Earache is most commonly seen in young children under the age of 4. Usually the problem is infection in the middle ear, known as otitis media. Colds and throat infections can lead to earache as the bacteria (and/or virus) can spread up through the nasal passages and along the Eustachian tubes, passages which connect the middle ear to the back of the nose and throat. The bacterial infection can produce pressure, inflammation and swelling and hence cause pain in the middle ear.
The Eustachian tube will usually allow any excess secretions from the middle ear to drain away into the nose and throat. If the tubes get blocked the secretions can build up and become infected. In children middle ear infections are more common because the Eustachian tubes are often lying more horizontally which makes drainage tricky, fluids can build up producing a perfect environment for bacterial growth and infection. As children grow the tubes tend to naturally bend downwards into a more vertical position allowing for better drainage making ear infections less likely.
Most bacterial middle ear infections will be quickly treated with antibiotics. Many parents do not wish their children to undergo multiple antibiotic treatments in early life for fear of antibiotic resistance occurring later. Antibiotics also destroy good bacteria in the digestive system which are now recognised as being very important for overall health.
‘Glue ear’ is a middle ear infection where the ear is ‘leaky’, medically this is called otitis media with effusion. Glue ear is caused by fluid build up in the ear. Often children with glue ear will be fitted with grommets, which are small plastic tubes inserted into the eardrum. Grommets allow air to flow into the ear and help drainage. Many parents, however, are not keen on grommets as there have been links to slight hearing loss later in life.
A recent study (1) interested me, it assessed a nasal spray for the treatment of chronic leaky middle ear infection in children. The spray contained probiotics, naturally occurring ‘good’ bacteria. The study is preliminary but the results were very promising and the study authors say that it could prevent the need for grommets and protect against hearing problems. The spray was very efficient at dramatically reducing ear fluid and complete or significant recovery in in many cases.
Probiotic nasal sprays are not yet commercially available for the use of middle ear infection in children. However, there is evidence is mounting to suggest that oral probiotic and prebiotic supplements may be helpful in strengthening the general immune system and preventing childhood nasal and respiratory tract infections. (For more inforation and definitions of prebiotics and probiotics see my blog posts on IBS)
Recently a paper(2) published in the British Journal of Nutrition found that oral probiotic supplements may offer a safe means of reducing the risk of early acute middle ear infections, antibiotic use and the risk of recurrent respiratory infections during the first year of life. The study was small but well designed and involved 72 formula fed infants age 2 months or younger. 32 of the infants received daily formula supplemented with probiotics 12 months. 40 infants acted as controls and were given formula without probiotics. Incidence of infection and recurrent infection was recorded. During the first 7 months of life, 22 % infants receiving probiotics and 50 % infants receiving placebo experienced acute middle ear infection. Antibiotics were prescribed for infections in 31 % infants receiving probiotics compared to 60 % infants receiving placebo. During the first year of life 28 % infants receiving probiotics and 55 % infants receiving placebo suffered with recurrent respiratory infections. The study suggests that probiotics may offer a safe means of reducing the risk of early acute ear infection and reducing antibiotic use and the risk of recurrent respiratory infections during the first year of life.
Another recent study (3) found that feeding supplements containing prebiotics and probiotics to newborn infants was safe and seemed to increase resistance to infections during the first 2 years of life. The study was well designed and began with pregnant mothers who were given either a mixture of probiotics or placebo for 4 weeks before they were due to give birth. Their babies were given the same probiotics in conjunction with a prebiotic or placebo for 6 months after birth. 925 infants were involved and followed up for 2 years. During the 6-month supplement intervention, antibiotics were prescribed less often in the prebiotic/probiotic group than in the placebo group and throughout the 2 year follow-up period, infections occurred less frequently in the group receiving these supplements.
It may well be useful to speak to your GP or practice nurse about probiotic supplements if your child has already had frequent ear infections and/or antibiotic use. Antibiotics are really effective at clearing painful infections but do also kill the good bacteria in the digestive system. There is evidence to suggest that good bacteria in the digestive system are important for overall immune health and may prevent subsequent infection. Taking a prebiotic and probiotic supplement after antibiotic therapy is probably a very wise way of re-establishing balance in the digestive system. Prebiotic and probiotic supplements specifically designed for children are readily available to buy.
(1)Skovbjerg S et al. 2009. Spray bacteriotherapy decreases middle ear fluid in children with secretory otitis media. Arch Dis Child. 94(2):92-8.
(2) Rautava S, Salminen S, Isolauri E. 2008. Specific probiotics in reducing the risk of acute infections in infancy – a randomised, double-blind, placebo-controlled study. Br J Nutr. 6:1-5. [Epub ahead of print]
(3) Kukkonen K et al. 2008. Long-term safety and impact on infection rates of postnatal probiotic and prebiotic (synbiotic) treatment: randomized, double-blind, placebo-controlled trial. Pediatrics. 122(1):8-12.
Writen by Ani Kowal