Manage ear infections before winter arrives
count myself lucky that my kids weren’t particularly prone to ear infections, but plenty of my friends’ kids were and I know what an impact it had on their families.
In general practice, ‘‘he/she seems to have a sore ear’’ is a comment we hear daily from parents and probably even more often over the winter months.
Usually, the context is that of a middle-ear infection, known as otitis media (OM). Outer ear infections occur as well, but they affect the canal (from the opening of the ear on the outside towards the ear drum) and present with quite different symptoms.
Although middle-ear infections (OM) can occur in isolation, it is probably more accurate to think of them as part of the spectrum of symptoms that go along with a ‘‘cold’’ or ‘‘upper-respiratory tract infection’’.
When our upper respiratory tract is infected, the tube between the back of the nose and the middle ear (known as the eustachian tube) is a great passage for bugs to travel down, infecting the middle-ear as well as the throat, nose and everything else along the way. This is far more likely to happen in children and babies as their eustachian tube is shorter and flatter, enabling the bugs to get in more easily.
Otitis media is incredibly common and, worldwide, is a leading cause of ill health and disability, especially in developing countries. It is thought that about two-thirds of all children will experience at least one episode of OM before they turn 3 years old.
Many are affected three or more times. It is most common in babies and young children, but can affect older children and adults, too. Other risk factors for developing OM include:
Living in a house with smokers
Living in overcrowded conditions Attending creche or day care, as there is greater exposure to bugs from other children
Being bottle-fed – breastfeeding for at least the first three to six months of life is protective
❚ Enlarged tonsils or adenoids, as this may affect the ability of the eustachian tube to function properly.
Although it can be obvious that your child has an ear infection, it is sometimes a bit more subtle, especially in younger children. The following are symptoms that might suggest OM:
❚ A painful ear or ears – In OM, the pain is caused by pressure behind the ear drum from a build-up of infected fluid. Typically it comes on quickly and is quite severe but it usually subsides quickly too. Many kids feel much better within
24-48 hours.
❚ Being grizzly or grumpy – Younger children may not be able to identify the source of their pain, but may be clingy and far more irritable than usual, especially at night when there is nothing to distract them; they may also be tired, off their food and generally ‘‘unwell’’.
❚ Runny nose, fever, cough and sore throat – These aren’t specific to the ear infection itself, but it is common to have cold symptoms at the same time.
❚ Pulling or rubbing the affected ear to try to get relief
❚ Adults and older children may complain of reduced hearing on the affected side and sometimes their balance is also impaired
❚ In some cases, if the infected fluid in the middle-ear puts enough pressure on the drum, the drum will burst (known as a perforation) – this actually leads to a sudden relief from the pain, so many children will feel heaps better once this happens.
Although ear infections can turn your normally placid easy-going, sleeping child into a distressed, screaming bundle, don’t be alarmed – most ear infections will not require any management other than plenty of TLC and good pain relief. For all families with young children, make sure you have a good supply of paracetamol and ibuprofen and that you know the correct dosing for your children.
This depends on weight, not age, so check with
your doctor or pharmacist if you aren’t sure, as it’s important to give enough to relieve pain, but not overdose them. Pain relief is much more effective if it is given regularly while your child needs it, rather than waiting for the pain to flare up again.
I suggest keeping a chart of what you have given when and sticking to the timings as accurately as is possible – if you are anything like me, when you’re running on no sleep and the kids are sick, it is easy to lose track of who has had what.
Antibiotics have almost no role to play, unless there are particular complications, or symptoms aren’t resolving as expected.
Most cases, even if they are caused by a bacteria as opposed to a virus, will go away within a few days without antibiotics, so I always advise parents to avoid them where possible. Managing without antibiotics reduces the risk of unnecessary side-effects and also avoids contributing to the problem of global antibiotic resistance.
Any very young child (under 2) with a fever should be seen by a doctor, as it is important to rule out more serious infections.
Older children who aren’t particularly unwell, can tell you their symptoms, and who may well have had ear infections before, don’t need to be taken for an urgent check-up as they can usually be very safely managed at home.
However, even if you choose to manage this at home, I suggest that all children with OM get reviewed a few weeks after they have recovered.
One of the biggest risks of this condition is that the fluid behind the ear drum doesn’t fully drain away, leaving a thick substance that is almost impossible to hear through. This complication is known as glue ear and can have a huge impact on your child’s ability to hear, communicate and perform at school.
Your doctor or practice nurse can perform a simple test to check if your child’s ear drum is moving as it should be, or whether they need to get further assessment to rule out, or treat, glue ear.