Oman Health: Ear infection in children

Most children have at least two bouts of ear infection before they are 5 years old. These are caused by common viral infections which circulate in the general population and against which a child is not immune. Anyone can get an ear infection, but children get them more often than adults. Five out of six children will have at least one ear infection by their third birthday. There are three main types of ear infections. Each has a different combination of symptoms. 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. An ear infection usually is caused by bacteria and often begins after a child has a sore throat, cold, or other upper respiratory infection. If the upper respiratory infection is bacterial, these same bacteria may spread to the middle ear; if the upper respiratory infection is caused by a virus, such as a cold, bacteria may be drawn to the microbe-friendly environment and move into the middle ear as a secondary infection. Because of the infection, fluid builds up behind the eardrum. Most ear infections happen to children before they’ve learned how to talk. If your child isn’t old enough to say “My ear hurts,” here are a few things to look for: •Tugging or pulling at the ear(s) •Fussiness and crying •Trouble sleeping •Fever (especially in infants and younger children) •Fluid draining from the ear •Clumsiness or problems with balance •Trouble hearing or responding to quiet sounds Read: Ministry announces two Crimean-Congo hemorrhagic fever deaths Earache Earache is a common symptom of ear infection. However, not all earaches are caused by an ear infection. If a child has earache but is otherwise well, an ear infection is unlikely. Mild earache is often due to a build-up of mucus in the middle ear after a cold. This usually clears within a few days. Pain that you feel in the ear can be referred pain from other causes such as tooth problems or the jaw joint. How to treat an acute middle ear infection? Normally the child will start crying or tugging at his ear. Never panic in such situation, many parents put oil or any liquid that they get in the house to decrease the pain. Give your child some paracetamol or ibuprofen, calm the child down and don’t use any ear drops without recommendation of a doctor. Ear drops when used without recommendation can at times cause severe repercussions. Antibiotics Antibiotics are not advised in most cases. This is because the infection usually clears within 2-3 days on its own and antibiotics make little or no difference to the speed of this. There are many good reasons not to take antibiotics. If your doctor isn’t able to make a definite diagnosis of OME and your child doesn’t have severe ear pain or a fever, your doctor might ask you to wait a day or two to see if the earache goes away. As per the paediatrics guidelines, doctors are advised to observe and closely follow these children with ear infections that can’t be definitively diagnosed, especially those between the ages of 6 months to 2 years. If there’s no improvement within 48 to 72 hours from when symptoms began, the guidelines recommend doctors start antibiotic therapy. Sometimes ear pain isn’t caused by infection, and some ear infections may get better without antibiotics. Using antibiotics cautiously and with good reason helps prevent the development of bacteria that become resistant to antibiotics. Possible complications It is common for some fluid (mucus) to remain behind the eardrum after the infection clears. This may cause dulled hearing for a while. This usually clears within a week or so and hearing then returns to normal. Sometimes the mucus does not clear properly and ‘glue ear’ may develop. Hearing may then remain dulled. Repeated ear infections (for example, due to having several colds in a row) can lead to glue ear. See a doctor if dulled hearing persists after an ear infection has gone, or if you suspect your child is having difficulty in hearing. If the eardrum bursts (perforates) then it usually heals over within a few weeks once the infection clears. In some cases the perforation remains long-term and may need treatment to fix it. If a child is normally healthy then the risk of other serious complications developing from an ear infection is very small. Rarely, a serious infection of the bone behind the ear develops from an ear infection. This is called mastoiditis. Very rarely, the infection spreads deeper into the inner ear, brain or other nearby tissues. This can cause various symptoms that can affect the brain and nearby nerves, including abscess and meningitis. You should always consult a doctor if a child with earache: •Becomes more ill. •Has an illness which seems severe to you. •Does not improve over 2-3 days. •Has a temperature above 39°C. A fever like this is not generally considered a danger to your child. Children develop high temperatures in many common illnesses, including ear infections, urinary tract infections, roseola (a common childhood virus), and flu. However, when the temperature is above 39°C your child is more likely to have an illness or infection that needs your doctor’s help. (If your child is under 3 months old then you should see a doctor if their temperature is above 38°C). •Develops any symptoms that you are not sure about. Precaution and prevention Most children have at least two bouts of ear infection before they are 5 years old. These are caused by common viral infections which circulate in the general population and against which your child is not immune. There is generally nothing you can do to prevent the infection from occurring. Currently, the best way to prevent ear infections is to reduce the risk factors associated with them. Here are some things you might want to do to lower your child’s risk for ear infections. •Vaccinate your child against the flu. Make sure your child gets the influenza, or flu vaccine every year. •Wash hands frequently. Washing hands prevents the spread of germs and can help keep your child from catching a cold or the flu. •Avoid exposing your baby to cigarette smoke. Studies have shown that babies who are around smokers have more ear infections. •Never put your baby down for a nap, or for the night, with a bottle. •Don’t allow sick children to spend time together. As much as possible, limit your child’s exposure to other children when your child or your child’s playmates are sick. How long will it take for a child to get better? Your child should start feeling better within a few days after visiting the doctor. If its been several days and your child still seems sick, call your doctor. Your child might need a different antibiotic. Once the infection clears, fluid may still remain in the middle ear but usually disappears within three to six weeks. What happens if the child keeps getting ear infections? Some children may continue to have middle ear infections, sometimes as many as five or six a year. Your doctor may want to wait for several months to see if things get better on their own but, if the infections keep coming back and antibiotics aren’t helping, many doctors will recommend a surgical procedure that places a small ventilation tube in the eardrum to improve air flow and prevent fluid backup in the middle ear. The most commonly used tubes stay in place for six to nine months and require follow-up visits until they fall out. If placement of the tubes still doesn’t prevent infections, a doctor may consider removing the adenoids to prevent infection from spreading to the Eustachian tubes. —Dr Benaifer Bilimoria is ENT at Atlas Hospital, Al Ghubra, Oman