Children's Health

Otitis Media or Middle Ear Infections

Definition: Acute otitis media is inflammation of the middle ear due to a bacterial or viral infection, usually secondary to an upper respiratory tract infection. It is common in young children from 3 months to 3 years. The first complaint is usually of a persistent severe earache. Hearing loss may occur along with fever, nausea, vomiting, diarrhoea and drainage from the ear. Babies may demonstrate irritability, fussiness or difficulty in sleeping, feeding or hearing. Perforation of the tympanic membrane (eardrum) is major complication. 

Recurrent otitis media is particularly common in younger children.  One of the main reasons for this is that the Eustachian tube does not have much of a slope, preventing adequate drainage of mucous.  One factor that leads to increased mucous production, is dietary with wheat and dairy products being the major offenders.  It is the build up of mucous which then provides the perfect breeding ground for bacterial or viral infection. 

Unfortunately, over-use of antibiotics has lead to resistance and recurrent infections.  The following is just one of many studies into the use of antibiotics to treat otitis media: 

Antibiotic Use in Children with Otitis Media Increases Risk for Recurrence - Another reason to wait and see 

Clinicians often prescribe antibiotics for treatment of uncomplicated acute otitis media (AOM) [middle ear infection] in children despite lack of evidence for improved outcomes. To examine the effects of antibiotic treatment on recurrence of AOM, investigators in the Netherlands surveyed parents of 240 children (age range, 6 months to 2 years) about 3 years after the children had participated in a multicentre, randomised, double-blind trial of amoxicillin (40 mg/kg/day in 3 doses) or placebo for treatment of AOM (JW Emerg Med Apr 1 2000). Seventy percent of parents returned questionnaires. 

Parents reported at least one episode of AOM since the 6-month post-treatment follow-up visit significantly more often in the amoxicillin group than in the placebo group (63% vs. 43%). Even after adjustment for confounding factors, children in the amoxicillin group had 2.5 times the risk for recurrence. In sensitivity analysis among children who were not prescribed antibiotics during the 6 months after randomised treatment, the adjusted odds ratio for recurrence was 4.4. Ear, nose, and throat surgery was less likely in the amoxicillin group (21% vs. 30%).  

The authors note that wide confidence intervals limit interpretation of the results and caution that the findings cannot be generalized to children with underlying disease or who live in under-resourced conditions. 

Comment: One more nail in the coffin for antibiotic use in simple otitis media! This practice increases risk for colonization with resistant pathogens and recurrent infections in individual children and contributes to antibiotic resistance in the general population. In uncomplicated cases, be assured that resolution without antibiotics is the rule, not the exception, and try a "wait-and-see prescription," rather than immediately starting unnecessary antibiotics. There are also many natural supportive remedies available – both preventative and treatment options.

Reference:  Bezáková N et al. Recurrence up to 3.5 years after antibiotic treatment of acute otitis media in very young Dutch children: Survey of trial participants. BMJ 2009 Jun 30; 338:b2525. (http://dx.doi.org/10.1136/bmj.b2525) 

Always seek the advice of a qualified health practitioner.  Should your child require antibiotic treatment, then remember to replace the good gut bacteria and support the immune system to prevent recurrent infections.  This is where your Family Naturopath can help.