Ear Infections - Wait or Treat?

May 4, 2018

By Barret Procyshyn

One of the most frustrating illnesses a toddler or child can have is an ear infection. As a dad, I have been quite lucky (knock on wood) that my children have not had to suffer through too many of them. Recurrent ear infections are exponentially frustrating for parents. Quite often pharmacy staff sees exhausted parents shuffling their crying children into the walk-in clinic. Acute Otitis Media (AOM) is an infection of the middle ear cavity and is considered one of the most common infections children get. In fact, a child has a 75% chance of getting an ear infection at least once by the time they are only a year old. Even though the weather is starting to warm up, acute otitis media still sends families to the walk-in clinic.

If you are a parent whose children have had ear infection, you will agree with the fact ear infection symptoms do not go unnoticed. These very evident symptoms include acute ear pain, which is often only in one ear. The pain usually develops quickly in a matter of hours. Accompanying the pain will often be a feeling of pressure, tugging or pulling on the ear, as well as fever and reduced hearing. Children too young to communicate or explain their symptoms appropriately will show fussiness, irritability, poor feeding and most fun of all for parents: disrupted sleep cycles.

So, after the child is up all night in pain and discomfort parents usually decide to seek medical help. It can be very frustrating to wait to see a physician and then not get any antibiotics for the infection. As frustrating as this may be, there is some good reasoning for this. The spontaneous recovery rate for AOM is approximately 75-85%. This means approximately 8 in 10 children suffering from AOM will have their symptoms disappear without the use of medication. It is now quite common for a health care provider to suggest watching and waiting. This involves not starting antibiotic treatment for 48-72 hours and only providing pain medication such as acetaminophen (Tylenol). This delayed treatment is practiced in children greater than 6 months of age, who have not had recurrent infections in the past.

If treating with pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil) follow the instructions on the side of the products container, based on the child's weight and age. Make sure doses are adequate so pain is properly controlled. Treatment using decongestants and antihistamines should not be used as they are not effective and can have adverse side effects.

While watching and waiting before treatment is increasing in popularity; acute otitis media is still the most frequent reason for a child receiving antibiotics in North America. Due to high frequency of antibiotic use we are seeing high rates of resistant infections, and more treatment failures. Interestingly, children who attend daycares, spend significant amounts of time with unrelated children or who received antibiotic treatment within the past three months are more likely to develop a resistant infection. Second hand smoke toxins (even on clothing) also increase the risk of hard-to-treat infections so parents have never had more reasons to quit. Treatment with antibiotics almost always uses the recommended oral route; and research shows five days of treatment is almost as effective as 10 days. A shorter duration reduces antibiotic exposure and reduces the risk of developing resistance. Depending on the antibiotic chewable and liquid formulations are available. Some products may also be compounded, so speak to your clinic pharmacist to determine which product is best for your child. Antibiotics are often dosed higher as compared to other types of infections, which can sometimes create high volumes of liquid which must be taken.

Hot or cold compresses can sometimes be used. Use caution when using heat therapy and do not let the child sleep with a hot water bottle or pad so eliminate the risk of burns. The use of heated oils or warm water in the ear is never recommended and has significant risk.

Acute otitis media can be very stressful on the child and the parents. Your pharmacist is available to answer any questions about antibiotic or analgesic (pain) treatment. While it is hard to watch and wait on your child's health; it can sometimes be beneficial and the healthy choice as well.


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