But what is the most likely way a parent can accurately “guess” if their child has a bacterial ear infection to be concerned about? By gauging the ability of their child to get their sleep at night, as well as monitoring their state of health leading up to the disrupted night of sleep. If a child’s sleep pattern is disrupted after having runny nose and viral upper respiratory symptoms (i.e. a cold) in the preceding days, it is more probable that he may have an ear infection.

Otitis media, or an ear infection, is usually preceded by a process where increased mucus and secretions are produced (as in the common cold). This fluid is trapped at the opening of the eustachian tube of the affected ear in the back of the throat. The eustachian tube communicates directly with the middle ear, and as the mucus remains there, bacteria colonize and multiply, engendering the production of purulent fluid. This fluid eventually accumulates and places pressure on the tympanic membrane or eardrum. As the eardrum is exquisitely enervated, the child usually feels pain at this point. In some instances, so much fluid is produced that the ear drum ruptures from the pressure, releasing the purulent fluid via the external ear canal. Needless to say, the child usually feels better after this.

In addition to the common cold, allergies and teething may produce the kind of fluid that can promote an ear infection. In certain children, the overwhelming factor may be a eustachian tube which doesn’t function well. In such individuals, the resting pressure within the eustachian tube is negative, and hence acts as a “vacuum cleaner” in sucking up all the fluid that may be present in the back of the throat, thereby causing a chronic state of fluid presence in the eustachian tube.

Such children are prone to frequent ear infections. As such, they are also prone to chronic conductive hearing loss, thereby jeopardizing their language development, especially during the critical imprinting phases early in toddlerhood. Myringotomy, or ear tubes, are placed in children precisely because of this (to prevent language delay) and not because of the frequent ear infections per say. The overwhelming majority of children are not subject to chronic or permanent hearing loss despite multiple ear infections.

So mostly likely, the child in the above vignette does not have an ear infection due to the fact he is not in terrible discomfort. If he does have an infection, he most probably has the type which will not lead to the sequella that are sometimes seen if an ear infection is left untreated (mastoiditis, meningitis). Furthermore, in this day and age, as pediatricians have been urged not to overuse antibiotics, most might not treat him, as they would prefer his own immune system to handle the infection (as it almost always does in these cases.) If the child is in terrible discomfort, however, the likelihood for the sequella increases slightly, and most would be compelled to treat.

By Matteo J. LoPreiato MD
http://www.theberlincitizen.com/articles/2006/02/23/local_news/news08.txt