Earaches are the number one cause of pediatric visits. Fluid can easily build up in a child’s tiny middle ear, creating pressure on the eardrum and causing intense pain. Most ear infections, however, are painful but not serious. According to Dr. Richard M. Rosenfeld, a professor and chair of otolaryngology at SUNY Downstate Medical Center in Brooklyn, 70% of children with ear pain get better on their own within two or three days.
Here are the three types of ear infections:
- Acute Otitis Media is painful and responds to antibiotic treatment. Usually caused by bacteria.
- Otitis Media with Effusion is fluid build up in the ear without any signs of infection (pain, redness, fever). Usually caused by a viral infection and not helped by antibiotics.
- Otitis Externa (Swimmer’s Ear) is an infection that can cause the ear to itch and be very sensitive to touch or pressure. There may be drainage from the ear. Antibiotics may help.
When I was a young mom, antibiotics were routinely prescribed at the first sign of a possible ear infection. And, still today, ear infections are the most common reason that antibiotics are prescribed for children. We now know that the overprescribing of antibiotics can contribute to antibiotic resistance. Just last year the CDC issued a Threat Report on antibiotic resistance. In an effort to promote antibiotic best practices, the CDC encourages what they call, “antibiotic stewardship:”
- Ensuring all orders have dose, duration, and indications.
- Get cultures before starting antibiotics.
- Take an antibiotic “time-out.” Reassess antibiotics in 48 5o 72 hours.
AMERICAN ACADEMY OF PEDIATRICS GUIDELINES
The American Academy of Pediatrics (AAP) treatment guidelines for ear infections were revised in 2013 to reflect CDC concerns over antibiotic resistance. The AAP recommends:
Clinicians should diagnose acute otitis media (AOM) in children who present with the following:
- moderate to severe bulging of the tympanic membrane (TM)
- discharge from the ear not due to acute otitis externa (swimmer’s ear).
- recent (less than 48 hours) onset of ear pain (holding, tugging, rubbing of the ear)
- intense redness of the TM.
Clinicians should not diagnose AOM in children who do not have middle ear inflammation.
The management of AOM should include an assessment of pain. If pain is present, the clinician should recommend treatment to reduce pain.
The clinician should prescribe antibiotic therapy
- for AOM in one or both ears in children 6 months and older with moderate or severe earache for at least 48 hours or temperature of 102.2°F or higher.
- for AOM in both ears in children 6 months through 23 months of age with mild earache and temperature less than 102.2°F.
The clinician should either prescribe antibiotic therapy or offer observation with close follow-up based on joint decision-making with the parent(s)/caregiver
- for AOM in one ear in children 6 to 24 months of age without a severe earache and with temperature less than 102.2°F.
Clinicians should reassess the patient if the caregiver reports that the child’s symptoms have worsened or failed to respond to the initial antibiotic treatment within 48 to 72 hours and determine whether a change in therapy is needed.
Clinicians should not prescribe prophylactic antibiotics to reduce the frequency of episodes of AOM in children with recurrent AOM.
Clinicians may offer tympanostomy tubes for recurrent AOM (3 episodes in 6 months or 4 episodes in 1 year with 1 episode in the preceding 6 months).
TYMPANOSTOMY (EAR TUBES)
Many children with recurring ear infections undergo tympanostomy tube placement–surgical insertion of drainage tubes in the eardrum. Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. However, many doctors themselves believe that the surgery is prescribed more than is necessary. A study of more than 6,600 children who had undergone tube placement found that almost 60 percent of the surgeries performed were unnecessary or had risks equal to benefits.
UNDERLYING CAUSES OF EAR INFECTIONS
Babies who are breastfed have a lower incidence of ear infections than do formula fed babies and the AAP recommends exclusive breastfeeding for at least six months. Second-hand smoke can aggravate ear infections and some studies show that pacifier use puts babies at higher risk for ear infections. If your child experiences more than two ear infections a year, you should look for underlying causes. There are several reasons why fluid might build up in the middle ear. They include:
Allergy. Many studies have suggested a link between food intolerance and middle ear problems. One study tested 104 children with recurring middle ear problems for food allergy and discovered 81 to be allergic. After eliminating the offending foods, 86% got better, and 94% got worse when the offending foods were reintroduced. The most common allergens are dairy products, wheat, egg white, peanuts, and soy. If your child suffers from recurring ear infections, you might first try eliminating dairy products or wheat from his or her diet, then the other common allergens.
Nutritional deficiency. Researchers have found that children with high susceptibility to ear infections are often deficient in zinc, iron, or vitamin A. One study found substances related to the improper intake of dietary fats in the middle ear fluid of children with otitis media. Eating transfatty acids–found in margarine as well as french fries, donuts, cake frostings, and other junk foods–can set the stage for inflammation. Often children with recurrent earaches improve simply by switching to a more wholesome diet.
Mechanical obstruction. A blockage of the eustachian tube can occur as a result of swollen tonsils or adenoids, or from structural problems in the bones surrounding the ear. The biomechanics of these delicate bones can be disrupted by any physical trauma, including a fall or a difficult birth. Chiropractic adjustments or craniosacral therapy are often effective at resolving these problems and preventing recurring ear infections.
NATURAL REMEDIES FOR EARACHES
Herbs. Ear drops can help relieve the pain of an earache. A blend of mullein and garlic oil is a good choice because of its antiviral and antibacterial properties; St. John’s wort and calendula can also be added. You can buy herbal ear drops or make your own. Garlic can be irritating to the ear canal in high concentrations, so be sure to dilute the garlic oil with other oils such as mullein. If you want to learn how to make your own herbal infusion, see the tutorial above from master herbalist, Susun Weed.
To administer ear drops: Run hot water over a spoon until it is warm, pour a few drops of oil onto the spoon to warm the oil. Alternately, run the glass dropper filled with oil under warm water and test its temperature by putting a drop on the back of your hand. Next put two to three drops of the oil in each ear while your child is lying down; plug the ear loosely with a cotton ball. Repeat two or three times a day for no more than four days.
Aromatherapy. Make an aromatherapy ear rub with several drops of lavender, tea tree oil, and chamomile essential oils in 1 ounce of olive oil. Rub the oil mixture around the outside of the ear and over the lymph nodes on the side of the neck, or dab a cotton ball in the oil, gently place it in the ear, and leave it in until the infection is gone, replacing it with a fresh cotton ball several times a day.
Homeopathy. Homeopathic remedies can be administered at home to relieve the pain of occasional earaches. See Homeopathic Medicine At Home for more information.
- If your child is angry, fearful, and sensitive to light and noise, consider Belladonna, which is effective for earaches that come on suddenly, with severe, throbbing pains.
- Chamomilla is good for earaches associated with teething.
- Children who need Pulsatilla tend to be weepy, sensitive, and clingy. Their cheeks will be pale, and there may be a thick, yellow-green discharge from the nose or the ear. Symptoms often come on gradually, frequently following a cold.
- Aconite is for the sudden onset of earache after a chill. The child may awaken in the night screaming with pain and appearing anxious and scared.
- Recurring earaches also respond well to homeopathic treatment; consult a trained homeopath for help in choosing the right remedy.
And, don’t forget the natural soothers of a cozy bed, a cool washcloth on the forehead, or a hot water bottle to lean against. Good simple food, hearty soups, homemade lemonade and the company of loved ones are sure to help the healing process.
Peggy O’Mara is the editor and publisher of peggyomara.com. She founded Mothering.com in 1995 and was its editor-in chief until 2012. She was the editor and publisher of Mothering Magazine from 1980 to 2011. The author of Having a Baby Naturally; Natural Family Living; The Way Back Home; and A Quiet Place, Peggy has conducted workshops at Omega Institute, Esalen, La Leche League, and Bioneers. She is the mother of four and grandmother of three.