There are many myths and facts that surround ear pain and ear infection. What makes things worse is that there is often a great deal of variation in the way different doctors treat ear pain and ear infection. So I am starting a new series aimed at helping Smart Parent get the facts they need to make intelligent decisions about how best to treat (or not treat) ear pain and ear infection.
Myth #1: Ear pain always means my child has an ear infection.
False. There are many causes of ear pain and most children who complain of ear pain DO NOT have an ear infection. The most common reason children complain of ear pain is eustachian tube dysfunction. The eustachian tube is a small tube that connects the ears to the back of the nose. When this tube functions properly, fluid is able to drain out of the ears into the nose. However, in the setting of nasal congestion the eustachian tube may become blocked which keeps fluid from draining out of the ears. In some cases this extra fluid may be felt as pressure in the ears and cause slight discomfort.
Myth #2: Ear Infections require antibiotics to get better.
False. When you look through all the medical literature it is has been rather clearly established that roughly 81% of ear infections resolve completely on their own without any antibiotics. By using antibiotics you can increase than number to 93%, a meager 12% increase.
Myth #3: If my child has an ear infection and does not get antibiotics immediately something BAD will happen.
False. As mentioned above, roughly 4 out of 5 ear infections will completely resolve even if you do not use any antibiotics at all. Many European countries wait a few days before starting antibiotics. If the symptoms (ear pain, fever, etc.) persist then they start an antibiotic. This approach was recently adopted by the American Academy of Pediatrics (AAP) in this clinical practice guideline. The meaningful outcomes do not seem to change by delaying antibiotics for a few days. However, the number of unnecessary treatments and the amount of antibiotic resistance is significantly less with this approach.
Myth #4: Ear infections cause permanent hearing loss.
False. Ear infection, treated or not, virtually never causes any permanent hearing loss.
FACT #1: Ear infections are painful.
True. An ear infection is essentially an abscess behind the ear drum. Just like any other abscess, it is painful. However, the ear pain is generally very responsive to oral pain relievers or in some cases ear drops.
Fact #2: If my child has ear pain for more than a few days I should see my doctor.
This is true. Ear pain that does not resolve in 2-3 days is more likely to require antibiotic treatment.
Fact #3: If my child has ear drainage or pain behind the ear I should see my doctor.
True. These are the two most common complications of ear infections. Both generally require antibiotics. Pain and redness behind the ear maybe a sign of mastoiditis, which is infection in the bone behind the ear. It is estimated to occur in 1:1000 ear infections. Mastoiditis and ear drainage is easily treated.
Fact #4: You can use Over-the-Counter Pain medication to treat most ear infections.
Tylenol and Motrin are both good options for pain relief when your child has ear pain. They can be used together if needed. However, you should use them as needed, not scheduled around the clock. Remember that these medications are also fever reducers, and fever reduction is not always good. Read my page on fever for more information.
There is also good evidence to suggest that over-the-counter (non-prescription) ear drops are effective for pain relief and treatment in children and may be equivalent to antibiotics in most cases.
My next post covers the common misconception that all ear infections need to be treated with antibiotics. This simply is not true. To learn more click read my next post:
This is the current AAP Policy: Diagnosis and Management of Acute Otitis Media. In this article you will find the currrent recommendations and rationale behind those recommendations.