Ear Infections (Otitis Media)

Except for the common cold, ear infections are the most common childhood illness. Nine out of ten children have an ear infection sooner or later; half will have six or more infections before age four years.They are relatively rare in some children yet extremely frequent in others. We do not really understand the reason for this difference, but it is likely that most children who have frequent ear infections have inherited this tendency.
The middle ear is the space behind the eardrum that contains the tiny bones that transmit sound waves from the eardrum to the hearing nerves. The Eustachian tube connects the middle ear to the throat.The purpose of this tube is to allow air to pass from the throat into the middle ear. This allows the air pressure in the middle ear to remain the same as the pressure outside the body. That's why you feel your ear "pop" when you descend from a higher altitude to a lower altitude.

Ear infections seldom occur by themselves, but usually occur as part of a common cold. The virus that infects the nose and throat during a cold causes swelling, congestion, and mucous production. These factors can cause a blockage of the Eustachian tube. This allows the build up of mucous in the middle ear space. This fluid is a perfect environment for bacteria, and as the bacteria grow, the fluid turns to pus, resulting in an ear infection.

As the amount of fluid and pus in the middle ear builds up, the eardrum cannot vibrate normally. Hearing then decreases, and, as the eardrum stretches with further accumulation of fluid, pain results.

Children tend to get fewer ear infections as they get older. There are probably two reasons for this. Most children get fewer colds as they get older because they build up immunity to more viruses as time goes by. Also, the Eustachian tube gets bigger and seems to work better with growth.

Treatment for Ear Infections

Since the discovery of Penicillin in the 1940's, antibiotics have been the main treatment of ear infections. Before 1940, children with ear infections could only be treated with various methods of pain relief. Children with ear infections almost always recovered on their own without medicine. However, there were rare cases where the infection spread, causing mastoiditis, meningitis, or other infections, and an occasional child that developed a chronic ear infection that permanently affected hearing. Since the introduction of antibiotics, these problems are almost nonexistent. Most parents (and even many doctors) find it hard to believe that ear infections go away just as fast without antibiotics as with antibiotics. Yet this has been proven in many research studies where half of the children with ear infections were treated with an antibiotic and half were given a placebo (i.e., sugar pill). So the main reason for using an antibiotic for an ear infection is to prevent complications.

Experiments have also shown that none of the many antibiotics now available cure ear infections any better than any others. They are all about the same. That is why most pediatricians choose an antibiotic based on

safety and cost instead of using the newest, most advertised drug. Occasionally, some bacteria might be resistant to the first antibiotic prescribed. However, since each ear infection is from new bacteria, there is no way to predict when this might happen. In other words, just because an antibiotic failed to work with a past infection does not mean that it won't work with a later infection.

Acetaminophen (e.g., Tylenol) will usually relieve the pain of an earache. In more severe cases, the physician may prescribe eardrops to numb the pain or oral codeine to use for a day or two.