Gentle help for aching ears

Silvan wakes up crying. «My ear hurts,» the seven-year-old explains to his father, who has rushed to his bedside in the middle of the night. Silvan is burning up, he has a fever of almost 39 degrees. His father gives Silvan an ear compress and gives him a painkiller so that he can sleep again. The next morning, Silvan is still complaining of an earache and the fever persists, so his father calls the paediatrician's surgery.

«Treat the pain for 48 hours with an anti-inflammatory painkiller,» advises the medical practice assistant. «If Silvan still has ear pain after that, come round.» Silvan's father is surprised. He thought that anyone with a middle ear infection would have to take antibiotics. Because that's how he knew it from his own childhood. But that's no longer the case today, according to the recommendations of Paediatrics Switzerland.

«Most national recommendations in Europe advise a wait-and-see approach to prescribing antibiotics for acute otitis media,» according to the website of the professional organisation of paediatricians in Switzerland.

A middle ear infection is a bacterial inflammation

But right from the start. An acute inflammation of the middle ear, or otitis media as it is technically known, is a viral or bacterial inflammation of the middle ear and usually occurs in conjunction with an upper respiratory tract infection. The middle ear is located between the eardrum and the inner ear. It is filled with air and contains three small bones: the malleus, incus and stapes. The middle ear is connected to the nasopharynx via the Eustachian tube - also known as the Eustachian tube.

Many middle ear infections heal on their own. In the past, antibiotics were prescribed more quickly.

Alexandra Jäggi, paediatrician

If a child suffers from a cold or other inflammation of the mucous membranes, the eustachian tube becomes swollen. If fluid accumulates in the middle ear, it can no longer drain away. If viruses or bacteria present in the nasopharynx then migrate into the middle ear, an inflammation of the middle ear develops. This becomes visible to paediatricians through the bulging, whitish or yellowish eardrum because the middle ear is filled with pus.

If the pressure there becomes too great, the eardrum bursts and the pus runs out of the ear. This is known as a perforated middle ear infection. The injury to the eardrum usually causes no symptoms and heals on its own. The middle ear infection itself is not contagious, but the preceding respiratory infection is.

Shortened Eustachian tube

There are probably few parents who have never experienced a middle ear infection, as it is one of the most common reasons for visiting the paediatrician's practice in infancy. Otitis media occurs more frequently in the first three years of life, but it can also affect older children or even adults.

There are two reasons for the accumulation in infancy. Firstly, the eustachian tube is shorter in small children and runs more horizontally than in older children and adults. This makes it easier for pathogens from the nasopharynx to ascend into the middle ear. On the other hand, small children suffer more frequently from respiratory infections as their immune system is not yet fully developed. A middle ear infection usually manifests itself with earache, pressure on the ears or ringing in the ears. It is often accompanied by fever and hearing loss, sometimes also headaches.

Correct diagnosis is important

«Today we know that many middle ear infections heal on their own. In the past, antibiotics were prescribed more quickly,» explains Alexandra Jäggi, a paediatrician in Freiburg. Nevertheless, it is very important to make a correct diagnosis. On the one hand, to avoid unnecessary antibiotic prescriptions and, on the other, to avoid missing any complications.

Today, complications are very rare thanks to appropriate therapy.

Alexandra Jäggi, paediatrician

This includes, for example, mastoiditis, the spread of inflammation to a part of the skull bone that lies behind the ear. Another feared complication is the spread of the infection to the inside of the skull, which can be life-threatening. «However, thanks to appropriate treatment, serious complications are very rare nowadays,» says Alexandra Jäggi.

Another reason why antibiotics were prescribed more quickly in the past was the assumption that they would alleviate the pain. Today, however, it is known that antibiotics do not always have an effect on the pain. Anyone who has ever had otitis media as an adult knows how painful it is. Pain relief and inflammation inhibition are therefore at the centre of treatment.

The disadvantages of antibiotics

The use of antibiotics has two major disadvantages, which is why paediatricians are now more reluctant to prescribe them. Firstly, the bacteria develop resistance. It is more difficult to fight a subsequent infection with such bacteria. Secondly, antibiotics also kill off the good bacteria in the gut, which can lead to diarrhoea, vomiting or abdominal pain. And: «The intestinal flora can remain disturbed for several months,» explains Alexandra Jäggi.

To rebuild the intestinal flora, Katharina Kolb recommends taking probiotics and prebiotics - even while antibiotics are still being used. The naturopath from Schaffhausen explains: «Probiotics contain living microorganisms that colonise our intestines. Prebiotics help to nourish these good bacteria.» From a conventional medical point of view, the benefits of these food supplements have not yet been conclusively clarified. «If they do no good, they certainly do no harm,» says Alexandra Jäggi.

Helpful household remedies

Silvan is now lying on the sofa with an ear compress. For Katharina Kolb, onion compresses are the first choice for earache, as the onion has an anti-inflammatory effect. Mother's milk has the same effect and can also be instilled directly into the ear of older children, if available. Drinking herbal teas or inhaling are also home remedies that can help heal a middle ear infection.

Simple household remedies can often prevent the worst from happening.

«Naturopathy is always my first choice. It stimulates the body to heal itself,» explains Katharina Kolb. Simple home remedies can often prevent worse things from happening. But she also says: «If there is no improvement after 48 hours, if both ears are affected or if secretions are running out of the ear and the child is visibly unwell, then conventional medicine is called for.»

Silvan is much better after two days. The pain and fever are almost gone, but he still can't hear very well. «If the hearing loss lasts longer than a few days, a visit to the paediatrician is necessary,» says Alexandra Jäggi. Then it could be a so-called tympanic effusion. This is a build-up of fluid in the middle ear that cannot drain away because the eustachian tube is blocked.

Occurrence of a tympanic effusion: often occurs with middle ear inflammation

A tympanic effusion often occurs in children who repeatedly suffer from acute middle ear infections. Doctors refer to so-called recurrent middle ear infections if a child suffers from them at least three times in six months or four times in a year. In such cases, it is advisable to consult an ear, nose and throat specialist. In the case of a tympanic effusion, nasal sprays containing cortisone are usually used as a first step. Another option is to aspirate the fluid through the eardrum using a fine needle. The final options are the insertion of tympanic tubes to ventilate the ear or the removal of the adenoids if they are enlarged.

Cigarette smoke irritates children's mucous membranes, making them more susceptible to infections.

Alexandra Jäggi

Some parents are familiar with the situation: while one child repeatedly develops middle ear infections, the other has never had one. In fact, certain children are more susceptible to it. Why this is the case is unclear. What is certain is that a predisposition to it can be inherited. In addition to genetic factors, there are other factors that increase the risk of middle ear infection. These include passive smoking, for example. «Smoke irritates children's mucous membranes, which makes them more susceptible to infections,» says paediatrician Jäggi. Furthermore, children who attend a daycare centre are more frequently affected by middle ear infections because they also suffer more respiratory infections.

Preventive measures against earache

So what can parents do to prevent middle ear infections? Anyone who smokes within their own four walls should refrain from doing so. Another measure is the pneumococcal vaccination. Before the vaccination came along, pneumococci were the most common cause of bacterial middle ear infections. Since the vaccination has been available, the number of middle ear infections has decreased.

If you have a child at home who is susceptible to otitis media, it is a good idea to react at the first sign of a cold. It is important that the nose is as clear as possible so that the eustachian tube does not swell up. Nasal sprays or drops as well as other household remedies such as onions, inhalation or alternative medical remedies such as Schüssler salts can help.

All of Silvan's symptoms subsided after a few days. He can also hear well again - if he wants to. Can he now dive again and go into the mountains? «Yes,» says Alexandra Jäggi, «children only have to refrain from diving if their eardrums have burst.» Otherwise, it is only a problem if the children dive very deep, which is not usually the case. «When flying and travelling in the mountains, parents should bear in mind that children are often unable to equalise pressure immediately during or after a middle ear infection and this can be painful for them.»