Now ear this: Detecting and treating ear infections

Recognizing an ear infection isn't always as easy as you may think. Read on for the latest on diagnosing, treating and preventing ear infections

My daughter was 2½ the morning she woke up and reported matter-of-factly: “I have a ear fa-fection.” The paediatrician soon confirmed this diagnosis. Having already been troubled by three or four acute ear infections in her short lifetime, my little girl had become all too familiar with the symptoms.

Up to 95 percent of Canadian children suffer through at least one ear infection by age seven. Until their small skulls grow, the Eustachian tubes — one per ear forming a passageway from middle ear to back of throat — aren’t very efficient at draining, making for a convenient bacteria superhighway. An ordinary cold virus can trigger a secondary infection in the ears. So can allergens or irritants that cause congestion and clog the tubes.

Is it or isn’t it?

An acute ear infection often causes pain, fever and irritability, a surefire recipe for a thoroughly miserable child. But this triad of symptoms doesn’t show up in all cases. Some kids signal a problem by pulling at their ears — if they’re old enough to reach for them. Others might eat less. A toddler with a fluid-filled ear canal may have a tendency to teeter over.

When Shannon Holland’s son, Connor, had infections in both ears at five months of age, his only symptom was a sleep worthy of Rip Van Winkle. “I had a child who didn’t nap,” recalls the Wroxeter, Ont., mom. “And he was napping for five hours at a time.”

The general rule is that the younger the child, the less able he is to indicate where the problem is and the less specific the symptoms can be, says Glen Ward, a paediatrician in Surrey, BC. He’s seen babies with raging ear infections who had little to show for it beyond diarrhea.

A child over the age of two may be able to communicate that her ear hurts, as my daughter did. By school age, she may even tell you that she can’t hear properly. If your child is also just getting over a cold, consider it another clue.

A doctor can diagnose otitis media (ear inflammation) with an otoscope. If infected, the eardrum will appear inflamed and may bulge. And though it’s usually bacteria partying in your child’s ears, the inflammation could also be due to a virus, which is untreatable with antibiotics. “The only true way to know if it’s bacterial is to stick a needle in,” says Ward. Since that’s unlikely to be a child’s idea of big fun, treatment is usually based on age and physical symptoms rather than a lab test.

Paediatricians once reached for their prescription pads at the first sign of a red ear — just in case bacteria was the culprit. That was before worries about drug-resistant superbugs. Increasingly, doctors now take a wait-and-see approach, mostly in cases where the child is older than two years and fever is mild. Various studies support this strategy, showing no greater risk of complications.

“About 80 percent of ear infections clear spontaneously,” explains Ward. “It’s a small set that actually needs antibiotics.” You can thank your child’s mighty white blood cell soldiers, which can beat down some bacterial infections.

If you opt to wait it out on a doctor’s recommendation, be prepared to clear your calendar for a couple of days so you can keep a close eye on your kid. “It may turn into something we have to treat,” says John Manoukian, an otolaryngologist who teaches at Montreal’s Royal Victoria Hospital. Watch for changes such as a spiking fever (39ºC/102ºF) or pain that isn’t relieved with acetaminophen, which may mean the infection is getting worse.

Whether or not antibiotics are prescribed, the main focus of home treatment is to control the pain, so stock up on acetaminophen or ibuprofen for the first day or two. Keep your child well hydrated, and make sure she gets plenty of rest.

What if you don’t realize your poppet is feeling poorly? You may have heard that an untreated ear infection can lead to meningitis or a brain abscess, but before you panic at the notion that your child is at risk, rest easy: These rare complications are triggered by severe infections, not those with no-show symptoms.

More likely, a string of undetected ear infections can cause hearing problems, which can impact language development and learning in the first five or six years of life. Manoukian notes that a child who’s had chronic ear infections often doesn’t realize that he can’t hear clearly. “He doesn’t know the difference between what’s normal and not normal.”

If your child turns the TV up loud, or doesn’t answer when he’s offered dessert (don’t worry, of course, if he ignores your requests to pick up his toys), it might mean he is not hearing as well as he used to. “Sometimes these kids start having changes in the way they speak, as well,” adds Ward. “Their speech is less clear and less precise.” If you suspect your child’s hearing has deteriorated, see your doctor.

An ounce of prevention

Since ear infections often evolve from common cold and flu viruses, Ward pushes all the well-known tips for staving off sickness. “Eat well, get plenty of sleep and practise good hand hygiene,” he advises.

If your child is constantly in the company of other kids — at school or daycare — he’s more likely to pick up the germs that can lead to ear infections. Keeping your child home from daycare when he’s sick will protect him and his playmates.

It also helps to keep your children away from airborne irritants such as second-hand smoke, which can cause mucus to thicken and drain less efficiently. If your child has allergies, controlling symptoms will help prevent tube blockage.

Regardless of risk factors for ear infections, some kids just seem to get loads of them. The shape of their Eustachian tubes may be more prone to blockage, or their immune systems may be immature. Sara Shears, who lives near St. John’s, says her son Jonathan was “the king of ear infections” from six to 14 months of age, until he finally had ventilating tubes put in to keep his ears clear. This surgery is often recommended for children with chronic ear infections. But that doesn’t mean it’s the right choice for every child; doctors are divided on whether ventilating tubes always make a long-term positive difference.

The vaccine Prevnar — which is now included in routine infant immunizations — may also help, protecting your child against seven subtypes of pneumococcus bacteria. In addition, it appears to offer some protection against middle ear infections as well as nastier complications like meningitis. And it lessens the chances she’ll need ear tube surgery.

If your child does suffer through more than her fair share of ear infections, be heartened to know that they’ll slack off as she grows, usually by age seven. “One of the big differences between infants and older children is that their anatomy is bigger,” says Ward. And bigger body parts mean a better drainage system.

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