Gulf Coast Family

by Carl S. Ingber, MD, FAAP, After Hours Pediatrics Urgent Care

An ear infection is one of the most common diagnoses made in ill children between 6 and 24 months. By age three, 80-90% of all children have had at least one ear infection. Pediatricians diagnose this condition when an ill child, usually with fever, fussiness or pulling the ear, has a red, swollen eardrum with fluid behind the eardrum. Treating an ear infection is important to reduce the risk of complications, such as hearing loss, rupture of the eardrum and spread of the infection.

A few days after the start of a common cold, or when a child has nasal congestion due to allergies, a child with an ear infection may develop fever and fussiness, wake up more frequently at night and have a decreased appetite. Hearing loss and imbalance as well as vomiting and/or diarrhea are sometimes present. Accurate diagnosis is not always straightforward, since many ear canals are quite narrow or have wax that prevents a clear view of the eardrum.

Although controversy exists regarding the need to treat every child with an ear infection, there is agreement on the use of antibiotics in children under 2 years of age, especially if there are significant signs and symptoms of disease, such as high fever and marked ear pain. In older children who are mildly ill and whose pediatricians can offer close follow-up, antibiotics may not be prescribed initially. When antibiotics are used, the first choice is amoxicillin; however, alternatives may be required for difficult-to-treat infections, or for children who are allergic to penicillin.

Pain control may be achieved with Tylenol or Advil/Motrin. Occasionally, numbing drops may give prompt temporary relief. These drops should be used for only 2–3 days once treatment has started, and only 1–2 days before seeking medical attention for a child with a suspected ear infection. Follow-up care is necessary if improvement does not occur in 3–4 days, at which time a different antibiotic may be prescribed. Also, follow-up in 2–3 months has been suggested to make sure the fluid in the middle ear has resolved. Persistence of this fluid may lead to speech delay.

Sinus infections are another form of upper respiratory infection, but these may be difficult to diagnose. A child with a prolonged cold of more than 7–10 days who then develops a fever or has green or yellow nasal discharge may have a sinus infection. Since the sinuses can’t be seen without x-rays, the diagnosis is made based on the history. By contrast, ear infections are diagnosed based on history and physical examination. Antibiotic treatment is similar, but it may need to be continued for a longer period of up to 3 weeks, since antibiotics do not easily reach the sinuses.