Children and Ears

Americans spend billions of dollars each year treating ear problems in children; much of it on doctor visits, drugs and surgery. Ear infections are the number one reason children visit a doctor's office, and the number of children coming in with ear infections has risen over the past decade. There are several reasons for this including bottle-feeding, increased allergies, greater pollution, more children in daycare, and exposure to cigarette smoke. Interestingly, boys develop infections in the ears more often than girls do, and it is not clear why.

Children in general seem to experience far more ear infections then adults, and this is because their Eustachian tubes are immature. Infants and children have a more horizontal Eustachian tube without gravity to assist in drainage. It is also much shorter and collapses more easily compared to an adult tube; the opening in the throat is more rounded, making it easier for secretions to find their way up into the middle ear. Additionally, babies tend not to swallow when they are asleep (they drool), and less swallowing means less ventilation of the middle ear. All of these differences result in a buildup of negative pressure which causes pain and this leads to restless nights.

Anyone who has had difficulty clearing their ears after flying in an airplane, or anyone who has had the congestion of a cold that "clogged" their ears knows how Eustachian tube dysfunction feels. Children with chronic nasal congestion can feel this way all the time. These children think the world always sounds muffled and it is no surprise that they cannot speak clearly. The most common causes of Eustachian tube dysfunction are allergies and respiratory infections. Traditionally doctors have given antihistamines to dry up secretions and decongestants to clear the passages. However, the side effects of these two medications can be problematic, especially in children.

Molly was brought into my clinic by her mother because the kindergarten teacher was concerned that she was not paying attention in class. A quick screen in the office indicated a "conductive hearing loss". Mom wanted to avoid medications if possible, so she agreed to try nasal rinsing. Soon Molly was "washing" like a pro, and two weeks later the repeat hearing test was normal. A simple and safe approach resolved her problem.

Hearing is one of the most important windows to a child's world. Through good hearing, a child learns language skills and an appreciation for the world around him or her. If you are concerned about your child's ability to hear well, speak to your physician. If the problem is chronic congestion or infections, ask about nasal rinsing. It could change your child's life.

Adenoids and tonsils are lymph tissues that normally enlarge as a child ages, peaking in size during elementary school years and beginning to shrink just before puberty. The adenoids are situated in the upper throat, in the back part of the nose, right next to the Eustachian tube opening. The tonsils are lower in the throat. These tissues will remain enlarged if constantly irritated, aggravated and stimulated by recurrent infections or allergies. These chronically enlarged tissues prevent the Eustachian tube's normal drainage, which can contribute to recurrent ear infections.

Ear infections are the most infection children experience but not all infections require antibiotics. For years, doctors would automatically prescribe antibiotics when any fluid was found in the middle ear, especially in children. If the fluid persisted, they would recommend surgical placement of drainage ports, PE tubes, in the eardrum - a manmade exit for the fluid. These tubes do not correct the original problem, but they do allow the fluid to drain out the ear canal if the Eustachian tube is blocked. More recently, the Academy of Pediatrics acknowledged that routine antibiotics and PE tubes may not be the best approach and has now released new recommendations. A watch and wait approach to most ear infections is the newest guideline, but as in the past, it is up to each physician to decide on the necessity of using antibiotics.

These recommendations will hopefully contribute to a decrease in the overuse of antibiotics and a reduction in bacterial resistance. Using fewer medications will reduce the development of adverse drug reactions as well. Sometimes these medications are warranted, but I recommend a first line treatment that is much safer and often more effective in addressing the core issue as compared to medication: Nasal washing with hypertonic buffered salt water.

From the Expert
Antibiotic overuse is a particular concern. Many children with nasal disease seem to become "antibiotic-dependent" that is, their symptoms seem to be relieved while taking antibiotics, but then relapse shortly after the treatment course ends. A new antibiotic is then started, and the cycle then repeats itself over and over, sometimes for many months.
Michael Cooperstock, MD, MPH
Pediatric Infectious Disease
University of Missouri, Columbia, Medical Center

 

FAQ's regarding ear infections
What exactly is an ear infection in and what causes them?

Ear infections are accumulation of mucus and bacteria within the Eustachian tube (see diagrams below). Infections ALWAYS begin in the nose. The nasal membranes swell, excessive mucus is produced, thicken mucus in the drainage pipes (the nose, the sinus, the ears) fail to drain well. In children these tubes are smaller and the Eustachian tube is more horizontal, hence, the excessive mucus/bacteria fail to drain. The infection results.

 

Can we prevent ear infections?
Yes, we can reduce and prevent ear infections by keeping the nose clean, breast feed, stay away from large groups (day care), avoid exposure to smoke (this paralyzes the nose hair, the cilia) and keep your fingers crossed.

 

How Can Infections Be Treated?
A natural approach to ear infections begins and ends with lots of liquids. Lots of fluids, lots of exposure to moisture (baths, etc) and cleaning the nasal passages. In fact a new study suggests CHILDREN WHO WASH THE NOSE DO NOT DEVELOP EAR INFECTIONS! I have personally witnessed this over 25 years of medical practice and many of my colleagues agree. The Academy of Pediatrics strongly supports NOT treating with antibiotics unless the child is very ill, feverish, or very young. Finally, more professionals are seeing the light that antibiotics are not the only answer. In fact overuse of antibiotics results in bacteria to develop resistance, among other issues.

Is there special season for ear infections?
Cold season and allergy season is ear infection season. Whenever the nose is troubled, the ears are at risk.

What can we do to reduce the risk of ear infections?

• Breastfeed instead of bottle-feed.
• Avoid exposing your child to cigarette smoke.
• Prevent allergies, adjust living environment for fewer allergens.
• Provide healthy unprocessed foods for fewer allergies.
• Avoid daycare if your child is younger than 2 years old.
• Keep the nose clean.
• Avoid medications that dry and thicken the mucus, such as antihistamines.
• Maintain hydration, avoiding sugary juices (teach your children to drink water).
• Treat GERD (Gastroesophageal Reflux) if it is present.
• Apply warmed moist compresses to the outer ear for 20 minutes every few hours.
• Work with your child's medical provider so that your collaborative efforts will bring about the most effective and least invasive solutions
• If your child is getting worse, see your medical provider!

Be Well, Dr. Hana Share your experiences or ask a question This email address is being protected from spambots. You need JavaScript enabled to view it.
Hana R. Solomon, M.D. 573-999-0450
Author of Clearing the Air, One Nose at a Time: Caring for Your Personal Filter