Ear infections are a familiar -and unpleasant-reality for many children. Whether a child is simply tugging at their ears or screaming with ear pain, it's important for parents to recognize the signs and symptoms of an ear infection and to take the appropriate steps, working with their physician, to determine whether it is an ear infection or another disorder. Left untreated, ear infections can cause continued ear pain and fever or worse --mild to severe hearing loss that may cause delays in speech and language development.

Ear infections continue to be a significant problem for children. "Acute otitis media is the most common bacterial infection afflicting children. By the age of three, over 80 percent of children in America have suffered at least one episode," said Stan Block, M.D., clinical professor of pediatrics at the Universities of Kentucky and Louisville.

In fact, ear infections in children are the No. 1 reason for emergency room visits and the No. 1 reason for office visits to the doctor for illness - accounting for approximately 25 million doctor visits each year.
Ear infections also are the top reason for use of antibiotics in children. Resistance to antibiotics has increased over the past decade, largely due to overuse. An estimated 30 percent to 50 percent of ear infections are misdiagnosed, which has contributed to this excessive use of antibiotics. In many cases, parents pressure physicians to prescribe an antibiotic when it is questionable that ear infection is present.

In the past, if a child was tugging at their ear and was in pain, it was generally assumed that a history of ear infections supported a current diagnosis of ear infection. A pediatrician's advice was sought, and in most cases a prescription for an antibiotic was written. After a few days, the child was taken back to the physician to determine whether the infection had subsided.

Guidelines for diagnosing and treating ear infections recently adopted by The American Academy of Pediatrics and The American Academy of Family Physicians emphasize accurate diagnosis and treatment of children with certain ear infections but withholding antibiotics for those with uncertain signs of ear infection.

"We have found that many parents and some physicians are not aware of the new guideline, which puts an emphasis on 'watchful waiting' and a certain diagnosis of the ear infection prior to prescribing antibiotics," said Michael Pichichero, MD, pediatrician and professor at the University of Rochester in New York.

How Ear Infections Develop
In a healthy child, the middle ear space (behind the ear drum) is filled with air; which allows for the passage of sound waves so that a child can hear. When a child has a cold, upper respiratory infection, allergies, or sinusitis, the middle ear may become filled with fluid.

Otitis Media occurs when fluid fills the middle ear space and is present with both acute otitis media (when there is infected fluid in the middle ear) and otitis media with effusion (when there is uninfected fluid.) The new AAFP/AAP guideline recommends confirmation of middle ear fluid and middle ear inflammation as part of the diagnosis of an ear infection, according to Jerome Klein, M.D., FAACP and professor of pediatrics at Boston University School of Medicine.

Monitoring is Key
A child may exhibit several signs of a possible ear infection, many of them similar to childhood ailments such as teething. It is important for parents to watch for:

• Fever
• Irritability
• Tugging on the ear
• Sleeplessness

The medical guideline recommends that when an ear infection cannot be confirmed, the doctor may suggest that in children over 24 months, parents treat the pain with over-the-counter medication and practice "watchful waiting," or continue monitoring their child for signs of an ear infection. If the symptoms persist or worsen, parents should contact the child's doctor.

Many physicians also suggest follow-up monitoring after a confirmed diagnosis of ear infection. Even if symptoms have disappeared, the presence of middle-ear fluid can last 30-90 days after the ear infection has subsided, increasing the chances an infection will recur. The retention of fluid in the middle ear makes it feel to the child like they are wearing ear plugs. Prolonged time with fluid in the middle ear may result in continued hearing loss, which may result in delayed speech and language development.

To assist with "watchful waiting," parents may consider using a new home monitoring device that detects middle-ear fluid. Incorporating technology originally developed for physicians and used by health professionals nationwide, the EarCheck Middle Ear Monitor provides a quick, accurate and painless method of detecting middle-ear fluid. The device shows a simple-to-read green, yellow and red scale indicating whether fluid is present and requires monitoring or a visit to the doctor. The monitor incorporates technology recognized by the new AAP/AAFP guidelines.

"Parents now have the opportunity to assist the pediatrician in assessing their child's middle ear status with a device that is as easy to use as an ear thermometer," Block said.

Ear health is important to children's overall health and development. Parents should include monitoring for signs of an ear infection as a key part of their family's health prevention efforts.

Resources
EarCheck Monitor
WebMD
Dr Greene

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About the Author
William N. Nelson, BSME, MS, MBA, is president/CEO of Innovia Medical/Ear Check, a Lenexa, Kan.-based company founded to develop and market technology that detects sign of ear infection.

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