New Thinking Surrounding Ear Infections


Parents and guardians who believe their child has an ear infection often take them to doctors to get them treated. That has almost been a ritualistic practice however, there is new thinking surrounding ear infections.

"Until eight or nine years ago, we'd treat each ear infection at diagnosis," said Dr. David Tunkel, director of pediatric otolaryngology at Johns Hopkins School of Medicine and chairman of the pediatrics committee for the American Academy of Otolaryngology. "The thought was, you would reduce the symptoms quicker," Tunkel said. "Then it became clear that many children who weren't treated with antibiotics actually did well without the initial treatment."

According to the U.S. National Institutes of Health, ear infections are the most common illness among infants and young children. They estimate three of every four kids will have an ear infection before age 4. These painful infections occur in the middle ear and are called otitis media.

Ear infections many times can heal without a lot of attention however pediatric otolaryngologist, Dr. Richard Rosenfeld, stressed that "observation is different than no treatment." Rosenfeld is chairman of otolaryngology at Long Island College Hospital and the State University of New York Downstate Medical Center.

Many physicians are now recommending observation before medication and some doctors are now sending parents home with a "safety net" prescription, one to have on hand in case the situation worsens. Parents are encouraged to ask their doctor for specifics on the timeline for observation, which most doctors say last one to three days. Parents should also watch for pain.


Tunkle stated that observation isn't advised for all kids, even if they're healthy and 2 years or older and if a child with a fever of 102 or more would typically be treated."We don't want to withhold antibiotics from kids," he said.

These guidelines are aimed to address concerns about resistance to antibiotics that can develop from overuse. In fact, a study reported in the British journal BMJ in July found that ear infections come back more often in kids who've been treated with antibiotics. In the three years after being treated for an ear infection, 63 percent of the kids who were given the antibiotic amoxicillin had recurrent ear infections, compared with 43 percent of those not treated with an antibiotic.

"Parents are becoming used to the idea that antibiotics are not the first choice," Tunkel said. He believes that pain control and pain management might need to take center stage, at least initially. For pain, Rosenfeld suggests ibuprofen over acetaminophen because, he said, "it lasts longer."

"If our goal is to get your child to sleep through the night, you are going to achieve that better with ibuprofen than acetaminophen," he said.

It is thought that someday kids might be able to be vaccinated against ear infections and scientists are currently working on such a vaccine according to a presentation at the 2009 annual meeting of the American Society of Microbiology.

Until then parents need to begin to focus on pain relief rather than antibiotics which makes children resistant and increases the return of the infection.