My one-year-old son keeps getting ear infections and has fluid trapped behind his eardrum that won't drain. The doctor kept putting him on antibiotics even though it didn't seem to be helping. I got a second opinion, and the second doctor said it might be an allergy to milk. He took my son off milk, and now we're waiting to see if his ears will drain naturally. If not, the doctor wants to put tubes in his ears. He prescribed codeine for his pain. I'm not real comfortable giving him codeine because he is so young, but the Tylenol doesn't seem to help. All he does is cry. Is there anything I can do to help with the pain and get his ears to drain without having to put tubes in his ears? The idea of putting tubes in a one-year-old's ears scares me quite a bit!

A.

You are fortunate to have found a doctor who recognizes the connection between allergies and chronic ear infections. Allergies to food and also to environmental factors can cause a chronic inflammation in the throat and respiratory passages, which in a small child can lead to blockage of the eustachian tubes. The eustachian tubes are the passageway from the throat to the middle ear and when blocked, fluid can accumulate in the middle ear providing an excellent medium for the growth of bacteria resulting in an ear infection. Discontinuing allergenic foods like milk (eggs, wheat and citrus are other common food allergens) and eliminating environmental allergens like dust and pollens allows inflammation to subside and the fluid from the middle ear to drain. It can take up to three months for fluid to completely clear, so it is important to be patient. Pacifiers, bottles, cigarette smoking in the home and exposure to lots of cold viruses in a day care setting can aggravate the situation and should be stopped.

Fluid in the middle ear by itself usually does not cause pain. It can cause difficulty with hearing and with speech development. Severe pain in the ears indicates an infection is present which should be treated, usually with the appropriate antibiotic. If just fluid is present, a decongestant or antihistamine can help with decreasing inflammation and promoting fluid drainage. Ask your doctor if it would be appropriate to use one of these. Codeine is a strong medication, and should be reserved for severe pain. It is ok to use it as prescribed in a young child as long as it is truly needed for pain relief.

Besides an antibiotic for the infection causing the severe pain, you can use warm compresses to the ear for pain relief. Also, there are analgesic ear drops that your doctor can prescribe or over-the-counter preparations of St. John's Wort and Garlic oil ear drops. Always have the ears examined before using any ear drops, since they are contraindicated if the eardrum has ruptured. Plain acetominophen or a non-steroidal anti-inflammatory in the appropriate dose for a child is often effective for ear pain relief.

For children with chronic ear infections who don't respond to antibiotic therapy and anti-allergy treatment, ear tubes are sometimes necessary to allow for fluid drainage from the middle ear and can be very effective at interrupting the cycle of infections. It is a major surgery requiring general anesthetic, so it is not without some risk. However, the vast majority of children who have ear tubes put in have no problems. If ear tubes are placed, the ears must be protected from water entering the ear canal during bathing or swimming and it is very important to have the ears checked regularly to make sure the tubes are in place and functioning properly.

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