Email a Friend
Print Article
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
31 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.
i am 22 years old and i dont think i have ever had an ear infection, tell about 1 week ago. my ear hurts really bad and its really hard to sleep. i have like a lump on the out side of my ear and i really cant hear out of my ear it feels like i have water in my ear. is this just a normal ear infection or should i go to the doctor. i am now going on my 3rd day of not being able to hear out of it. is there anything i can do to treat it at home. and is there anything i shouldnt do?
I've had infections every year for the last three years, I've got it right now too, in my experience ive just treated the pain with pain releivers and a warm(hot) towel, one thing ive learned is to not poke at it with any thing, I've gone to the dr. so he can prescribe some anti-biotics, they work o.k. not as fast as one might think but it gets some work done, so if the pain is too much i'd recomend to go to the Dr.'s Office.
I know how bad the pain can get, I was 18 years old when I got my first infection, and I had no Idea about what to do, I couldnt even sleep, so I understand what you're going thru, even us guys as macho as we are will almost humble down to anything when we get ear infections.
i am 44 and had never had an ear infection in my life till i moved a year age. since then i have had 5 . no i dont swim alot and have tried manyyyyyy ideas, water removal drops, wax removal drops, ear plugs when i take a shower ..etc the last time they even gave me oral antibiodics and drops...any other ideas? no insurance this is getting pretty nuts in the money dept
I'm in the same boat with Zara and our anonymous friend as well. I am 46 and had surgery last year to remove a cholestiatoma (spelling?) from my left ear. My ear bones were severely damaged and replaced with a titanium implant. I have my hearing back but it still sounds like I 'hear thru my skull'. I doubt that makes any sense to anyone else, but it's the only way I know how to describe it. I am very fortunate to have found Dr. Wazen at the Silverstein Institute in Sarasota, FL.
In spite of the difficulties I've had my whole life with my ears, I still think a few warm drops of 'sweet oil' - commonly known as olive oil, a hot water bottle, a couple of aspirin and a shot of whiskey is the best medicine for ear infections. The results are about the same as antibiotics and pain pills, and a lot cheaper. Just my humble opinion....
I am 36 years old and I recently had an MRI and it said I have mastoiditis and I am wondering what that is?
Mastoiditis is an inflammation of the mastoid bone in the middle and inner ear. Look up "mastoiditis" at medline plus for pictures and articles.
My son has also had problems with ear problems since he was 15 and so far three surgeries to remove and try to contain the (correct spelling is...) Cholesteatoma. Now he is 21 and has begun suffering from migrains and balance
problems a year after the 3rd surgery. We're hoping it'll get better or be gone for good...but I fear it is growing back. We had a BAHA implant put in to restore his hearing. Without it he's totally deaf in his right ear.
My son has this cholesteatoma he already has mild to moderate hearing loss.h eis 5 they say he has to have the surgery because the pocket thibg behind his esr is full and putting oressure on the brain wall and his nerve behind his ear. Is this the only way?
I feel for all the people who have suffered from chronic otitis media. I'm in the anti-antibiotics camp for the most part. Although I realize this problem is largely mechanical, especially in small children, I can't help but wonder how much of it has to do with suppressed immune function in people who have generally poor diets, who fail to exercise adequately, who over medicate, and who do not get adequate sleep each night.
Doctor, If your main point is ... recurrent ear infections might signal a larger underlying problem, then I'm definitely on board. I too was diagnosed with cholesteatoma by a very skilled otologist/neurotologist after being misdiagnosed by general practitioners for at least 14 years (probably longer). It took my hearing to disappear entirely before a well-meaning GP referred me to one of her friends from med school. Everyone ... and I mean everyone ... that I know that struggles with cholesteatoma has been misdiagnosed (perhaps a euphemism for 'not believed') until the damage is pretty severe. Thankfully I have a prosthesis that works pretty well in my right ear and a hearing aid that works pretty well for my left ear. I have to be honest though, this has really shaken my confidence in medicine. I've even had doctors look at my prosthesis and think it's a tube (my otologist warned me that they might). To answer the one person's question about treatment for cholesteatoma ... unfortunately, the only treatment is surgical removal.
Matt
Wow. I'm glad to see I'm not the only one. I've had 4 surgerys in my right ear and 2 to clear the choleastatoma. They did not replace my eardrum. I was a little afraid to have surgery again. Last year I had them check to see if the choleastatoma returned. They did a hearing test and x-ray (or CT- can't remember). My ear bothers me, but it's not painful. I'm an endurance runner and teach fitness classes with LOUD music. How do you know the cholestatoma is back? What type of doc should I look for?
Yeah, I know what you mean. I had a Cholesteatoma surgery for nothing. It made my hearing worse. Why do Ear, Nose, Throat doctors prescribe ear surgery as a first line of defense, rather than as a last resort. Why? Why? Why? It's the patient that has to live with the physical consequences of the surgery (not to mention the huge medical bills courtesy of the doctor-hospital bureaucracy.
This comment is to warn parents and adults who are dealing with prolonged pain or hearing loss as a result of an ear infection. My husband was diagnosed with an ear infection in early May, we are currently at the end of July and with three courses of antibiotics and steroids he continued with problems. His specialist finaly suggested having an MRI of his brain. His diagnosis is left-sided mastoiditis. This is treatable, but complications are scarey. Please, if you or your children have been diagnosed with an ear infection and it does not get better with the first course of antibiotics, don't allow your doctor to play the waiting game - find a doctor willing to get you answers much sooner, it's YOUR health!!
I am a mother of 4 sons 3 of which have had tubes put in there ears due to fluid build up and ear infections. I am reading all of your comments and I find it interesting to hear that most of you don't know about the complications due to leaving an ear infection for 2 long without getting it treated.
The ear canal is very close to the brain and all of that fluid in the ear causing the infection can also lead to an infection of the fluid around the brain.
If you have a lump coming out of any place by the ear and you are in serious pain go get it looked at don't ask people on here if you should.
Zara, my 9 yr old has Choleastaoma and be thankful your parents did have you go through the surgeries to remove it because if it goes untreated the tumor can blow out or burst the main artier in the ear and you can bleed to death. Even after they get it all out you still have a 10-20% chance it will come back.
I guess what I am saying is if you have an ear infection or your child does and it hasn't gone away in 3 days and they are in pain go get it checked. Save your hearing or your child's.
If the ear infections happen all the time then there is something else going on and that is how we found out about the Choleastatom with my 9 yr old. If there is fluid in the ear they can't see the tumor.
I am 37 and have been dealing with serious and chronic ear infections my entire life. I have one right now as a matter of fact. I wish the doctors could fix this so I wont be in massive pain all the time.
I was a premature baby at birth(2lbs. 2oz.)and thought that all my medical problems were because of that. Chronic ear infections, chronic strep throat and much more.
I am 30 years old i have Choleastaoma in my ears. Surgeries DO NOT help me out at all. I am about totally deaf in both of my ears. I found out when I was 15 yrs old that I have had Choleastaoma all my life since I was a baby. :(
My son is 8 and we have had recurrent ear infections time and time again. He has had 3 set of tubes in his ears, waiting for the 4th. He still gets some fluid build up and infection with the tubes, and sometimes he dose respond at all to antibiotics. Thankfuly he dose not act as if the infections cause as much pain as they could, however he will run high fevers until an antibiotic has kicked in. Should I ask our Dr. about checking for tumors or would he have already mentioned it, if he thought it was a problem? He also get crazy copper colored ear wax that drains like watered down honey. His ears always look disqusting,like we never have cleaned them. It will ;eak on his pillow,cloths, and face. Any suggestions
Something very wierd happened to me, yesterday I went Skiing and on the way up the mountain my ears were having trouble adjusting to the elivation. after a while it was fine but, when I comepletely came off the mountain my ears were in just a little pain. more so, I could barely hear out of them they were not equlizing at all no matter what I tried, chewwing gum, yawning, stretching my jaw ect... now a day later I am still having trouble hearing out of them, for they feel very congested though there is not much pain in them at all. has anyone else experienced this if so what can I do thats cheap im on a college student budget with no health insurence PLEASE help!!
If you have a comment about this blog post, you are in the right place. However, if you have a question for Dr. Moser, please visit him on the Ear, Nose & Throat message board.
If your question is urgent, you should of course consult your own physician.
Post a Comment