Wednesday’s Ask Dr. Walt — Recurrent Ear Infections

Dear Dr. Walt,

My son gets recurrent middle ear infections (acute otitis media). Since ear infections are so common in toddlers and kids, what would you recommend for prevention and treatment? Would you recommend a natural, non-antibiotic treatment or would you go straight the doctor for antibiotics?

—Recurrent Otitis in Ohio

Dear Sore Ears,

If the child’s eardrum is intact, then the infections of the middle ear almost always ascend from the throat through the eustachian tubes.

More than eighty percent of children experience at least one episode before the age of 2 years. Environmental risk factors include childcare attendance, exposure to older siblings, exposure to tobacco smoke, absence of breastfeeding, bottle-feeding in a supine position, pacifier use, and failure to vaccinate the child for the influenza virus or the Haemophilus lnfluenzae Type B (Hib) or pneumococcal bacteria.

Therefore, to prevent recurrent ear infections in children, it is recommended:

  1. an annual influenza vaccination, as well as all recommended pneumococcal and Hib vaccines,
  2. avoidance of exposure to environmental smoke and group daycare (when feasible), and
  3. stopping pacifier use.
  4. There is also some evidence for the use xylitol syrup or xylitol-containing chewing gum that you could discuss with the child’s doctor.

It’s hard to prevent ear infections since many children, especially those who attend daycare, are susceptible to colds.

Careful hand-washing regimens can help reduce the chance of catching colds, so it’s important to remind your kids to wash up as often as possible.

What about treating a child suspected of an acute ear infection?

The most important treatment is immediate pain control, which can often be accomplished with simple analgesics (ibuprofen or acetaminophen) and warm compresses to the ear or warm oil drops into the ear.

There is no proof that antihistamines or decongestants help. However, the use of immediate antibiotics has fallen by the wayside, as most of these infections are actually caused by viruses and the overuse of antibiotics has led to increase in antibiotic resistance. Furthermore, antibiotics only shorten recovery by one day on average and ten to twenty kids must take an antibiotic to benefit only one of the children.

Because of this, most doctors caring for children now utilize what is called “delayed antibiotic therapy” for healthy kids six months or older.

Several studies have reported on the success of this type of treatment, which is also called “safety net antibiotic prescription (SNAP)” or “a wait-and-see prescription (WASP),” where an antibiotic prescription is written, but the family is instructed to fill it only if the child has not improved within two to three days.

These studies have demonstrated that only two-thirds of prescriptions are subsequently filled, and that patients in the immediate treatment group fare no differently than those in the delayed treatment group.

One caveat: children from six months to two years of age and with bilateral disease may respond less well with this approach.

Dr. Walt

© Copyright WLL, INC. 2018. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.
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