A recurring malady has most parents going back for that pink stuff in fridge a pain in the ear

November 09, 1993|By Kathleen Curry | Kathleen Curry,Knight-Ridder News Service

The first time your child develops an ear infection, you panic.

The second time, you nurture and worry but take heart that it will pass.

The fourth time -- as you buy yet another bottle of the cotton-candy-pink antibiotic du jour and realize you've visited the doctor more than you've seen Junior's grandmother this year -- you start to wonder if maybe something is wrong with this picture.

Where are all these ear infections coming from? Is your child cursed? You swear your mother never had to cope with this.

But you know you aren't alone -- virtually every child in the preschool is a veteran of a handful of ear infections.

Measles and mumps may be childhood diseases of the past, thanks to vaccines, but today's kids have their own scourge: otitis media, inflammation and infection of the middle ear.

Here's proof of what you may have suspected:

Earaches are almost epidemic. They are the most common reason for doctor visits for children younger than 6.

Diagnosis of otitis media has skyrocketed recently. In 1992, the Centers for Disease Control and Prevention in Atlanta reported a 178 percent increase in ear infection diagnosis between 1975 and 1990. In 1975, there were 10 million doctor visits for earache; by 1990, there were 25 million visits, costing more than $1 billion annually.

Nine of 10 children will have at least one ear infection. Most have at least one acute ear infection by age 3, and more than one-third of all children have three acute infections, according to the 1992 editions of the "American Family Physician Reference."

Treating ear infections is a booming industry.

The minor surgical procedure of inserting tiny plastic tubes in the middle ear to drain fluid is the most common surgery on children in the United States.

And at least two expensive antibiotics commonly prescribed for ear infections have joined an elite group of about a dozen drugs that have rung up more than $1 billion in annual worldwide sales each. Ceclor and Augmentin -- developed to combat new, penicillin-resistant strains of bacteria -- cost four to five times as much as generic versions of amoxicillin.

It is not surprising, then, that the treatment of ear infections has spawned a growing debate in health care.

Why are ear infections so abundant these days?

To Dr. Charles Bluestone, an internationally recognized authority ear infections, the answer is simple: day care.

"Virtually every study ever done on the increase in otitis media has shown that day care is the most important difference," Dr. Bluestone said in a recent interview.

An otolaryngologist (ear and throat surgeon) with Children's Hospital in Pittsburgh, Dr. Bluestone said infants and preschoolers in day care have a much higher incidence of respiratory infections in general and ear infections in particular.

"A child's immune system doesn't mature until age 5, and the eustachian tube [which is blocked during ear infections] doesn't mature until 5 or 6," Dr. Bluestone said.

"It makes these kids prone when their systems are challenged by the viruses and bacteria that are constantly around in day cares."

Another key factor in higher rates of ear infection: less breast-feeding of infants.

In a recent study outlined in the Journal of Pediatrics, Dr. Bluestone said infants who were breast-fed at least four months had statistically fewer ear infections than those who were not breast-fed or were breast-fed for less time.

As ear infections mount, parents find themselves on a treadmill of antibiotics and repeat infections, all the while wondering whether something the doctor is doing is wrong. Will repeat doses of antibiotics cause some harm along with the good?

"Yes, the organisms are changing, and the widespread use of antibiotics is changing them, making tougher, more resistant strains" of disease-causing bacteria, Dr. Bluestone said. "It's a vicious circle."

"We may be coming to the end of the antibiotic era. Resistance to these new super-strong bugs is becoming a big problem, and the new antibiotics are so expensive they drive up the cost of health care."

The answer may be an ear infection vaccine.

Research under way by several drug companies and hospitals aims to develop a vaccine to eradicate the most common pathogen that causes ear infections.

"If it works, it could mean that maybe 40 percent of the ear infections today could be prevented," Dr. Bluestone said.

But now, the best defense is the pink defense.

"If a child has acute otitis media -- pain, maybe fever and fluid -- recent studies show that antibiotic treatment is still the best avenue, and amoxicillin (often given as a pink liquid) is the best and cheapest," Dr. Bluestone said.

For chronic cases, the final step often has been to insert ear tubes.

Meanwhile, those who promote alternative medicine -- including

homeopathy and natural methods of healing -- say antibiotics and ear tubes are both overused.

Allergies cause many ear problems and can be cleared up without intervention other than diet and the use of herbs, they say.

In short, there's no easy answer. But take heart.

Middle-ear problems drop dramatically after age 8.

Which gives you a few years' rest before the next worry -- puberty.

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