Earache & Ear Infections

What is Acute Otitis Media? (from Stan L. Block, MD; https://www.pediatricweb.com/webpost/iframe/MedicalConditions_433.asp?tArticleId=128)

“Acute otitis media is an infection of the middle ear, generally caused by bacteria. In acute otitis media (i.e., an ear infection or an infection of the middle ear), pus and infected fluid accumulate in the middle ear space.

The tympanic membrane (eardrum) appears inflamed, reddened, and often protrudes outward. Usually, an ear infection begins after the eustachian tube (a small tube connecting the back of the nose to the middle ear space) has become swollen, congested, and closed, most commonly resulting from an ongoing viral respiratory infection.

Acute otitis media should not be confused with: 1) external otitis (“swimmer’s ear”)-a painful bacterial infection of the superficial skin of the ear canal, or 2) otitis media with effusion (secretory otitis or “fluid ears”)-an accumulation of non-inflamed fluid behind the eardrum.”

Pain and Acute Otitis Media:
When the air-containing chamber behind the eardrum fills with fluid or pus during an earache, pressure builds up against the eardrum causing pain, sometimes severe. Not all ear pain is an ear infection. Pain can be a sign of congestion which normally builds up when a child has a cold. Parents wonder if they need to rush to the emergency room when this pain situation occurs at night. The important immediate treatment is pain relief. A weight-based dose of acetaminophen (Tylenol) or ibuprofen (Motrin/Advil), sleeping upright, and a warm washcloth or heating pad over the ear usually helps within 30-45 minutes.

To Treat or Not To Treat?
Roughly 50%-60 % of ear infections are caused by viral agents and will not respond to antibiotic therapy. Most ear infections caused by bacteria will resolve without antibiotic therapy. Only a small percentage of ear infections will require antibiotic therapy for a cure and these are most typically seen in children under the age of 2y. The evidence further suggests that symptoms, primarily pain, are only shortened by one day in children who are treated with antibiotics, and this pain can be relieved by analgesics such as Tylenol and Motrin/Advil. As a result, there has been much discussion as to the necessity for the use of antibiotics in the treatment of uncomplicated acute otitis media in children.

A concern about the rising rates of antibiotic resistance and the growing cost of prescription antibiotics has caused the medical community and the general public to focus attention on the need for judicial use of antibiotic therapy. Acute otitis media is the most common infection for which antibacterial agents are prescribed for children in the United States. The greater increase in resistance among the bacteria that cause ear infections has led to an increase in the use of broader spectrum and generally more expensive antibiotics. The American Academy of Pediatrics and American Academy of Family Physicians Subcommittee on Management of Acute Otitis Media has recommended an observation without the use of antibiotics for uncomplicated acute otitis media in otherwise healthy children over the age of 6 months. This observation option refers to deferring antibiotics for 48 to 72 hours and limiting management to symptom/pain relief using analgesics such as ibuprofen and acetaminophen. If pain persists and/or fever is present after the observation period, antibiotic therapy may be initiated.

If your child is experiencing ear pain, you should treat the pain as suggested above. If your infant has had a cold and now has a fever, seems to have pain and sleep disruption, he/she may have an ear infection.  Please call our office to schedule a sick visit or to speak to the provider on call after hours. You may also bring your child to our walk-in hour from 8:30-9:30 a.m. on non-holiday weekdays.