family Practice 1996; 43-55), it was determined that satisfaction was predicted by two factors: (1) Time spent by the medical provider explaining the illness, and (2) the patient's understanding of the treatment choice. Satisfaction was NOT predicted by whether they received antibiotics or not.
Parents with a screaming child are not that enthusiastic about withholding antibiotics. It is going to take some extra appointment TIME for the medical provider to explain the rationale for not treating some of these infections, and to convince parents that this is the right way to go.
It is only when medical providers begin to treat patients as equals and encourage them to become partners in their own and family's care, will we get a handle on the astronomical use of antibiotics -- antibiotics for a medical condition that has been proven, beyond a shadow of a doubt, to be self-limiting in most cases.
Universal changes in medical philosophy rarely happen suddenly. That, too, takes time. Whether the American medical community can jump from the current indiscriminate use of antibiotics to waiting a week, like our European counterparts, is questionable. But, we can compromise. How about waiting three days before treating healthy children with an uncomplicated middle ear infection? Give our ancient and remarkable immune system a chance to work! Count to three; wait and see.
Efforts to reduce antibiotic use will have many benefits. First, it will reduce the cost of medical care. Second, it will reduce the creation of community "super-bugs" -- microorganisms that have rapidly become resistant or even immune to antibiotics. And, lastly, initially withholding antibiotics will help strengthen our immune systems. Immune systems only improve by overcoming a biological challenge.
It is has been said that what doesn't kill us will make us stronger. While we never want children dying or developing complications from middle ear infections again, the "watch and wait" method makes excellent biological sense. Human beings have been naturally fighting pathological microorganisms as long as we have shared this planet -- millions of years. Antibiotics have only been around since the late 1930s.
These watch and wait guidelines are not intended for every child. Babies under 3-6 months of age should be treated early, as well as children who are immunocompromised or have other serious heath issues. However, for the vast majority of kids, it is perfectly safe and reasonable to take a deep breath and count to three (days).
Remember that pain should always be addressed while you are waiting those three days to see if antibiotics are going to be needed. The relief of pain is really the child's primary goal, Withholding antibiotics does not mean you should withhold the treatment of pain. Ear infections hurt!
While acetaminophen (Tylenol) and ibuprofen (Motrin) may be all that is needed for most children, some ear pain may require a bit more. A codeine-containing prescription for a few days can be used. There are also benzocaine-containing ear drops that the medical provider can prescribe that are helpful. Finally, make sure that your children have been immunized against pneumococcal disease - a common cause of middle ear infections. Get the Prevnar vaccine.
Something has to be done, folks. Like global warming, we are already paying the economic and biological price of our frequent antibiotic use. Next time that your medical provider whips out that prescription pad, ask if it would be reasonable to wait a few days before starting an antibiotic. Your doctor may be pleasantly surprised, but I suspect he/she will be willing to work with you on this "new" concept.
Related Topics: Slime Behind Chronic Ear Infections?, Drug-Resistant Staph a Growing Concern
Technorati Tags: ear infection, antibiotic, MRSA, pediatrics
24 Comments:
As a child I spent all day every day of my summer vacations swimming. I have always suffered with swimmer's ear and still do though I no longer swim. Getting a little water in my ears can cause intense pain and make the slightest touch on the outer ear very painfull. I only recently learned what was the cause of my pain but now have a cure. A little rubbing alcohol in my ears will mix with the water and evaporate.
Yes, alcohol is used for swimmer's ear prevention. As a matter of fact, dilute white vinegar will also help (and be less drying than alcohol).
The TYPE of ear infection that I am referring to in this Blog is a MIDDLE EAR INFECTION...an entiredly different medical condition than swimmer's ear (otitis externa).
When my child had an ear infection we immediately wanted antibiotics to "make him feel better." Consequently, he got Steven's Johnson's Syndrome(a severe allergic reaction to pcn) from it and was admitted in a burn unit. Since then, I do not treat my kids with antibiotics unless I see that it is absolutely indicated. My kids have been fine and we have conquered ear infections without antibiotics since.
how well do tubes help to prevent infections?
TUBES
Tubes do prevent some middle ear infections, but that is not their true purpose. Tubes, also known as Pressure Equalization Tubes, are inserted to make sure the middle ear space is filled with AIR and not fluid. When the middle ear is filled with fluid, it causes conductive hearing loss and predisposes the person to repeated ear infections. Bacteria will tend to migrate up the eustachian tubes into the middle ear. If there is fluid in this space, like a stagnant pond, the bacteria will find a welcome environment to thrive.
My daughter had never so much had a cold and then her top two teeth appeared at 14 months. She did not exhibit any signs of an ear infection, yet when I brought her to the md, she had one. Over the next two months she not only got two more top teeth, but her top molars, as well as two more ear infections. Once again she did not exhibit any signs whatsoever...no pulling on her ear, sleeping/eating normally, no fever, etc. What is the connection between teething and ear infections. Both her md and the np said there is really no correlation.
My pre-teen has pierced ears, but she can't wear cheap metal earrings. She wears cheap metal earrings anyway. I told her to put on ointment when she wears cheap metal earrings, but we don't have any. She now has small keloids in both ears. What can I do to get rid of them?
So will the vinegar drops help cure the type of ear infection you are talking about or is that only good for swimmer's ear?
Good article. My wife and I are both comfortable not getting a prescription if we take the kids into the doctor. When the prescription pad comes out I always ask, "Is this really necessary?" However, one point that is missed in this article, is the fact that parents have to work and kids have to go to school. Almost all children services and schools do not want your child if they've had a fever within the last 24 hours. So working parents will have to stay home from work, often times taking turns. Unfortunately in this busy world that we live in, getting the infection on the road to recovery quickly is more of a lifestyle choice and (especially in our case) less of a knee-jerk antibiotic dependency.
My 22 month old duaghter has had several ear infections, since she was 9 months old. Our MD referred us to a specialist, who then recommended ear tubes, due to possible 30% hearing loss in the right ear. Has anyone had their child with tubes and what side effects were there? Is there any other safe way to avoid the surgery? The surgery date is coming close. Should we wait and get a second professional opinion, before going with the surgery?
I have a pup whose got an ear infection heard there is an at home remidy for helping puppies and babyies. Can anyone help me out?
Tubes are a wonderful investment the only problem is that they do not like coming out of anistisia. they start talking tons more and they don't bother them anymore in the long run. It is well worht it
I'm a 25 year old ear infection sufferer. Tubes, pills, drops, vaccums, tubes pills, drops, vaccums....repeat. Early I had violent reactions to pinicillin so alternatives to the pills were sought. To date I've had 15 sets of tubes. I can barely hear and all the reconstructive surgeries done to my drums have failed. I've had teeth extracted, organs removed and had my sinus cavities stuffed and searched for the answer. Specialists from different cities all think they have the answer but no one has my answer.
As an adult I wait it out. I use alcohol or vinegar when I feel one coming on. I eat a few advil a few times a day for a week and it goes away waiting for some other inconvenient day to take me down. I've been searching for an answer for a very long time. I agree with waiting it out. I reccomend a sleep aid for the bad days. If Idevelop one in my sleep I can still wake up sobbing like a baby and pounding the pillow in pain just like I did when I was a babe. But everything else they stuck me with or treated was equally scary, especially knowing nothing ever worked.
My daughter got tubes when she was 11 months and they have been a blessing. She hasn't had and ear infection since (now 20 months old). Before the tubes, she had one every month since she was 2 months.
It's comfortint to know that I am not alone with this repeated cycle of ear infections. My 7 month old has had six antibiotics administered, thus far and I am very worried about antibiotic resistance. I'm also worried about the consequences this can have on his immune system. Ear tubes are being recommended, but I'd like to see if I can prevent them until he's a little older. Does anyone know how often one can use vinegar/ alcohol drops? Can they be used with ear tubes? I'm also worrie about Post Tympanostomy Tube Ottorhea.
My son had tubes at the age on 1. Before tubes we were at the doctor every other week, sometimes every week or twice a week with ear infections. He has tubes on 06.01.2006.....and Honestly it has helped with the ear pain/fever..etc. But not the infections. His ears drain fluid non stop....I am talking dripping from the ear. We have spent several thousand of dollars in drugs to help...antibotics, ear drops....etc. We got on alery shots and allergy medicine every day....nothing seems to help. I am a young mother and I make sure that my child is taken care of. I make sure that he gets his medicine. He even has special ear plugs made by beltone to fit his ears so no water can get in to feed the bacteria,,,,but we continue to had ear problems. I really feel like the Doctors think I am just some young stupid mother that does not take care of her kid, because he is really smart acting when we go to the doctor. My son takes way to much medicine to just be three years old. He has so many doctors.......we are at one every week. I don't knwo what to do.....Does anyone have suggestions?
My son had tubes at the age on 1. Before tubes we were at the doctor every other week, sometimes every week or twice a week with ear infections. He has tubes on 06.01.2006.....and Honestly it has helped with the ear pain/fever..etc. But not the infections. His ears drain fluid non stop....I am talking dripping from the ear. We have spent several thousand of dollars in drugs to help...antibotics, ear drops....etc. We got on alery shots and allergy medicine every day....nothing seems to help. I am a young mother and I make sure that my child is taken care of. I make sure that he gets his medicine. He even has special ear plugs made by beltone to fit his ears so no water can get in to feed the bacteria,,,,but we continue to had ear problems. I really feel like the Doctors think I am just some young stupid mother that does not take care of her kid, because he is really smart acting when we go to the doctor. My son takes way to much medicine to just be three years old. He has so many doctors.......we are at one every week. I don't knwo what to do.....Does anyone have suggestions?
My son has suffered with ear problems every since he was born. That was 7 years ago and he still has problems. He has had tubes put in his ears 6 different times now. We just found out last year he has conductive hearing loss, chronic otitis media and sinus problems. I always knew he had hearing problems it was getting the doctor's to recognise the savarity of the situation. I don't know what step is next but for all other parents out their. I understand and you just have to be strong and persistant with your doctor. Don't be afraid to ask questions.
We had our child check out for ear infections and they scheduled tubes. After talking with the my childs doctor, she advised us to wait and see. the doctor who scheduled the tubes didnt re-check for fluid so we did and the results were better but he still had fluid. It is coming out of the season for ear infections so we will monitor. Is this the right decision?
having the ear infections along with a diabetic don't mix. My son has had many ear infections that he never complained of. The only way we even knew is when the doctor mentioned that he had an ear infrection, but it looked like it was healing on its own fine.
Now, he is a big swimmer and recently contracted swimmers ear after double otitis media which he has never had. I do my best to let him swim because he needs the excercise, but now it seems that it is causing more problem.
Antibiotic aside my problem is that no doctor will recognize the pain this child is in and treat it so that he is more comfortable. Never has he screamed in pain with otitis media than he has with this swimmers ear. I feel if the doctors want you to wait it out thats fine, however, take care of that immediate pain!
Is it true that the tubes do not always work and you could be making the investment several times over with no possitive results? This was recommended, however, for that reason I have been hesitant.
I had tubes in my ear when I was younger and now I have to wear earplugs when I go swimming. Yesterday, I got water in my ear and it for a few minutes there was intense pressure and pain. The pain went away, thankfully, but the water is still in my right ear. The eardrum in my right ear has a hole in it, so maybe the water could have gotten behind the eardrum. I've tried everything, but it still has not come out. I am hesitating on putting more liquid in my ear such as alcohol and drops because I had some bad experiences as a child and I honestly think that putting liquid in my ear will make it worse. Is there anything I can do?
please take ear infections and pain serrious i am 31 never had an ear infection now i have MRSA in both ears the pain in unbearable most of the time and no i dont work in a hospital i daont work at all so make your md culture your ears and check for MRSA i went to 4 doctors before i was tested
As a baby my son had recurrent ear infections and tonsilitis. After he turned two he had tubes put in his ears and his tonsils and adnoids taken out. He was ear infection free for quite awhile. Recently he has been getting ear infections with lots of greenish clear drainage. If he rubs his ear then touches his skin he breaks out. The first time I noticed the terrible drainage I took him to the hospital. They cultured his ear and the results were MRSA. He was put on Bactrim and it seemed to clear up, but shortly after he was finished with the antibiotic it came back. He's been off and on antibiotics more than I would ever like since this has began and the drainage keeps coming back. He is going to the ENT again in a week and I hope the doc can figure out what to do. I'm worried that this will turn into a big problem and spread and become life threatening to my baby. I would appreaciate any suggestions anyone has. I'm a very scared mommy who just wants her son to get better.
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