Treating chronic ear infections in kids

Dealing with ear infections in young children can be a difficult part of parenting.

It’s a fact that Dr. Kathryn Halyko, a pediatrician at UnityPoint Clinic Pediatrics Cedar Rapids, knows firsthand, both from her experience diagnosing and treating chronic ear infections and as a parent.

“I’ve got two kids with tubes, and if I had to do it again, we would,” said Halyko, referring to a common treatment where plastic or metal tubes are inserted into the ear to improve drainage and reduce the likelihood of future infections.

There are some symptoms of ear infections to watch for in young children, she noted. “You’ll notice that your child is often fussy. Usually ear infections hurt more when you’re laying down, so you can notice they’re grumpy and often it’s worse at night.”

Ear infections in kids are most common under the age of 3, with kids between the ages of 6 and 24 months being the most susceptible. They commonly follow other illnesses, such as a cold.

“The fluid builds up in their ears, just clear fluid from being stuffy and not draining as well. And that’s exactly what the bacteria that causes the ear infections likes.” Halyko noted that ear infections can be common in children who go to daycare, where germs can spread easily.

Why young kids are prone to ear infections

Anatomy is a main reason that young children can have problems with ear infections, explained Dr. Ryan Dempewolf with Physicians’ Clinic of Iowa. “Certainly they can happen later, but as children get older they typically outgrow the infection problems,” he said. “Their anatomy makes it more likely for them to collect fluid behind their eardrums and they are frequently exposed to more illness in general, such as in daycares.” Other risk factors for recurrent ear infections include things like tobacco smoke exposure, family history, and certain congenital conditions. For example, children with Down Syndrome have more issues with infections. Children with allergies can have more problems with their ears as well.

Dr. Andrew Liu, an otolaryngologist at Mercy Ear, Nose & Throat Clinic, agreed. “The younger you are, the more prone you are to ear infections because in adults, those ear canals sit at a pretty good angle and they drain pretty easily, but actually babies sit almost horizontal,” he said. “So when they get sick it’s a lot harder to drain. And so that’s why most of our kids that are getting chronic ear infections and then needing ear tubes are younger than two or three.”

“Parents can prevent ear infections in their children by fully vaccinating their children, especially with the pneumococcal, H. influenza and yearly influenza vaccines,” said Dr. Jorie Shire, a pediatrician at Physicians’ Clinic of Iowa. “Vaccines prevent these very common bacteria and viruses that cause the majority of ear infections. It has also been documented that breast feeding for at least three months protects against ear infections. Of course, not smoking in your home, car or around your children will prevent ear infections.”

When to see an ENT specialist

According to the American Academy of Pediatrics, ear infections are considered chronic when your child has three separate episodes in six months or four in the last year, with one of those episodes being within the last six months. At this point your pediatrician would likely refer you to an ENT for tube placement surgery.

An ENT referral is especially likely for children younger than 2, because chronic ear infections can lead to speech delay due to having fluid in the inner ear, balance problems, and in rare cases hearing loss.

“That’s right in the middle of the critical period for speech development,” said Liu. “So by putting tubes in for a child who’s had recurrent ear infections, it’s really very important to allow for their ability to hear and develop speech and ability to communicate.”

Halyko noted that some parents are hesitant to consider ear tubes, but she tells her patients about the impact it can have on the whole family. “If you have to have a surgery during childhood, this is the one to have,” she said. “It’s about a 5-minute procedure.”

Liu agreed that tube placement is a quick procedure. “It is does require general anesthesia for kids, but no breathing tube or IV is needed typically,” he said. “The child is put to sleep with a mask and anesthetic gas. It takes me about two minutes to place tubes most of the time. The surgery goes fast and you are home in no time. Most kids will act like nothing even happened by the evening of surgery.” He noted that pain management is pretty easy, and there will be a follow-up appointment after six months to check the tubes. The tubes usually fall out on their own in about one to one and a half years, and Liu noted that some kids will need more than one set of tubes.

Children are often prescribed oral antibiotics for ear infections, but oral antibiotics can only be effective for so long, Dempewolf explained. “Antibiotic resistance development and side effects are real concerns, and tubes help kids use far fewer oral antibiotics,” he said.

Shire noted that the tube placement can reduce the need for oral antibiotics. If your child has ear tubes in place you will notice ear drainage when they have an ear infection, which can then be treated with ear drops instead of oral antibiotics.

“This is what is expected and what we want to happen,” said Dempewolf. “It means the tube is open and working. With tubes in, the child can have an infection treated with antibiotics drops. The drops are topical and do not cause the same kind of problems oral antibiotics do.”

Kids can still get infections even with tubes in, but they will happen far less often than they would without tubes.

“Ear tubes are not a magic bullet. They don’t stop ear infections,” Liu said. “The idea is that it helps drain the fluid out of the middle ear to provide relief from the pressure and pain.”

Like Halyko, Shire also has some personal experience she shares with her patients’ families. “As a parent of two children who both required ear tubes due to recurrent ear infections, I would recommend the surgery to help the child sleep, prevent loss of school or daycare and overall feel better.”