The Ins and Outs of Ears: Ways to Treat and Prevent Ear Infections in Children

Written By: Alan Greene, M.D.

Ask a room full of people if they’ve ever had an ear infection, and chances are most of the hands will go up. Ear infections are so common that not only are they the number one reason antibiotics are prescribed for children, they are also the number one reason kids undergo surgery. And, no surprise to any parents out there, they’re one of the most common ailments keeping children awake in the midst of the night.

Statistics show that 20% of children acquire an ear infection in the first year, along with 40% by age 2 and 60-80% by age 4. While the percentage increases with age, most ear infections occur in children ages 6 months to two years, with the colder months of October to March accounting for the highest rates of infection overall.

Ear infections might be considered a “plumbing problem” related to the respiratory system. The little opening that we sometimes clean with Q-Tips extends into a small tube that reaches into the ear, ending at the eardrum, or tympanic membrane. Behind this porous membrane is another area, called the “middle ear.” The middle ear is lined with tissue much more moist and delicate than the skin outside the eardrum. It can be likened to the lining of the inside of your cheeks. This damp environment needs a system for drainage, thus the presence of Eustachian tubes. This portion reaches from the middle ear to the back of the throat, where fluid levels within the ear can be balanced by draining themselves as needed. Infection occurs when the ability to naturally drain excess fluid is blocked, and this section of the ear becomes backed up, creating the ideal breeding ground for bacteria.

Infections of this sort are typically characterized by redness, swelling and pain within the ear, along with the more obvious signs of general fussiness and trouble sleeping. Sometimes ear infections may come in tandem with a cold, when the body is producing extra mucous and having trouble clearing it out. Other triggers can include exposure to smoke (cigarette, fire, or other types), in addition to seasonal or environmental allergies. While it’s certainly painful to witness a child dealing with an ear infection, recent studies show that the historic use of antibiotics as the first resort may, in fact, be unnecessary.

It’s no secret that antibiotic resistance is on the rise, largely due to over-enthusiastically prescribing them. However, a study by Cochrane showed that only 1 in 20 children actually needed antibiotics in order to fight the bacteria present in an ear infection. The other 19 naturally fought it off on their own. In addition to that, a study using chinchillas, whose ear structure is very similar to humans, showed that waiting several days before administering antibiotics enabled them to heal faster. The theory is that a delay in the use of antibiotics enables the body’s immune system to start fighting off the infection, while giving antibiotics too quickly essentially “tricks” the body into thinking it doesn’t need to work as hard to fight for itself.

There are certainly circumstances in which antibiotics are necessary, and they are undeniably helpful when used appropriately. For children under 6 months, antibiotics may be the better choice. The same is true in cases of severe pain, or if a fever is higher that 102.2 degrees. If both ears are infected, this may also be a time when antibiotics are appropriate, as the immune system is fighting double the battle. In addition, if a child regularly experiences 3 or more infections in 6 months, or over 4 in a year, special drainage tubes may be a good option. However, if infections are infrequent, the fever is relatively low and pain is manageable, waiting a couple days will likely give the immune system enough time to right itself naturally.

The evidence that children are more often than not equipped to address ear infections naturally is great news. For these children, exhibiting signs of an ear infection it’s often best to begin by keeping an eye on their symptoms for 48-72 hours. During this period one of the best things to do is help reduce inflammation and swelling in order to make the ear more comfortable. Olive oil, especially when infused with anti-inflammatory, pain-reducing herbs such as garlic, mullein and St. John’s wort, can be very soothing when gently warmed and administered to the ear with a dropper. The appropriate dose of ibuprofen also manages pain and reduces swelling, making it especially helpful for children to rest at night.

There are also several ways to help prevent the onset of ear infections. Children who are breastfed have been exposed to antibodies that boost the immune system, and thus incur fewer incidents of infection. Weaning children off pacifiers after 6 months has also shown to reduce infection, as well as attending smaller daycare groups of less than 6 children. Keeping smoke of all types and synthetic fragrances out of the home also reduces the likelihood of ear infections.

While ear infections may be common in your household, there are ways to reduce the frequency, and soothe your child when they do occur. Always be sure to address pain and inflammation in the ear so children are able to rest, which enables the immune system to work more effectively. Natural ear drops can greatly alleviate symptoms, without adversely affecting beneficial bacteria in the body.

There are also many great resources if ear infections are common in your household. And if this is the case, don’t despair. Children’s bodies are incredibly adaptable. Supporting a healthy, balanced microbiome can do wonders to boost the immune system, paving the way for less sick days and more play dates!

Want to learn more? Check out our podcast episode dedicated to ear infections

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