Ear Infections

If your baby seems extra irritable, has been pulling at his ears, has a fever, and/or difficulty sleeping then your baby should be examined for a possible ear infection.  Older kids will usually tell you that their ear hurts, though some seem less aware of the pain and fever is their first symptom.  

Ear infections are a common cause of illness in early childhood. They are often seen a few days after a cold.  Thankfully, the pneumococcal vaccine and breastfeeding helps prevent many of them.  Other ways to prevent ear infections are to stay healthy with frequent hand washing. Also, avoiding exposure to cigarette smoke can help. 

What happens in the body? 

Anatomy of ear with labels by Annie Campbell, University of Dundee School of Medicine 2016

There is a tube behind the small ear bones, called the eustachian tube, that connects to the back of the throat. This tube drains fluids and allows air to get into the space behind the ear bones for them to function properly.  Naturally children have flatter, shorter eustachian tubes than adults. Therefore, it’s easier for viruses and bacteria to climb back up the tube and infect the middle ear.  Also, bottle fed infants are more likely to get ear infections most likely because of the way they lie to bottle feed and because they don’t get the protective factors from breastmilk. There are three main types of ear infections:

Acute Otitis Media

Acute otitis media (middle ear infection or AOM) is diagnosed by looking at the ear drum usually by looking through an otoscope in the ear canal.   The infected ear drum would be inflamed and swollen as the fluid in the middle ear pushes on the ear drum from the inside. This pressure is what causes the pain. Thanks to the pneumococcal immunization most of these infections are viruses that don’t require antibiotics.  However, the American Academy of Pediatrics still recommends antibiotics for ear infections in babies younger than 6 months or severe illness in older babies.  There are times we may recommend watchful waiting for children.  Often an ear infection will resolve in 48 to 72 hours without antibiotics. You can give your children Brufen syrup to help with the pain during this time.

Because of the widespread use of antibiotics, we are finding antibiotic resistant infections in the United States.  In Malawi, antibiotic resistance is becoming a big health concern as well. For that reason, it’s important that your child is seen by a health care provider to properly diagnose and prescribe the correct antibiotic and correct dose to correctly treat the ear infection and reduce the risk of antibiotic resistance.  Thankfully, the government is now requiring pharmacies to turn in prescriptions for antibiotic sales. As parents, it’s important that you DO NOT give your child an antibiotic without a health care provider’s supervision.

Otitis Media with Effusion

Sometimes the eustachian tube isn’t draining properly and there is simply non-infected fluid built up in the middle ear.  This is called an otitis media with effusion (OME).  This often resolves without intervention in about 3 months.  OME does not need antibiotics. However, we like to watch and ensure that the fluid drains and doesn’t affect the child’s hearing. For that reason, we recommend that these children are followed by the ABC Audiology (hearing) clinic. They are located in the building to the left of the main clinic and are open Monday through Friday, accepting walk-in patients.  In rare instances, especially if hearing is affected, they may recommend ear tubes to help drain the fluid.  Since this a surgical procedure risks and benefits of the surgery in Malawi should be discussed with your healthcare provider.

Otitis Externa

Otitis Externa (outer ear infection) also called Swimmer’s Ear is the third type of ear infection that we commonly see. Unlike the AOM and OME, otitis externa does not affect the middle ear, but is an infection of the ear canal.  The child will complain of ear pain, but does not usually have a fever. If gentle tugging on the ear causes pain, then it’s more likely an otitis externa. In the emergency room, I have seen swelling so significant that the ear canal was nearly swollen shut. So, don’t ignore outer ear infections. These infections are usually treated with antibiotic ear drops prescribed by your doctor.  Sometimes they can be quite difficult to treat and have lots of drainage that requires dry mopping. At the audiology clinic at ABC they can teach you how to do that.

Thankfully, the following recommendations can help prevent otitis externa:

  1. Keep ears dry.  After swimming gently tip your ears to the side to allow the water to drain and gently dry with a soft cloth or towel.  You want to avoid too much rubbing in the ear as this can irritate the ear canals even more.
  2. As long as the ear drum is not ruptured, mix 1 part rubbing alcohol and 1 part vinegar and pour about 5 ml in each ear after swimming and allow to drain out. This dries out the ear canal and restores the ear to the normal more acidic pH.
  3. Don’t put anything smaller than your elbow in your ear. Picking at your ear, ear swabs, tissue, etc… irritate and infect the ear canal. 

(mayo clinic: Home Remedies: suffering from swimmer’s ear)

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