The average child consumes an astounding three months’ worth of antibiotics for otitis media (ear infections) before the age of two. In recent years in the United States, the practice of prescribing antibiotics for ear infections has become almost universal, although it remains controversial in other nations. The frequent diagnosis and treatment of otitis media is having a huge effect on both our environment and on each child who in total receives more than 30 million courses of antibiotics given for ear infections every year. More troubling is that the routine administration of antibiotics has caused a skyrocketing incidence of resistant bacteria (superbugs), which is making many of these medicines useless.
Wouldn't it be wonderful if there were a way to cut the incidence of antibiotic use for otitis media? In fact, there is.
The most effective solution is for physicians to be more accurate in diagnosis.
Much of the time, ear infections are diagnosed when they don’t really exist.
Most of the unnecessary and inappropriate antibiotic use associated with treating "ear infections" comes from treating conditions that are thought to be acute otitis media but are actually some other illness, such as a viral upper respiratory tract infection. If a crying child with a respiratory infection has a low-grade fever, he/she will almost invariably have some abnormality in the examination of the eardrum, due to either the crying itself, or some middle ear fluid, neither of which is actually an ear infection.
Inappropriate diagnosis and treatment:
- Much of what qualifies as otitis media is in actuality part of the natural history of a cold and resolves quickly without any specific treatment.
- When an office or emergency room physician is faced with a fussy child and exhausted parents, it is common to give a diagnosis of otitis media.
- The diagnosis of acute otitis media is not always certain, especially if the child is crying, or has a fever, both of which can cause the eardrums to become red, mimicking a primary sign of ear infections.
- Pediatricians often give an antibiotic because they feel under pressure to do so, believing it is what the parent wants.
- It is easier and less time-consuming for a doctor to write a prescription than to explain why it is not necessary.
Otitis media is chiefly a disease of infancy. Children will have fewer problems after three years. Ear infections are common in infants and children in part because their Eustachian tubes become clogged easily, so fluid can build up and bacteria can take this opportunity to overgrow, causing infection. Things that can cause blockage include colds (upper respiratory infections), allergies, tobacco smoke, the use of pacifiers, daycare, being formula-fed (not being breastfed) and being fed while lying down.
- Breastfeeding works. Breast milk contains antibodies that offer protection from ear infections. Exclusive breastfeeding until for at least three months reduces the incidence of otitis media, and this effect persists four to 12 months after breastfeeding ceases.
- Keep your child away from sick children. Limiting daycare exposure for very young children decreases the risk of upper respiratory tract infection and, therefore, otitis media. Children in large daycare programs will have more infections than children in small groups.
- Protect your child from secondhand smoke. Children exposed to smoke have more episodes of otitis media than children not exposed. Secondary smoke in the home causes irritation of the respiratory tract in household contacts, so make sure that no one smokes in your home. When away from home, stay in smoke-free environments.
- Underlying environmental or food allergies can lead to recurrent ear infections. Up to 1/3 of all cases of ear infections are due to dairy or milk allergies. Other foods may be suspect, but the frequent connection between dairy and ear infections suggests that the elimination of dairy is a good first strategy. Other allergens in the environment, such as dust and feathers, can be eliminated by household allergy-control measures.
- Pacifier use in children younger than three years increases the risk for recurrent otitis media by up to 25%. Pacifier use contributes to otitis media by making it more likely for viruses and bacteria to be sucked into the middle ear. Avoid the use of a pacifier, prolonged sucking on a bottle, or even a sippy-cup. Always have the child sit upright when drinking rather than lying down.
Most children with ear infections would get better without antibiotics.
In light of the fact that a large majority of children with acute otitis media recover without antibiotics, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) issued a joint statement in March of 2004 on how to treat patients with ear infections. These organizations now recommend a "wait-and-see approach" for the first 72 hours after diagnosis. That suggestion holds for children who:
- Are older than age 6 months (Six months was chosen as the lower age limit because there are limited data on this approach in younger children and severe illness is more difficult to recognize.)
- Are otherwise healthy
- Have mild signs and symptoms or an uncertain diagnosis
Despite the evidence that in 80 to 90 percent of truly diagnosed cases the infection will clear up on its own, doctors continue to write millions of unnecessary prescriptions.
AAP guidelines also suggest that pediatricians encourage families to prevent ear infections by reducing risk factors. For babies and infants these include breastfeeding for at least six months, avoiding "bottle propping" and eliminating exposure to passive tobacco smoke.
The problem with antibiotics
In most cases the drugs do more harm than good, leading to side effects, antibiotic resistance and a cycle of hard-to-treat and recurring infections.
The antibiotic taken for an infection may also kill many of the beneficial microflora in the intestines at the same time, and when they are eliminated, the child very often suffers from gastrointestinal problems including diarrhea and yeast overgrowth.
Because most ear infections do not need antibiotics, the goal of treatment is the alleviation of pain until the infection subsides.
If your child is uncomfortable, heat alone is helpful in relieving pain, so simply applying warm oil into the ear canal helps with the pain. A few drops of gently heated oil (baby oil, mineral oil, vegetable, garlic or olive oil) will have a soothing effect on the inflamed tympanic membrane (eardrum).
Often when a child experiences recurrent ear infections or chronic fluid in the ear, he /she will be referred to the otolaryngologist (ear, nose and throat doctor) to place tubes in the ear, a surgical procedure. These small implants, or tympanostomy tubes, are open at both ends and are inserted into eardrum incisions made by the surgeon. Tubes come in various shapes and sizes and are made of plastic or metal. They are left in place until they fall out by themselves or until they are removed by a doctor.
Tympanostomy tube insertion is the most common procedure that requires general anesthesia for children in the United States, with over half a million surgeries done each year.
Tube placement in children does not treat the underlying problem that led to the ear disease, nor does it "cure" the condition that led to the surgical intervention. Rather, the inserted tube keeps fresh air circulating in the middle ear until the child grows and the Eustachian tube function normalizes.
Overuse and Problems
Doctors in the past have been concerned that if surgery was not used in the case of persistent middle ear fluid, children could face long-term developmental impairment. However, placing ear tubes in young children who develop fluid in the ears does not improve speech, hearing or psychological development. There is absolutely no evidence of long-term benefit with tube placement for otitis media
The best course in dealing with ear problems is to find out what is most likely to be the cause and to treat the underlying condition rather than relying on multiple courses of antibiotics or tympanostomy tubes. At the first sign of an ear infection, or if your child has had chronic problems in the past, it is worth considering the risk factors above and eliminating as many offenders as possible.