Ear Infection Health Article

Prevention

Although otitis media seems inevitable in childhood, some measures can be taken to decrease the chance of repeated infections and fluid accumulation. Breastfeeding provides some protection against URIs, which in turn protects against the development of otitis media. If a child is bottle-fed, parents should be advised to feed him or her upright, rather than allowing the baby to lie down with the bottle. General good hygiene practices (especially hand washing) help to decrease the number of upper respiratory infections in a household or daycare center. Hand sanitizers are preferable to antibacterial soaps, which may contribute to bacterial resistance.

The use of pacifiers should be avoided or limited. They may act as fomites, particularly in a daycare setting. In children who are more susceptible to otitis media, pacifier use can increase by as much as 50% the number of ear infections experienced.

Two vaccines can prevent otitis media associated with certain strains of bacteria. One is designed to prevent meningitis and other diseases, including otitis media, that result from infection with Haemophilus influenzae type B. Another is a vaccine against Streptococcus pneumoniae, a very common cause of otitis media. Children who are at high risk or have had severe or chronic infections may be good candidates for these vaccines; in fact, a recent consensus report among pediatricians recommended routine administration of the pneumococcal conjugate vaccine to children younger than two years, as well as those at high risk for AOM. Parents should consult a healthcare provider concerning the advisability of this treatment.

Another vaccine that appears to lower the risk of AOM in children is the intranasal vaccine that was recently introduced for preventing influenza. Although the flu vaccine was not developed to prevent AOM directly, one team of researchers found that children who were given the vaccine before the start of flu season were 43% less likely to develop AOM than children who were not vaccinated.

As of early 2003, there is no vaccine effective against M. catarrhalis. Researchers are working on developing such a vaccine, as well as a tribacterial vaccine that would be effective against all three pathogens that commonly cause otitis media.

A nutrition-based approach to preventive treatment is undergoing clinical trials as of late 2002. This treatment involves giving children a dietary supplement of lemon-flavored cod liver oil plus a multivitamin formula containing selenium. The pilot study found that children receiving the supplement had fewer cases of otitis media, and that those who did develop it recovered with a shorter course of antibiotic treatment than children who were not receiving the supplement.

After a child has completed treatment for otitis media, a return visit to the practitioner should be scheduled. This visit should occur after the course of antibiotic has been completed. It allows the practitioner to evaluate the patient for the persistent presence of fluid within the middle ear. In children who have a problem with recurrent otitis media, a small daily dose of an antibiotic may prevent repeated full attacks of otitis media. In children who have frequent bouts of otitis media or persistent fluid, a procedure to place ventilation tubes within the eardrum may help to equalize pressure between the middle ear and the outside, thus preventing further fluid accumulation.

BOOKS

Duran, Marlene, et al. "Infections of the Upper Respiratory Tract." In Harrison's Principles of Internal Medicine, 14th ed., edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998.

"Otitis Media and its Complications." In Nelson's Textbook of Pediatrics, edited by Richard Behrman. Philadelphia: W.B. Saunders Co., 1996.

Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part I: Chiropractic and Osteopathy. New York: Simon & Schuster, 2002.

Ray, C. George. "Eye, Ear, and Sinus Infections." In Sherris Medical Microbiology: An Introduction to Infectious Diseases, edited by Kenneth J. Ryan. Norwalk, CT: Appleton and Lange, 1994.