Q. Our 15-month-old is just getting over her fourth ear infection. Each time, I give her the prescribed antibiotic and she gets better for a while, only to develop another within a few months. And now the doctor says that my daughter has fluid behind her eardrum that may affect her hearing. What's the difference between this and her past infections? I loathe the idea of giving her antibiotics so often.
A. Parents and babies aren't the only ones who deal with frequent ear infections. A pediatrician uses an otoscope -- the special instrument used to examine the ear -- almost as often as her trademark stethoscope. That's because inflammation of the middle ear, known as otitis media (OM), is the most common illness diagnosed in childhood next to the common cold: By 12 months of age, nearly three-quarters of all children have had at least one infection, and almost half endure three or more by the time they're 3 years old.
Despite its prevalence, OM is tough to diagnose and manage correctly. It is a general term that refers to both acute otitis media (AOM), infected fluid behind the eardrum in the space known as the middle ear, which is associated with fever, ear pain, and irritability; and otitis media with effusion (OME), an accumulation of fluid behind the eardrum that usually produces no symptoms of illness. Doctors often confuse the two: One study found that pediatricians misdiagnosed OME as AOM about 50 percent of the time. And since they are treated differently, it's important that your doctor get this one right.
Acute Otitis Media
AOM often begins with a cold that causes inflammation and swelling of the eustachian tube (a narrow passage between the middle ear and the throat), allowing fluid to accumulate behind the eardrum in the middle-ear space. This trapped fluid can serve as a breeding ground for bacteria that cause an infection with painful inflammation and bulging of the eardrum. Pain can be worse when the baby is sucking, swallowing, and lying down, due to pressure changes in the middle ear.
Symptoms often include a runny nose and congestion as well as fever, which can range from 100°F to 104°F. Ear pain can cause a preverbal child to tug at her ear, be irritable, have a hard time sleeping, and feel uncomfortable during feedings. If the infection is severe and goes untreated, you may see blood-tinged fluid and pus in the ear canal, indicating a ruptured eardrum. This will usually heal withoutcomplications, but you should report any such symptoms to your pediatrician.
AOM in young children is treated with an antibiotic (usually a ten-day course of amoxicillin, given in higher doses than in the past). Ear pain and fever should be gone within three days, and children are usually symptom-free by seven days. Nevertheless, it's extremely important to complete the full course of medication to eradicate all the infecting bacteria and prevent a recurrence.
Occasionally, an ear infection does not respond to the first antibiotic, and if symptoms have not improved within 72 hours, the pediatrician will likely prescribe an alternative antibiotic that will be effective against the resistant strains of bacteria. Your baby's doctor may also recommend using an over-the-counter, nonaspirin pain medication (such as acetaminophen or, if your baby is over 6 months, ibuprofen) to relieve your child's earache and reduce her fever. It's important not to give your child aspirin, however, because it has been linked to Reye's syndrome, a serious illness in children affecting the brain and liver.
Marianne Neifert, M.D., is a pediatrician, the mother of five adult children, and the author, most recently, of Dr. Mom's Prescription for Preschoolers.
