If you’re a parent, chances are you’re pretty familiar with ear infections. Formally known as ‘Otitis Media,’ this ailment refers to inflammation of the middle ear. The middle ear is the small space behind the ear drum that houses the small bones of the ear. This part of the ear is normally air-filled, however, when someone becomes ill with a viral or bacterial sickness, or when fluid from an illness cannot easily drain for an extended period of time, inflammation and infection can ensue.
Otitis Media is quite common and has a much higher prevalence in children than in adults. This is mainly because children have eustachian tubes (the drainage tubes from the ear to the throat) that lie more horizontal than those of adults. This allows more stagnation of any fluid contents from sickness and congestion. Even so, adults can also be susceptible to ear infections if their eustachian tubes become blocked from inflammation, among other reasons.
So, what should a parent make of the child who was fine in the morning but is then complaining vehemently of ear pain by the time he or she is home from school? Is this urgent, and if so, what can he or she expect from a visit to our practice?
The answer to these questions, unfortunately, are not “one size fits all.” For example, an ear that is painful is not always infected or may not appear infected for quite a few hours after the pain has started. Sometimes signs (the things the provider sees) and symptoms (the things you or your child feel) don’t seem to correlate at all. But, for the most part, you should bring your child in if he or she has a persistent earache associated with fever, fussiness, poor eating or any other obvious sign of worsening illness or persistent pain.
For children under 2 years old, antibiotics are often warranted if signs and symptoms both suggest an infection of the middle ear. For infants under six months with a red, inflamed ear drum and any parent-reported symptoms (fever, irritability, poor sleeping and eating, etc.), antibiotics should definitely be used.
For children over 2 years of age, however, it is often wise to watch the child and treat with supportive care like Tylenol or Motrin to see if the infection can clear on its own. This approach is deemed “watchful waiting” and is a good way to decrease the overuse of antibiotics. These infections are rarely dangerous in otherwise healthy people and may not need to be treated. Another important point to note is that opting out of antibiotics on the first visit to your doctor and then adding them on a subsequent trip in 24 to 48 hours has not been shown to cause poorer outcomes.
In short, you and your practitioner can jointly agree on a treatment plan that should definitely include pain relief, but may or may not include antibiotics on the first visit for what you believe to be an ear infection.