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Wednesday, July 9th, 2008

| CWK Producer

Three-year-old Isabella doesn’t like to be without her favorite pacifier.  “The fish pacci,” she says.   

So the ‘fish pacci,’ as she calls it, is always close at hand.  Even on walks around the neighborhood with her dad, she’ll have a couple of pacifiers stowed away in her backpack, just in case of ‘emergencies.’

So why the predilection for pacifiers? “They make me feel better,” Isabella says.

That may be true, to a point, but in at least one respect, pacifiers may be making a lot of kids feel worse.  According to a new study of nearly 500 babies, researchers in the Netherlands found that children who use a pacifier are twice as likely to suffer from ear infections.

Why?

Experts don’t really know why, but they have some ideas.  “Possibly the pressure in the estuation tube which runs from the middle of the ear to the throat,” suggests pediatrician Dr. Phillip Weiss. “By sucking in throughout longer periods actually can cause pressure to either suck germs into the middle-ear space, or prevent them from normally draining.”

Isabella, like a lot of kids, has had a bout or two with ear infections.  “Yes, definitely, when she was little she did go through that, but I never made a connection between the pacifier and ear infections,” says her dad, Al Picallo.

Doctors say this new information has to be measured against the benefits some parents feel pacifiers provide.  “Worst-case scenario,” says Dr. Weiss, “even if your child does get a few more ear infections, if the positive effect you’re getting from the pacifier, if you feel your child is really a calmer baby with a pacifier, you need to just make your decision to use it.”
 
Picallo says while he’s now slowly weaning away Isabella from pacifiers, he doesn’t regret letting his daughter use them.   “You know, if that’s the one indulgence, then, you know, we’re guilty.”

Tips for Parents

Acute otitis media is an inflammation of the area behind the eardrum (tympanic membrane). This area is called the middle ear. Deep within the outer ear canal is the eardrum. The eardrum is a thin, transparent membrane that vibrates in response to sound waves. The middle ear is a small cavity that contains air and sits behind the eardrum. When the eardrum vibrates, tiny bones within the middle ear transmit the sound signals to the inner ear. In the inner ear, nerves are stimulated to relay the sound signals to the brain. The eustachian tube, which connects the middle ear to the nose, normally ventilates and equalizes pressure to the middle ear. When your child's ears "pop" when yawning or swallowing, the eustachian tube is adjusting the air pressure in the middle ear.

Acute otitis media is an infection that produces pus within the middle ear. Older children will often complain about ear pain, ear fullness, or hearing loss. Younger children may demonstrate irritability, fussiness, or difficulty in sleeping, feeding, or hearing. Fever may be present in a child of any age.

These symptoms are frequently associated with signs of upper respiratory infection, such as a runny or stuffy nose or a cough. Severe ear infections may cause the eardrum to rupture. The pus will then start to drain out of the middle ear and into the ear canal. The hole in the eardrum from the rupture will usually heal with medical treatment.

The period of incubation is variable, but usually otitis media is preceded by 4 to 7 days of upper respiratory tract infection.

According to the American Academy of Pediatrics, Otitis Media (inflammation of the middle ear) is the most frequent primary diagnosis at visits to US physician offices by children younger than 15 years. Otitis media particularly affects infants and preschoolers: almost all children experience one or more episodes of otitis media before age 6.  Other than colds or coughs, otitis media is the most common illness young children encounter, accounting for at least 30 million sick child visits to the doctor each year.

Seventy-five percent of children experience at least one episode of otitis media by their third birthday. Almost half of these children will have three or more ear infections during their first three years. It is estimated that medical costs and lost wages because of otitis media amount to $5 billion a year in the United States. Although otitis media is primarily a disease of infants and young children, it can also affect adults

Otitis media is an infection or inflammation of the middle ear. This inflammation often begins when infections that cause sore throats, colds, or other respiratory or breathing problems spread to the middle ear.

Because the term otitis media encompasses a range of diseases, from acute to chronic and with or without symptoms, the Otitis Media Guideline Panel has narrowed the topic. They have identified two types of otitis media as most often encountered by clinicians:

• Otitis media with effusion--fluid in the middle ear without signs or symptoms of ear infection.
• Acute otitis media--fluid in the middle ear accompanied by signs or symptoms of ear infection (bulging eardrum usually accompanied by pain; or perforated eardrum, often with drainage of purulent material).

Otitis media is often difficult to detect because most children affected by this disorder do not yet have sufficient speech and language skills to tell someone what is bothering them. Common signs to look for are:

• unusual irritability
• difficulty sleeping
• tugging or pulling at one or both ears
• fever
• fluid draining from the ear
• loss of balance
• unresponsiveness to quiet sounds or other signs of hearing difficulty such as sitting too close to the television or being inattentive

While the exact etiology of acute otitis media is still somewhat unclear, doctors know that the onset of the problem is closely related to bacterial or viral infection associated with colds, sore throats or other respiratory problems. Basically, the problem is directly related to the physiological structure of the ear.  The ear has three main parts: the outer ear, middle ear, and inner ear. A tiny tube, called the eustachian tube, connects the middle ear to the back of the throat and nose. When a child has a cold, nose or throat infection, or allergy, the eustachian tube can become blocked, causing a buildup of fluid in the middle ear. If this fluid becomes infected by bacteria or a virus, it can cause swelling of the eardrum and pain in the ear. This type of ear infection is called acute otitis media.

There are several risk factors for developing childhood ear infection, including:

• Age - Infants and young children are more likely to get ear infections. The size and shape of their eustachian tubes make it easier for fluid to build up. Ear infections occur most often in children between 3 months and 3 years of age. Also, the younger a child is at the time of the first ear infection, the greater the chance he or she will have repeated infections.
• Sex - Although researchers are not sure why, boys have more ear infections than girls.
• Heredity - Ear infections can run in families. Children are more likely to have repeated middle-ear infections if a parent or sibling also had repeated ear infections.
• Colds/Allergies - Colds often lead to ear infections. Children in group childcare settings have a higher chance of passing their colds to each other because they are exposed to more germs and viruses from the other children. Allergies that cause stuffy noses can also lead to ear infections.
• Tobacco smoke - Children who breathe in someone else's tobacco smoke have a higher risk of developing health problems, including ear infections.
• Bottle-feeding - Babies who are bottle-fed, especially while they are lying down, get more ear infections than breastfed babies. If you bottle-feed your child, hold his or her head above the stomach level during feedings. This keeps the eustachian tubes from getting blocked.

References

• The National Institutes of Health (NIH)
• American Academy of Pediatrics
• Juluis Center for Health Science and Primary Care, University Medical Center Utrecht

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