Understanding Ear Infections

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Bicycles. Tulips. Windmills. When I thought of the Netherlands, that's what used to come to mind. But the source of a sea change in treating oor besmetting? (Sorry, in English: ear infections.) That's why I love the Dutch now.

Over the past 20-odd years, European researchers, led by the Dutch, have published a quiet but pivotal series of studies, all pointing to the same radical conclusion: When it comes to ear infections, kids just don't need antibiotics as often as we thought. The numbers are whopping. In one study, out of 240 children ages 6 months to 2 years with "acute otitis media," as we Hippocratic oath guys call it, 87 percent did not need antibiotics to recover. In a bigger sample (4,860 kids ages 2 to 12), more than 90 percent got better without antibiotics after just a few days. Turns out 66 percent of infections aren't strictly bacterial, so antibiotics wouldn't work anyway.

What I Preach

These studies are transforming how we treat ear infections in the US. Back in the mid '90s, when I was in med school, eight out of 10 kids who went to the doctor for ear infections were treated with antibiotics. Doctors defaulted to amoxicillin faster than pharma reps handed out samples it seemed. Such aggressive prescribing led to some serious concerns, including mounting bacterial resistance to antibiotics.

In 2004, the American Academy of Pediatrics and the American Academy of Family Physicians made it official; they changed their guidelines to allow for "watchful waiting" for ear infections when it makes sense. I've found this works for most kids most of the time.

What I Practice

Bear in mind, medical school does not confer immunity—I am a dad first. I endure ear infections with my own kids, and after my wife and I work our way through various home remedies, I confess I sometimes agitate for the hard stuff. And so she yins (just watch and wait, dummy) against my sometimes impatient yang to treat their infections as I was first taught in med school, before the Dutch showed us the light.

Like most moms, she's right most of the time.

Alternatively...

Can treatments such as herbal therapy, acupuncture, and homeopathy help ear infections? My colleague Dr. David W. Miller, a pediatrician and diplomate of Oriental medicine, says the holistic approach is worth considering. Admittedly, many primary care doctors may be less familiar or comfortable with these methods. But Dr. Miller says to bring it up anyway. Your child's pediatrician should know what you're considering, and maybe you'll even get a referral. Go David!

Prevention: Some Reminders

Dr. Jerome O. Klein, a pediatric infectious disease specialist at Boston University (and ear infection sensei), offers advice:

• Small group daycare (rather than large group care) lessens the chance of germ exposure.
• Breastfeeding reduces the incidence of respiratory infections, which can lead to ear infections.
• Keeping up with immunizations for overall health.
• Hand washing—kids, parents, everyone.
• No smoking—kids, parents, everyone.

By the Numbers

• 75—Percentage of US children who will have at least one ear infection by their third birthday.
• 2 months to 12 years—Age group with highest number of infections, peaking in the toddler years.
• 0—Number of objects smaller than your elbow that you should stick in your child's ear.
• 51—Percentage of time a pediatrician correctly diagnoses an ear infection.
• 74—Percentage of time an ear, nose, and throat doc correctly diagnoses an ear infection, but hey, they're specialists.
• Immeasurable—Number of sleepless nights, days of discomfort, and lost time from work, school, or the playground due to ear infections.