Young children with acute otitis media are three times more likely to suffer from recurrent ear infections if they are treated with antibiotics! 

In one of the first prospective long term studies of children with acute otitis media, Dutch researchers followed up 168 children treated by GPs for an episode of acute otitis media.  

Half were randomised to received amoxicillin in three doses and half to placebo.  

While there was no difference in recurrence rates in the first year after treatment, after three years the rates of recurrent otitis media were 63% for the antibiotic group and 43% for the placebo group.  

The researchers say this means a 20% higher risk of recurrent acute otitis media with antibiotics was seen even after adjusting the results for other factors, such as allergy and a previous tendency to have recurrent ear infections.  

However, they note that 30% of children in the placebo group had to undergo ear, nose, and throat surgery on initial infection, compared with only 21% in the amoxicillin group. They say the difference in recurrence rates between the two groups could be due to antibiotic use causing an ‘unfavourable shift’ towards the growth of resistant bacteria. Early use of antibiotics might impair the natural immune response and weaken protection against further episodes they argue.  

And whilst antibiotics may reduce the length and severity of the initial ear infection, their use may encourage doctors’ attendance in future episodes and antibiotic resistance. “This is another argument for judicious use of antibiotics in children with acute otitis media,” they conclude.

Ear Infections in Children

Otitis media is an inflammation of the middle ear. When the eustachian tube becomes blocked (often the result of allergies, a cold or upper respiratory infection), fluid can’t drain properly. Bacteria that are present can grow in the stagnant fluid, leading to an ear infection (acute otitis media).

According to the American Academy of Otolaryngology – Head and Neck Surgery, almost all children get at least one ear infection. The condition is more common in children than in adults because a child’s eustachian tube is shorter and straighter than that of an adult, making it easier for bacteria to travel up the tube to the middle ear. Children also tend to have larger adenoids (tissue containing infection-fighting cells). The adenoids are located close to the opening of the eustachian tube in the throat. So when they enlarge, the adenoids can block the eustachian tube.Ear Tubes for Chronic Otitis MediaWhen otitis media is recurrent or chronic, or when the condition causes hearing loss or speech problems, doctors may recommend placement of ear tubes (also known as ventilation or tympanostomy tubes). The child is placed under general anesthesia and a tiny hole is cut into the ear drum. Then the ear tube is placed inside the hole. The tubes contain a small, center hole, which allows air to reach the middle ear and ventilate the space.The American Academy of Otolaryngology – Head and Neck Surgery says more than 500,000 ear tube surgeries are performed every year in the U.S. It can be done at any age, but most patients are children between one and three.Fixing Ear DrumsAfter an initial ear infection, fluid can remain inside the middle ear for weeks to months. Chronic inflammation or infection can impede hearing and lead to temporary or permanent hearing loss. In young children, hearing loss can cause a delay in speech development and interfere with learning.Chronic otitis media can cause changes within the ear as well. David Kaylie, M.D., Otologist with Duke University Medical Center, says blockage of the eustachian tube causes a vacuum to form inside the middle ear. That causes the eardrum to get sucked inward and, eventually stretch and form a “pocket.” The stretched ear drum doesn’t vibrate well and can cause hearing problems. Ear tubes can relieve the pressure inside the middle ear, but won’t fix the stretched ear drum.Traditionally, the stretched ear drum is fixed by surgically removing the stretched “pocket” and patching the eardrum with a piece of tissue taken from underneath the skin above the ear. It takes six months to a year before hearing is restored and, according to Dr. Kaylie, there’s no guarantee hearing will return to normal. In about 8 percent of patients, the graft doesn’t take and patients require another surgery to patch the hole.The Ear LaserDr. Kaylie is now using a laser system, called the OmniGuide® BeamPath™ OTO, to fix some ear drum pockets. It uses a carbon dioxide laser with a flexible fiber and mirror system. The so-called "perfect mirror" allows the laser to bounce down the flexible tube without losing energy on its way to the target.The middle layer of the eardrum is made of collagen. When the fiber tip is aimed at the target pocket, the laser energy tightens the collagen and causes the eardrum to shrink back to its original shape. Then, an ear tube is placed in the eardrum.The laser procedure takes about five minutes and is done under general anesthesia. When patients wake up, they are often able to hear better immediately. There is no postoperative pain and minimal recovery. Most are back to their normal activities by the next day.

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