What's New in Middle Ear Infections
Most of the antibiotics prescribed for children in the U.S. are for the treatment of middle ear infections. In light of overwhelming evidence that antibiotics are not necessary in many (most) cases, old habits are difficult to change. Medical providers are continuing to prescribe stronger and stronger antimicrobial medications, and parents are still demanding them.
Americans are a "quick-fix", fast-food culture. Parents bring children to our clinic within hours of complaining about ear pain. New parents panic when they see their infants pulling on their ears. If ear-pulling alone was a definitive sign of a middle ear infection, then why aren't they bringing in children who pull their toes...or little boys who pull on their penises?
The less a person knows about a disease or condition, the more they tend to fear it. In the management of childhood ear infections, education is often much more powerful than medication. Since eardrums are "hidden" from the prying eyes of most parents, they do not want to take chances. When eyes become red in conjunctivitis (pink eye), parents know immediately. When eardrums become red - one of the signs of a middle ear infection - parents can't see it; unless, of course, they have a good home otoscope. All parents should have a home otoscope (about $30) and know how to use it.
If you were born after the mid-1930s, you were always living in a world that had access to antibiotics. Prior to that time, people were still getting ear infections, but perhaps not as frequently as today. So, what cured them? The answer is simple: our own immune systems. People at that time used warm oil in the ears; used heating pads, and of course, shelled out aspirin for the pain. Severe ear infections warranted a rare visit to the general practitioner. The standard of care for severe ear infections prior to 1935 was a surgical myringotomy - a small slit was made into the red, bulging eardrum to relieve painful pressure and allow the pus to drain. This was done without anesthesia. Did it work? Yes. We still use myringotomies today, but we insert a little tube so the hole will not close. This is the basis for using tubes in children.
Since the first antibiotic (sulfa), and the most popular one (penicillin) was developed, people considered them modern miracles. Antibiotics were being tried and used for everything. For most of young parents today who of children with ear infections, these were our grandparents. Our grandparents loved antibiotics, especially shots. I still see them today, accompanying their grandchildren, asking for a "shot". We now have over two dozen antibiotics that can be used in children with middle ear infections, but should we be using them? Some experts say "no". Others say "sometimes". I am in the "sometimes" camp.
Pathogens are changing. What caused ear infections in our parents when they were children, are not the same weak bugs any more. Our use and overuse of antibiotics over the last generation or two has contributed to the evolution of some nasty super-bugs. Now, it is a whole new ball game. Antibiotics do save lives and spare seriously-ill children from the ear infection complications of the past, such as mastoiditis or meningitis. Rather than abandon antibiotics, we need to use them more judiciously...and, not at all in many cases.
Parents are confused. Medical providers do not enjoy being antibiotic gatekeepers, but we have to take a stand sometimes. Medical providers are really just consultants for your child's health. It is really up to all of us to change old habits and approach middle ear infections a new way. Actually, it is time to rediscover some of those "old ways".
When your child has a suspected middle ear infection, it is NOT an emergency. No parent likes to see their child in pain or febrile, so why not try treating the pain at home first, before rushing off to the ER. I can almost guarantee that you will leave with an antibiotic when you visit an ER. Why? Parents expect an antibiotic; ER physicians are busy with life-threatening events in other rooms, so they do not have time to be confrontational with a sleep-deprived parent. It is much easier to shell out an antibiotic than it is to take to time to explain why an antibiotic is not needed. An ER-treated ear infection is unbelievably expensive, so a better course of action would be to wait. Treat the child's pain at home and try to wait a few days (yes, days!) to see if the child's immune system will save you the insurance co-pay. Parents need to trust the immune system. Our immune systems have protected us for millions of year before antibiotics made their debut.
Pain management is a huge issue. Ear infections hurt! If you have ever had a middle ear infection as an adult, you will know what I speak. The pain can be humbling to adults, so please be sympathetic to children in pain. Adults want codeine or Vicodin; we expect children to get by on a little acetaminophen. As a society, we often forget that the smallest people have the least coping skills. When kids are in pain, we have to treat it. If you have a child with recurrent, painful middle ear infection, you have to be prepared. Effective pain management will buy you time - time for the immune system to do its job.
Pain can be treated in two ways: topically, using analgesic eardrops, and orally, using pain medications. Most parents will give acetaminophen, but because middle ear infections are an inflammatory event, ibuprofen may work better (if you child is over age six months). Auralgan is a benzocaine topical ear drop that requires a prescription. All parents with children with recurrent ear infections should have this in their medicine cabinets, but they will need to ask their medical providers in advance. Auralgan, alone, can save you from those late-night ER visits. Since ear infections like to stick out their ugly heads at 3 AM, it needs to be available. Auralgan cannot be used if children have tubes or if there is a ruptured eardrum (blood and pus coming out of the ears).
Are antibiotics ever needed? You bet...sometimes. The number one reason for hospitalizing children prior to World War II was for ear infections. Antibiotics helped put a damper on those rare complications that could cause permanent deafness or even death. The vast majority of "uncomplicated" middle ear infections will go away...on their own...without the intervention (or interference) of your doctor. Babies under three to four months have inherently poor immune systems and must be treated. Children with prior histories of severe middle ear infections need to be treated. Children who appear toxic (very ill) or have evolving complications most likely need antibiotic intervention. This is why we have doctors and other medical professionals - to make these difficult treatment decisions.
Your medical provider is your partner in this battle. Work with them; not against them. Trust their medical judgment, or find one that you do trust. Educate yourself and learn to use the tools, like a home otoscope. Don't let fever cause you fear, and don't let pain go untreated. Trust the immune system and allow it time to work. Don't expect or demand antibiotics, but if they are prescribed, respect and use them appropriately.
Related Topics: Technorati Tags: ear infections, antibiotics, childrens health
Americans are a "quick-fix", fast-food culture. Parents bring children to our clinic within hours of complaining about ear pain. New parents panic when they see their infants pulling on their ears. If ear-pulling alone was a definitive sign of a middle ear infection, then why aren't they bringing in children who pull their toes...or little boys who pull on their penises?
The less a person knows about a disease or condition, the more they tend to fear it. In the management of childhood ear infections, education is often much more powerful than medication. Since eardrums are "hidden" from the prying eyes of most parents, they do not want to take chances. When eyes become red in conjunctivitis (pink eye), parents know immediately. When eardrums become red - one of the signs of a middle ear infection - parents can't see it; unless, of course, they have a good home otoscope. All parents should have a home otoscope (about $30) and know how to use it.
If you were born after the mid-1930s, you were always living in a world that had access to antibiotics. Prior to that time, people were still getting ear infections, but perhaps not as frequently as today. So, what cured them? The answer is simple: our own immune systems. People at that time used warm oil in the ears; used heating pads, and of course, shelled out aspirin for the pain. Severe ear infections warranted a rare visit to the general practitioner. The standard of care for severe ear infections prior to 1935 was a surgical myringotomy - a small slit was made into the red, bulging eardrum to relieve painful pressure and allow the pus to drain. This was done without anesthesia. Did it work? Yes. We still use myringotomies today, but we insert a little tube so the hole will not close. This is the basis for using tubes in children.
Since the first antibiotic (sulfa), and the most popular one (penicillin) was developed, people considered them modern miracles. Antibiotics were being tried and used for everything. For most of young parents today who of children with ear infections, these were our grandparents. Our grandparents loved antibiotics, especially shots. I still see them today, accompanying their grandchildren, asking for a "shot". We now have over two dozen antibiotics that can be used in children with middle ear infections, but should we be using them? Some experts say "no". Others say "sometimes". I am in the "sometimes" camp.
Pathogens are changing. What caused ear infections in our parents when they were children, are not the same weak bugs any more. Our use and overuse of antibiotics over the last generation or two has contributed to the evolution of some nasty super-bugs. Now, it is a whole new ball game. Antibiotics do save lives and spare seriously-ill children from the ear infection complications of the past, such as mastoiditis or meningitis. Rather than abandon antibiotics, we need to use them more judiciously...and, not at all in many cases.
Parents are confused. Medical providers do not enjoy being antibiotic gatekeepers, but we have to take a stand sometimes. Medical providers are really just consultants for your child's health. It is really up to all of us to change old habits and approach middle ear infections a new way. Actually, it is time to rediscover some of those "old ways".
When your child has a suspected middle ear infection, it is NOT an emergency. No parent likes to see their child in pain or febrile, so why not try treating the pain at home first, before rushing off to the ER. I can almost guarantee that you will leave with an antibiotic when you visit an ER. Why? Parents expect an antibiotic; ER physicians are busy with life-threatening events in other rooms, so they do not have time to be confrontational with a sleep-deprived parent. It is much easier to shell out an antibiotic than it is to take to time to explain why an antibiotic is not needed. An ER-treated ear infection is unbelievably expensive, so a better course of action would be to wait. Treat the child's pain at home and try to wait a few days (yes, days!) to see if the child's immune system will save you the insurance co-pay. Parents need to trust the immune system. Our immune systems have protected us for millions of year before antibiotics made their debut.
Pain management is a huge issue. Ear infections hurt! If you have ever had a middle ear infection as an adult, you will know what I speak. The pain can be humbling to adults, so please be sympathetic to children in pain. Adults want codeine or Vicodin; we expect children to get by on a little acetaminophen. As a society, we often forget that the smallest people have the least coping skills. When kids are in pain, we have to treat it. If you have a child with recurrent, painful middle ear infection, you have to be prepared. Effective pain management will buy you time - time for the immune system to do its job.
Pain can be treated in two ways: topically, using analgesic eardrops, and orally, using pain medications. Most parents will give acetaminophen, but because middle ear infections are an inflammatory event, ibuprofen may work better (if you child is over age six months). Auralgan is a benzocaine topical ear drop that requires a prescription. All parents with children with recurrent ear infections should have this in their medicine cabinets, but they will need to ask their medical providers in advance. Auralgan, alone, can save you from those late-night ER visits. Since ear infections like to stick out their ugly heads at 3 AM, it needs to be available. Auralgan cannot be used if children have tubes or if there is a ruptured eardrum (blood and pus coming out of the ears).
Are antibiotics ever needed? You bet...sometimes. The number one reason for hospitalizing children prior to World War II was for ear infections. Antibiotics helped put a damper on those rare complications that could cause permanent deafness or even death. The vast majority of "uncomplicated" middle ear infections will go away...on their own...without the intervention (or interference) of your doctor. Babies under three to four months have inherently poor immune systems and must be treated. Children with prior histories of severe middle ear infections need to be treated. Children who appear toxic (very ill) or have evolving complications most likely need antibiotic intervention. This is why we have doctors and other medical professionals - to make these difficult treatment decisions.
Your medical provider is your partner in this battle. Work with them; not against them. Trust their medical judgment, or find one that you do trust. Educate yourself and learn to use the tools, like a home otoscope. Don't let fever cause you fear, and don't let pain go untreated. Trust the immune system and allow it time to work. Don't expect or demand antibiotics, but if they are prescribed, respect and use them appropriately.
Related Topics: Technorati Tags: ear infections, antibiotics, childrens health
13 Comments:
Had my parents known this, they would saved a lot of pain and two Choleastatoma surgeries on my left ear.
Now I'm half deaf in that ear anyway.
Today I learned that there was such a thing as a home otoscope. Thank you, doctor Rod! I have a child who is prone to ear infections and an otoscope would certainly let me keep an eye on the "silent" ones (she has had tubes put twice for those).
With all due respect, this is easy for Doctor Rod to say!
I was routinely afflicted with incredibly painful ear infections from childhood up through my late teens. Even now (I'm in my late 30s) I still occasionally get them, though now they are much less severe than when I was a kid.
In my experience at least, antibiotics are the only cure. When I try to wait them out, it never works. So I can have a week of feeling miserable and then go get antibiotics, or I can go get antibiotics right away and start feeling better the next day. The choice seems clear.
Every person is different....to the person that "always" needed antibiotics, then perhaps you did. Your experience may be different, but for the vast majority of CHILDREN, antibiotics are often NOT NEEDED, at least early in the course of a middle ear infection.
For you new otoscope-users...KEEP PRACTICING and KEEP ACTIVELY PARTICIPATING in your care.
I have to agree with the individual who posted the third comment. The last time I had an ear infection my doctor told me to wait it out. Two days later the pain was so bad it was worse than child birth. I also could not open and close my mouth without any pain. I was back at the doctor's office and put on antibiotics. I also had my ear drum burst with it. Just give me the antibiotics right away!
I've had frequent ear infections growing up (between the two ears I've had at least 25 eardrum bursts medically documented) I also had cholestiatoma surgery when I was 15. In my opinion, the antibiotics I took for treatment growing up (ages 6 months - 14 yrs) either weakened my immune system to this specific bacteria and/or made the bacteria stronger and harder to kill. My body's reaction to antibiotics (cold-sweats, nightmares, severe nausea) made it so I started refusing to take them. Yes, I'd have an ear infection a few days longer, but I could still sleep, eat, and work. So I believe I am anti- antibiotic. And I'm with Zara on the half deaf bandwagon (which sucks being a musician)!
My 2 older children tended to form bullae on their eardrums, so they were often treated with oral antibiotics as well as antibiotic ear drops. When my pediatrician learned that I'd acquired a home otoscope, he was kind enough to give me lessons. Most helpful with the younger one, since his only symptom, at times, was blood and pus dripping from the affected ear.
My younger son, thank goodness, has never had an ear infection. He's 12, so I think it MIGHT be safe to say that now. I, unfortunately, continue to get them occasionally. I've learned to check my blood sugar before calling my doc. If that's OK, I can generally wait it out. One of the few advantages of being diabetic.
Thank you for the education. My dad and I suffered from ear infections well into adulthood, and now my nine year old gets them regularly. I'm a firm believer in waiting because antibiotics are so overused today.
However, last year she had a really bad one and had blisters in her ear-which I've never even heard of-and, a lot of horrible pain. They gave her Tylenol with codeine at its worst.
Now, she has one, again, and I can't decide weather to take her to the doctor because my doc is more pro antibiotic than we are.
To all ear infection sufferers I had same problem with my son. Then I did not want to give him again and again medication so i start search why he is getting ear infection, then I learned most of ear infection couse is food alergy. For most kids it is corn, chicken and tomato. When I stop feeding my son chicken, tomato of any kind including ketchup and corn his ear infection disapeared completly so give it a try.
TThank You so much, this is very strange as these are the foods he craves.
Glenda Fight for Lyme awareness
I am 26 years old and I have had an ear infection for 5 days now. I have not had one since I was 10. For the last 5 days I have been taking antibiotics and using the prescribed drops. I still have a lot of pain and severe hearing loss in that ear. Is that normal?...Is there anything I should do?...I am just really scared about my hearing loss.
I'm 54 and I've had three ear infections in the last ten months. Two on the right ear, one on the left. But it's nearly impossible to find any information about ear infections in adults. I figure with three in one year something has to be causing this? And only once was it (possibly) cause by a cold.
My doctor gives me Vicodin and antibiotics, but no insight into the cause.
Perhaps my last comment was overstated, but I was in a lot of pain. Not that I have pain killers...
We did talk about the cause of ear infections today. Well, prevention of them, anyway. He suggested a daily alcohol/vinegar regime, a drop or two in each ear.
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