Breaking the Cycle of Ear Infections

Ear infection recurrence and surgical treatment reduced through stricter diagnosis and fluid draining

(RxWiki News) Some parents may feel like their children get one ear infection after another. This cycle may continue until, finally, ear tubes are needed. A new treatment may help stop the revolving door of ear infections. 

Otitis media is the formal name for ear infections. When fluid gets trapped behind the ear drum, such as after a cold or allergies, it can become infected and very painful. 

If a child has too many ear infections, a small tube may be surgically inserted into the ear drum to help drain fluid and prevent build up. 

A recent study found that a stricter requirement for diagnosing ear infections and the use of specialized treatment may have led to less recurrent ear infections and a reduced need for ear tubes in children. 

"Talk to a doctor about treatment options when your child has an ear infection. "

Michael Pichichero, MD, of Center for Infectious Disease and Immunology, Rochester General Hospital Research Institute in New York, and colleagues set out to see if using strict diagnostic criteria for acute otitis media and specific treatment options would reduce recurrent ear infections and ear tube surgeries.

The researchers developed a stricter diagnosis and treatment of ear infections than what the American Academy of Pediatrics currently recommends. 

The stricter definition required the child to have a bulging or fullness of the tympanic membrane (ear drum) with cloudy fluid and reduced or absent movement of the ear drum. A doctor uses a device called an otoscope, inserted in the ear, to view the ear drum. To confirm an ear infection diagnosis, the doctor drains fluid from the ear.

The Academy's guidelines do not require fluid to be drained for a confirmed ear infection diagnosis and many doctors have not received specialized training to do so.

The Academy recommends ear tubes for children with three to four recurring infections in a year or for a very long lasting infection. Using the stricter definition for infection, researchers said, could prevent overdiagnosing and the need for ear tubes. 

The particular treatments used in the study were tympanocentesis (removal of fluid from behind ear drum with a needle) and specific antibiotic treatment.  

The five-year study included 1,482 children that were patients at a pediatric office and a community clinic. Children at the pediatric office,  whose parents agreed to participate in the study, were treated for ear infections using the researchers' new method. 

When a child in the new treatment group (254 children) had symptoms of an ear infection, pediatricians used the strict diagnosing criteria and treatment, which included fluid drained from the ear. If the child tested positive for antibiotic resistance, a different antibiotic was prescribed. 

A total of 208 children, also patients at the pediatric office but not participants in the study, were used as a comparison group. When a child from this group had symptoms of an ear infection, they were evaluated using the strict diagnosing criteria but did not have fluid drained from their ears or get a different antibiotic. 

Another comparison group included 1,020 children seen at a community clinic. These children were diagnosed and treated for ear infections based on the Academy's current recommendations, which included high doses of amoxicillin medication. These children did not have fluid drained from their ears.

Results showed that only 5.9 percent of children treated with the new method developed recurrent ear infections, compared to 14.4 percent of non-participating children from the pediatric office and 27.3 percent of children from the community clinic. Recurrent means they had three ear infections within six months or four infections within 12 months. 

The study also showed that 2.4 percent of the children in the new treatment group received ear tubes, compared to 6.3 of non-participating children from the pediatric office and 14.8 of the community clinic children.

Researchers suggested that the stricter diagnosis, draining the fluid from the ear and using medication the child could not build up a resistance to led to fewer children being diagnosed with recurrent ear infections that required tubes. 

"Improvement in the teaching of otoscopy and tympanostomy procedure (draining fluid) would go a long way to improving the accuracy of acute otitis media diagnosis and then lessen the rates of tympanostomy tube insertions," authors commented in the study. 

The study had some limitations. The effect of draining the fluid could not be measured separately on recurring ear infections and tube insertion. Draining the fluid was done in different manners and produced mixed results when measured. The children were not randomly assigned to different groups. 

This study, titled "Reducing the Frequency of Acute Otitis Media by Individualized Care," was published in The Pediatric Infectious Disease Journal. It was funded by the National Institute of Healths and National Institute on Deafness and Other Communication Disorders. Dr. Pichichero and colleagues disclosed no conflicts of interest.

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Review Date: 
February 18, 2013