Recurrent Ear Infections

For today’s Ask Dr.Mom’s post, we will be talking about those pesky ear infections (aka otitis media). Specifically, the ones that keep coming back.

Dear Dr.Mom

I have a child who is prone to ear infections. Is there anything we can do to avoid them?

—Kent

When our children become ill we almost always wonder if it could have been prevented. After all, one of our main goals as parents is to keep our children healthy. When something such as an ear infection keeps rearing its ugly head we wonder if we’re doing our part to prevent them. Yes, there are some measures we can take to be proactive and try to head them off. However, with that being said, please don’t lay the guilt on yourself should these ear infections keep coming back. A significant number of children will be prone to recurrent ear infections.

When the doctor tells you that your child has an ear infection, what she is saying is that your child has a middle ear infection. The space behind the ear drum has become infected and this usually occurs following a viral cold. The mucus and congestion caused by the virus doesn’t drain properly and becomes secondarily infected by bacteria thus necessitating the need for antibiotic treatment. Some cases of ear infections can be monitored by a wait and see approach as many will resolve on their own. This decision is up to you and your doctor and should be monitored closely.

So, why should we be so concerned with recurrent ear infections? Primarily because recurrent ear infections could potentially interfere with your child’s hearing and thus set him up for potential speech delay. Recurrent ear infections are usually defined by having more than 3 ear infections in 6 months or more than 4 ear infections within a year. Should your child fall into this category, he certainly warrants a visit to a Ear Nose Throat (ENT) specialist to further evaluate his condition.

Is my child at risk for recurrent ear infections? Here are some factors associated with recurrent ear infections:

• Short eustachian tubes: the eustachian tube connects the middle ear to the back of the nose. When this tube is short and not fully developed, drainage of mucus could be hampered. Insufficient drainage following colds can set a child up for ear infections. As a child grows, the infections become less frequent as the eustachian tube lengthens and becomes more vertical.
• Daycare at a young age: this is mostly due to exposure to more viruses. These children will catch more colds and hence be at higher risk for ear infections.
• Pacifier use: this can be a contributing factor. It’s in no way a causative one by itself, however, if a child is prone to recurrent ear infections, pacifier use can further increase their frequency.
• Exposure to cigarette smoke: this is a huge risk factor for children. The smoke causes inflammation in middle ear and hampers proper drainage.
• Allergies: environmental (such as dust) and food (such as milk protein) allergies cause congestion and inflammation. Both of which can create a setting for recurrent ear infections if left untreated.
• Gastroesophageal reflux (GER): This has also been shown to cause inflammation of the eustachian tube, thus potentially blocking drainage from the middle ear.

Prevention:

• Breastfeed: breastfeeding has been shown to be protective against ear infections.
• Do not bottle prop: feed your baby at an angle and not lying down.
• Do not use a pacifier if your child is prone to ear infections.
• Avoid exposure to cigarette smoke.
• Treat any underlying allergies.
• Treat reflux if present.
• Frequent hand washing during cold and flu season to prevent illnesses that may lead to ear infections.
• Boost your child’s immunity by ensuring a well balanced diet, plenty of sleep and exercise.
• Vaccinate your child against the flu and with the Prevnar vaccine. The Prevnar vaccine protects against the pnuemoccocus bacteria commonly attributed to ear infections.

Even after taking all these precautions, there will be some children with persistent recurrent ear infections. Some may require percutaneous tympanostomy tubes (PE tubes) to aid in drainage. Some will outgrow them as they get older, and some will require daily prophylactic antibiotics at the first sign of a cold to prevent their onset. Talk with your child’s doctor about finding the right solution for your child.

Take home point: Be sure to treat any underlying medical conditions your child may have, such as allergies. By taking care of your child’s allergy symptoms, this alone could greatly reduce the frequency of ear infections. Second, realize that ear infections are not contagious. The viruses causing the colds that may lead up to them are.

Has your child been faced with recurrent ear infections? If so, what were some preventions and/or treatments that helped?

*Please continue to submit your awesome questions by e-mailing me at mommamd4two(at)aol(dot)com.*

*The information provided here is for informational purposes only. It should not be considered medical advice and is not a substitute for seeking medical attention from your own doctor. Always see a doctor should you have concerns regarding your child’s health, diagnosis, or treatment. If you feel you have a medical emergency, call 911*