Earache is one of the most common reasons for young children to see a doctor, and acute otitis media-or “middle ear infection”-is the most common reason for children under 5 years of age to use antibiotics. 25% of children will have an ear infection on their first birthday, and 60% will have an ear infection by the age of 5.
As a pediatrician, I see children’s ear infections in the clinic every day. Since these are related to viral upper respiratory tract infections, we usually see most ear infections in autumn and winter, when flu and cold viruses are prevalent. However, due to COVID-19 last winter, almost all people wear masks, many children are out of school, and the number of viral upper respiratory tract infections has dropped sharply. As a result, we have seen very few ear infections in the clinic.
This summer, with the lifting of COVID-19 restrictions, we have seen a comeback of many respiratory viruses, followed by middle ear infections.
How the ear is infected
The middle ear space, the space behind the ear drum, is connected to the back of the throat by the Eustachian tube. When people, especially children, become crowded, they tend to accumulate liquid in this space.
If a child catches a cold for a period of time, the accumulated fluid will become infected, usually by bacteria that migrate from the back of the nose or throat. As the child grows, their skull will grow longer and the Eustachian tube will drain more easily as it begins to slope down to the back of the throat. Over time, children will also develop immunity to the common cold virus, and the number of illnesses will decrease, so overall ear infections will decrease with age.
The three most common bacteria that cause middle ear infections are Haemophilus influenza, Streptococcus pneumoniae with Moraxella catarrhalis.
Interestingly, before we got the pneumococcal vaccine Streptococcus pneumoniaeAmong children between 6 months and 5 years of age, approximately 60%-70% of ear infections are caused by these bacteria. However, after these vaccines were added to the childhood immunization series in 2001, the rate of ear infections dropped overall, and the proportion of streptococcal pneumonia gradually dropped to 15%-25%. Haemophilus influenza It now causes most ear infections.
Diagnosis and treatment guidelines
The American Academy of Pediatrics’ latest guidelines for acute otitis media (diagnosed by physical examination) were released in 2013. The doctor will use a device called an otoscope to examine your child’s ears to see if the eardrum is red or swollen or if there is fluid behind it. Sometimes the doctor will blow a small puff of air in the ear to see if the eardrum is moving well. If there is an infection behind the ear drum, it will not move with the air.
Acute otitis media is usually treated with antibiotics, and antibiotics are usually recommended for ear infections in children under 2 years of age. For children over 2 years old, if they have fever or severe pain, or both ears are infected, antibiotics are recommended. In the case of no fever or only one side infection, it is recommended to wait a day or two before starting antibiotics, because sometimes these infections will clear up on their own in older children.
This is different from the treatment of external ear infections-otitis externa or “swimming ear disease”-which can be treated directly with antibiotic ear drops. When the ear canal is very swollen, use a gauze core to carefully drip antibiotic drops into the deep part of the ear canal.
How to prevent ear infections
Following the recommended childhood vaccination schedule is an important part of preventing or at least reducing the frequency of ear infections. Pneumococcal vaccines are particularly important. Ear infections are a common complication of influenza in children; about 40% of children under 3 years of age will have influenza in their ears. Therefore, the annual flu vaccine can also help prevent ear infections.
Breastfeeding has also been proven to prevent ear infections, and exclusive breastfeeding for the first six months provides the greatest protection. The higher levels of protective antibodies in breastfed infants and the immune factors found in breast milk help provide this protection.
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Children exposed to more viral upper respiratory tract infections have an increased risk of ear infections. Children in group daycare settings are more susceptible to infections, so ear infection rates are higher. That being said, as a mother of a child who likes day care, it is important to note that group child care is usually the most affordable or only option for families, so it is not clear whether day care can really be avoided. Because ear infections are less common in older children, the risk in school is lower than in daycare.
Exposure to tobacco smoke is also a risk factor. Caregivers quit smoking when possible and minimize children’s exposure to tobacco smoke to reduce the risk of ear infections.
Some children use ear tubes to help prevent recurrent ear infections. If your child has at least 3 ear infections in six months or a year, your pediatrician may refer you to an otolaryngologist to determine if the operation is beneficial to your child.