To prevent ear infections, you have to prevent colds
© 2013 Roy Benaroch, MD
“My toddler keeps getting ear infections. There’s got to be a way to help with this. What can we do to prevent them?”
It’s frustrating, I know. Ear infections—doctors call them “otitis media”, because we need fancy-pants names for ordinary things—are very common, and account more antibiotic prescriptions than any other pediatric infection. Why do kids get so many of them?
If you stick your finger in your ear, it won’t go very far. Which is probably a good thing. If your finger were oddly thin and pointy, though, you’d be able to reach down your own ear canal to touch your eardrum (doctor-speak: “tympanic membrane”), a little flimsy sheet of tissue that closes off the end of the outer ear parts and separates the ear canal from the middle ear. Ordinarily, on the other side of the eardrum is a small, open, air-filled space through which sound waves can be transmitted with the help of three interlocking little bones. The important thing to remember is that this middle ear cavity is sealed off on all sides, and is supposed to be filled with ordinary air. There is a little drainage tube on the bottom which can allow tiny droplets of normal mucus to drain out of the middle ear into the nose. All of this works pretty well, most of the time.
Until the drainage tube (doctor-talk, “Eustacian tube” or “Auditory tube”) gets clogged up. Then the middle ear space fills with nice warm mucus. That sits there. And you can guess what happens: bacteria love warm, stagnant mucus. Party time = infection in the middle ear = Mommy, my ear hurts!
What causes congestion that clogs up the drainage tube? Usually, a common cold virus. Junior gets the dreaded yuck, gets all snotty, the tube clogs, and normal mucus can’t drain. That leads to ear infections.
Little kids get far more ear infections than adults. They get far more colds, especially if they’re enrolled in group care. They’re not very good at blowing their little noses and clearing out mucus. But most importantly, that drainage tube of theirs is oriented horizontally, and it’s thin—the net effect being, it doesn’t drain well. They’ve basically got lousy gutters, and the mucus builds up behind them, especially when there’s a lot of snot around.
Ear infections do run in families, probably because some families tend to have even worse middle ear anatomy that predisposes to more infections. Parental smoking is also a big-time contributor to ear infections, because that contributes to chronic congestion and poor drainage. Sometimes, chronic nasal allergy causes nasal congestion, poor drainage, and at least some ear infections. But by far, the biggest contributor to ear infections are ordinary common cold viruses. In fact, during an ordinary cold young children will develop an ear infection about half of the time.
So what can be done to prevent ear infections? The only really practical strategies are to try to prevent the spread of cold viruses:
- Avoid group care, if possible
- Stress the importance of handwashing
- Practice good cough and sneeze hygiene—we should cough into our elbows, not our hands!
In addition, try to avoid second-hand smoke, and make sure that your children are up-to-date on their immunizations. Though there is no one immunization that will prevent all or even most ear infections, some infections can be prevented by making sure that your child has had the pneumococcal conjugate and influenza vaccines.
Weekend ear pain action plan—you do NOT have to rush to the ER, but you ought to help your child feel better when there’s a suspected ear infection
What to do if your child seems to get too many colds