Transcription:
Ear Infections in Children

Melanie Cole (Host): If you're a parent, you know about ear infections; the late night tears, the ear tugging, the repeated trips to the pediatrician, the warm cloths in the microwave on their ear for the pain. You know what it's like, but really what are ear infections, and is there a way to prevent them? My guest today is Dr. Karin Hotchkiss. She's the Medical Director for Pediatric Otolaryngology at BayCare Health. Dr. Hotchkiss, what is an ear infection, and why do so many children get them?

Dr. Karin Hotchkiss, MD (Guest): That's a great question. When we talk about ear infections, it's inflammation of the ear, and typically when we talk about ear infections, most people will come in and ask if they have an outer ear infection or an inner ear infection. There's actually three parts of the ear; the outer, the middle, and then the inner part of the ear that can cause ear infections. So what we're thinking about when we're talking about younger kids - and really it's somewhat age group specific - when we're talking about children under the age of five, usually that's a middle ear infection. So fluid that accumulates in the ear behind the ear drum.

Children older than that tend to get more of what we call the outer ear infection, or the swimmer's ear infection. Both can be extremely painful, and both can certainly keep you up in the middle of the night grabbing for that warm compress or heading to the afterhours to seek medical care.

Melanie: So speak about the screaming versus the silent infections, and the tips to differentiate. I mean I had a son, Doctor, who did not scream and cry until the thing was practically bleeding. So some kids these don't affect quite so severely, do they?

Dr. Hotchkiss: Sure. So interestingly, I call it the screaming ear infections, that's the child who presents pain, fever in the middle of the night, it's stop traffic, go seek medical attention. These are the ones that really drive your life crazy because they're unpredictable, and they happen at after hours, and you're ending up with antibiotics or sometimes even injections. These are the ones also sometimes that can be so severe that you end up in the ER seeking medical attention.

These are pretty obvious. When the parents go through this role three or four times in a six-month period, this is oftentimes how you get to a specialist. And it makes sense for the parents when they come in and, "Yes, I've had a problem. Yes, I know that I need to get something- some relief," and then surgery sometimes has been already talked to them, or introduced as a relief to these.

The other, what I call the silent ear infections, and these are the infections that are silent, meaning they don't have a lot of symptoms. So you're not getting that pain, you're not getting that fever, you're not getting in the middle of the night stop traffic kind of symptoms, but more of the fluid has been in the ear, and they're silent in the fact that the kids aren't showing symptoms.

These are the kids though who may be having subtle symptoms. The, "What? Huh? I'm not really paying attention. I'm not hearing you. The TV volumes are a little bit louder." Or sometimes speech and language delay becomes an issue. And so these are the families that will seek medical attention, the pediatrician or the primary provider may look in the ear and find that there's fluid. Sometimes this can be a little confusing to the family, because again, they're silent. They're not seeing those symptoms, but those children as well can certainly be at risk for having issues from ear infections.

And so sometimes when parents come in and are astounded that there's actually an issue, I tell them that these are the silent infections or chronic fluid that's been in the ear.

Melanie: Once they end up at the pediatrician or in your office, one question parents always have is about antibiotics, and even sometimes ear drops. Speak about what you do as far as treatment is concerned, and in this day in age of antibiotic stewardship, are we watching and waiting or are we using antibiotics every time?

Dr. Hotchkiss: Great question. So I will really have to tip my hat off to the pediatrician, and to the Urgent Care providers, or the primary physicians who are managing because they're on the frontlines when they're seeing the patients come in. And yes, there has been a push to be a bit more conservative on antibiotics. So meaning if a child comes in, they may have a bulging ear but they're not having symptoms, they're not having the classic fever, pain in the middle of the night kind of symptoms, there is a push to try and watch conservatively. If this is a viral infection, which can certainly cause fluid in the middle ear, it may not respond to antibiotics. Remember, antibiotics treat bacterial infections.

So giving that watch and wait and see approach. If not both symptoms progress, or don't respond to conservative management, that is where antibiotics come into play. This is where the pediatrician really is key in helping to manage these children. Typically by the time we have three or four courses of antibiotics, this is where a referral to a specialist comes into play, and this is really more where I meet the family to help transition that care plan.

Typically three infections in six months, four in a year that require antibiotic therapy is where we start considering possibly ear tube placement, and this is usually where a pediatrician or a primary care provider may make a referral to a specialist. And then this is the point where we start to meet with the families and see if they are a surgical candidate.

Melanie: And what is that like for both the parents and the child?

Dr. Hotchkiss: Well oftentimes by the time the parents get to my office they're really looking for some relief. Their life has been a little bit crazy because they've spent a lot of time in the pediatrician or primary care office seeking antibiotics. Of course antibiotics come with their own side effects, so things like upset tummies, and change of appetite. Usually when kids come in with ear infections, they may have upper respiratory symptoms as well. So sinus issues, not breathing well, chronic cough issues that can lead to reactive airway. All of these cause poor quality of life issues, so when we're looking at children to come in, really we take into account the quality of life and to see if maybe a surgical option would be helpful at that point.

I can back up as well. You had asked earlier about topical therapy versus oral therapy. So oral therapy is really good when there's a middle ear infection, meaning the infection is behind the ear drum, and there's an attacked tympanic membrane. We have to put medicine through the mouth to get through the bloodstream to deliver the medication to the middle ear space.

If there's a perforation or somebody has a hole in the eardrum, sometimes that's a controlled hole with an ear tube, we can actually use drops to treat that middle ear infection. Also if there's an outer ear infection from a swimmer's ear, that's actually where ear drop therapy comes into play as well. I just wanted to make that differentiation there.

Melanie: Is there any way to prevent ear infections?

Dr. Hotchkiss: Great question. There are some things that we can do that are helpful. Certainly daycare is a huge risk factor for ear infections because all of a sudden you have a bunch of children who are in a smaller environment, are able to pass germs more freely back and forth. So if you- most parents though who have to pick a daycare option, we get it, we're seeing more families who have two parents that are working outside of the home. So if you have an option when looking at daycares, certainly you want to look at a smaller environment. So if you can do an in-home daycare, or potentially a nanny share, that's much more beneficial than something that has a large environment. I usually say to the parents, "How many children walk through the door of the daycare? Not just within the room that your child may be in, but it's how many kids walk through that door- that front door? Because they're all sharing the same play spaces, and they're sharing the same bathrooms, and potentially the same playground to pass germs around." So that's one thing to think about.

The second thing is I do think vaccination is very important for children. We've done a great job in our vaccination programs, and vaccines really do save lives. So I do encourage parents to stay up-to-date on their vaccines if possible.

And then the third, there are some other risk factors that are a little bit harder to control for. Certainly family environments. So I usually say if there's more kids in the family, you're going to have more germs that are passed around. Unfortunately that is part of the nature that can't be controlled for. We also talk a little bit about family history. So if a mom or a dad had ear tubes, there's certainly an increased risk just because of how our faces are formed. We pass those onto our children and so that can affect a station tube of drainage.

I do get asked a lot about feeding habits. So for instance, babies who lay down in bed with a bottle. There may be a little bit of an increased risk for that, but I usually tell parents, "I'm not sure that that's usually the end-all be-all." I also get asked a lot about breastfeeding, and certainly breastfeeding is fantastic for children because we pass immunoglobulins along from Mommy to the infant child, and certainly breastfeeding is wonderful, though I don't think that's the end-all be-all for protection. So sometimes we can still have breastfeeding moms who bring their children in who still are at high risk for ear infections, but it certainly helps.

Melanie: And what about dealing with them when they are happening? We mentioned a little bit about the warm compress. What do you want parents to know as you wrap up, Dr. Hotchkiss, about dealing with those ear infections? Those late night tears, the kids crying and the pain, or the little babies tugging on their ears; what can we do for them right at that time? Give us your best advice.

Dr. Hotchkiss: So certainly over-the-counter analgesics. Tylenol is a great choice, Ibuprofen if the children are over six months is safe to use as well and following the bottle indications for that. I do encourage parents though if we're having pain in the ear to get an ear exam, because lots of things can cause ear infections. Believe it or not, just because we've got pain in the ear, doesn't always mean there's an infection. Sometimes it's teething that can refer pain to the ear, certainly there can sometimes be lumps or bumps in the neck or other muscle issues that can cause pain in the ear, and then sometimes throat issues. A lot of the things in the back of the nose or throat may actually refer pain to the ear. So I certainly encourage parents, if their baby is not consolable with a Tylenol or an Ibuprofen, that they should seek medical care to get a full head and neck exam.

Melanie: Thank you so much, Doctor, for being with us today, and for sharing your expertise on something that many, many parents experience all throughout their child's childhood really, and it's so important to learn about it and know what we're dealing with, so thank you so much again. You're listening to BayCare HealthChat. For more information, please visit www.BayCare.org. That's www.BayCare.org. This is Melanie Cole, thanks so much for listening.