Due to swimming in contaminated water or force-feeding, ear infections can be caused by several innocuous everyday activities. Understanding the causes, symptoms and possible interventions can help parents deal effectively with this common childhood problem
Ear infections are common in infants with 75 percent suffering at least one infection before the age of three, making it one of the most frequently occurring afflictions of early childhood.

While older child may be able to vocalise ear pain, toddlers are unable to express themselves other than with non-stop wailing. Some infants may pull or tug at the ear and parents may discover the problem by touching the ear and discern if it aggravates pain. Fever may or may not be a symptom. When no cause can be found it would be advisable to consult a paediatrician.

Most ear infections start innocuously. Viruses usually cause them, resulting in fever and a runny nose for hours or days before excruciating pain sets in. Later, there may be local visible signs such as a watery or purulent discharge. The usual panacea is to drain the ear, but while this therapy may relieve pain, the infection may persist.

It’s important to note that there is a connection between the nose, throat, and middle ear. As long as all connections are open and functioning well, there is little chance of an infection. But if any of them are blocked, pressure and secretions build up behind the eardrum causing tension and swelling. If these secretions remain stagnant in the middle ear, they can become secondarily infected with bacteria.

Causes

Some children develop recurrent ear infections because they are fed in a prone, lying down position. For instance, bottle-fed infants are often put to sleep with the bottle in their mouths. Apart from the feeding position, bottle-fed formula milk could cause ear infection. Breast milk on the other hand contains protective immunoglobulins. Consequently infants exclusively breastfed for the first six months are less likely to develop ear infections.

• Parents also tend to entertain unrealistic expectations of the amount of food children should eat. Frustrated parents often force-feed solids to an uncooperative child while she is in a lying down position. Food particles can enter the eustachian tube connecting the throat and ear resulting in blockage of the passage which could cause an infection.

• Passive exposure to cigarette smoke also increases the chance of ear contagion by 50 percent. Unless the adult smoker quits, children will remain susceptible to recurrent ear infections.

• Most secondary bacterial infections including of the ear are caused by the pneumococcal and H Influenzae group of bacteria. Hib and pneumococcal vaccines should be administered to children, together with triple antigen to reduce the number and frequency of ear illnesses.

• Swimming in contaminated water can cause painful ‘swimmer’s ear’ i.e, ‘otitis externa’ an infection of the external ear canal. This condition is different from ‘otitis media’ or middle ear infection. Ear infections are also caused by bathing in a basin or tub and by bacteria or a fungus. Therefore using ear plugs or drying out the ears with a hair drier after swimming and bathing is advisable. If there is a purulent discharge, antibiotics may be required.

Usually viral ear infections subside on their own in 72 hours with complete recovery. However please note that viruses do not respond to antibiotics and therefore will not help shorten the course of the disease or prevent progression to a bacterial infection.

Care and treatment

For acute ear infections, quick administration of saline nose drops every two hours unblocks the nose and soluble paracetamol tablets, drops or suspension (10-15mg/kg/dose) every four-six hours reduces pain and fever. A mild antihistamine could dry up secretions, and steam inhalations will also open up the nasal passage. Sometimes anaesthetic (not antibiotic) ear drops may be required to ease the pain.

Ear drops are effective only if they are properly administered. Children should be placed on a flat surface (never on a pillow or the lap). The ear should be facing upwards and the outer ear should then be gently pulled upwards and outwards to administer the drops. Anaesthetic drops will not cure the infection but will mitigate pain.

A paediatrician should be consulted if an ailing infant is less than six months old, or suffers other illnesses such as congenital heart disease or is in an immunocompromised state (cancer or HIV infection).

If pain or fever persists beyond 72 hours, it’s quite likely that a secondary bacterial infection has occurred. This needs administration of antibiotics in the correct dose and duration. Please note the prescribed dosage should not be disontinued because the child “looks better”. Nor should the same antibiotic be purchased OTC (over the counter) and self-administered for subsequent infections.

How serious is anear infection?

Ear infections can cause hearing loss. This is usually short term but can persist if the virus persists. If a chronic infection is neglected, it can extend to other structures in the middle ear and damage them, leading to permanent hearing loss. It can cause pus formation and abscesses.

Chronic infections with persistent discharge for three-six months may require surgery — myringectomy or tympanostomy. Any hole in the eardrum may need to be closed with a skin patch and the tonsils and adenoids removed as they can also contribute to blockage of the eustachian tube.

Ear infections can be tough on parents and toddlers. But understanding the causes, symptoms and possible interventions can help reduce the mental and physical trauma and enable parents to deal effectively with this common childhood affliction.

(Dr. Gita Mathai is a Vellore-based paediatrician and author of Staying Healthy in Modern India)