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Ear Infections Form
 Printable version
Part 1: Discussion of the Primary Symptoms of Acute Otitis Media (Acute Ear Infections)
- Ear Tugging - one of the most common reasons that young children are brought to their doctor, ear tugging is not a symptom of an ear infection. Young children like to tug on their ears. They might tug more if there is fluid in the ear or if the ear feels ‘funny’. Careful research has verified that children are not more likely to tug on their ears when they have Acute Otitis Media [AOM]. Shockingly, careful studies (e.g. Pediatrics December 1992; 90:1006) have found that 0% of children with ear pulling as the main symptom had an ear infection. Even in conjunction with fever, only 15% of those brought in for ear pulling actually had ear infections. Most commonly, children will pull their ears due to itchiness caused by soap or shampoo in the canal, or by a healing infections, teething, exploration, comfort, or habit.
- Pain - most cases of AOM are painful. The pain builds as the pressure in the ear builds, from a dull ache to a sharp stabbing pain. The pressure is relieved intermittently, so the pain comes in waves and the pain is worse at night. Because most ear infections occur in children under two years old, the best evidence are symptoms indicating pain such as crying or screaming (usually less than half an hour), fussiness, irritability (worse when lying down), or a sudden increase in difficulty sleeping, especially at night. The child will often have no pain the following morning. In an older child, “My ear hurts!” is the most reliable symptom. According to TCM, pain is caused by a ‘lack of free flow’ or poor circulation. Dull pain is associated with qi stagnation in Chinese medicine whereas stabbing pain is associated with blood stasis.
- Fullness or Decreased Hearing - in an ear infection, fluid fills the middle ear. Older children often mention a feeling of fullness or decreased hearing in the affected ear. This is difficult to detect in an infant, but you might notice shaking of the head. The ear is considered one of the nine orifices of the body in TCM and when obstructed (like in an ear infection) can cause the symptom of fullness in the ears or decreased hearing.
- Fever - only one third to one half of children with an ear infection will present with a fever. Temperatures over 104 degrees occur in fewer than 5% of ear infections. Fevers are more common in infants and toddlers than in older children. There are many causes of fever but in infants and toddlers, the combination of fever and pain is most often an ear infection. In TCM, fever (especially an acute fever) is due to some form of pathological ‘heat’ in the body.
- Systemic symptoms – ear infections are sometimes accompanied by other symptoms such as loose stool or vomiting. Acute Otits media is often accompanied by nasal congestion and/or a runny nose. According to TCM these nasal symptoms are due to phlegm accumulation in the body. Something must plug the Eustachian tube for an ear infection to occur. An upper respiratory infection is often the cause of this blockage and if present, will be accompanied by its associated symptoms. Remember this blockage may be caused by a change in elevation, allergies, an irritant (such as cigarette smoke), reflux, or drinking a bottle while lying on the back.
- Fluid in the Ear – for objective evidence you can use a device called EarChek to further verify the diagnosis of AOM. This valuable device uses sonar-like technology to detect fluid in the ear. EarChek is inexpensive, accurate, and simple to use at home (by parents). If there is no fluid, there is no ear infection. If fluid is present, only direct visualization of the eardrum by a skilled observer can determine if this is an acute ear infection.
Part 2: Tips to Build Your Child’s Immune System and Prevent Ear Infections
- Breastfeeding – is effective in reducing the number of ear infections in a child. Nursing for the first year is best, but even a few weeks of breastfeeding has shown to decrease the amount of ear infections for the child’s first three years of life.
- Massage – various pediatric Chinese massage techniques (Tui Na) are effective in boosting the immune system and may be shown to parents or day care providers to help prevent ear infections.
- Proper Nutrition, Sleep and Decreased Stress – all help improve a child’s (and adult’s) immunity.
- Limit Day Care Size - to six or fewer children especially in the winter months for children under age 2.
- Dummy (Pacifier) - Stop giving children a pacifier. Sucking on a pacifier can pull germs into the middle ear. Avoiding pacifiers can reduce ear infections by 50 percent for children in day care.
A study published in the September 2000 issue of Pediatrics looked at the effect of simply having nurses give an educational leaflet to parents about the side impact of pacifier usage. As well, the nurses instructed parents to limit pacifier use to moments when the child was falling asleep (and stopping it entirely by about 10 months of age). This form of education decreased continuous pacifier use by more than 20% and ear infections by almost 30%.
University researchers from Finland included 845 children attending day care in their published study on ear infections. They followed the children in the study for 15 months, keeping track of behaviors which might influence the number of ear infections. In addition to pacifier use, the following behaviours were monitored: breast feeding, parental smoking, thumb sucking, bottle use and social class.
According to this study, the most obvious factor affecting the frequency of ear infections was with pacifier use, which increased the frequency by 50%. The average number of annual ear infections was increased from 3.6 to 5.4 episodes in those less than 2 years old. In older children (2-3 years of age), pacifier use increased the number from 1.9 to 2.7 ear infections per year.
One possible explanation given was either the sucking motion associated with pacifier use hinders proper Eustachian tube functioning (which normally keeps the middle ear open and clean). Or, particularly in day cares the pacifiers collect germs which spread infection. In TCM, saliva is considered the fluid of the spleen and the excessive use of a pacifier may lead to an accumulation of dampness or fluid that may block the Eustachian tube. Once this dampness has accumulated and stagnated, this may lead to localized heat or inflammation. The authors in the study suggest that pacifiers be used only during the first 10 months of life when the need for sucking is strongest and episodes of ear infections are less likely.
A more recent study that included only children less than 2 years old also supported the above evidence that excessive pacifier use can increase the likelihood of ear infections. These researchers reported that a 33% reduction in the rate of ear infections was noted when pacifier use was limited. The authors of this study recommend that pacifier use be reduced to moments when falling asleep after 6 months of age and discontinued altogether after 10 months of age.
- Avoiding Germs – according to modern medicine respiratory infections that lead to ear infections are often spread by touch or by fomites. Frequent hand washing and cleaning of toys are both helpful.
- Fresh Air – in order to have a strong immune system and healthy body, children need to be exposed to fresh air regularly.
- Avoid passive exposure to cigarette smoke - up to 2 million ear infections are caused by passive smoking each year in the US.
- Avoid having your child drink while lying flat on his/her back
- Identify and treat allergies – it is estimated that up to 40 percent of ear infections are caused in part by the Eustachian tubes being swollen by allergies. Dust is the most common airborne allergen and food allergies (esp. dairy products) are also more common in children who frequently suffer from ears infections.
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