Ear Infections in Children
Mar 18, 2015
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
I'm going to pretend to be a relationship expert today. You are romantically interested in someone. You are planning out the first date. Where should you go? A movie? Dinner at a restaurant? See a band at the WAC? Those are all terrible ideas. If your new romance is going to fail, and it probably is, you want it to fail fast. Just like an internet start up company, you want to fail early and move on, so you don't waster a lot of time on a lost cause. Here are the only three sane options for your first three dates. Date one: map reading. Pick somewhere you and your date have never been before. Pick 2 random spots on the map. One of you drive and the other navigate to the first point and then switch for the second point. No GPS's or phones allowed. If there are any tears or yelling, relationship over. Date two: Hanging Wall Paper. Find a wall. Buy supplies. Agree on wall paper color. Get wall covered perfectly in 1 hour. Get your potential future mother-in-law to critique you work. If you passed this test you are ready for date three. If you didn't, but you are still interested in the other person, work on a self upgrade. Maybe a better job. Doctor is a good choice.
Fast forward to becoming a family doctor. Congratulations on making it through 7 plus years of education and a bunch of on the job experience in about 15 seconds. Your patient today is Eric. He is 4 years old. Eric complains to that his ear hurts. You examine Eric and determine that he has acute otitis media or a middle ear infection. What should you do? Should Eric get an antibiotic? Recent guidelines from the Canadian Pediatric Society say maybe not.
Acute otitis media or a middle ear infection is very common in children. It is estimated that 75% of children will have an ear infection by the time they are one year old. Why do so many children get ear infections? Daycare and anatomy are major risk factors. Young children have a shorter and more horizontal eustachian tubes as compared to adults. The eustachian tubes, among other things, helps fluid from behind the ear drum drain out. If these eustachian tubes become blocked or squeezed shut by inflammation, fluid behind the ear drum can become trapped. Daycares expose children to lots of virus and bacteria. Infections from viruses and bacteria can cause the eustachian tubes to become inflamed and blocked. There is even the suggestion that yournger children may have less of a certain antibody called secretory immunoglobulin A. Since this antibody makes it harder for bacteria to stick in the nose and throat, if children have less of it, they may have more bacteria hanging around ready to cause ear infections.
As you talk to Erics mom, you find out he had an upper respiratory tract infection for a few days before his ears started to hurt. You figure that the virus from this infection inflamed his eustachian tubes and caused his adenoids to swell. Erics eustachian tubes got blocked and fluid got trapped behind his ear drum. The blocked tube also created a bit of a vacuum and pulled bacteria from Erics nose and throat back into his middle ear space. The bacteria grew in the trapped fluid and voila, Eric got an ear infection!
An interesting thing about middle ear infections is we dont know exactly what is going on behind the ear drum. The only way to find out what is causing an ear infection is to push a big needle through Erics ear drum, draw out some fluid and test it. I dont think hed like that much. However some brave, unfortunate children have had their ear drums poked for science, so we know that most ear infections have bacteria in the fluid behind the ear drum. As a doctor, you know that antibiotics can kill bacteria. So every ear infection should get an antibiotic, right? That brings us back to the Canadian Pediatric Society.
What are the experts at the Canadian Pediatric Society recommending you do with Eric? Nothing. If the child is older than 6 months, doesnt have other under-lying complicating diseases, and doesnt have a fever over 39 C or severe ear pain, then parents should just watch the child. The reason is that about two thirds of children will have their ear infection symptoms just go away in 48 to 72 hours without antibiotics. If the child doesnt get better in 48 to 72 hours, then the parents should take them back to the doctor to get an antibiotic.
You want to be a good family doctor and follow the guidelines. You should tell Erics mom that although she has taken time off work to see you, and she has a cranky four year old with a sore ear, she should just go home with no antibiotic prescription. Do you think she will be very happy? Probably not. So you make a deal with her. First you explain to her that only about 1 in 15 kids with ear infections need an antibiotic to get better. Then you tell Erics mom that antibiotics arent without risk. About 20% of kids on antibiotics get diarrhea. A smaller number of children on antibiotics can get things like rashes, trouble breathing or antibiotic resistance. Erics mom calms down. Eric has gotten a rash before on an antibiotic, so she understands the risk.
You tell Erics mom to go to the pharmacy and ask the pharmacist for the appropriate doses of acetaminophen and ibuprofen for Eric based on his weight. This should make Erics ear feel better for the next 48 to 72 hours. You also give Erics mom a prescription for an antibiotic, but you tell her not to fill it. She will leave the prescription at the pharmacy. That way if he doesnt get better in 48 to 72 hours, Erics mom can get him a prescription without having to get back into see you. Good job, doc!
You probably failed the first two dates and should have moved onto the next romantic partner, but instead you upgraded yourself to a doctor. You are now ready for date three: shoe shopping. If your partner loves shoes, you must be prepared to spend all day faking interest and enthusiasm. If you partner hates shoes, you must convince them to buy shoes more often than once a decade and that it is not a waste of time and money to shop somewhere other than Walmart for a formal occasion. You will find you fail the map, wall paper and shoe tests with most potential partners. However, when you find that one that passes all three tests grab hold and don't let go. This relationship thing is so easy!
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
Otitis media guidelines: http://www.cps.ca/documents/position/acute-otitis-media