Reducing childhood ear infections

Many parents of young children know the agony of ear infections -- pain or discomfort, fever, stuffiness or runny nose – often leading to sleepless nights for kids and parents.

But the best defense might be unexpected: Haemophilus influenzae type b and pneumococcal vaccination.

The rate of ear infections – particularly bacterial infections – among children who get these recommended vaccines, has dropped significantly, said Jevon Plunkett-Rondeau, MD, PhD, a pediatric hospitalist at Cape Cod Hospital, and the mother of three young children. "Children should get four doses of the Haemophilus influenzae type b (Hib) and pneumococcal vaccines between the ages of 2 months and 2 years, according to the U.S. Centers for Disease Control.

“Most infections are actually caused by viruses, due to the same viral cold that’s causing the runny nose and cough,” said Dr. Plunkett-Rondeau, who treats children hospitalized in Hyannis and also consults on pediatric cases in the Emergency Department. The Pediatric Hospitalist program at Cape Cod Hospital is affiliated with Boston Children’s Hospital.

“The two bacteria that were causing the majority of ear infections – we’re doing a pretty good job of vaccinating against those. There are still bacterial ear infections, but they are much less common than 15 or 20 years ago,” she said.

Those pesky viral ear infections are still around, meaning parents and pediatricians have to make decisions about treatment.

In children, an ear infection is usually an inflammation of the middle ear – the part between the eardrum and the inner ear -- that occurs when fluid builds up behind the eardrum. Children are particularly susceptible to them partly because their eustachian tubes are smaller and more level than those of adults, making it harder for the tubes to drain, according to the National Institutes of Health.

Left untreated, bacterial infections can cause problems, Dr. Plunkett-Rondeau said. “True bacterial infections of the ear can traverse and go into the deeper parts of the inner ear.”

Unlike bacterial infections, viral types don’t respond to antibiotics. But, there’s no way for a pediatrician to know the cause when they look into a child’s ear, she said.

Some doctors suggest parents wait a few days before starting antibiotics to see if the infection clears, she said. She often gives parents a prescription for antibiotics and suggests they only fill it if symptoms don’t improve in 48 hours or so.

In the meantime, parents can try to keep children comfortable with Tylenol and ibuprofen, as long as they stick to doses that are appropriate for a child’s weight and age, she said.

“I’m pretty generous with Tylenol and ibuprofen,” she said. “I try to be sympathetic that it’s uncomfortable.”

Ear-pain drops sold over the counter have not been shown to be particularly effective, she said. “I don’t recommend it if I can’t promise benefit.”

Chronic Infections

Some children suffer from chronic ear infections. And the rate of infections is higher among Native American and Hispanic children, according to the NIH. Doctors also have identified colonies of antibiotic-resistant bacteria, called biofilms, present in the middle ears of most children with chronic ear infections. There is research under way to learn how to eliminate these biofilms.

One solution for chronic infections is tympanostomy tubes – small tubes that help drain fluid and are inserted surgically in children’s ears under general anesthesia. But a study published in May 2021 in the New England Journal of Medicine found no difference in the number of recurring infections among children 6 to 35 months old with tubes versus those treated with antibiotics. And fears about children with repeated ear infections building up resistance to antibiotics have not come to fruition, Dr. Plunkett-Rondeau said.

She described the decision for parents as a “balancing measure” of weighing repeated antibiotics against the risk of a surgical procedure in a young child.

Meanwhile, the best defense against ear infections is vaccination, she said.

“I just want to reiterate that the vaccines we have available make some of these ear infections rare.”