Medical Monday: Ask Dr. Joe

Q: My 18 month old has been getting recurring ear infections since he was five months old. My doctor keeps treating him with antibiotics and is referring us to an ENT, possibly for tubes. I’m wondering when you decide to treat with antibiotics, or is it worthwhile waiting it out with Tylenol for pain and hoping it will pass, and exploring alternative methods before pursuing surgery?

A: This is a tricky situation. I am assuming you have older children at home who are school aged and possibly bringing home viruses. Your little one then, becomes the unfortunate recipient of the effects of the virus. Infants and young children are more prone to ear infections because the ear canal (eustachian tube, specifically) is smaller and is flatter. As the children grow it gets larger and angled, thus making ear infections less likely. Additional risks are enlarged for tonsils/adenoids, which are usually present with children who mouth breath or snore at night. 

This is the background to your question. Ear infections are largely initially caused by viruses. If an ear has a little fluid and is a little red, there is no need to immediately start antibiotics, especially if there is a viral cause. We call that watchful waiting. The ear should be rechecked in 24 to 48 hours. If it’s not better or if worse, antibiotics are needed. If the ear has pus layered or the drum is bulging and ready to burst, then antibiotics are definitely needed. After an ear infection, fluid may remain in the ear for a while. If it is clear, it usually can be monitored and will resolve on its own but can be a breeding ground for bacteria and may get reinfected. The fluid may not clear if the child’s adenoids are enlarged because the eustachian tube may be obstructed. This chronic fluid may impair a child’s hearing and may require adenoids to be removed and/or tubes to be placed so that it does not impact the child’s life (sleep issues and speech are just two aspects that can be impacted by chronic fluid). 

If your child is getting recurrent ear infections, not just from viral infections, you may also want to ask your pediatrician if there is any possibility of an immune disorder or some other factor that may be impairing his ability to clear bacteria or is putting him at risk for other, more serious, infections. 

As far as alternative methods of treating/preventing ear infections, the best prevention is good hand-washing and minimizing viral infections.  I am not aware of too many other ways of preventing or treating the infection. In the good old days, some doctors used to do fine needle aspirates of the fluid in their office and allow the infection to drain. I don’t think that is done routinely anymore, except for some ENTs who have specialized equipment.

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