Ear infections are one of the most common infections that we treat here at Pediatrix Urgent Care. Because ear infections are more common in children, parents are often unclear about the symptoms, treatment and severity of an ear infection. Below we debunk six common myths.
MYTH 1
All children or adolescents with middle ear fluid need to be treated with antibiotics.
ANSWER: NO
Acute otitis media (AOM) is a severe infection of the middle ear fluid. Middle ear effusion (MEE) or otitis media with effusion (OME) refers to fluid in the middle ear cavity, which can happen after AOM or if there is dysfunction of the Eustachian tubes.
MEE occurs in both otitis media with effusion and AOM. MEE can be seen after antibiotic treatment of AOM, but it is not an indication for repeat antibiotic treatment unless it gets infected again. The importance of accurately diagnosing AOM cannot be overstated. Accurate diagnosis ensures appropriate treatment, since AOM requires antibiotic therapy, while OME does not. Ultimately, accurate diagnosis prevents overuse of antibiotics, which can lead to the development of resistant organisms.
MYTH 2
Children and adolescents with confirmed ear infections must be treated with antibiotics.
ANSWER: NO
Roughly 80% of children with acute ear infections get better without antibiotic treatment. Also, studies show delaying antibiotic treatment does not increase the likelihood of developing a severe illness. 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 children 6 months to 23 months of age.
During observation, steps must be put in place to ensure follow-up and to begin antibiotic therapy if the child worsens or fails to improve within 48 to 72 hours of ongoing symptoms. Gathering as much information as possible is also essential because a progressively or severely ill child is more likely to have a bacterial infection that may not improve quickly.
Starting an antibiotic is reasonable if your child is:
2 months or younger and has a diagnosis of certain or suspected acute infection
Between the ages of 6 months and 2 years and has severe symptoms with a diagnosis of certain or suspected acute infection
Between the ages of 2 and 12 years and has severe symptoms with a diagnosis of certain acute infection
Severe symptoms are defined as moderate or severe ear pain for at least 48 hours or a temperature of 102.2°F or higher.
MYTH 3
My child’s ear infection should always be treated with Amoxicillin.
Answer: NO
Here are some reasons to go with something different or stronger than Amoxicillin:
If the fever and fussiness are not improving after 48 to 72 hours of an antibiotic, your child may need a stronger one.
If Amoxicillin has not worked two or three times in the past, then it’s OK to start with a stronger antibiotic for future infection.
If your child has taken Amoxicillin in the past 4 to 6 weeks and then develops another ear infection, chances are that this infection is resistant and needs a stronger antibiotic.
If your child is allergic to Amoxicillin
If there is accompanying pink eye with discharge which increases the likelihood of bacteria (non-typeable hemophilus influenza), which is commonly resistant to Amoxicillin.
If you are looking for virtual urgent care for kids, you are in luck. Pediatricx Urgent Care now provides the convenience of telehealth appointments so you can easily call or video chat with our pediatricians right from your home.
MYTH 4
Most ear aches are due to middle ear infection.
ANSWER: NO
Symptoms such as ear tugging or ear pain, while often helpful in nonverbal children, may also indicate middle ear fluid without infection. Other symptoms, such as irritation of or blisters on the eardrum, may be due to a viral infection (myringitis). Eustachian tube dysfunction with hearing loss is common in children with allergic rhinitis, enlarged adenoids especially after a plane ride or referred pain from a dental or throat problem.
Ear pain as a symptom should be distinguished from pain in the external canal due to otitis externa, which results in pain on movement of the earlobe and inflammation of the ear canal usually without any systemic symptoms such as fever.
MYTH 5
Children’s ear infections aren't serious.
ANSWER: NO
Rarely, a severe or untreated infection can rupture your child’s eardrum. However, ruptures don’t happen very often and heal quickly.
Repeated ear infections or chronic middle ear fluid without infection can sometimes cause hearing loss and scarring. In rare cases, untreated ear infections lead to mastoiditis (a skull infection behind the ear) or meningitis.
Follow up with your child’s doctor to make sure the infection has cleared up and that the eardrum is healing well. As long as your child’s condition is minor and not life-threatening, you’ll be able to discuss it with a pediatrician via telemedicine.
MYTH 6
There is no way to prevent ear infections.
ANSWER: NO Breastfeeding until at least 6 months is recommended to help prevent acute ear infections. Parents should also avoid “bottle propping” and limit children’s exposure to secondhand smoke.
Each Pediatrix Urgent Care and walk-in clinic located in greater Orlando, Melbourne, Jacksonville and Port St. Lucie areas is designed to be a child-friendly, efficient, doctor-recommended alternative to the emergency room. Reserve A Spot Now or simply walk-in.
Dr. Ayodeji Otegbeye
About the Author:
Dr. Ayodeji Otegbeye, better known as “Dr. O” is the President and Founder of Central Florida Pediatrics Intensive Care Specialists and Night Lite Pediatrics Urgent Care. Dr. O was the Medical Director of Children’s Medical Services in the Central Florida Region (Orange, Seminole, Osceola and Brevard Counties) from 2004 – 2019; and the Medical Director of Leesburg Regional Hospital Pediatric Hospitalist Program.
Disclaimer: These articles are not intended to be used for diagnosis or treatment. It is aimed at presenting a perspective only and is not a substitute for a prescription. Anyone experiencing a medical condition should consult their doctor.