Infections: Otitis Media (Middle Ear Inflammation) in Children

 

Transcript:

 

Guest:  Dr. Sandra Fowler - Pediatrics

Host:  Dr. Linda Austin – Psychiatry

 

Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m talking, today, with Dr. Sandra Fowler who is Associate Professor of Pediatrics here at the Children’s Hospital, at MUSC.  She is an expert in infectious disease.  Dr. Fowler, let’s talk about a very common childhood ailment, otitis media, which is earaches, ear infections.  Most kids get them from time to time.  When should a parent be particularly concerned, and when should a parent seek medical attention?

 

Dr. Sandra Fowler:  It’s a very common problem.  I think any time a child is experiencing a fever and ear pain or a high fever that’s unexplained and the child is not feeding well, not acting well, not playing normally, they need to be evaluated by a physician.  When that diagnosis ends up being otitis media, some of the management recommendations have actually changed from what I was trained to do.  We’re approaching them more conservatively than we had in the past.  What that means is that there are now a number of children for whom we don’t recommend antibiotic therapy, at least not in the very beginning of the illness.

 

Dr. Linda Austin:  Why not?

 

Dr. Sandra Fowler:  Interestingly, a large percentage of ear infections will resolve within 48 to 72 hours, without treatment.  So, what we’re trying to do is select out those ear infections that really don’t need antibiotics and reserve antibiotic use for those that aren’t going to improve.  We want to minimize exposure of a child to medicines that they don’t need and we have to be concerned about our antibiotic use and how common use of antibiotics selects for more and more resistant bacteria.  So, there’s kind of a personal reason to use it and a global public health reason to be more careful in our antibiotic use.

 

Dr. Linda Austin:  What are the warning signs that an earache might be really serious and something to be very concerned about?

 

Dr. Sandra Fowler:  Well, earaches, in and of themselves, can be very painful.  The immediate complications, besides the pain and discomfort, are that the eardrum can rupture and drain pus out of the ear.  In the old days, and it happens still, occasionally, some other infections can develop as a result of the ear infection.  One is something called mastoiditis, which is an infection of the bone surrounding the ear, and, very rarely, meningitis can be a complication of an ear infection.

 

Dr. Linda Austin:  Now, when an eardrum ruptures, the fluid and pus is released and so, actually, the pain can get much better, although it can be very alarming to see what comes out.  If there is a rupture, should that be particular cause for concern for the parent, or can they can just continue to watch.

 

Dr. Sandra Fowler:  Well, I think that child should see a physician to be evaluated in a global sense.  But, you’re right, it’s like draining an abscess, once that pus comes out, that pus under pressure is released, many times a child will feel relief and will have a decrease in the pain.  And, for most children, the eardrum itself will heal itself over time. 

 

Dr. Linda Austin:  There’s another condition that can be related, serous otitis, that can lead to temporary hearing difficulties in kids.  Can you describe what that is?

 

Dr. Sandra Fowler:  Serous otitis means that there’s fluid in the middle ear, but it’s not pus, so it probably doesn’t have bacteria in it.  It can result from a viral infection.  It can result from swelling in the throat and around the tubes where the ears drain into the throat such that they can swell up and become blocked and that vacuum is created that causes fluid to collect in the middle ear, and that is that serous fluid.  I guess the best way I can describe it is that it feels like the ear is stopped up or it feels like a kind of stabbing pain in the ear, so it can also be painful.  And, if the child has a cold associated with it, there can also be fever with it.

 

Dr. Linda Austin:  Some of those kids get tubes in their ears, right? 

 

Dr. Sandra Fowler:  That happens much less commonly than in the past.  Tubes are pretty much reserved for children who have recurrent episodes of bacterial infection in the middle ear, or for children who show that they’ve had a documented impact on their hearing with the presence of the fluid in the middle ear.

 

Dr. Linda Austin:  One of the things that can be so hard on parents is traveling with kids in airplanes and having them cry and scream as the plane, especially, is coming down and the pressure changes.  Is there anything parents can do to help their kids with that?

 

Dr. Sandra Fowler:  Getting them to swallow is probably one of the most effective things.  Adults who’ve experienced that know that to be true.  So, if it’s a young infant, get them to take a bottle so that they’re continually swallowing, or an older child, give them something to drink.

 

Dr. Linda Austin:  How about use of decongestants?

 

Dr. Sandra Fowler:  Well, as you know, they have come under fire from the FDA lately as being ineffective and potentially dangerous for children less than two.  So, that severely limits their use in older children.  In fact, some would not recommend their use for children less than six.  Their effectiveness has come into question as to whether they really work anyway, and there could be some harm, so we’re trying to reduce the use of those agents for young children.

 

Dr. Linda Austin:  Dr. Fowler, thank you so much for talking with us.

 

Dr. Sandra Fowler:  You’re welcome.

 

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