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Ask Dr. Sears: Persistant Ear Infections

Q. My 10-month-old son has just been diagnosed with his second major ear infection within only a few months. The first time, it went away after three different types of antibiotics. For this current infection, he has taken three antibiotics, plus had two antibiotic shots. We were told to make an appointment with an ear, nose and throat specialist to discuss putting tubes in his ears, but I've heard they don't really help. Is this true? And are there other alternatives we can try to prevent him from going through this again?

A. There are three conditions—anatomical and immunological—that increase infants' susceptibility to ear infections. The first concerns the position of the Eustachian tube, the tiny tube that connects the middle ear to the back of the throat and equalizes the pressure between the two. In infants, this tube is positioned horizontally, which allows germs from the nose and throat to travel more easily into the middle ear. As a child grows, the angle becomes more vertical, making the passage of germs into the middle ear more difficult. The second problem is the infant immune systems, which is not yet fully developed; babies are therefore more prone to respiratory infections of all kinds. The third condition exists among baby's with allergies. Allergies can clog the nasal passages and Eustachian tubes, and this prevents middle-ear fluid from draining. The fluid becomes like water in a stagnant pond—a culture-medium for bacteria.

No matter how vigorously you treat ear infections, fluid can still build up in the middle ear because of the Eustachian dysfunction. If the fluid stays there for several months, two harmful things happen. First, the middle-ear fluid pressing on the eardrum prevents it from vibrating normally, which keeps your infant from hearing properly. Diminished hearing during this important stage of speech development can result in speech and hearing problems later on. Second, the fluid grows increasingly thick and more gluelike with each passing day, and thus more resistant to drainage.

Placing tubes in the ears does help. Here's a breakdown of this simple, outpatient procedure: Under a light anesthesia, the ENT specialist pokes a tiny hole in the eardrum and drains the fluid. Then, in order to equalize the pressure and allow for continued drainage, he inserts a plastic tube about the size of a pencil lead. This tube is left in the ear for about six to nine months, and then falls out on its own. After it falls out, the eardrum heals naturally. Tubes are an established way to decrease the frequency of ear infections and the need for antibiotics. They also preserve a child's hearing while the Eustachian tubes grow to a more vertical position. Since tubes do leave some scar tissue on the eardrum, however, the operation is performed only when less invasive treatments have failed.

Here are some preventive measures you can try before resorting to the tube procedure:

Build your infant's immunity.

The three best foods for strengthening a child's immune system are fruits, vegetables, and seafood. Fruits and vegetables contain immune boosters called phytonutrients, and seafood contains immune-boosting omega 3 fats. (Wild salmon is the richest source of these omega 3's and the safest seafood for children.)

Reduce allergies.

Environmental allergens cause stuffy noses and, in turn, stuffy Eustachian tubes. Start in the bedroom and dustproof your baby's sleeping environment as thoroughly as possible. Avoid smoking around your baby at all costs—don't ever take him into a room or restaurant where there are smokers. Studies show that infants exposed to smokers have three times the number of doctor visits for respiratory infections—and that includes ear infections. Also consider food and formula allergies. If you are bottle-feeding your baby and he's reacting, the likely culprit is a cow-milk-based formula. Discuss with your child's health care provider the possibility of switching to a hypo-allergenic formula. Also, be sure to feed your baby upright (at least 30 degrees). Bottle-feeding your baby while he's lying down can cause milk to enter the Eustachian tube and trigger inflammation. If you're still nursing, continue as long as possible: Breast milk has immune-boosting properties that can lessen the frequency and severity of ear infections.

Offer a "nose hose" and a "steam clean."

These are my standard home remedies for all upper respiratory infections. Since germs and mucus from the nose enter the Eustachian tube, a cleaner nose is more likely to yield healthier ears. Spritz a spray saltwater nasal solution (you can buy this over the counter or make it yourself by mixing ¼ teaspoon of salt in a cup of water) into your baby's nasal passages. Then use a nasal aspirator (also available at pharmacies) to gently suck out the loosened secretions. Before putting baby to bed, give him a nose and sinus "steam clean": Turn the shower on, close the door and sit with him in the steamy bathroom for ten minutes.

Lessen exposure to germs.

If your infant is in a crowded daycare setting, try to move him to an environment with fewer babies in a larger space.

I suggest you try the above preventive measures for a few months before deciding on having tubes put in your baby's ears. If the ear infections persist, tubes may well be the wisest treatment option.

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