Ear Infection… or NOT?


It’s inevitable: with the start of the school year comes the onslaught of snot. Germs travel throughout the classrooms, cafeterias and locker rooms. As winter draws nearer, the problem multiplies like the bacteria and viruses that cause it, and many of their effects include ear symptoms. The issue lies in knowing when an earache is actually an infection. There is a high likelihood that a visit to an urgent care facility will end with a prescription for an antibiotic; but, most ear pain is not due to bacteria that the medicine is meant to fight. Every year, millions of antibiotic prescriptions are written for otitis media (middle ear infection), despite the fact that 75 percent of them are caused by viruses which, in fact, are not affected in the least by the antibiotic.

Most ear pain is not due to bacteria that antibiotics are meant to fight.

A child screaming in agony from an earache is plenty of motivation to take the antibiotic, just in case, even if only for peace of mind; but doing so can result in resistant organisms both in the child and in the general population, as a whole. In multiple studies, the “wait and see” approach, i.e. “no” to antibiotics but “yes” to pain control, decongestants, etc., results in just as quick a recovery without the risk of resistant bugs or reactions to unnecessary antibiotics.

As the father of twin boys who had their share of snot and infections, I know how tempting it can be to reach for the “pink stuff” when a kid is miserable. So, here are some tips for approaching earaches, in general.

If the child’s hearing is good, then it’s not an ear infection. By definition, an ear infection occurs in the middle ear – a typically air-filled space that conducts and amplifies sound that goes through it to the inner ear. So, when there is anything but air in that space (like pus in the case of infection), sound transmission is severely diminished and hearing is affected. When a kid complains of an earache but can still hear their video game or phone just fine, it’s probably not otitis media.

Okay, your kid is in misery with ear pain, but his hearing is great … what else could it be? Well, there’s another type of ear infection: otitis externa (OE), otherwise known as an external ear infection. The most common type is also called “swimmer’s ear,” which can be excruciatingly painful; sometimes, even a light tug at the ear will elicit screaming. This is in contrast to the middle ear infection, in which a gentle tug is not nearly as painful. The other difference between OM and OE is that with OE, hearing is usually pretty decent. Unless the canal is completely swollen shut, sound still gets through and the effect on hearing is mild, compared to OM which causes kids to ask, “Huh?” all day long. The other difference between OE and OM is that with OE, there is likely to be drainage from the ear canal that forms crust at the outer edge.

So, what if your child has an earache, his hearing is great, a tug is minimally painful and there is no drainage? Well, it’s probably NOT an ear infection. Lots of other problems can cause this scenario. Sore throats, toothaches and jaw aches can all cause what’s called referred ear pain, because the pain signal piggy-backs on the same nerve as the ear – so it “feels” like an earache, even though the ear is perfectly normal. This is why kids recovering from a tonsillectomy often complain of severe earache, even though their ears are perfect.

Before reaching for that antibiotic, refer to these tips and see if you can perhaps go without it!


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