Barring the truly unusual, such as critters nesting deep within, most middle-ear infections are caused by a trapped buildup of fluid behind the eardrum.
It's practically a rite of passage as infants grow into children, during which time the eustachian tubes mature and allow for better fluid drainage. Until then, it's a perfect pool for breeding bacteria or harboring visiting viruses.
Pediatricians and physicians have long treated ear infections, but every once in a while new guidelines surface. Recently, the American Academy of Pediatrics announced a few changes, and here's what Memorial Hermann Sugar Land family physician Dr. Rehal Bhojani had to say.
Diagnosis: New criteria for diagnosing an ear infection involves using pneumatic tympanometry during examination, a tool that actually measures the quantity of fluid behind the eardrum. Previously, doctors evaluated symptoms, visible inflammation, bulging eardrum and presence of fluid.
Treatment: Doctors now know that most ear infections are viral. If it doesn't improve in seven to 10 days, an antibiotic such as amoxicillin is an option. If the child is 6 months to 23 months old, has moderate to severe pain for at least 48 hours, a temperature of 102.2 or higher or infection in both ears, antibiotics may be in order.
Advice to parents: If you want to try over-the-counter pain relievers or antihistamines before calling a doctor, Bhojani advises parents to follow dosing instructions carefully and to not combine medications. The child's pain is caused by pressure behind the eardrum, and a doctor would poke a hole in the eardrum to release the fluid and ease pressure.
Tubes or not: The AAP defines recurrent ear infections as having three within six months, or four within the past year, as long as one was in the past six months. Minor surgery to place temporary ear tubes - which allow for better fluid drainage - is considered a better choice than prophylactic antibiotic treatment.