Photograph provided by Pixabay, Holger Kraft
 

Here are 6 childhood ear infection facts that parents often don't know. How do I know that many parents don't know these things you ask... because I've been practicing pediatrics for 37 years , that's how. Let's test your pediatric ear infection knowledge in this edition of Portable Practical Pediatrics.

 

This pedcast was originally posted on may 19, 2019.

Musical Intro

What Causes Ear Pain? 

Have you ever wondered what is going on when your child complains of ear pain while having a cold. And how do you know if your young child, with little ability to talk or localize pain, if he or she is hurting?  It reminds me of an afternoon 30 something years ago when I was taking care of my son Ben who had a bad cold. He was two years old at the time. I couldn't get him to play, read a book with me, or eat anything. He was just acting strange. And he cried about everything. He was old enough to be verbal but wasn't complaining of anything, just crying, crying, crying. After a few hours of this, his genius pediatrician father, yours truly, wondered if he might have an ear infection complicating his bad cold. I pulled out my otoscope and oh yes, he had a hot one. I felt terrible that I didn't think about this earlier in the day and he had suffered all day. So much for that medical degree and 4 years of pediatric training... I learned that day that being a parent is different.

So what was causing little Ben's pain? Any of the structures around the ear can cause ear pain including your child's teeth, their muscles of chewing, the joint in their jaw that moves with chewing, or their tonsils, but...when it comes to causes of ear pain, the big gorilla in the room is a middle ear infection caused by trapped infected mucous behind their ear drum.  Sure enough, Ben's infection was the middle ear type, an extension of his cold back into his ear, and his pain was caused by a sudden outward pressure on his ear drum from the pus that developed in his middle ear. "Ow!"  You may not be aware but a child's eardrum is as sensitive as their corneas and when it gets pushed on, its not fun!

History of Treatment of Middle Ear infections

   --  In my childhood, ear infections were treated by lancing your eardrum. My pediatrician, let's call him Dr. X, simply reached into his pocket and pulled out a little instrument called a myringotomy knife (that means eardrum knife) and he simply cut your eardrum letting the pressure and pus out of my eardrum.  Needless to say Dr. X was not my favorite person and I learned quickly not to EVER complain of an earache.  When he was not cutting my eardrum, his nurse was always giving filling my bottom full of penicillin.  Dr. X and his nurse made quite a team.  Fortunately, medicine has moved forward from those days.  For the rest of the twentieth century, antibiotics alone became the mainstay of treatment for otitis media. More humane and very effective until the era of antibiotic resistant bacteria arrived... you know those super bugs that just laugh at our strongest medicines and refuse to die. Their existence has forced a revolution in treatment in the past decade.

Some Interesting Facts About Otitis Media

Parents need to consider otitis media when their children have a snotty nose, usually for a few days, and they start acting like they have pain-maybe by just crying a lot like Ben did, or pulling at their ears, or not sleeping, or a myriad of other more subtle signs. Most ear infections afflict preverbal children so knowing when to take them to the pediatrician can be challenging. At the beginning of my pediatric career, a full 40% of all visits to my office were related to ear infections. Not today, mainly because a vaccine that most children in the U.S.