How to handle ear infections

Andrew started nursery school at 18 months and immediately began bringing home his fair share of bugs, but there was one in particular that just wouldn’t go away. “I assumed he had a cold like all the other kids,” says his mother, Alison Dunn, “until a rash appeared on his cheeks and he got really cranky.” A trip to the doctor revealed Andrew had his first ear infection. “I felt awful,” Dunn says. “I had no idea — and he’d been sick for awhile.”

Liane Johnson, a paediatric otolaryngologist and associate professor at Dalhousie University in Halifax, is quick to reassure parents who don’t catch on right away. “Ear infections are hard to diagnose, even for doctors,” she says. Because young children’s ears are so small, it’s difficult to get a good view, even when a doc is peering in with an otoscope (which looks like a tiny flashlight). Excessive crying can make them look red, too. Johnson’s own son had diarrhea for 10 days before she realized the problem was in his ears. “My son’s symptoms were fussiness and diarrhea, contrary to what I learned in my clinical training.”

If you’re like most parents, though, you’ll soon learn to recognize your child’s basic signs. “In infants and small children, irritability and inconsolable fussiness are common, as well as fever and trouble sleeping,” says naturopath Allison Patton, in South Surrey, BC. “Older children might complain of ear pain, and their symptoms may also include vomiting, diarrhea and hearing loss in the affected ear.” The symptoms can be very individual, Johnson adds. “For instance, ear pulling can sometimes be a symptom, but in younger kids, it can also be a sign that they’ve just discovered their ears.”

According to Statistics Canada, 50 percent of children have an ear infection by age three, and chronic infections affect 13 percent of children. A lot of it has to do with anatomy, Patton says. “Young children’s Eustachian tubes, which connect the middle ear to the throat, are more horizontal than adults’, preventing fluid from draining properly, and increasing the risk of infection.” Genetics also play a role — so if you were susceptible, chances are your kids will be, too.

Ear infections usually come in two waves. The first is from about age one to two when children start daycare or catch colds from older siblings,and the second is from about age five to seven, when kids are exposed to more illnesses at school. Regardless of age, infections are usually triggered by colds or allergies. (You should also stay away from poking around in little ears with cotton swabs — earwax is healthy, and attempting to remove it yourself can cause damage.) The tiny tubes behind the eardrums get swollen from infection, and fluid can’t drain. “The fluid builds up until it’s like a wallpaper paste,” says Johnson.

And, as parents soon discover, that first ear infection can quickly be followed by a second, then a third. “Because children get colds so frequently, the fluid doesn’t have time to drain,” says Johnson. “It can take up to 90 days to clear up completely.”

After his first ear infection, it wasn’t long before Andrew was getting one a month. “It got to the point where I could tell just by looking at him that he had an infection,” Dunn says. (In Andrew’s case, symptoms included red cheeks, watery eyes, irritability and ear pulling.) In Canada, the latest recommendation for children under age two is to treat ear infections with antibiotics. For older children, doctors follow the “wait and see” approach by treating symptoms, such as pain and fever, for 48 hours before resorting to antibiotics if things aren’t improving. (Despite worries about drug resis- tance, two recent studies in the New England Journal of Medicine found children two years and younger recovered more quickly when treated with antibiotics right away.)

“Basically, I tell families there’s nothing wrong with just treating the symptoms,” Johnson says. Warm compresses may provide some comfort, in addition to acetaminophen or ibuprofen. The benefit of antibiotics is that they kill the bacteria causing the infection, and kids feel better within 24 to 48 hours. But if the pharmacist knows your name, that’s not a good sign. “If the pattern of ear infections repeats itself until your child is, say, only going a few days between each course of antibiotics,” says Johnson, “it may be time to consider tubes.”

Having tubes put in is a surgical procedure that requires a general anaesthetic and takes about 10 minutes. The tubes look like little plastic beads and are placed inside the eardrum to relieve pressure and help ventilate the ear . “Best of all,” says Johnson, “up to 90 percent of kids won’t get another ear infection.” Another reason to go the tube route is if chronic ear infections are making your child hard of hearing, which can happen when fluid buildup prevents sound from vibrating the eardrum. “If ear infections occur repeatedly and affect a child’s hearing, it can cause long-term problems such as slowed speech and delayed learning development,” says Patton.

Dunn decided to have tubes put in Andrew’s ears when she discovered his recurring infections had led to an 80-percent loss in his hearing. “By age two he was barely speaking, and then we found out that he couldn’t hear,” Dunn says. “But after the tubes were put in, he passed a hearing test with no problem.” The tubes usually stay in place for about a year and a half. Johnson says most parents’ main concern is whether or not their child can go swimming. Although Andrew wore custom earplugs in both the bath and the pool, Johnson has a photo in her office of her daughter with her head covered in soap bubbles, despite the tubes in her ears. “I don’t want kids to end up being afraid of the water, so I tell families to just live life the way they normally would,” she says. And if a child does get an ear infection, 48 hours of antibiotic drops are all it takes to clear it up.

After two years, Andrew’s tubes were removed, and he hasn’t had an ear infection since. The tubes made a huge difference for the whole family, Dunn says. “It was hard on all of us every time Andrew had an infection — no one slept and everyone was tired and miserable.” Fortunately, most children outgrow ear infections between ages six and eight, Johnson says. “I even have graduation stickers for kids when they get to that stage and I always tell them that some day I’ll just be a distant memory in their past.”

A version of this article appeared in our August 2012 issue under the headline: "Now ear this," p. 34.