Practical Practitioner

By: Pamela Egan, FNP-C CDE

Guidelines recommend watchful waiting for silent ear infection

Symptom-less ear inflammation that affects more than 2 million American children a year should be handled with watchful waiting and no treatment unless it remains for at least three months, new guidelines say.

Sometimes called silent ear infections, the condition that sometimes follows a cold, results in an estimated $4 billion in annual medical costs, including drugs and operations to implant ear drainage tubes.

While in some cases treatment is needed, at least 75 percent of cases clear up on their own within three months, according to the guidelines from the American Academy of Pediatrics, published in the May edition of the Academy’s journal, Pediatrics.

The federal Centers for Disease Control and Prevention estimates at least 6 million courses of unnecessary antibiotics are prescribed yearly for the condition, which is known medically as otitis media with effusion, or fluid in the middle ear.

Sometimes the fluid contains bacteria, but the guidelines say antibiotics are not recommended for routine treatment, although in some cases short-term use may produce benefits, especially as a last resort before tube surgery.

Antihistamine and decongestant drugs are sometimes recommended but are useless for the condition and should be avoided, the guidelines say.

Otitis with effusion or fluid can cause temporarily muffled hearing and sometimes result in a delay in learning a language. Hearing tests should be performed if the fluid condition lasts longer than three months, and language tests are recommended if there is evidence of hearing loss or learning problems, the guidelines say.

Surgery, usually implanting ear tubes, should be considered if the condition lasts four months or longer and children show signs of persistent hearing loss, according to the guidelines.

The condition is different from classic ear infections- acute otitis media that usually cause pain and other symptoms of inflammation and infection.

This article was originally published May 17, 2004 in The St. Tammany News.

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