Middle ear infections (otitis media) are so common that 75% of all toddlers have had at least one by their third birthday. Some children are constantly plagued by this most common of all childhood illnesses and may need surgery to install tubes in their ears or to have their adenoids removed. Others may suffer from high fever, ruptured eardrums or hearing loss that can hurt their ability to learn to talk and understand new words.

Otitis media is a very old human ailment; examinations of 2600-year-old Egyptian mummies show evidence of perforated eardrums and damage to the mastoid bone (the bulging bone behind the ear) from infection spreading into the skull. Such skull infections were common in the days before modern antibiotics. In 1932, purulent otitis media accounted for 32% of all the admissions to Bellevue Hospital in New York City.

My own father suffered from such an infection when he was a little boy; when he had a raging ear infection, the doctors wrapped him in a sheet and stuck a long, skinny knife into his ear to pierce the eardrum and release the pus and pressure. This was completely without anaesthesia, of course. Eventually he had to have part of his mastoid removed. He still has a deep scar behind his ear.

There are two types of otitis media:

  1. acute otitis media: (AOM) The interior of the ear and the eustacian tubes are infected and swollen, and mucus and fluid are trapped inside the ear. This is often very painful, but a few children experience no pain.

  2. otits media with effusion (OME): in this condition, fluid stays trapped in the ear after the infection is over. This can cause hearing and balance problems and also provides a fertile ground for new infections.

Children are most at risk of developing ear infections because their immune systems are not fully formed and because their eustacian tubes are shorter and angled in such a way as to make them get clogged with mucus more easily.

But ear infections may soon become a thing of the past.

Scientists are working on developing safe vaccines against the bacteria that commonly cause ear infections. Such bacteria include:

One bad bug researchers at Children's Hospital in Columbus, OH have targeted is Haemophilus influenzae. In addition to ear infections, it can also cause pneumonia and, rarely, meningitis (an infection of the covering of the brain).

So, a vaccine against H. influenzae and its kin could give infants a powerful dose of protection to keep them healthy throughout childhood.

One vaccine is already on the market. Prevnar, which was approved for use in the U.S. in 2000, protects children from Streptococcus pneumoniae bacteria. Such pneumococcal bacteria are common culprits behind ear infections (like H. influenzae, they can also cause meningitis). Nobody knows when the other vaccines will be ready, but parents can help protect their children in the meantime.

If you have a baby, breastfeed him or her if you can. Infants get antibodies from their mothers' milk that defend against infections. Conversely, there has been some indication that formula in bottles can become easily contaminated with bacteria that then reinfect children drinking from them. Babies who get ear infections in their first year are most prone to chronic infections later because they tend to develop a colony of bacteria in their throats that doesn't go away easily.

Keep a close watch on your children's health. Don't let people smoke around them, because smoke can damage the delicate membranes of children's throats and ears and give bacteria a foothold to grow. If your child complains of ear pain, seems to have balance problems, or if your toddler is crying and pulling at his or her ears, take your child to the doctor as soon as you can.

If your doctor gives you antibiotic medicine for your child, make sure you and childcare providers know when to give doses. The type of antibiotic and treatment depends on whether the infection is acute or recurrent and on what type of bacteria are the cause, but children will often need to take antibiotics for 10-14 days to fully clear up an infection.

Make sure your child finishes all the medicine. Some children may need treatment up to two weeks, and they may look and feel better before the medicine bottle's empty. If you stop giving them their medicine too soon, bacteria lurking in their systems could come back stronger than ever before (and newly-resistant to the antibiotic your child was taking).

Until more vaccines are ready, prompt and complete antibiotic treatment is the best way to ensure that your child doesn't suffer from ear infections again.



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