Almost one in five clinicians will give a child an antihistamine or an antihistamine-containing cold medicine to give added relief to children with ear infections. Even when they don’t, parents will often pick up an over-the-counter product on their own. Their use seems to be rising, as antibiotic use is falling.

The idea is that these should decrease congestion and unplug the Eustachian tubes, allowing the infected fluid in the ear to clear. And besides, they can make kids sleepy! Do they really help?

A beautifully designed study in the September 2003 issue of the Journal of Pediatrics concluded that antihistamines make the situation worse – lengthening the time that it takes the ear infection to go away.

I suggest giving most kids with ear infections eardrops to relieve the pain while their bodies fight the infections. This can help them sleep while they heal.

The American Academy of Pediatrics established in 2002 five guidelines for the care of children who have tympanostomy tubes.

The first guideline calls for a follow-up visit within the first month after surgery to ensure that the tubes are open and functioning, to answer questions, and to agree on a plan for any new ear infections.

The second guideline calls for hearing tests. A baseline test should be done before tubes are placed, and unless the hearing was perfect, a follow-up hearing test should be performed after the surgery.

The third guideline calls for routine follow-up visits every 6 months, to monitor the functioning of the tubes and the healing of the eardrums. These visits could be done by either a pediatrician or an ENT, but the results should be communicated between both.

The fourth guideline calls for both a pediatrician and an ENT to be involved in the child’s care until the tubes are out, the eardrums have healed, hearing has normalized, and the child’s own Eustachian tubes are working.

The fifth guideline outlines a number of situations when a child needs to see the ENT between routine visits. These include problems such as ongoing drainage from the ear, worsening hearing, language delay, ear pain, or balance problems.

While the needs of individual children will vary, I’m pleased to have a general roadmap for care after tubes, so that important issues are less likely to fall through the cracks.

Dr. Greene’s Answer:

Fluid in the middle ear, which often goes undetected for weeks or months at a time, is an important hidden problem. This silent occupant of our children’s ears can have lingering effects years after the fluid has cleared up.

The first golden moment you gazed at your son in the delivery room, he was already beginning an amazing journey of learning. And how do children learn? They take in the world by using their five senses. The sight of your face, the feel of your touch, the taste of your milk, the scent of your unique aroma, and the sound of your voice combine together to teach your son about the world.

Some children enter the world in silence.

Each year about 20,000 children in the United States are born with permanent hearing loss. Often this isn’t discovered until the children are 3 years old and their language is noticeably delayed. We now know that hearing loss significantly impairs the ability to learn — not just learning to speak but also to walk, to read, to write, to do well in school and to get along well with others.

The sooner hearing loss is detected and addressed, the better children will do overall. For this reason, I strongly support universal screening of hearing in newborns. Now that quality hearing tests for babies are inexpensive (as little as $25), failing to provide or at least offer this to all parents is irresponsible.

But these 20,000 children with congenital hearing loss are only the tip of the iceberg. In April 1998, the Journal of the American Medical Association reported a staggering 7 million children in the United States with hearing loss significant enough to impair the ability to learn. Most of these children have temporary hearing loss, but even though the hearing loss is temporary, the impact can last a lifetime.

Language development during the first few years of life is nothing short of amazing! A child is born unable to understand any words, yet is speaking in complete sentences within a few years. During this flowering of development, there are certain critical windows when different sounds are learned. For instance, someone who reaches 8 to 10 months of age without hearing Chinese will lose the ability to distinguish between some of the vocal sounds of that language.

What a tragedy if the language you miss out on hearing is your own! The most common age for temporary hearing loss is during that same precious time when the miracle of language development is unfolding. The most common cause for temporary hearing loss is the fluid in the middle ear space associated with ear infections. (Incidentally, you will find a chapter on what you can do to help prevent these situations in my book, The Parent’s Complete Guide to Ear Infections.)

In a healthy ear, air fills the middle ear space. Sound waves enter the ear canal and vibrate the eardrum at the end of the canal, allowing us to hear. Whenever a child has an ear infection, germ-containing fluid enters the middle ear space from the back of the nose or throat. The eardrum can’t vibrate freely, resulting in a 15 to 40 decibel hearing loss.

On average, fluid lingers for 3 weeks following an ear infection, but it can remain for months at a time. Usually, 12 weeks of fluid is considered the cutoff for concern. However, Robert Ruben, M.D., of the Albert Einstein College of Medicine, has been able to detect long-term language delays (noticeable 9 years after the fact) in children who had 8 or more weeks of fluid between 6 and 12 months of age. Fluid that is present for 8 weeks is certainly worth knowing about.

Detecting silent fluid in the ears is the main reason for re-check exams following ear infections. This clear fluid, however, is not always easy to see. It may have been missed, but it quite possibly could have arisen afterwards. OME is the name of fluid in the ears that arises with no other symptoms.

It’s not really possible to know from one look in the ears, even a very careful one, how long the fluid has been there. Sometimes the fluid in the ears is thin and watery. Sometimes it is very thick. It used to be thought that the fluid got thicker as time progressed. Studies at the Armed Forces Radiobiology Research Institute have now shown that the character of the fluid does not correlate with the amount of time it has been there.

Once fluid in the ear has been detected, it should be monitored until it has gone. This monitoring could either be examination by a skilled professional, or simple home monitoring using the accurate, new EarCheck Middle Ear Monitor (with ongoing discussions with your physician about the results).

Your son’s normal hearing test 3 months ago is very reassuring. While there is fluid in the ear, though, we know that his hearing is somewhat decreased. When fluid is thought to have been there for 6 to 12 weeks, it is time for another hearing test to determine to what extent the hearing is impaired. While I am glad that his fluid is in only one ear, hearing loss in even one ear can still affect language and learning, especially in boys (who generally have fewer connections between the two sides of the brain than girls).

As your story reminds us, Brenda, many kids have fluid in one or both ears without anyone knowing. Middle ear fluid is a hidden problem that can powerfully affect our children’s experiences of the world. When we are aware of its presence, we can take appropriate steps to insure that our kids have the richest opportunities to explore the fascinating world around us.

Septra and Bactrim are both brand names for a combination antibiotic called trimethoprim-sulfamethoxazole.

In children, the most common uses are for ear infections and urinary tract infections.

It also has a role in the treatment of chronic bronchitis, traveler’s diarrhea, shigella, and in both the treatment and prevention of pneumocystis carinii pneumonia.

Most bacteria must manufacture their own supply of folic acid or folate. Animals (and some bacteria) depend on outside sources of folic acid, getting what they need from what they eat. Trimethoprim and sulfamethoxazole are both compounds that block the internal production of folic acid. Thus these compounds are relatively safe for humans, yet lethal to many bacteria.

The sulfamethoxazole component of Septra is a sulfa (or sulfur containing) drug. It causes fewer side effects than the other sulfa drugs, but its side effects should be respected.

The most common significant adverse effects are allergic skin reactions. Most of these are mild, but occasionally they are quite severe. Septra should be discontinued at the first sign of a skin rash.

Excess sun exposure should be avoided by anyone taking Septra.

Sulfa drugs may precipitate in the urine, producing crystals that can cause bleeding, urinary obstruction, or kidney damage. This is best prevented by using the most soluble of the more than 150 different sulfa drugs (such as the sulfamethoxazole in Septra) and by drinking lots of fluids while on the medication.

Allergic kidney damage can also occur, underscoring the need to stop taking Septra at the first signs of an allergic skin rash. When Septra is used on an ongoing basis, occasional blood and urine testing (a urinalysis, CBC, BUN, and creatinine) can detect early signs of problems.

Septra should not be used in children with folate deficiency.

Septra interacts with Dilantin, with methotrexate, and with anticoagulant medications; it should be used cautiously if these other drugs are being taken.

Septra should not be used in children under 2 months of age.

Consult your pediatrician before using it for children who have severe allergies or asthma.