When should I worry about an ear infection in my child?

Ear infection – one of the common causes of doctor’s visit, in San Diego and everywhere.  Infants or toddlers often wake at night, irritable and fussy, pulling on their ears and crying, maybe with a cold and a fever. This all too familiar scenario has all of the hallmarks of an ear infection (or, more formally, Acute Otitis Media with Effusion).

Ear infections are very common in the first several years of life. Indeed, as many as 80% of children up to age three will have one. The occasional ear infection (1 to 2 times per year) is almost the norm, especially in children who attend a large group daycare. These routine ear infections are usually treated with an oral antibiotic. In recent years the American Academy of Pediatrics and American Academy of Otolaryngology have issued guidelines that indicate that children older than two may be monitored without using an antibiotic so long as they do not have a high fever or severe symptoms. Much of the decision-making depends on an accurate diagnosis. In any case using Tylenol or ibuprofen to manage the pain and fever is always appropriate.

healthy ear
healthy ear
infected ear
ear infection

What are the risk factors for the development of recurrent ear infections?
The main risk factor is exposure to viral upper respiratory tract infection (colds) and classically occurs with exposure in a daycare environment. Although it starts with a runny nose, in some children it progresses to a bacterial infection in the ear. A strong family history of ear problems suggests a genetic predisposition to getting ear infections as well. Environmental issues such as allergy and smoke exposure also increase the risk of recurrent ear infections. Breast-feeding is felt to be protective and is recommended for newborns and infants for at least the
first six months of life.

What are the concerns when a child has recurrent ear infections?
The concerns with ear infections fall mostly into two categories. The first is the practical impact of multiple ear infections on the child and family. Although antibiotics are one of the most valuable tools in modern medicine, recurrent use can lead to allergic reactions, GI problems, battling the child to take the antibiotics, or the bacteria becoming antibiotic resistant. Recurrent infections can impact on the ear drum, although fortunately, long term damage is relatively rare. And no parent wants to see their child suffering with ear pain, make multiple trips to the doctor and pharmacy and miss time from work or school.

The second issue relates to persistent middle ear fluid (formally, Chronic Otitis Media) with associated hearing loss and speech development concerns. With every acute ear infection fluid forms in the middle ear (the area behind the ear drum). Resolution of this “middle ear effusion“ can vary and the fluid can last as long as three months and still be considered “normal.“ However, this fluid reduces the vibration of the three ear bones and results in a decrease in hearing. Normal hearing is critical to appropriate speech development. Middle ear fluid does not
get better with antibiotic treatment and repetitive courses of antibiotics are not appropriate here. The child’s hearing will return to normal once the fluid resolves.

When do I need to see the ear specialist?
Recurrent acute otitis media and persistent middle ear fluid both can create a significant health concern and impact on the quality-of-life of the child and the family. Although there are various reasons to seek out an ENT specialist, the main ones are recurrent ear infections (three or more infections in 6 months or 4 infections in a year), ear infection symptoms which do
not respond to different antibiotics and fluid in the middle ear for more than three months. Your primary care doctor will guide you as to referral.

standard otoscope
standard otoscope
Dr. Pransky using a microscope to examine an ear
Dr. Pransky using a microscope to examine an ear for infection

Dr. Seth Pransky is a Pediatric Otolaryngologist at Pediatric Specialty Partners in San Diego. Dr. Pransky was the Director of Pediatric Otolaryngology at Rady Children’s Hospital for 20 years. He is an expert in pediatric ear disease and sinus problems, complex airway and voice abnormalities and sleep apnea in children. He trained at the Washington University School of Medicine, the University of Pennsylvania, and National Children’s Hospital in DC.  His new private practice office is in the La Jolla Medical and Surgical Center, at 8929 University Center Lane, Suite 208.
Families can call for an appointment at (858) 625-0809 or through the Pediatric Specialty Partners website, pediatricspecialtypartners.com.