Childhood Ear Infections: A Multibillion-Dollar Industry

Ear infection, or otitis media is the most common medical problem for children in the United States, and it is the most common reason for prescribing antibiotics for infants and children. Not only do nine out of ten children develop at least one ear infection each year, but almost one-third of these children develop chronic congestion with fluid in the middle ear that can lead to hearing loss and make the child a candidate for myringotomy, or tube placement by a specialist.

Babies who drink from a bottle while lying on their backs may get milk and juice into their eustachian tubes, which increases the occurrence of ear infections. Children who are breast-fed for at least a year have been shown to have much fewer infections than those weaned earlier.1

Studies also point to the fact that most ear infections early in life are viral, not bacterial.2 The vast majority of ear infections resolve nicely on their own, whether bacterial or viral, without an antibiotic. It is a common practice in this country to treat all ear infections with an antibiotic. Whether bacterial or not, our children get a routine prescription for an antibiotic at every minor illness. This cycle often is repeated many times, which may beget other medical problems in adulthood.

In some European countries, antibiotics are used for ear infections only when there is a persistent drainage or persistent pain because these infections resolve on their own more than 85 percent of the time without treatment.3 Studies show that the majority of ear infections are of viral etiology. For example, 75 percent of pediatric ear infections were caused by common respiratory viruses in a microbiological survey.4 Generally speaking, the use of antibiotics should be reserved for serious or life-threatening infections, not conditions that the body is well-equipped to resolve on its own. More and more physicians and authorities are recommending treating ear infections with antibiotics only when symptoms are not improving within three days and it is accompanied by drainage, fever, or persistent pain. Instead, eardrops for pain relief (available with a prescription) and other pain relievers can be used if the child is too uncomfortable to sleep.

A medical study reported on 168 children treated with antibiotics only if the illness followed an unusual course with high fever or profound weakness of if the child had a history of purulent meningitis or a concurrent serious bacterial infection. They followed up any children who did not recover in the typical time frame. As a result of their well-designed protocol, antibiotics were recommended by the physicians for only ten children, or less than 6 percent of all children presenting with acute ear infections. No serious complications, such as mastoiditis, meningitis, or permanent hearing loss, were observed.5

This is similar to the way I treat childhood ear infections, except that I also incorporate nutritional excellence, which I find dramatically reduces the likelihood of ever having an ear infection in the first place and then improves the likelihood of a quick recovery if illness does occur.

Another international study following over 3,000 children treated by general practitioners in nine countries showed that antibiotics did not improve the rate of recovery from ear infections. Nearly 98 percent of U.S. physicians in the survey prescribed antimicrobials routinely, the highest percentage of all countries surveyed.6 The variable showing the strongest relationship with protection from ear infections was breast-feeding.7

Yet another double-blind study of fifty-three pediatric practices from the Netherlands placed half the children (aged 6 months to 2 years) with ear infections on placebo and the other half on ten days of amoxicillin. Parents kept a detailed symptom and outcome diary, all children were reexamined on day four and day eleven, and a researcher visited all children at home six weeks after treatment to collect information and perform tympanometry (measurement of eardrum mobility) and an ear exam. The median duration of fever was two days in the treatment group and three days in the placebo group. Similarly, symptoms resolved in a median of eight days in the treatment group and nine days in the placebo group.8

Ear infections early in life are generally a self-limited event during upper respiratory (viral) illnesses; they should not be routinely treated with antibiotics. The vicious cycle of poor nutrition and the overuse of antibiotics works to place a tremendous disease burden on the future health of our children. We bring our young (improperly fed) children to physicians with their first ear infection. At this point the majority of these infections are viral, not bacterial. Nevertheless whether it's viral, bacterial, fungal, or some mixture, a healthy child has no problem recovering from an ear infection without antibiotics. In the United States almost all these children are routinely given antibiotics. Taking the antibiotic kills off the beneficial bacteria and promotes the colonization of more disease-causing strains, and now the next ear infection has a greater chance of being bacterial, not viral. Viral, bacterial, or a mixed infection, it matters not, because at the next visit your kid gets another antibiotic anyway, starting the cycle of infection after infection, antibiotic dependency, and impaired immune function.

The typical doctor does not take care to avoid the use of these dangerous drugs; he does not champion nutritional excellence to prevent future infections. The weak immune system from nutritional negligence leads to more frequent and more serious illness that is more difficult to recover from; then antibiotics complicate the issue and weaken the immune system further.

As a result of accumulating evidence documenting the dangers of antibiotics and their overuse, new guidelines for treating ear infections in children were just released from a joint offer effort of the American Academy of Family Physicians and the American Academy of Pediatrics. These guidelines represent a major shift in policy and thinking by physician leadership. The guidelines encourage doctors to initially manage the pain and not prescribe antibiotics for children who present with ear infections and to defer antibiotic use for the sicker children who are not improving two or three days later. I hope doctors will heed this message.

1. Ramakrishna T. Vitamins and brain development. Physiol Res1999;48(3):175-187. Brown JL, Sherman LP. Policy implications of new scientific knowledge. J Nutr 1995;125(8S):2281S-2284S. Schoenthaler SJ, Bier ID, Young K, et al. The effect of vitamin-mineral supplementation on the intelligence of American schoolchildren: a randomized double-blind placebo-controlled trial. J Altern Complement Med 2000;6(1):19-29.
2. Leiva PB, Inzunza BN, Perez TH, et al. The impact of malnutrition on brain development, intelligence and school work performance. Arch Latinoam Nutr 2001;1(1):64-71.
3. Haag M. Essential fatty acids and the brain. Can J Psychiatry 2003;48(3):195-203.
4. Bowman S, Gortmaker S, Ebbeling C, et al. Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics 2004;113(1):112-118.
5.Saelens BE, Ernst MM, Epstein LH. Maternal child feeding practices and obesity: a discordant sibling analysis. Int J Eat Disord 2000;27(4):459-463.
6. French SA, Lin BH, Guthrie JF. National trends in soft drink consumption among children and adolescents age 6 to 17 years: prevalence, amounts, and sources, 1977/1978 to 1994/1998. J Am Diet Assoc 2003;103(10):1326-1331.
7. Muntner P, He J, Cutler JA, et al. Trends in blood pressure among children and adolescents. JAMA 2004;291:2107-2113.
8. Tsugane S, Sasazuki S, Kobayashi, Sasaki S. Salt and salted food intake and subsequent risk of gastric cancer among middle-aged Japanese men and women. Br J Cancer 2004;90(1):128-134. Ngoan LT, Mizoue T, Fujino Y, et al. Dietary factors and stomach cancer mortality. Br Cancer 2002;87(1):37-42. Nozaki, Tsukamoto T, Tatematsu M. Effect of high salt diet and Helicobacter pylori infection of gastric carcinogenesis. Nippon Rinsho 2003;61(1):36-40.

This writing originally appeared in Disease-Proof Your Child.

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Comments (2) Read through and enter the discussion with the form at the end
philip anderson - February 10, 2006 12:38 PM

Dr. Fuhrman,
My child has developed an ear infection and we are being urged by our pediatrician to start antibiotics if it doesn't clear-up within two weeks. He has developed this infection since going to cows milk formula (five feeding per day) and he doesn't feed while lying down. Might the cause of the infection be the cows milk? Should we switch to soy formula until the problem is resolved? What are your suggestions?

Thanks, Philip Anderson, Bloomington, IN

Sammi Parr - December 12, 2010 11:57 AM

Dr Fuhrman,
My nearly 2yr old grandson is getting recurring ear infections. He was breast fed until he was 14 months old and has soya and almond milk since he was weaned. He eats a wide variety of fruit, vegetables, nuts, seeds, grains, beans and pulses on a vegan diet. We left him for 10 days with the first infection as he did not appear to be in pain but his ear was seeping. He was prescribed antibiotics as the infection moved to the outside of his ear. The gp took a swab to find out what the bacteria was. His ear cleared up but came back a few weeks later, he was in pain for one day, then fine, again the ear seeping and again we left it to clear up itself but it had not so the gp gave him the antibiotic to match the bacteria. A few weeks later he has developed another ear infection, one night of pain then fine with a seepeing ear. We did not see the gp but again it had cleared up and now a few days later, a night of pain and now not himself seems uncomfortable seeping ear. Just wondering what to do?

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