Ear Infections: What Every Parent Needs to Know
Ear infection (otitis media) is one of the most common illnesses of childhood and the primary cause for antibiotic use in children, costing the U.S. roughly $5 billion each year. While all children are susceptible, children with a cold, the flu, or other upper respiratory symptoms are particularly vulnerable due to the swelling of the Eustachian tubes and the production of mucus. Immature Eustachian tubes in infants and young children make them prone as well.
Three Types of Ear Infections
• Acute otitis media (AOM) is the most common ear infection. Parts of the middle ear are infected and swollen, and fluid is trapped behind the eardrum. This causes pain in the ear—commonly called an earache. Your child might also have a fever.
• Otitis media with effusion (OME) sometimes happens after an ear infection has run its course and fluid stays trapped behind the eardrum. A child with OME may have no symptoms, but a doctor will be able to see the fluid behind the eardrum with a special instrument.
• Chronic otitis media with effusion (COME) happens when fluid remains in the middle ear for a long time or returns over and over again, even though there is no infection. COME makes it harder for children to fight new infections and also can affect their hearing.
How Can I Prevent An Ear Infection?
Regular cold/flu prevention can help to prevent the infections that typically result in a secondary ear infection. Aiding the drainage process is also important to prevent fluid collection in the first place.
Prevention methods include:
• Feed baby upright (never sleep with a bottle) and focus on keeping baby semi-upright when possible during a cold or the flu.
• Chiropractic care. While high quality studies are lacking, there are many reports that chiropractic care can help improve drainage and reduce the risk of infection.
• Osteopathic manipulation. Osteopathic manipulation techniques have been found to help encourage drainage, reducing the risk of recurring infections.
Do Ear Infections Require Antibiotics?
Within the United States, five in every six children will experience an ear infection by the age of 2 years old, making ear infections the most common cause of sick-child physician visits and the most common rationale for antibiotic administration. According to the Healthy People 2020 objectives, 77.8% of pediatric visits for an ear infection resulted in a prescription for antibiotics. These are often broad spectrum antibiotics or third generation antibiotics.
In spite of this frequent prescription rate, studies show that antibiotics don’t have a benefit in most ear infections. The vast majority of ear infections resolve on their own without antibiotic treatment. This takes a couple of days in many cases, and can coincide with antibiotic treatments, leading many parents to believe the antibiotic is actually curing the infection, furthering the belief that they won’t go away on their own.
Antibiotics don’t relieve pain or distress. They will not make children feel better sooner. Pain relief treatments are responsible for that. Reducing the inflammation and the accumulation of fluid will make children feel better; an antibiotic does neither of those things.
The AAP has clearly recommended since 2004 that practitioners use the “wait and see” approach for most children. Given that 61% of children naturally have decreased symptoms within 24 hours, with or without antibiotics, the official recommendation is that antibiotic use be delayed for the first 48-72 hours in most children. This will dramatically reduce the use of needless antibiotics, reserving them for the small percentage of children that would receive the most benefit.
What Can I Do To Make My Child Comfortable?
GARLIC OIL
While antibiotics show little benefit in the literature, herbal oil* does test well for improvement of the infection. A study published in Pediatrics outlines a double blind trail using a garlic, mullein, calendula, St. John’s Wort, and lavender infused olive oil compared to amoxicillin. The result shows an equal rate of improvement after 3 days, and better improvement with the herbal drop compared to the antibiotics. It concluded that these herbal drops were less expensive, well absorbed and well tolerated.
BASIL ESSENTIAL OIL
A 2005 study looked at the potential for sweet basil (linalool ct) to reduce overall healing time for ear infections.* This study found that a sweet basil oil led to significant improvement after just 1 day for most subjects, with full recovery for most subjects after 3 days for infections.
COMFORT MEASURES
Since an ear infection will pass on its own, treatments may also include comfort measures to reduce the effects of pain. These include warm compresses and pain relievers, which can be offset by the use of milk thistle.
*Note: Natural ear oils should not be applied to eardrums which have ruptured. If in doubt, confirm the diagnosis to ensure that the diagnosis is an actual infection and not simply redness or swelling.
REFERENCES
Gates GA. Cost-effectiveness considerations in otitis media treatment. Otolaryngol Head Neck Sur. April 1996. 114 (4): 525-530
Healthy People 2020. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion.
Kristinsson, K., Magnusdottir, A., Petersen, H., & Hermansson, A., (2005). Effective treatment of experimental acute otitis media by application of volatile fluids into ear canal. The Journal of Infectious Disease. 191:1876-1880.
S Coker TR, Chan LS, Newberry SJ, et al. Diagnosis, Microbial Epidemiology, and Antibiotic Treatment of Acute Otitis Media in Children: A Systematic Review. JAMA. 2010;304(19):2161-2169.
Subcommittee on Management of Acute Otitis Media Diagnosis and Management of Acute Otitis Media Pediatrics Vol. 113 No. 5 May 1, 2004; 1451 -1465
Vaz LE, Kleinman KP, Raebel MA, Nordin JD, Lakoma MD, Dutta-Linn MM, Finkelstein JA. Recent trends in outpatient antibiotic use in children. Pediatrics. 2014;133(3):375-85.
NIH Pub. No. 97-4216 July 2002
Soni, A. Ear Infections (Otitis Media) in Children (0-17): Use and Expenditures, 2006. Statistical Brief #228. December 2008. Agency for Healthcare Research and Quality, Rockville, MD
Rosenfeld RM, Vertrees JE, Carr J, et al. Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials. J Pediatr.1994;124 :355– 367
Del Mar C, Glasziou P, Hayem M. Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis. BMJ.1997;314 :1526– 1529
Glasziou PP, Del Mar CB, Hayem M, Sanders SL. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev.2000;4 :CD000219
Rosenfeld RM, Kay D. Natural history of untreated otitis media. In: Rosenfeld RM, Bluestone CD, eds. Evidence-Based Otitis Media. 2nd ed. Hamilton, ON, Canada: BC Decker Inc; 2003:180–198