Ear Infections (Otitis Media) in Children

Description

Alternative Names

Prevention

There is some evidence to suggest that use of pacifiers may increase risk of otitis media in children under three years old. Nevertheless, some physicians believe any association is exaggerated and that the comfort a child derives from sucking (either thumb, breast, or pacifier) is more important than any presumed increase risk for ear infection.

Breastfeeding

Breastfeeding offers protection against many early infections, including ear infections. For one, the mother's milk provides immune factors that help protect the child from infections. Also, to be breastfed, infants are held in a position that allows the Eustachian tubes to function well. If possible, new mothers should breastfeed their infants for at least six months. For bottle-fed babies, to improve protection mothers should not lay babies down with their bottle; they should hold the infants in the same way they would to breastfeed them.

Preventing Colds and Flus

The best way to prevent ear infections is to prevent colds and flus in the first place.

Good Hygiene. Colds and flus are spread primarily when an infected person coughs or sneezes near someone else. A very common method for transmitting a cold is by shaking hands. Everyone should always wash his or her hands before eating and after going outside. Ordinary soap is sufficient. Waterless hand cleaners that contain an alcohol-based gel are also effective for every day use and may even kill cold viruses. (They are less effective, however, if extreme hygiene is required. In such cases, alcohol-based rinses are needed.) Antibacterial soaps add little protection, particularly against viruses. In fact, one study suggests that common liquid dish washing soaps are up to 100 times more effective than antibacterial soaps in killing respiratory syncytial virus (RSV), which is known to cause pneumonia and has been associated with ear infections. Wiping surfaces with a solution that contains one part bleach to 10 parts water is very effective in killing viruses.

Reducing Stress. Interestingly, giving children affection and helping them relax could help prevent colds. More than one study has reported that people with low stress who also have an active social life have fewer colds than people who have high stress levels or those who have low stress and few social connections.

Dietary Factors and Supplements

Healthy Diet. Daily diets should include foods such as fresh, dark-colored fruits and vegetables, which are rich in antioxidants and other important food chemicals that help boost the immune system.

Foods Containing Lactobaccilli (Good Bacteria). Researchers are also studying the possible protective value of certain strains of lactobacilli, bacteria found in the intestines. Some of these strains, particularly acidophilus, are used to make yogurt. According to one Finnish study, children attending day care who ate milk containing the strain lactobacilli GG could reduce respiratory infections in these children by 10% to 20%. More research is warranted. (The strain used was not the kind found in most commercial yogurt products,)

Xylitol. Xylitol, a sugar alcohol produced naturally in birch, strawberries, and raspberries, has properties that fight Streptococcal pneumonia bacteria. Studies are reporting that children who chew gum or swallow a syrup containing xylitol experience significantly fewer ear infections. It also reduces cavities. Chewing gum (Clen Dent) may be more effective than the syrup. Although in one study, xylitol did not reduce bacteria in the nose and throat, it did prevent ear infection. (It does not appear to prevent ear infections in children who are having colds or flus.) Some health providers report that even children one and a half years old can learn to chew and not swallow gum. Studies have not been clinically tested children between six and 18 months, the highest-risk age group for otitis media. This is an area for further research. The gum is not widely available in the US although it can be purchased on the Internet (www.xylitolworks.com).

Avoiding Exposure to Cigarette Smoke

Parents or others should not smoke around children. Several studies have found that children who live with smokers have a significant risk for ear infections. One study even suggested that the more the mother smoked the higher the risk.

Preventing Viral Influenza

Preventing influenza (the "flu') may prove to be a more important protective measure against ear infections than preventing bacterial infections. For example, studies report that children who were vaccinated against influenza experienced 33% to 36% fewer ear infections during flu season than unvaccinated children. (The vaccine provided no additional protection at other times.)

Viral Influenza (Flu) Vaccines. Vaccines against influenza (the "flu') currently employ inactivated (not live) viruses to produce an immune response that will then attack the active virus. Vaccines are now given by injection in the fall, usually between October and December. Antibodies to the influenza virus usually develop within two weeks of vaccination, and immunity peaks within four to six weeks, then gradually wanes. A live but weakened intranasal vaccine (FluMist) is proving to be effective and safe in children and is awaiting approval by the FDA at the time of this report.

In general, experts recommend that the flu vaccine be given to all children over six months with a condition that requires regular medical care. Children who are susceptible to recurrent ear infections should probably be given vaccinations against influenza viruses. In fact, in 2003 the American Academy of Pediatrics (AAP) and the CDC encourages vaccination in all children, including healthy children, between six months and two years of age. This recommendation may vary from year to year depending on the supply of the vaccine.

Possible negative side effects include the following:

• Allergic Reaction. Newer vaccines contain very little egg protein, but an allergic reaction still may occur in people with strong allergies to eggs.
• Soreness at the Injection Site. Up to two thirds of people who receive the influenza vaccine develop redness or soreness at the injection site for one or two days afterward.
• Flu-like Symptoms. Other side effects include mild fatigue and muscle aches and pains. They tend to occur between six and 12 hours after the vaccination and last up to two days. These symptoms are not influenza itself but an immune response to the virus proteins in the vaccine. Anyone with a fever, however, should not be vaccinated until the ailment has subsided.

Antiviral Drugs. Antiviral agents have now been developed to treat influenza. One such drug, oseltamivir (Tamiflu), is approved for use in children age one and older. Studies report significant reduction in symptoms and in the incidence of ear infections with this agent. In another study, when the antiviral drug, zanamivir (Relenza), was administered in the nasal passages of adults with influenza, middle ear abnormalities were reduced from 73% to 32%. This drug is available for children greater than seven years old for treatment of influenza, but no research has determined it value for preventing or treating otitis media in children.

Preventing Bacterial Infections

Preventive Antibiotics. Antibiotics have been used to prevent bacterial infections in children with recurrent ear infections (four or more episodes a year). Studies suggest, however, that overall they only prevent one episode a year, and are not generally recommended for prevention, except for specific situations.

Pneumococcal Vaccine. The pneumococcal vaccine protects (Prevnar or PCV7) against S. pneumoniae (also called pneumococcal) bacteria, the most common cause of middle ear infections and other respiratory infections. It has now been added to the Recommended Childhood Immunization Schedule and is also specifically approved for preventing otitis media. An important 2003 study indicated that these vaccinations could result in 1.7 million fewer office visits among four million children, 24% fewer procedures for tube implants, and significantly fewer antibiotic prescriptions.

The recommended schedule of immunization is four doses, given at two, four, six, and 12 to 15 months of age. Infants starting immunization between seven and 11 months should have three doses. (Parents should be sure their infants receive their second and third doses by six months in order to achieve on-going protection from ear infections.) Children starting their vaccinations between 12 and 23 months only need two doses. And those who are over two years old need only one dose.

Experimental Agents

Researchers have observed that the noses and throats of children who are prone to ear infections harbor smaller numbers of the "friendly" bacteria, notably alpha-streptococci. These bacteria, normally found in the upper airways, compete for space with harmful bacteria. They therefore help prevent overproduction of the harmful bacteria. Interesting research is underway using a nasal spray containing alpha-streptococci. In early studies, the nasal spray has helped to protect against recurrent otitis media in susceptible children.