FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

ANTIBIOTICS MAY NOT HELP OTITIS MEDIA

Question: My children, particularly my youngest, who is 2, have trouble with frequent middle ear infections. I've read that antibiotics may not help this condition, but our doctor prescribes them. What is the current thinking about middle ear infections?

Answer: From your description, it appears that your child has had repeated episodes of what we doctors call "acute otitis media." Acute means that each episode is "short and severe" rather than "long, drawn out and chronic." Otitis is Latin for "inflammation of the ear." Media, likewise, refers to the location in the "middle" area of the ear.

Before I proceed further, I need to provide a brief lesson on the anatomy of the ear: The middle ear area is a small, enclosed area located immediately behind the eardrum. It is sealed off, except for a tiny channel that connects with the sinus area behind the nose. The purpose of this conduit - called the eustachian tube - is to equalize air pressure behind the eardrum with that on the outside.

The space provided by the middle ear and the "pressure release" furnished by the eustachian tube normally allow the eardrum to vibrate freely when it is struck by sound. When there is pressure or fluid within the middle ear space, the movement of the eardrum is impeded. This results in decreased hearing and often in ear pain.

Middle ear infections result from bacterial or viral infection of the eustachian tube and the middle ear space. Pressure and fluid accumulate in the middle ear causing symptoms that all parents recognize a fussy child pulling at his or her ear. There are a number of antibiotics your doctor might prescribe to try to hasten relief. Amoxicillin, the most common, produces a cure in 60 to 70 percent of those taking it as do most antibiotics used for middle ear infection.

However, since 40 to 60 percent of acute middle ear infections clear up within two weeks without any antibiotic therapy, some authorities - but not most - recommend against using these drugs. Another factor that your doctor must take into account is the likelihood that your infection is caused by a virus rather than a bacteria. Despite common misconceptions, antibiotics are useless against viral infections.

Once a decision is made to use an antibiotic, your doctor is faced with the difficult decision of which one of the wide variety of antibiotics will be most effective in this case. As you can see, your doctor's decision on an antibiotic for your child's ear infection is based somewhat on educated guesswork.

A chronic middle ear infection, one characterized by a painless infection that continues for weeks and in which fluid accumulates behind the eardrum, is an even more perplexing problem. In this type of infection, the hearing is impaired to some degree because of the fluid behind the eardrum, and the ear feels full - but the ear isn't painful any longer. Antibiotics are often prescribed for a period of 4 weeks or more to treat this, but the benefits of this therapy are even less clear than are those for acute otitis media.

It is hard for parents and physicians to patiently wait as a child suffers with an ear infection. We often recommend antibiotic treatment when we know that the chance of it providing relief is less than perfect but still the chance of benefit exists. This is why your children are given antibiotics for their ear infections. What we also know is that otitis media is increased in children who are in day care, particularly day care out of the home, those with another child in the family having otitis media, bottle fed babies, and particularly in those exposed to second hand smoke. Unfortunately, exposure to second hand smoke is the only one of these risk factors that can easily be changed for most families.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.