Childhood ear infections are misdiagnosed and over treated

It seems like I'm always telling you about something in the medical community that's being overdone, misdiagnosed, or mistreated. Sadly, it's often a combination of all three. The latest news is about the growing misdiagnosis and over-treatment of a common childhood malady-the ear infection.

Ear infections are incredibly difficult to identify in young children. First off, there are subtle differences between an ear that's inflamed by an actual ear infection and inflammation that's caused by fever or crying.

To determine the exact cause of inflammation, the doctor has to get a good look in the already tiny ear canal of an uncomprehending little patient who's writhing in pain. But that's not all - the doctor must then determine whether what he's seeing (in tiny snippets as his patient wriggles to get away into the arms of his or her mother) is indeed an infection, or merely a build-up of fluid inside the ear. Unlike a fever, fluid in the ear should not be treated with antibiotics.

Oh, and fluid in the ear? That condition is often a predecessor to the onset of an ear infection. It also, by the way, can occur in the immediate aftermath of an ear infection.

What I'm getting at here is that ear infections can be extremely tough to diagnose in small children. I can sympathize with the predicament pediatricians find themselves in, but I'm not going to let them off the hook that easily. They're not doing their little patients any favors by overmedicating them. No matter how much easier it makes their lives-and the lives of the parents involved.

Mistreatment for ear infections means antibiotics. But according to the Agency for Healthcare Research and Quality, there's hardly any evidence that these antibiotics are effective. In fact, the antibiotics could be worsening the situation, resulting in the child building up an antibiotic resistance that could make any future infections more difficult to treat.

I've recommended against the widespread prescription of antibiotics in all but truly appropriate or acute cases. Why? The reason is that their overuse contributes to the acceleration of mutations that can cause bacteria to become drug-resistant. And I don't just mean that toddlers will need stronger doses and longer courses of treatment for their next bout of infection. I mean that administering antibiotics willy-nilly can give rise to killer "superbugs" that no antibiotic can kill.

In 2004, both the American Academy of Family Physicians and the American Academy of Pediatrics advised doctors to adopt a "wait-and-see" approach in the diagnosing of ear infections, based on symptoms and the age of the child. But of the 83 percent of the doctors who say they agree with this approach, even those doctors only practice this in about 15 percent of their cases.

It's time for these doctors to start practicing what they preach because when it comes right down to it, 80 to 90 percent of ear infections will resolve themselves without any antibiotics whatsoever.